NEUTROPHIL-LYMPHOCYTE RATIO (NLR) AND LYMPHOPENIAAS PROGNOSTIC FACTORS OF OVERALL SURVIVAL IN LOCALADVANCED RECTAL CANCER

Abstract

Purpose: Inammation is a marker associated with carcinogenesis in solid tumours. In locally advanced rectal cancer (LARC), neoadjuvant chemoradiotherapy (nCRT) followed by total mesorectal excision (TME) is the standard treatment with high rates of local control, although we lack prognostic factors that involve the patient's immune status. Specic immunity measured in a blood count can be helpful in determining the neutrophil-lymphocyte ratio (NLR) and lymphopenia. Method: Retrospective study in 137 patients diagnosed with LARC, who underwent nCRT and TME. Blood analysis was obtained prior to initiation of nCRT to obtain lymphocytes and NLR with a cut-off value of 3, the cut-off value of lymphopenia was determined for toxicity scale of Common Terminology Criteria for Adverse Events (CTCAE v5.0), and the sample were divided in two groups: 0-3 and 4-5 toxicity scale. Both prognostic factors were compared with tumour regression grade (TRG) and overall survival (OS). Results: Pre-operative NLR showed 75,2% of patients with a value under 3 a 24,8% with a value up 3, with a signicantly pathologic regression (p=0,004) and with OS (p=0,001) in favor to low NLR. Lymphopenia was signicantly higher in the second group (p=0,034) and associated with poor OS. The follow-up were 34,35 months. Conclusion: Elevated pre-operative NLR and lymphopenia are prognostic factors for poor outcome and OS in rectal cancer patients. Therefore, these factors may be considered as potential biomarkers that need to be further validated by prospective studies.