ESTRO 2022

Session Item

Saturday

May 07

16:55 - 17:55

Room D3

Lower GI

Co-Chair: , France;

Chair: , Italy

Session Code: 1500

Session Type: Proffered Papers

Track: Clinical

17:35 - 17:45

External validation of the Hemo-Eosinophils-Inflammation index as a prognosticator in anal cancer

, Italy

Presentation Number: OC-0272

Abstract

Abstract Title:

External validation of the Hemo-Eosinophils-Inflammation index as a prognosticator in anal cancer

Authors:

Pierfrancesco Franco¹, Annamaria Porreca², Marta Di Nicola³, Giovanna Mantello⁴, Francesca Valvo⁵, Najla Slim⁶, Stefania Manfrida⁷, Maria Antonietta Gambacorta⁸, Francesca De Felice⁹, Stefano Vagge¹⁰, Marco Krengli¹, Elisa Palazzari¹¹, Mattia Falchetto Osti¹², Alessandra Gonelli¹³, Gianpiero Catalano¹⁴, Patrizia Pittoni¹⁵, Marco Lupattelli¹⁶, Maria Rita Niespolo¹⁷, Maria Elena Rosetto¹⁸, Gabriella Macchia¹⁹, Oreste Durante²⁰, Fernando Munoz²¹, Rolando Maria D'Angelillo²², Domenico Genovesi²³, Luciana Caravatta²⁴

¹University of Eastern Piedmont, Department of Translational Medicine, Novara, Italy; ²"G. D'Annunzio" University of Chieti-Pescara, , Laboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, Chieti, Italy; ³"G. D'Annunzio" University of Chieti-Pescara, Laboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, Chieti, Italy; ⁴Azienda Ospedaliero Universitaria Ospedali Riuniti, Department of Oncology and Radiotherapy, Ancona, Italy; ⁵CNAO National Center for Oncological Hadrontherapy, Radiotherapy Unit, Clinical Department, Pavia, Italy; ⁶IRCCS San Raffaele Scientific Institute, Department of Radiotherapy, Milano, Italy; ⁷"A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radiotera-pia Oncologica ed Ematologia, Rome, Italy; ⁸"A. Gemelli" IRCCS, Fondazione Policlinico Universitario, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Rome, Italy; ⁹Policlinico Umberto I, "Sapienza" University of Rome, Department of Radiotherapy, Rome, Italy; ¹⁰IRCCS Ospedale Policlinico San Martino, Department of Radiation Oncology, Genua, Italy; ¹¹Oncological Referral Center, Radiation Oncology Department, Aviano, Italy; ¹²Sant'Andrea Hospital, Sapienza University of Rome, Unit of Radiation Oncology, Rome, Italy; ¹³Azienda Ospedaliero-Universitaria Pisana, Department of Radiotherapy, Pisa, Italy; ¹⁴IRCCS Multimedica, Radiation Oncology Center, Sesto San Giovanni, Italy; ¹⁵Asst Lariana, Ospedale di Como, Radiation Oncology Unit, Como, Italy; ¹⁶University of Perugia and Perugia General Hospital, Radiation Oncology Section, Perugia, Italy; ¹⁷Azienda Ospedaliera San Gerardo, Radiotherapy Unit, Monza, Italy; ¹⁸Belcolle Hospital, Radiotherapy Unit, Viterbo, Italy; ¹⁹Gemelli Molise Hospital – Università Cattolica del Sacro Cuore, Radiation Oncology Unit, Campobasso, Italy; ²⁰Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Radiation Oncology, Alessandria, Italy; ²¹Azienda U. S. L. della Valle d'Aosta, Radiation Oncology, Aosta, Italy; ²²Tor Vergata University, Radiation Oncology, Rome, Italy; ²³Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy; ²⁴"SS Annunziata" Hospital, "G. D'Annunzio" University of Chieti-Pescara, Radiation Oncology Unit, Chieti, Italy

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Purpose or Objective

Few prognostic factors has been recognised in squamous cell carcinoma of the anus (ASCC). Some are related to patient (gender), others to tumor (size, nodal involvement, HPV status). No laboratory index is currently validated as a prognosticator to guide clinical decision-making. We recently developed a prognostic scoring system based on laboratory inflammation parameters, [Hemo-Eosinophils-Inflammation (HEI) index], including baseline hemoglobin level, the systemic inflammatory index (platelet x neutrophil/lymphocyte), and eosinophil count. HEI was shown to discriminate prognostic groups for disease-free (DFS) and overall (OS) survival in ASCC treated with concurrent chemoradiation (CHT-RT). We tested the accuracy of the model on a multicentric cohort for external validation.

Material and Methods

Patients treated with CHT-RT with intensity-modulated techniques were enrolled from a national network and characteristics were collected, with baseline serum biomarkers. The Kaplan–Meier curves for DFS and OS according to HEI risk groups were calculated and the log-rank test was used to test the difference in survival estimates. Cox proportional hazards models were used to assess the influence of prognostic factors on DFS and OS. The exponential of the regression coefficients provided an estimate of the hazard ratio (HR) and the 95% confidence interval (95%CI). All p-values were two-tailed and a p-value<0.05 was statistically significant. For model discrimination, we determined Harrell's C-index, Gönen & Heller K Index and the explained variation on the log relative hazard scale based on D statistic.

Results

A total of 635 patients was available for the analysis. Proportional hazards were adjusted for age, gender, tumor stage, chemotherapy and radiotherapy. Two-year DFS was 77%(95%CI:72.0-82.4) and 88.3%(95%CI:84.8-92.0%) in the HEI high- and low- risk groups, respectively. Two-year OS was 87.8%(95%CI:83.7-92.0) and 94.2%(95%CI:91.5-97) in the same 2 groups (Figure.1). Multivariate Cox proportional hazards model showed a HR=2.02 (95%CI:1.25-3.26; p=0.004) for the HEI high-risk group with respect to OS and a HR= 1.53 (95%CI:1.43-3.40; p=0.029) for DFS (Table.1). Harrel C-indexes were 0.682 and 0.659 in the validation dataset, with respect to OS and DFS, respectively. Gonen-Heller K indexes were 0.672 and 0.705, respectively.

Conclusion

The HEI index proved to be a prognosticator in ASCC patients treated with CHT-RT. Model discrimination in the external validation cohort was acceptable.