New Scale Predicting Distant Recurrence in Locally Advanced Lower Rectal Cancer Patients After Neoadjuvant...

Area of Science:

• Oncology
• Gastroenterology
• Medical Diagnostics

Background:

• Neoadjuvant chemoradiotherapy (nCRT) is standard for locally advanced lower rectal cancer (LALRC).
• nCRT is effective against locoregional recurrence but less so for distant recurrence.
• Predicting distant recurrence risk before nCRT is crucial for optimizing treatment strategies.

Purpose of the Study:

• To develop and validate a novel predictive scale for distant recurrence in LALRC patients.
• To assess the scale's association with distant relapse-free survival (DRFS).
• To explore the scale's utility in guiding treatment selection, such as total neoadjuvant chemotherapy.

Main Methods:

• Retrospective analysis of 51 LALRC patients treated with nCRT.
• Classification into high-, intermediate-, and low-risk groups based on pre-treatment neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR).
• Cox proportional hazards model and log-rank test were used to analyze DRFS and identify independent risk factors.

Main Results:

• Distant recurrence rates were significantly higher in the high-risk (61.5%) and intermediate-risk (42.9%) groups compared to the low-risk group (20.8%).
• The new scale was an independent predictor of DRFS (p=0.004 for high-risk vs. low-risk).
• Three-year DRFS rates were 38.5% (high-risk), 56.3% (intermediate-risk), and 81.7% (low-risk).

Conclusions:

• A novel scale combining pre-nCRT NLR and LMR effectively predicts distant recurrence in LALRC.
• This scale is independently associated with distant relapse-free survival.
• The scale may assist in selecting appropriate patients for intensified treatment, like total neoadjuvant chemotherapy.