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Rolul biomarkerilor serici in predictia raspunsului la tratamentul neoadjuvant in cancerul

de rect jos situat

Maria-Gabriela Anitei1,2, Ioanid Serban-Nicolae1 , Adrian Pantazescu1, Ionut Hutanu1,2,


Bogdan Filip1,2, Iulian Radu1,2, Madalina-Mihaela Gavrilescu,2, Ana-Maria Musina1,2, Mihaela
Buna-Arvinte1,2, Adrian Panuta1,2, D.V. Scripcariu1,2, Ana Grigoras1, Irina Lupu1 Alexandra
Avram, V. Scripcariu1
1Clinica I Chirurgie Oncologica IRO Iasi
2Universitatea de Medicina si Farmacie Gr. T. Popa, Iasi

Introducere : Tratamentul neoadjuvant radioterapic este gold standard pentru cancerul de


rect jos situat, local avansat a carui indicatie este in functie de evaluarea cTNM. Raspunsul la
tratamentul neoadjuvant este variat, de unde interesul recent pentru diversi factori de predictie
ai acestuia. Studiul rolului sistemului imunitar in modularea raspunsului local la radioterapia
externa poate sta la baza unor scoruri de predictie a regresiei tumorale.

Obiectiv: Obiectivul acestui studiu este de a evalua importanța raportului limfocite-


monocite în ceea ce privește răspunsul la tratamentul neoadjuvant pentru pacientii cu cancer
de rect jos situat, local avansat si de a aprecia asocierile existente dintre raportul limfocite-
monocite (RLM) si status limfoganglionar.

Material si metode: S-au analizat retrospectiv 738 pacienti diagnosticati cu cancer de rect,
diagnosticati si tratati chirurgical in Clinica I chirurgie Oncologica IRO Iasi in intervalul ianuarie
2016 – decembrie 2018. Dintre acestia, un numar de 272 cazuri (36.9%) au avut tratament
neoadjuvant de lunga durata conform clasificarii cTNM urmat de tratament chirurgical cu viza
de radicalitate oncologica. A fost evaluat RLM, raspunsul la tratamentul neoadjuvant conform
scorului Dworak precum si numarul de ganglioni examinati per caz, numarul de ganglioni pozitivi
raportati la numarul de ganglioni totali examinati (RLN = ratio lymph nodes), statusul de invazie
limfatica, venoasa si perineurala (VeLiPi).

Rezultate: Raspunsul favorabil la tratamentul neoadjuvant a fost pentru 122 pacienti (scor
Dworak 2-3-4) iar 150 pacienti au fost considerati non-responderi (scor Dworak 0-1). Numarul
mediu de ganglioni examinati pe piesa operatorie a fost de 14 ganglioni (cu variatii de 4-46
ganglioni), iar invazia limfatica/vasculara/perineurala a fost prezenta la 95 pacienti. Rezultatele
testului t student arata faptul că exista corelatii intre valoarea RLM si scorul Dworak, RLM si RLN,
RLM si statusul VeLiPi la pacientii cu neoplasm de rect jos situat, radiotratat neoadjuvant
(p<0,05).

Concluzie: RLM poate fi un factor util in predictia raspunsului la tratamentul neoadjuvant


precum si factor de prognostic in cancerul de rect jos situat.

Cuvinte cheie : cancer de rect jos situat, tratament neoadjuvant, raport ganglioni
pozitivi/ganglioni totali, raport limfocite/monocite

The role of seric biomarkers in predicting the response to neoadjuvant treatment for low
rectal cancer

Maria-Gabriela Anitei1,2, Ioanid Serban-Nicolae1 , , Adrian Pantazescu1, Ionut Hutanu1,2,


Bogdan Filip1,2, Iulian Radu1,2, Madalina-Mihaela Gavrilescu,2, Ana-Maria Musina1,2, Mihaela
Buna-Arvinte1,2, Adrian Panuta1,2, D.V. Scripcariu1,2, Ana Grigoras1, Irina Lupu1 Alexandra
Avram, V. Scripcariu1
1Department of Surgical Oncology, I –st Surgical Unit, IRO, Iasi
2Department of Surgery, UMF “Grigore T. Popa” Iasi

Introduction: Neoadjuvant radiotherapy is the gold standard in locally advanced low rectal
cancer, recommended by clinical TNM staging. The reponse to neoadjuvant therapy is variable,
thus the recent interest for finding prediction factors. Research of the immune system’s
modulating the response to neoadjuvant treatment has led to the development of certain
scores to predict response to neoadjuvant therapy.

Objective: The objective of this study was to evaluate the importance of lymphocyte-
monocyte ratio (LMR) as it pertains to the response to neoadjuvant treatment in patients with
locally advanced low rectal cancer and evaluate an eventual correlation between LMR and the
lymph node status.

Materials and methods: We retrospectively analyzed 738 cases of rectal cancer from
January 2016 to December 2018, who underwent surgery at the 1 st Surgical Unit of IRO IASI. Of
these, 272 cases received long-course radiotherapy, recommended by the cTNM staging,
followed by radical surgical treatment. We analyzed the LMR, the Dworak score, the number of
total lymph nodes and the ratio lymph nodes (positive lymph nodes/total lymph nodes -RLN) as
well as lymphatic, vascular and perineural invasion (VeLiPi).

Results: Favorable response to neoadjuvant treatment (Dworak 2-3-4) was observed in 122
cases, while 150 cases were considered non-responders (Dworak 0-1). The median number of
lymph nodes examinated was 14 (range 4-46). Lymphatic and/or vascular and/or perineural
invasion were found in 95 patients. T student test analysis showed a correlation between RLM
and Dworak score, RLM and RLN, RLM and VeLiPi status in patients with locally advanced low
rectal cancer with neoadjuvant radiotherapy (p<0,05).

Conclusion : RLM can be useful in predicting response to neoadjuvant therapy as well as a


prognostic factor in low rectal cancer.

Keywords: low rectal cancer, neoadjuvant treatment, ratio lymph node, lymphocyte-
monocyte ratio