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Correlation between extramural vascular invasion (EMVI) and systemic inflammatory response markers in rectal cancer
Background
Colorectal cancer (CRC) is the leading cause of cancer-related death worldwide. Rectal cancer constitutes around one-third of all CRCs. The current standard of care of patients with locally advanced rectal cancer is neoadjuvant radio/chemo-radiotherapy; however, treatment differs substantially across countries. Novel markers are required to optimize the treatment. Extramural vascular invasion (EMVI) is a well-established magnetic resonance imaging (MRI)-based negative prognostic marker. Systemic inflammatory response markers such as lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR) or platelet-to-lymphocyte ratio (PLR) are novel blood-based prognostic markers in many cancers, including CRC. We hypothesized if there is a relation between LMR, NLR, PLR and the presence of EMVI on pre-treatment MRI.
Methods
We conducted a retrospective analysis of 231 patients with locally advanced rectal cancer treated in the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland between August 2016 and January 2021. The inclusion criteria were as follows: 1) histologically confirmed rectal cancer; 2) pre-treatment staging with a high-resolution MRI scan of the pelvis and evaluation of EMVI status by an experienced radiologist; 3) clinical records including demographic and laboratory data available and complete. The exclusion criteria were: 1) presence of distant metastases at the time of diagnosis; 2) chemotherapy and/or radiotherapy applied prior to MRI; 3) presence of malignant tumors in other organs; 4) presence of hematologic malignancies and disorders that could substantially affect inflammatory markers; 5) prior immunosuppressive therapy. Sixty-three patients were found eligible for the study. We analyzed a routine blood examination of each patient and calculated their LMR, NLR and PLR. The median time between blood examination and pre-treatment staging MRI was 10 days.
Results
Thirty patients (47.6%) were EMVI-positive and 33 patients (52.4%) were EMVI-negative. There was a correlation between the stage of the disease and the presence of EMVI (p = 0.034). No significant differences were detected between EMVI-positive and EMVI-negative groups regarding the level of LMR, NLR and PLR. According to ROC (Receiver Operating Characteristic) analyses LMR, NLR and PLR do not differentiate patients in terms of EMVI; the AUC (area under curve) for LMR was 0.45 (95% CI = 0.30; 0.60); for NLR 0.53 (95% CI = 0.38; 0.68) and for PLR 0.55 (95% CI = 0.40; 0.69), neither of these parameters is a good predictor of the status of EMVI.
Conclusions
In conclusion, we found no correlation between LMR, NLR, PLR and EMVI in locally-advanced rectal cancer.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosures
All authors have declared no conflicts of interest.
