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The role of haematological parameters in predicting the response to radical chemoradiotherapy in patients with anal squamous cell cancer Cover

The role of haematological parameters in predicting the response to radical chemoradiotherapy in patients with anal squamous cell cancer

Radiology and Oncology
Volume 55 (2021): Issue 4 (December 2021)
By: ,  ,  ,  ,  ,  ,  ,   and    
Open Access
|Oct 2021
Figures & tables

Figures & Tables

Table 1

Patients’ disease, treatment and outcomes characteristics

CharacteristicsN (%)CharacteristicsN (%)
Age (years)NLR
    Mean (SD)61.9 (10.0)    Mean (SD)2.7 (1.7)
    Median (Range)63.0 (40.0–81.0)    Median (Range)2.1 (0.8–7.0)
GenderPLR
    Female36 (76.6%)    Mean (SD)159.4 (92.1)
    Male11 (23.4%)    Median (Range)132.9 (51.7–401.2)
Performance status (PS)1RT technique
    ECOG 013 (27.7%)2D23 (48.9%)
    ECOG 133 (70.2%)3D24 (51.1%)
    ECOG 21 (2.1%)The first RT part-dose (Gy)
T in clinical TNM    Mean (SD)36.1 (1.6)
    T218 (38.3%)    Median (Range)36 (30–45)
    T324 (51.1%)The second RT part-dose (Gy)
    T45 (10.6%)    Mean (SD)22.8 (2.5)
N in clinical TNM    Median (Range)23.4 (9–26)
    N017 (36.2%)Total dose (Gy)
    N130 (63.8%)    Mean (SD)58.9 (1.6)
UICC staging    Median (Range)59.4 (52–59.4)
    IIA10 (21.3%)OTT (days)
    IIB7 (14.9%)    Mean (SD)74.7 (14.2)
    IIIA8 (17.0%)    Median (Range)77 (51–134)
    IIIC22 (46.8%)Acute toxicity-first part
Tumour differentiation    Without or gr. I/II26 (55.3%)
    well24 (51.1%)    Grade III/IV21 (44.7%)
    moderate13 (27.7%)Acute toxicity-second part
    poor4 (8.5%)    Without or gr. I/II32 (68.1%)
    without data6 (12.8%)    Grade III/IV15 (31.9%)
Tumour size (cm)Tumour response at 6 months
    Mean (SD)5.2 (2.0)    CR30 (63.8%)
    Median (Range)5.4 (2.1–10.0)    PR15 (31.9%)
Initial haemoglobin level (g/L)    SD1 (2.1%)
    Mean (SD)116.3 (20.3)    PD1 (2.1%)
    Median (Range)124 (66–154)Follow-up period (months)
Pretreatment colostomy    Mean (SD)53.0 (30.9)
    No42 (89.4%)    Median (Range)44 (11–136)
    Yes5 (10.6%)Total47 (100%)

[i] CR = complete clinical response; NLR = neutrophil-to-lymphocyte ratio; OTT = overall treatment time; PD = disease progression; PR = partial regression; PLR = platelet-to-lymphocyte ratio; RT = radiotherapy; SD = stable disease; SD = standard deviation; UICC = Union for International Cancer Control; 1 ECOG PS = The Eastern Cooperative Oncology Group performance status

Figure 1

Disease-free survival (DFS), progression-free survival (PFS), and overall survival (OS) for the whole patient group.

Table 2

Comparison of characteristics of complete responders (CR) and non-complete responders (non-CR) to chemoradiotherapy

CRnon-CRrank Wilcoxon sum test
Age (years)
    Mean (SD)60 (10.7)65.1 (7.8)ns
    Median (Range)59.5 (40.0–80.0)65.0 (52.0–81.0)
Gender
    Male6 (20%)5 (29.4%)ns*
    Female24 (80%)12 (70.6%)
T in clinical TNM
    T213 (43.3%)5 (29.4%)
    T314 (46.7%)10 (58.2%)ns#
    T43 (10.0%)2 (11.8%)
N in clinical TNM
    N015 (50.0%)2 (11.8%)
    N115 (50.0%)15 (88.2%)p* < 0.05
Tumour size (cm)
    Mean (SD)4.7 (1.8)6.0 (2.1)p < 0.05
    Median (Range)4.9 (2.1–8.0)5.8 (2.3–10.0)
Initial haemoglobin level (g/L)
    Mean (SD)124.2 (16.9)103.0 (18.8)p < 0.01
    Median (Range)127.0 (66.0–154.0)101.0 (68.0–132.0)
Pretreatment colostomy
    No28 (93.3%)14 (82.3%)
    Yes2 (6.7%)3 (17.6%)ns#
Neutrophil-to-lymphocyte ratio
    N (%)16/30 (50%)16/17 (50%)
    Mean (SD)2.4 (1.8)3.1 (1.6)ns
    Median (Range)1.9 (0.8–7.0)3.2 (0.9–5.6)
Platelet-to-lymphocyte ratio
    N (%)16/30 (50%)16/17 (50%)
    Mean (SD)118.3 (54.9)200.5 (104.4)
    Median (Range)108.3 (51.7–256.6)158.9 (79.5–401.2)p < 0.05
DFS (months)
    Median (95% CI)NRNRp$ < 0.05
PFS (months)
    Median (95% CI)NR26 (> 17)p$ < 0.01
OS (months)
    Median (95% CI)NR71 (> 33)p$ < 0.01
ACSOS (months)
    Median (95% CI)NRNRp$ < 0.05
CFS (months)
    Median (95% CI)NR11 (> 10)p$ < 0.01
Total30 (100%)17 (100%)-

