Evaluation of nutritional indices and inflammatory markers in relation to response and survival in patients with rectal adenocarcinoma receiving neoadjuvant chemotherapy/radiotherapy

Colorectal cancer remains the third most common cancer in both men and women. Its incidence is 24,1 per 100,000 in men and 13,3 per 100,000 in women. Rectal cancer accounts for 20% to 30% of colorectal cancer cases, and its incidence is increasing due to the increasing elderly population in this age-related malignancy (3, 8). In recent years, the treatment strategy for rectal cancer has changed significantly, with total neoadjuvant therapy becoming increasingly prominent, particularly in patients with locally advanced rectal cancer. This provides patients with the opportunity for sphincter-preserving surgery. While the desired success rate cannot be achieved in advanced-stage patients due to a lack of complete pathogenesis, promising results are currently being achieved in terms of treatment and patient comfort in early-stage and locally advanced patients. New parameters need to be identified to further improve survival in these patients. Inflammation markers and nutritional scores are important in this regard. This study examined patients diagnosed with rectal adenocarcinoma at the Trakya University Faculty of Medicine Medical Oncology Outpatient Clinic between 2013 and 2023 and followed with neoadjuvant chemoradiotherapy. Patients who were not followed by us were excluded from the study. The demographic characteristics, complaints at diagnosis, stage, metastatic sites, pathology results, pathological response scores, tumor markers, neoadjuvant treatments administered, type of surgery administered, adjuvant treatments (if administered), disease-free survival times, and overall survival times were evaluated for the 102 patients included in the study. No significant correlation was found between the prognostic nutritional index calculated before neoadjuvant therapy and disease-free survival. Albumin levels determined before neoadjuvant therapy were associated with overall survival, disease-free survival, and survival time, and were found to be a strong prognostic inflammatory marker. However, when the effect of the prognostic nutritional index value before neoadjuvant therapy on overall survival was evaluated, a significant difference was found between patients with a prognostic nutritional index of ≤49,75 and those with a prognostic nutritional index of >49,75. When the effect of the prognostic nutritional index value after neoadjuvant therapy on overall survival was evaluated, a significant difference was found between patients with a prognostic nutritional index of ≤44,72 and those with a prognostic nutritional index of >44,72. In univariate analyses performed with prognostic nutritional index values ​​before and after neoadjuvant treatment, it was determined that the pre-neoadjuvant prognostic nutritional index value and the post-neoadjuvant prognostic nutritional index value were statistically significant.