Background:Neutrophil/lymphocyte ratio (NLR), defined as absolute neutrophils count divided by absolute lymphocytescount, has been reported as poor prognostic factor in several neoplastic diseases but only a few data are available aboutunresectable metastatic colorectal cancer (mCRC) patients (pts). The aim of our study was to evaluate the prognostic andpredictive role of NLR in the TRIBE trial.Patients and methods:Pts enrolled in TRIBE trial were included. TRIBE is a multicentre phase III trial randomizing unresectableand previously untreated mCRC pts to receive FOLFOXIRI or FOLFIRI plus bevacizumab. A cut-off value of 3 was adopted todiscriminate pts with low (NLR<3) versus high (NLR3) NLR, as primary analysis. As secondary analysis, NLR was treated as anordinal variable with three levels based on terciles distribution.Results:NLR at baseline was available for 413 patients. After multiple imputation at univariate analysis, patients with high NLR hadsignificantly shorter progression-free survival (PFS) [hazard ratio (HR) 1.27 (95% CI 1.05–1.55),P¼0.017] and overall survival (OS) [HR1.56 (95% CI 1.25–1.95),P<0.001] than patients with low NLR. In the multivariable model, NLR retained a significant association withOS [HR 1.44 (95% CI 1.14–1.82),P¼0.014] but not with PFS [HR 1.18 (95% CI 0.95–1.46),P¼0.375]. No interaction effect betweentreatment arm and NLR was evident in terms of PFS (Pfor interaction¼0.536) or OS (Pfor interaction¼0.831). Patients with low [HR0.84 (95% CI 0.64–1.08)] and high [HR 0.73 (95% CI 0.54–0.97)] NLR achieved similar PFS benefit from the triplet and consistent resultswere obtained in terms of OS [HR 0.83 (95% CI 0.62–1.12) for low NLR; HR 0.82 (95% CI 0.59–1.12) for high NLR].Conclusion:This study confirmed the prognostic role of NLR in mCRC pts treated with bevacizumab plus chemotherapy in thefirst line, showing the worse prognosis of pts with high NLR. The advantage of the triplet is independent of NLR at baseline.

Prognostic and predictive role of neutrophil/lymphocytes ratio in metastatic colorectal cancer: a retrospective analysis of the TRIBE study by GONO

Tonini G;Santini D
2018-01-01

Abstract

Background:Neutrophil/lymphocyte ratio (NLR), defined as absolute neutrophils count divided by absolute lymphocytescount, has been reported as poor prognostic factor in several neoplastic diseases but only a few data are available aboutunresectable metastatic colorectal cancer (mCRC) patients (pts). The aim of our study was to evaluate the prognostic andpredictive role of NLR in the TRIBE trial.Patients and methods:Pts enrolled in TRIBE trial were included. TRIBE is a multicentre phase III trial randomizing unresectableand previously untreated mCRC pts to receive FOLFOXIRI or FOLFIRI plus bevacizumab. A cut-off value of 3 was adopted todiscriminate pts with low (NLR<3) versus high (NLR3) NLR, as primary analysis. As secondary analysis, NLR was treated as anordinal variable with three levels based on terciles distribution.Results:NLR at baseline was available for 413 patients. After multiple imputation at univariate analysis, patients with high NLR hadsignificantly shorter progression-free survival (PFS) [hazard ratio (HR) 1.27 (95% CI 1.05–1.55),P¼0.017] and overall survival (OS) [HR1.56 (95% CI 1.25–1.95),P<0.001] than patients with low NLR. In the multivariable model, NLR retained a significant association withOS [HR 1.44 (95% CI 1.14–1.82),P¼0.014] but not with PFS [HR 1.18 (95% CI 0.95–1.46),P¼0.375]. No interaction effect betweentreatment arm and NLR was evident in terms of PFS (Pfor interaction¼0.536) or OS (Pfor interaction¼0.831). Patients with low [HR0.84 (95% CI 0.64–1.08)] and high [HR 0.73 (95% CI 0.54–0.97)] NLR achieved similar PFS benefit from the triplet and consistent resultswere obtained in terms of OS [HR 0.83 (95% CI 0.62–1.12) for low NLR; HR 0.82 (95% CI 0.59–1.12) for high NLR].Conclusion:This study confirmed the prognostic role of NLR in mCRC pts treated with bevacizumab plus chemotherapy in thefirst line, showing the worse prognosis of pts with high NLR. The advantage of the triplet is independent of NLR at baseline.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.12610/12215
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