Reduction of derived neutrophil-to-lymphocyte ratio after four weeks predicts the outcome of patients receiving second-l
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ORIGINAL ARTICLE
Reduction of derived neutrophil‑to‑lymphocyte ratio after four weeks predicts the outcome of patients receiving second‑line chemotherapy for metastatic colorectal cancer Giuseppe Antonio Colloca1 · Antonella Venturino1 · Domenico Guarneri1 Received: 21 March 2020 / Accepted: 15 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Systemic inflammation response (SIR) plays a role in predicting prognosis of patients with metastatic colorectal cancer (mCRC). Chemotherapy-induced neutropenia has been suggested as another evaluable prognostic and predictive factor. This is a retrospective analysis of derived neutrophil-to-lymphocyte ratio (dNLR) and its reduction > 10% after the first cycle of chemotherapy (R10) in a monoinstitutional series of patients with mCRC receiving a first-line and a second-line cytotoxic chemotherapy. The effects of the neutrophil-related variables on overall survival (OS) and on chemotherapy activity were analyzed. One hundred twenty-eight patients were selected. A relationship of dNLR with OS was evident at both time points, but disappeared after multivariate analysis, whereas R10 was independent prognostic factor only after second-line chemotherapy in multivariate analysis. A dNLR reduction > 10% before the second cycle predicts OS and disease control from second-line chemotherapy in patients with mCRC, in particular among patients with right-sided tumors and synchronous metastases. Keywords Colorectal cancer · Systemic inflammation · Neutrophil reduction · Prognosis · Second-line chemotherapy Abbreviations BMI Body mass index CEA Carcinoembryonic antigen CHT Chemotherapy CIN Chemotherapy induced neutropenia CIs Confidence intervals CRC Colorectal cancer CMS Consensus molecular subtype DCR Disease control rate dNLR Derived neutrophil-to-lymphocyte ratio ECOG PS Eastern Cooperative Oncology Group performance status HR Hazard ratio mCRC Metastatic colorectal cancer NLR Neutrophil-to-lymphocyte ratio OS Overall survival Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00262-020-02761-y) contains supplementary material, which is available to authorized users. * Giuseppe Antonio Colloca [email protected] 1
Department of Oncology, Ospedale Civile di Sanremo, Via G. Borea n. 56, 18038 Sanremo (Imperia), Italy
PFS Progression-free survival R10 DNLR reduction > 10% after the first cycle of chemotherapy RDI Relative dose intensity SIR Systemic inflammatory response
Introduction By the GLOBOCAN 2018 report colorectal cancer (CRC) is the forth most commonly diagnosed cancer and the second leading cause of cancer death around the world [1]. New drugs have improved the prognosis of patients with metastatic colorectal cancer (mCRC), increasing the median overall survival (OS) from 12 months to over 30 months. Furthermore, a better definition of disease subgroups [2], or the identification of predictive factors of treatment effect, such as microsatellite instability, RAS and B
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