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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

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusion

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.

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Acknowledgements

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

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Author notes

  1. Joo Hwan Lee and Jae Uk Jeong equally contributed to this work.

Authors and Affiliations

  1. Center for Colorectal Cancer, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Joo Hwan Lee, Sung Hwan Kim & Jong Hoon Lee

  2. Department of Radiation Oncology, Chonnam National University School of Medicine, Gwangju, Republic of Korea

    Jae Uk Jeong & Taek Keun Nam

  3. Department of Radiation Oncology, Ewha Women’s University School of Medicine, Seoul, Republic of Korea

    Songmi Jeong

  4. Department of Radiation Oncology, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Mina Yu

  5. Department of Radiation Oncology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Hong Seok Jang

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  1. Joo Hwan Lee
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Correspondence to Jong Hoon Lee.

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

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The authors declare that they have no conflict of interest.

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Lee, J.H., Jeong, J.U., Kim, S.H. et al. 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. Int J Colorectal Dis 34, 105–112 (2019). https://doi.org/10.1007/s00384-018-3174-8

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  • DOI: https://doi.org/10.1007/s00384-018-3174-8

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