SNFGE SNFGE
 
Thématique :
- Cancer colorectal (CCR)
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Pas encore
 
 
Nom du veilleur :
Docteur Roger FAROUX
Coup de coeur :
 
 
Annals of oncology
  2018/04  
 
  2018 Apr ;29(4):924-930.  
  doi: 10.1093/annonc/mdy004.  
 
  Prognostic and predictive role of neutrophil/lymphocytes ratio in metastatic colorectal cancer: a retrospective analysis of the TRIBE study by GONO.  
 
  Dell'Aquila E, Cremolini C, Zeppola T, Lonardi S, Bergamo F, Masi G, Stellato M, Marmorino F, Schirripa M, Urbano F, Ronzoni M, Tomasello G, Zaniboni A, Racca P, Buonadonna A, Allegrini G, Fea E, Di Donato S, Chiara S, Tonini G, Tomcikova D, Boni L, Falcone A, Santini D  
  https://www.ncbi.nlm.nih.gov/pubmed/29324972  
 
 

Abstract

BACKGROUND:

Neutrophil/lymphocyte ratio (NLR), defined as absolute neutrophils count divided by absolute lymphocytes count, has been reported as poor prognostic factor in several neoplastic diseases but only a few data are available about unresectable metastatic colorectal cancer (mCRC) patients (pts). The aim of our study was to evaluate the prognostic and predictive 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 unresectable and previously untreated mCRC pts to receive FOLFOXIRI or FOLFIRI plus bevacizumab. A cut-off value of 3 was adopted to discriminate pts with low (NLR < 3) versus high (NLR ≥ 3) NLR, as primary analysis. As secondary analysis, NLR was treated as an ordinal 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 had significantly shorter progression-free survival (PFS) [hazard ratio (HR) 1.27 (95% CI 1.05-1.55), P = 0.017] and overall survival (OS) [HR 1.56 (95% CI 1.25-1.95), P < 0.001] than patients with low NLR. In the multivariable model, NLR retained a significant association with OS [HR 1.44 (95% CI 1.14-1.82), P = 0.014] but not with PFS [HR 1.18 (95% CI 0.95-1.46), P = 0.375]. No interaction effect between treatment arm and NLR was evident in terms of PFS (P for interaction = 0.536) or OS (P for interaction = 0.831). Patients with low [HR 0.84 (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 results were 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 the first line, showing the worse prognosis of pts with high NLR. The advantage of the triplet is independent of NLR at baseline.

 

 
Question posée
 
Le ratio neutrophiles/lymphocytes plasmatique est-il un biomarqueur pronostique et prédictif de réponse au traitement dans le cancer colorectal métastatique ?
 
Question posée
 
Oui, dans cette étude rétrospective: les patients avec un ratio élevé ( > 3) ont une moins bonne survie globale et une moins bonne survie sans progression s’ils sont traités par bi-chimiothérapie et bevacizumab. Pas de différence de survie si le traitement comprend un triplet de chimiothérapie.
 
Commentaires

La place de ce potentiel biomarqueur pronostique, simple ,dans le cancer colorectal reste à confirmer en prospectif dans les situations métastatiques et adjuvantes. 

 
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