Analysis of treatment outcomes in patients with rectal cancer. Prognostic influence of neutrophil-lymphocyte index on survival
Summary. Purpose. To improve the effectiveness of surgical treatment of patients with rectal cancer after neoadjuvant therapy by studying the rates of overall and recurrence-free survival and analysing prognostic factors. Materials and methods of the study. The study analysed the results of treatment of 84 patients with rectal cancer who received treatment at the municipal non-profit enterprise «Precarpathian Clinical Oncology Centre of Ivano-Frankivsk Regional Council» in 2016–2021. All patients operated on by the author of the study were included in the study. At the first stage, the recurrence-free and overall survival of patients with rectal cancer was studied and analysed in correlation with the treatment received. At the second stage, the effect of the neutrophil-lymphocyte index on survival was studied by constructing Cox regression. Results. Higher rates of overall survival were observed in patients with neoadjuvant treatment: intensive care radiotherapy and radiotherapy with potentiation (the same survival rate was observed among the above patients). Thus, the overall survival rate of patients who did not receive adjuvant treatment is 1.3 times lower at the 60th month of follow-up compared to patients with neoadjuvant treatment. It was determined that from the 4th year of observation, recurrence was not observed only in patients who received intensive radiotherapy and radiotherapy with potentiation at the preoperative stage. Statistically, there was no significant difference between the above groups of patients in terms of cumulative survival: for example, at the 60th months of follow-up, the recurrence-free cumulative survival rate in patients whose neoadjuvant treatment included intensive radiotherapy was 17.1%, and in patients who received radiotherapy with chemotherapy potentiation before surgery it was 15.9%. Analysing the effect of neutrophil-lymphocyte index (NLI) on survival by constructing Cox regression, the following results were obtained: in the 3rd year of follow-up, the predicted overall survival of patients with minimal NLI values is 96.9%, which is 4.9% and 21.9% higher compared to Cox regression for average and maximum NLI values; statistical significance is substantial for all study groups. The 5-year prognostic overall survival rate for patients with minimal NLI values is 93.9%, which is 9.9% and 35.9% higher compared to Cox regression for average and maximum NLI values; statistical significance is substantial for all study groups. The 3-year predicted recurrence-free survival rate at the lowest NLI is 64%, and the similar 5-year predicted survival rate for this group is 48%. The predicted rates of recurrence-free survival of patients with the maximum NLI value were the worst: 3-year recurrence-free survival rate — 32%, predicted 5-year survival rate — 20%. Conclusions. The use of neoadjuvant treatment in patients with rectal cancer statistically significantly improves both overall and progression-free survival. At all studied observation intervals, similar results of the predicted recurrence-free and overall survival of patients with rectal cancer depending on the neutrophil-lymphocyte index are observed: significantly worse Cox regression is in patients with rectal cancer with maximum NLI.
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