Gastrointestinal Cancer

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SU_2_2010 - Immune Inflammation Indicators Predict Outcome in Anal Cancer Patients Undergoing Concurrent Chemo-radiation

Sunday, October 21
1:15 PM - 2:45 PM
Location: Innovation Hub, Exhibit Hall 3

Immune Inflammation Indicators Predict Outcome in Anal Cancer Patients Undergoing Concurrent Chemo-radiation
P. Franco1, F. Montagnani2, F. Arcadipane3, C. Casadei4, K. Andrikou5, G. C. Franco6, M. Scartozzi7, M. Mistrangelo8, L. Fornaro9, P. Cassoni10, S. Cascinu5, U. Ricardi6, and A. Casadei Gardini4; 1University of Turin, Department of Oncology, Torino, Italy, 2Department of Oncology, Medical Oncology, ASL Biella, Biella, Italy, 3Department of Oncology, Radiation Oncology, AOU Citta' della Salute e della Scienza, Turin, Italy, 4Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy, 5Modena Cancer Center, Department of Oncology/Hematology, University of Modena and Reggio Emilia, Modena, Italy, 6Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy, 7Department of Medical Oncology, University of Cagliari, Cagliari, Italy, 8Department of Surgical Sciences, University of Turin, Turin, Italy, 9Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy, 10Department of Medical Sciences, Pathology Unit, University of Turin, Turin, Italy

Purpose/Objective(s): Systemic inflammatory response has been shown to reflect the promotion of angiogenesis, DNA damage and tumor invasion through up-regulation of cytokines. Several inflammation and immune-based prognostic scores, such as lymphocyte count, neutrophil-lymphocyte ratio (NLR) and systemic immune-inflammation index (SII) have been developed to predict survival and recurrence in different oncological settings. In the present study, we investigated the influence of different clinical prognostic factors, particularly the immune inflammation indicators, on clinical outcomes in anal cancer patients undergoing concurrent chemo-radiation (CT-RT).

Materials/Methods: All patients in the present analysis had a histologically proven diagnosis of squamous cell carcinoma of the anal canal/margin and were treated with CT-RT according to the Nigro’s regimen. Pre-treatment SII (platelet x neutrophil/lymphocyte), NLR (neutrophil/lymphocyte) and PLR (platelet/lymphocyte) were obtained. Univariate and multivariate Cox models were set to explore the correlation between covariates and Progression-Free Survival (PFS) and Overall Survival (OS) Unconstrained univariate and multivariate logistic regression models were used to develop a nomogram able to predict the probability of response to CT-RT. Internal validation and calibration were performed using bootstrap method.

Results: A total of 161 consecutive patients were available for the analysis. Figure 1 shows the clinical variables predictive of PFS and OS. At univariate analysis SII was significantly correlated to PFS (HR:2.13;p<0.01) and OS (HR:1.70;p=0.046). NLR was significantly correlated to PFS (HR:1.13;p=0.05) but not to OS (HR: 1.15; p=0.06). Conversely, PLR was significantly correlated to PFS (HR:1.44;p<0.01) and OS (HR:1.43;p=0.02). For absolute values of platelets, neutrophils and lymphocytes, only platelet count was associated to PFS, but none of them was related to OS. On multivariate analysis SII retained a significant correlation to PFS (HR:1.43;p=0.0079), but not to OS (HR:1.13;p=0.15). On multivariate analysis with respect to OS, disease progression during CT-RT was the strongest predictive factor for both PFS (HR:41.36;p<0.0001) and OS (HR:42.15;p<0.0001). We developed a nomogram to predict the likelihood for disease progression. The final multivariate model included SII, basal hemoglobin values and clinical nodal involvement. The resulting nomogram showed remarkable predictive ability with a C-index of 0.847 (0.823-0.865) and a good calibration plot (Figure 2).

Conclusion: Systemic immune-inflammation index is strongly associated to clinical results and survival in anal cancer patients submitted to CT-RT. The low cost and the easy profile in terms of determination and reproducibility make SII a promising tool for prognostic assessment in this oncological setting.

Author Disclosure: P. Franco: None. F. Montagnani: None. C. Casadei: None. K. Andrikou: None. M. Scartozzi: None. M. Mistrangelo: None. A. Casadei Gardini: None.

Pierfrancesco Franco, MD, PhD

Biography:
Pierfrancesco Franco is currently Associate Professor at the Department of Oncology, Radiation Oncology, University of Turin. Pierfrancesco Franco is presently working on research projects in Clinical Oncology, focusing on gastrointestinal malignancies, head and neck and breast cancer. He is particularly involved in high-precision deliverey approaches in the aforementioned clinical settings.

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