Neutrophils in Rectal Cancer: The Sarandria Score - a New Clinical Prognostic and Predictive Score and Further Proof of Identifying Rectal Cancer as a Separate Clinical and Pathological Entity from Colon Cancer

This study is intended to shed new light on the role of neutrophils in rectal cancer and in the meanwhile emphasizing the differences between rectal and colon cancer, strengthening and highlight a new clinical prognostic and predictive scoring (Sarandria Score). This paper describes a novel scoring system that can be utilised as an inclusion criterion as well as a predictive and prognostic scoring system for patients with stage III rectal cancer.

Background: Colorectal cancer (CRC) is a major public health issue, since it is the third most commonly diagnosed cancer in men and the second most usually diagnosed cancer in women. Various studies have found significant differences in the responsiveness to adjuvant treatment and prognosis based on the main location of CRC (right-sided colon, left-sided colon, rectum). Previous research has linked a higher density of tumor-associated neutrophils (TANs) to a better response to 5-FU-based treatment in stage III CRC patients.

Results: The present state of knowledge on the involvement of neutrophils in colorectal cancer is assessed in this chapter, which includes a novel finding on the role of neutrophils in rectal cancer discovered by Dr. Nicola Sarandria. It covers a number of variables that point to neutrophils playing an anti-tumor role in rectal cancer when chemotherapeutic drugs are present (such as 5-fluorouracil). The clinical importance of TANs was investigated, as well as if it differed based on the main CRC's location (right-sided colon, left-sided colon, rectum).

Conclusions: This chapter introduces a new clinical prognostic and predictive scoring system (Sarandria Score) for rectal cancer patients with intratumoral neutrophilic infiltration, as well as the possibility of a new inclusion criteria based on this infiltrate for Stage III rectal cancer patients receiving 5-FU therapy. This chapter also includes information from the author's medical degree thesis, which showed that higher TANs densities were linked to better disease-free survival (DFS) in rectal cancer patients treated with 5-FU (while it was inversely related in patients without 5-FU therapy). This also adds to the evidence that what is now recognised as colorectal cancer can be divided into two types: colon and rectal cancer.