International Journal of Colorectal Disease

, Volume 34, Issue 1, pp 105–112 | Cite as

Nadir/pre-chemoradiotherapy ratio of white blood-cell count can predict tumor response and recurrence-free survival in locally advanced rectal cancer: a multi-institutional analysis

  • Joo Hwan Lee
  • Jae Uk Jeong
  • Sung Hwan Kim
  • Taek Keun Nam
  • Jong Hoon LeeEmail author
  • Songmi Jeong
  • Mina Yu
  • Hong Seok Jang
Original Article



The objective of this study was to evaluate whether change of white blood-cell (WBC) count before and during chemoradiotherapy (CRT) might be associated with susceptibility to radiation and tumor response.


Medical records of 641 patients with rectal cancer who received preoperative CRT followed by curative surgery were retrospectively reviewed in five tertiary centers. Complete blood cell with differential count was measured weekly during the period of CRT. We assessed nadir/pre-CRT ratio of WBC count as a predictor for tumor response to CRT and a prognostic factor for recurrence-free survival.


Enrolled patients were divided into low WBC ratio (LWR) and high WBC ratio (HWR) arms with cut-off value of 0.49 calculated by receiver operating characteristic curve. Of 641 patients, 490 (76.4%) and 151 (23.6%) were categorized into HWR (> 0.49) arm and LWR (≤ 0.49) arms, respectively. Complete pathologic response rate after CRT was significantly higher in LWR arm than that in HWR arm (23.8% vs. 12.2%, p = 0.001). In logistic regression analysis, carcinoembryonic antigen (CEA) level over 5 ng/ml [adjusted odds ratio (OR) 0.566, 95% confidence interval (CI) 0.351–0.912; p = 0.019) and HWR (adjusted OR 0.412, 95% CI 0.256–0.663; p = 0.001) were significantly negative factors of pathologic complete response. The 5-year recurrence-free survival rate was significantly higher in the LWR group than that in the HWR group (83.3% vs. 67.6%, p = 0.001).


Low nadir/pre-chemoradiotherapy ratio during preoperative CRT can predict good tumor response. It is significantly associated with improved recurrence-free survival in rectal cancer.


Chemoradiation Rectal cancer Response White blood cell 



Statistical analyses performed in this article were advised by Catholic Medical Center Clinical Research Coordinating Center.

Compliance with ethical standards

Each center obtained approval from respective Institutional Review Board before enrolling patients.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Joo Hwan Lee
    • 1
  • Jae Uk Jeong
    • 2
  • Sung Hwan Kim
    • 1
  • Taek Keun Nam
    • 2
  • Jong Hoon Lee
    • 1
    Email author
  • Songmi Jeong
    • 3
  • Mina Yu
    • 4
  • Hong Seok Jang
    • 5
  1. 1.Center for Colorectal Cancer, St. Vincent’s Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
  2. 2.Department of Radiation OncologyChonnam National University School of MedicineGwangjuRepublic of Korea
  3. 3.Department of Radiation OncologyEwha Women’s University School of MedicineSeoulRepublic of Korea
  4. 4.Department of Radiation Oncology, Bucheon St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
  5. 5.Department of Radiation Oncology, Seoul St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea

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