[i] ACSOS = anal cancer specific overall survival; CFS = colostomy-free survival; DFS = disease-free survival; CI = confidence interval; DFS = disease-free survival; NR = not reached; ns = not statistically significant; OS = overall survival; PFS = progression-free survival; SD = standard deviation; * = Pearson χ2 test; # = Fisher exact test; $ = log-rank test

Figure 2

(A) Kaplan-Meier plots for Disease-free survival (DFS), (B) progression-free survival (PFS), and (C) overall survival (OS) in relation to response to treatment after 6 months.

Table 3

Logistic regression analysis of the response to treatment after 6 months

OR (95%CI)Wild testOR (95%CI)Likelihood Ratio test
Age
    > 63 y vs. ≤ 63 y1.7 (0.4–6.6)p = 0.213-p = 0.884
Gender
    Male vs. Female2.1 (0.6–7.2)p = 0.468-p = 0.082
T in clinical TNM
    T3 vs. T2 T4 vs. T21.9 (0.5–6.9) 1.7 (0.2–13.7)p = 0.634-p = 0.940
N in clinical TNM
    N1 vs. N07.5 (1.4–38.7)p = 0.006-p = 0.133
Tumour size (cm)
    > 4 cm vs. ≤ 4 cm6.6 (1.3–33.8)p = 0.011-p = 0.602
Initial haemoglobin level (g/L)
    < 120 g/L vs. ≥ 120 g/L8.9 (2.2–35.6)p = 0.00113.4 (2.4–74.3)p* = 0.003
RT technique
    2D vs. 3D1.3 (0.4–4.2)p = 0.679-p = 0.784
Treatment break
    > 10 days vs. ≤ 10 days6.0 (1.6–22.3)p = 0.0059.6 (1.7–52.5)p* = 0.009
Completed chemotherapy
    No vs. Yes2.0 (0.4–9.3)p = 0.379-p = 0.555

[i] CI = confidence interval; OR = odds ratio; RT = radio therapy; * = wild test

Figure 3

Receiver Operating Characteristics (ROC) curve for the platelet-to-lymphocyte ratio (PLR) in relation to response to treatment after 6 months.

Table 4

Results of the ROC analysis for neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) and relevant events

CharacteristicsNLRPLR
AUC ROCa (95% CI)65.2% (45.3–85.2%)76.2% (59.5–92.9%)
Likelihood ratio testbnsp < 0.05
ROC-cut-off valuec-145.2
Sensitivity (95% CI)-68.7% (43.7–87.5%)
Specificity (95% CI)-75.0% (56.1–93.7%)

[i] AUC ROCa = Area Under the Receiver Operating Characteristics Curve (DeLong’s method); b = Likelihood ratio test for AUC ROC; c = Value with maximum sensitivity and specificity; CI = confidence interval; ns = not statistically significant

Table 5

The value of neutrophil-to-lymphocyte ratio (NLR) and platelet-tolymphocyte ratio (PLR) in prediction of CR vs. non-CR

CRnon-CRFisher Exact Test
NLR (literature cut-off value)
    < 3.013 (81.2%)7 (43.8%)
    ≥ 3.03 (18.8%)9 (56.2%)p = 0.06
PLR (literature cut-off value)
    < 160.013 (81.2%)9 (56.2%)
    ≥ 160.03 (18.8%)7 (43.8%)p = 0.25
PLR (ROC cut-off value)
    < 145.212 (75%)5 (31.3%)
    ≥ 145.24 (25%)11(68.7%)p = 0.03
Total16 (100%)16 (100%)-

[i] CR = complete clinical response, non-CR = non-complete clinical response; ROC = Receiver Operating Characteristics

DOI: https://doi.org/10.2478/raon-2021-0039 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099
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Language: English
Page range: 449 - 458
Submitted on: May 18, 2021
Accepted on: Jul 16, 2021
Published on: Oct 8, 2021
Published by: Association of Radiology and Oncology
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
anal cancer,
chemoradiotherapy,
haematological parameters
Related subjects:
Medicine,
Clinical medicine,
Radiology

© 2021 Suzana Stojanovic-Rundic, Mladen Marinkovic, Milena Cavic, Vesna Plesinac Karapandzic, Dusica Gavrilovic, Radmila Jankovic, Richarda M. de Voer, Sergi Castellvi-Bel, Zoran Krivokapic, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Volume 55 (2021): Issue 4 (December 2021)
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