The pretreatment systemic inflammatory response is an important determinant of poor pathologic response for patients undergoing neoadjuvant therapy for rectal cancer

Dreyer, S. B., Powell, A. G.M.T., McSorley, S. T. , Waterston, A., Going, J. J., Edwards, J. , McMillan, D. C. and Horgan, P. G. (2017) The pretreatment systemic inflammatory response is an important determinant of poor pathologic response for patients undergoing neoadjuvant therapy for rectal cancer. Annals of Surgical Oncology, 24(5), pp. 1295-1303. (doi: 10.1245/s10434-016-5684-3) (PMID:27873100)

Abstract

Background: Not all patients respond equally to neoadjuvant chemoradiotherapy (nCRT), with subsequent effects on survival. The systemic inflammatory response has been shown to predict long-term outcomes in colorectal cancer. The current study examined the association between systemic inflammation and nCRT in patients with rectal cancer. Methods: Between 1999 and 2010, patients who underwent nCRT were identified. Serum measurements of hemoglobin, C-reactive protein, albumin, modified Glasgow prognostic score (mGPS), and differential white cell counts were obtained before and after nCRT. The Ro¨del scoring system measured pathologic tumor regression, and magnetic resonance imaging and computed tomography determined radiologic staging. Results: The study included 79 patients. Of these patients, 37% were radiologically downstaged, and 44% were categorized as showing a good pathologic response (Ro¨del scores 3 and 4). As a validated measure of the systemic inflammatory response, mGPS (P = 0.022) was associated with a poor pathologic response to nCRT. A radiologic response was associated with a good pathologic response to treatment (P = 0.003). A binary logistic regression model identified mGPS (odds ratio [OR] 0.27; 95% confidence interval [CI] 0.07–0.96; P = 0.043) and radiologic response (OR 0.43; 95% CI 0.18–0.99; P = 0.048) as strong independent predictors of a pathologic response to treatment. Conclusion: The current study showed that a systemic inflammatory response before nCRT is associated with a poor pathologic response. Further study in a prospective controlled trial setting is warranted.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Horgan, Professor Paul and Dreyer, Dr Stephan and Going, Dr James and McSorley, Dr Stephen and Edwards, Professor Joanne and Powell, Dr Arfon and McMillan, Professor Donald
• Authors: Dreyer, S. B., Powell, A. G.M.T., McSorley, S. T., Waterston, A., Going, J. J., Edwards, J., McMillan, D. C., and Horgan, P. G.
• College/School: College of Medical Veterinary and Life Sciences > School of Cancer Sciences; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Annals of Surgical Oncology
• Publisher: Springer
• ISSN: 1068-9265
• ISSN (Online): 1534-4681
• Published Online: 21 November 2016
• Copyright Holders: Copyright © 2016 The Authors
• First Published: First published in Annals of Surgical Oncology 24(5): 1295-1303
• Publisher Policy: Reproduced under a Creative Commons License