Can Haematology Blood Tests at Time of Diagnosis Predict Response to Neoadjuvant Treatment in Locally Advanced Rectal Cancer?

George Ramsay (Corresponding Author), Duncan T Ritchie, Craig MacKay, Craig Parnaby, Graeme Murray, Leslie Samuel

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Outcomes in locally advanced rectal cancer are improved by neoadjuvant therapy followed by surgical resection. Some patients respond completely to preoperative treatment. Therefore, predicting the pathological response to preoperative therapy is of clinical importance. Accurate prediction would allow for tailored approaches to neoadjuvant therapy.

METHODS: All patients undergoing resection of rectal adenocarcinoma after neoadjuvant therapy between 2006 and 2015 were included in this cohort study. Patients were identified from a prospectively collected database and data were supplemented retrospectively with full blood count at diagnosis. Specimens resected following neoadjuvant therapy were graded according to pathological response. Follow-up data was obtained from the national registry. The primary outcome was complete pathological response.

RESULTS: Of 330 patients, 71 (21.5%) responded completely to preoperative therapy. Median age was 66 and 65% were male (n = 215). White cell count (WCC) was the most predictive marker, for predicting pCR; area under the curve (AUC) 0.666. This was higher than neutrophil/platelet ratio (AUC 0.652) or neutrophil/lymphocyte ratios (AUC = 0.437). Kaplan-Meier survival analysis showed those patients with WCC > 8 had poorer survival than those with WCC < 8 (p = 0.009).

CONCLUSION: Routinely collected haematology samples at the point of diagnosis can assist in predicting for complete response to neoadjuvant therapy. Although novel biomarkers will have a greater predictive value, this clinically available value test could help to assist in risk stratification of patients using routinely collected laboratory tests.

Original languageEnglish
Pages (from-to)495–501
Number of pages7
JournalDigestive Surgery
Volume36
Issue number6
Early online date28 Sep 2018
DOIs
Publication statusPublished - Oct 2019

Fingerprint

Neoadjuvant Therapy
Hematologic Tests
Hematology
Rectal Neoplasms
Area Under Curve
Cell Count
Neutrophils
Kaplan-Meier Estimate
Survival Analysis
Registries
Adenocarcinoma
Cohort Studies
Therapeutics
Blood Platelets
Biomarkers
Databases
Lymphocytes
Survival

Keywords

  • Neoadjuvant Chemoradiotherapy
  • Rectal cancer
  • Response to treatment
  • Receiver operator characteristics curves
  • PREOPERATIVE CHEMORADIATION
  • WATCH
  • PATHOLOGICAL RESPONSE
  • DETERMINANT
  • IMPACT
  • THERAPY
  • TO-LYMPHOCYTE RATIO
  • SYSTEMIC INFLAMMATORY RESPONSE
  • COUNT
  • PROGNOSTIC ROLE

ASJC Scopus subject areas

  • Gastroenterology
  • Surgery

Cite this

Can Haematology Blood Tests at Time of Diagnosis Predict Response to Neoadjuvant Treatment in Locally Advanced Rectal Cancer? / Ramsay, George (Corresponding Author); Ritchie, Duncan T; MacKay, Craig; Parnaby, Craig; Murray, Graeme; Samuel, Leslie.

In: Digestive Surgery, Vol. 36, No. 6, 10.2019, p. 495–501.

Research output: Contribution to journalArticle

Ramsay, George ; Ritchie, Duncan T ; MacKay, Craig ; Parnaby, Craig ; Murray, Graeme ; Samuel, Leslie. / Can Haematology Blood Tests at Time of Diagnosis Predict Response to Neoadjuvant Treatment in Locally Advanced Rectal Cancer?. In: Digestive Surgery. 2019 ; Vol. 36, No. 6. pp. 495–501.
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AU - Murray, Graeme

AU - Samuel, Leslie

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N2 - BACKGROUND: Outcomes in locally advanced rectal cancer are improved by neoadjuvant therapy followed by surgical resection. Some patients respond completely to preoperative treatment. Therefore, predicting the pathological response to preoperative therapy is of clinical importance. Accurate prediction would allow for tailored approaches to neoadjuvant therapy.METHODS: All patients undergoing resection of rectal adenocarcinoma after neoadjuvant therapy between 2006 and 2015 were included in this cohort study. Patients were identified from a prospectively collected database and data were supplemented retrospectively with full blood count at diagnosis. Specimens resected following neoadjuvant therapy were graded according to pathological response. Follow-up data was obtained from the national registry. The primary outcome was complete pathological response.RESULTS: Of 330 patients, 71 (21.5%) responded completely to preoperative therapy. Median age was 66 and 65% were male (n = 215). White cell count (WCC) was the most predictive marker, for predicting pCR; area under the curve (AUC) 0.666. This was higher than neutrophil/platelet ratio (AUC 0.652) or neutrophil/lymphocyte ratios (AUC = 0.437). Kaplan-Meier survival analysis showed those patients with WCC > 8 had poorer survival than those with WCC < 8 (p = 0.009).CONCLUSION: Routinely collected haematology samples at the point of diagnosis can assist in predicting for complete response to neoadjuvant therapy. Although novel biomarkers will have a greater predictive value, this clinically available value test could help to assist in risk stratification of patients using routinely collected laboratory tests.

AB - BACKGROUND: Outcomes in locally advanced rectal cancer are improved by neoadjuvant therapy followed by surgical resection. Some patients respond completely to preoperative treatment. Therefore, predicting the pathological response to preoperative therapy is of clinical importance. Accurate prediction would allow for tailored approaches to neoadjuvant therapy.METHODS: All patients undergoing resection of rectal adenocarcinoma after neoadjuvant therapy between 2006 and 2015 were included in this cohort study. Patients were identified from a prospectively collected database and data were supplemented retrospectively with full blood count at diagnosis. Specimens resected following neoadjuvant therapy were graded according to pathological response. Follow-up data was obtained from the national registry. The primary outcome was complete pathological response.RESULTS: Of 330 patients, 71 (21.5%) responded completely to preoperative therapy. Median age was 66 and 65% were male (n = 215). White cell count (WCC) was the most predictive marker, for predicting pCR; area under the curve (AUC) 0.666. This was higher than neutrophil/platelet ratio (AUC 0.652) or neutrophil/lymphocyte ratios (AUC = 0.437). Kaplan-Meier survival analysis showed those patients with WCC > 8 had poorer survival than those with WCC < 8 (p = 0.009).CONCLUSION: Routinely collected haematology samples at the point of diagnosis can assist in predicting for complete response to neoadjuvant therapy. Although novel biomarkers will have a greater predictive value, this clinically available value test could help to assist in risk stratification of patients using routinely collected laboratory tests.

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