Association of markers of systemic and local inflammation with prognosis of patients with rectal cancer who received neoadjuvant radiotherapy

Figures & data

Table 1 Characteristics of 76 patients with locally advanced rectal cancer

Characteristics	Data, n (%)
NLR
<2.0	35 (46.1)
≥2.0	41 (53.9)
CD8+ T-cell
<9	31 (40.8)
≥9	45 (59.2)
Age (years)
<60	56 (73.7)
≥60	20 (26.3)
Gender
Male	49 (64.5)
Female	27 (35.5)
Distance to anal margin (cm)
<5	49 (64.5)
≥5	27 (35.5)
Lymphovascular invasion
Yes	15 (19.7)
No	61 (80.3)
Neural invasion
Yes	14 (18.4)
No	62 (81.6)
Tumor nodules
Yes	16 (21.1)
No	60 (78.9)
Mucinous adenocarcinoma
Yes	8 (10.5)
No	68 (89.5)
T stage
T2/3	45 (59.2)
T4	31 (40.8)
N stage
N0	28 (36.8)
N1/2	48 (63.2)
TRG
1	7 (9.2)
2	22 (28.9)
3	16 (21.1)
4	27 (35.5)
5	4 (5.3)
Radiotherapy
Short course	36 (47.4)
Long course	40 (52.6)

Abbreviations: NLR, neutrophil-to-lymphocyte ratio; TRG, tumor regression grade.

Figure 1 Optimization of marker cutoffs in patients with LARC (n=76): Kaplan–Meier curves of OS for patients with low vs high NLR (A) and with low vs high CD8+ T-cell count (C). Waterfall plots showing distributions of the NLR (B) and CD8+ T-cell count (D) among all patients, used for optimal dichotomization by Cutoff Finder software.

Notes: The analysis was conducted by Cutoff Finder software.

Abbreviations: LARC, locally advanced rectal cancer; NLR, neutrophil-to-lymphocyte ratio; OS, overall survival.

Table 2 Clinicopathologic factors associated with NLR and CD8+ T-cells

Characteristics	NLR prior to nRT		P-value	CD8+ T-cells after nRT (%)		P-value
	<2.0	≥2.0		<9	≥9
Age (years)			0.498			0.761
<60	26 (34.2)	30 (39.5)		22 (28.9)	34 (44.7)
≥60	9 (11.8)	11 (14.5)		9 (11.8)	11 (14.5)
Gender			0.099			0.350
Male	20 (26.3)	29 (38.2)		19 (25.0)	30 (39.5)
Female	15 (19.7)	12 (15.8)		12 (15.8)	15 (19.7)
Distance to anal margin (cm)			0.848			0.737
<5	24 (31.6)	25 (32.9)		20 (26.3)	29 (38.2)
≥5	11 (14.5)	16 (21.0)		11 (14.5)	16 (21.1)
Lymphovascular invasion			0.014			0.561
Yes	3 (3.9)	12 (15.8)		9 (11.8)	6 (7.9)
No	32 (42.1)	29 (38.2)		22 (28.9)	39 (51.3)
Neural invasion			0.307			0.114
Yes	6 (7.9)	8 (10.5)		9 (11.8)	5 (6.6)
No	29 (38.2)	33 (43.4)		22 (28.9)	40 (52.6)
Tumor nodules			0.930			0.375
Yes	5 (6.6)	11 (14.5)		9 (11.8)	7 (9.2)
No	30 (39.5)	30 (39.5)		22 (28.9)	38 (50.0)
Mucinous adenocarcinoma			0.795			0.005
Yes	4 (5.3)	4 (5.3)		6 (7.9)	2 (2.6)
No	31 (40.7)	37 (48.7)		25 (32.9)	43 (56.6)
T stage			0.047			0.049
T2/3	23 (30.3)	22 (28.9)		15 (19.7)	30 (39.5)
T4	12 (15.8)	19 (25.0)		16 (21.1)	15 (19.7)
N stage			0.318			0.715
0	13 (17.1)	15 (19.7)		11 (14.5)	17 (22.4)
1/2	22 (28.9)	26 (34.2)		20 (26.3)	28 (36.8)
TRG						0.762
1				2 (2.6)	5 (6.6)
2–5				29 (38.2)	40 (52.6)
Radiotherapy						0.371
Short course				19 (25.0)	17 (22.4)
Long course				12 (15.8)	28 (36.8)

Note: The analysis was conducted by bivariate logistic regression.

Abbreviations: NLR, neutrophil-to-lymphocyte ratio; nRT, neoadjuvant radiotherapy; TRG, tumor regression grade.

Figure 2 Survival curves of patients with low NLR and high CD8+ T-cell count (n=19), low NLR and low CD8+ T-cell count (n=16), high NLR and high CD8+ T-cell count (n=26), and high NLR and low CD8+ T-cell count (n=15).

Note: The analysis was conducted by Kaplan–Meier method.

Abbreviation: NLR, neutrophil-to-lymphocyte ratio.

Table 3 Correlation of clinicopathologic factors with overall survival

Characteristics	Univariate				Multivariate
	HR	95% CI	P-value		HR	95% CI	P-value
NLR
<2.0/≥2.0	5.039	1.125–22.573		0.035	7.707	1.300–45.709	0.025
CD8+ T-cell (%)
<9/≥9	0.322	0.106–0.977		0.045	0.088	0.012–0.665	0.018
Gender
Male/female	0.280	0.063–1.255		0.096
Age (years)
<60/≥60	3.051	1.018–9.145		0.046	16.130	1.557–167.151	0.020
Distance to anal margin (cm)
<5/≥5	1.960	0.687–5.595		0.209
Lymphovascular invasion
Yes/no	4.715	1.649–13.483		0.004	7.166	1.115–46.047	0.038
Neural invasion
Yes/no	1.458	0.401–5.304		0.567
Tumor nodules
Yes/no	1.591	0.489–5.175		0.440
Mucinous adenocarcinoma
Yes/no	4.348	1.345–14.056		0.014	0.673	0.071–6.380	0.730
T stage
2–3/4	0.194	0.043–0.871		0.032	0.029	0.002–0.449	0.011
N stage
0/1/2	1.693	0.528–5.433		0.376
TRG
1/2–5	23.265	0.006–96,686.930		0.459
Radiotherapy
Short course/long course	0.529	0.176–1.590		0.257

Note: The analysis was conducted by the univariate and multivariate Cox regression.

Abbreviations: NLR, neutrophil-to-lymphocyte ratio; TRG, tumor regression grade.