Cancer Res Treat.  2016 Jan;48(1):232-239. 10.4143/crt.2014.351.

Sustaining Blood Lymphocyte Count during Preoperative Chemoradiotherapy as a Predictive Marker for Pathologic Complete Response in Locally Advanced Rectal Cancer

• Heo J
• Chun M
• Noh OK
• Oh YT
• Suh KW
• Park JE
• Cho O

• KMID: 2152280
• DOI: http://doi.org/10.4143/crt.2014.351

Abstract

PURPOSE
The objective of this study was to explore the relationship between the circulating lymphocyte level during preoperative chemoradiotherapy (CRT) and pathologic complete response (pCR) in locally advanced rectal cancer.
MATERIALS AND METHODS
From May 2010 to May 2013, 52 patients treated with preoperative CRT followed by surgery, were analysed. Patients received conventional fractionated radiotherapy (50-54 Gy) with fluorouracil-based chemotherapy. Surgical resection was performed at 4 to 8 weeks after the completion of preoperative CRT. Absolute blood lymphocyte counts and their relative percentage in total white blood cell counts were obtained from complete blood count tests performed prior to and after 4, 8, and 12 weeks of CRT. We analysed the association between achieving pCR and change in blood lymphocyte level during CRT, as well as clinical parameters.
RESULTS
Among 52 patients, 14 (26.9%) had evidence of pCR. Sustaining the blood lymphocyte count during CRT (lymphocyte count at 4 weeks/baseline lymphocyte count > 0.35; odds ratio, 8.33; p=0.02) and initial carcinoembryonic antigen < 4.4 ng/mL (odds ratio, 6.71; p=0.03) were significantly associated with pCR in multivariate analyses.
CONCLUSION
Sustaining blood lymphocyte count during preoperative CRT was predictive for pCR in rectal cancer. Further studies are warranted to investigate the association between pathologic responses and circulating lymphocyte count with its subpopulation during preoperative CRT.

Keyword

Chemoradiotherapy; Rectal neoplasms; Neoadjuvant therapy; Lymphocyte count; Pathologic complete response; Predictive factor

MeSH Terms

Blood Cell Count
Carcinoembryonic Antigen
Chemoradiotherapy*
Drug Therapy
Humans
Leukocyte Count
Lymphocyte Count*
Lymphocytes*
Multivariate Analysis
Neoadjuvant Therapy
Odds Ratio
Polymerase Chain Reaction
Radiotherapy
Rectal Neoplasms*
Carcinoembryonic Antigen

Figure

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  Fig. 1. Change of blood cell count value over time. (A) Absolute cell count. (B) Relative cell count. Data points indicate mean value and error bars indicate 95% confidence interval. WBC, white blood cell.

• 

  Fig. 2. Correlations between radiotherapy planning–associated parameters and the sustained lymphocyte ratio at 4 weeks of chemoradiotherapy. (A) Volume of planning target volume (PTV). (B) Sum of monitor unit (MU). (C) Body volume received more than 5% of prescribed dose. (D) Integral dose of body volume received more than 5% of prescribed dose.

Reference

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