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Is baseline neutrophil to lymphocyte ratio (NLR) an independent prognostic biomarker for progression free survival (PFS) and overall survival (OS) in metastatic colorectal cancer (mCRC)? Analysis of the AGITG MAX study

2016; Elsevier BV; Volume: 27; Linguagem: Inglês

10.1093/annonc/mdw370.137

1569-8041

Connie I. Diakos, Kenneth A. Wilson, Rebecca Asher, Val Gebski, Sonia Yip, Guy van Hazel, Bridget A. Robinson, A. Broad, Timothy Price, John Simes, Niall C. Tebbutt, Stephen Clarke,

Cancer Immunotherapy and Biomarkers

NLR (ratio of absolute neutrophil and lymphocyte counts) has shown prognostic utility for OS in a number of cancer types. The AGITG MAX study examined capecitabine (C) with C + bevacizumab (B) and C + B + mitomycin C (M) in first-line treatment of mCRC. CB demonstrated superiority over C for PFS and was comparable to CBM. We examine NLR in the MAX study to assess its utility for prediction of treatment effect, PFS and OS. PFS and OS estimates were obtained using the method of Kaplan-Meier and hazard ratios obtained using proportional hazards models. Analysis included adjusting for baseline (BL) disease and patient (pt) characteristics and investigating potential interaction effects between NLR status and significant BL predictors of outcome. MAX study recruited 471 pts; relevant BL haematological data was available for 403 pts (86%). At BL, 24% of pts had high NLR (≥5). High NLR correlated with rectal primary (p = 0.007), higher ECOG status (p < 0.001), more prior therapy (i.e. prior adjuvant/neoadjuvant) (p = 0.01), more sites of metastases (p = 0.006). Results of univariate analysis summarised in Table 1. On univariate analysis, pts with high NLR had significantly increased risk of progression & death. On multivariate analysis, high NLR, treatment group, ECOG status & liver involvement were significantly associated with PFS; high NLR, treatment group, ECOG status, prior adjuvant/neoadjuvant treatment & primary tumour site were significantly associated with OS. No significant interaction was observed between treatment & NLR status for both PFS & OS.Tabled 1Univariate analysis of baseline NLR in MAX studyOutcomeFactorMedian (mo) (95% CI)HR (95% CI) p-value UnivariateHR (95% CI) p-value Multivariate*PFSNLR < 5 NLR ≥ 57.5 (6.9-8.5) 5.9 (4.7-7.3)1.4 (1.1-1.8) 0.0061.4 (1.1-1.8) 0.004OSNLR < 5 NLR ≥ 519.8 (17.3-21.4) 12.1 (8.4-14.8)1.9 (1.4-2.4) <.00011.8 (1.3-2.3) <.0001* after adjustment for other significant prognostic factors Open table in a new tab * after adjustment for other significant prognostic factors NLR provides independent prognostic information for patients with mCRC receiving first-line treatment in the MAX study, for both PFS and OS. This should become a standard stratification indication for future randomised controlled trials.