Pretreatment MRI Parameters and Neutrophil-to-Lymphocyte Ratio Could Predict the Long-Term Prognosis of Locally Advanced Rectal Cancer Patients With Pathological Complete Response after Neoadjuvant Chemoradiotherapy.

BackgroundLocal advanced rectal cancer (LARC) patients who achieved pathological complete response (pCR) after neoadjuvant chemoradiotherapy (NCRT) generally have a favorable prognosis. This retrospective study aimed to evaluate the prognostic value of magnetic resonance imaging (MRI) parameters and neutrophil-to-lymphocyte ratio (NLR) in LARC patients with pCR.MethodsBetween 2015 and 2019, 180 LARC patients who achieved pCR after NCRT and surgery were included. MRI parameters and NLR were evaluated as potential predictors for 5-year overall survival (OS) and disease-free survival (DFS) using the Kaplan-Meier and COX regression analysis.ResultsWith a median follow-up time of 68.3 months, the 5-year OS and DFS rates were 94.2% and 91.4%, respectively. Thirteen patients (7.2%) died, 2 (1.1%) experienced local recurrence, and 15 (8.3%) experienced distant metastases. Pretreatment MRI parameters and NLR were correlated with 5-year OS and DFS in pCR patients in the univariate analysis. The multivariate analysis identified baseline EMVI and NLR as independent predictors for 5-year OS and DFS (all P < .05). Patients in the low-risk group (EMVI-negative and/or NLR ≤ 2.8, n = 159, 88.3%) had a more favorable 5-year DFS compared to those in the high-risk group (EMVI-positive and NLR > 2.8, n = 21, 11.7%) (95.6% vs 59.4%, P < .001), with similar findings for 5-year OS (97.4% vs 70.6%, P < .001).ConclusionsThis study showed that MRI parameters and NLR were associated with long-term prognosis in patients with pCR. These findings could aid in stratifying pCR patients and guide subsequent treatment and follow-up strategies.