***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND Characterising responders to neoadjuvant chemotherapy ( NAC ) is important to minimise overtreatment and the unnecessary delay of definitive treatment of urothelial urinary bladder cancer . OBJECTIVE To assess the effect of NAC on tumour downstaging and overall survival . DESIGN , SETTING , AND PARTICIPANTS A total of 449 patients from the r and omised prospect i ve Nordic Cystectomy Trials 1 and 2 were analysed retrospectively . Eligible patients were defined as T2-T4aNXM0 preoperatively and pT0-pT4aN0-N+M0 postoperatively . The median follow-up time was 5 yr . INTERVENTION The experimental arm consisted of cisplatin-based NAC ; the control arm consisted of cystectomy only . MEASUREMENTS The primary outcome was tumour downstaging defined as pathologic TNM less than clinical TNM . Different downstaging thresholds were applied : complete downstaging ( CD ) ( pT0N0 ) , noninvasive downstaging ( NID ) ( pT0/pTis/pTaN0 ) , and organ confinement ( OC ) ( ≤ pT3aN0 ) . Downstaging rates and nodal status were compared between the study arms using the chi-square test . Secondary outcome was overall survival ( OS ) stratified by treatment arm , downstaging categories , and clinical stages , analysed by the Kaplan-Meier method . The following covariates were tested as prognostic factors in univariate and multivariate analyses using the Cox regression method : age , sex , clinical stage , pN status , NAC , CD , NID , and OC . RESULTS AND LIMITATIONS Downstaging rates increased significantly in the NAC arm independent of the downstaging threshold . The impact was more prominent in clinical T3 tumours , with a near threefold increase in CD tumours . The combination of CD and NAC  showed an absolute risk reduction of 31.1 % in OS at 5 yr compared with CD controls . The combination of NAC and CD revealed a hazard ratio of 0.32 compared with 1.0 for the combination of no NAC and no CD . Limitations were the retrospective approach and uncertain clinical TNM staging . CONCLUSIONS Survival benefits of NAC are reflected in downstaging of the primary tumour . Chemo-induced downstaging might be a potential surrogate marker for OS Background Increasing evidence suggests that cancer-associated inflammation is associated with poorer outcomes . The neutrophil-to-lymphocyte ratio ( NLR ) , considered as a systemic inflammation marker , is thought to predict prognoses in colorectal cancer . In this study , we explored the association between the NLR and prognoses following neoadjuvant chemoradiotherapy ( CRT ) for locally advanced rectal cancer ( LARC ) . Material / Methods From February 2002 to December 2012 , a group of 202 patients diagnosed with LARC and receiving neoadjuvant CRT followed by radical surgery was included in our retrospective study . The associations between the pre-CRT NLR and clinicopathological characteristics , as well as the predictive value of pre-CRT NLR against survival outcomes , were analyzed . Results The average NLR was 2.7±1.5 ( median 2.4 , range 0.6–12.8 ) . There were 63 ( 31.2 % ) patients with NLR ≥3.0 , and 139 ( 68.8 % ) patients with NLR < 3.0 . Correlation analyses showed that no clinicopathological characteristics except age were associated with NLR . We did not find an association between NLR and survival outcomes . In multivariate Cox model analyses , the R1/R2 resection , lymph node ratio ≥0.1 , and perineural/lymphovascular invasion were independently associated with worse disease-free survival and overall survival . Conclusions In our cohort , the NLR did not correlate with survival outcomes in LARC patients undergoing neoadjuvant CRT . The prognostic value of NLR should be vali date d in large-scale prospect i ve studies Background : The ability of pretreatment laboratory markers of acute-phase inflammatory reactions like serum albumin level ( SAL ) , hemoglobin ( Hb ) , and absolute blood cell counts to predict complete pathological response ( CPR ) to neoadjuvant chemoradiotherapy ( NACRT ) in patients with locally advanced rectal cancer ( LARC ) has not yet been fully studied . Methods : We retrospectively examined the relation between SAL , Hb and absolute blood cell counts , and CPR rates  in 140 LARC patients treated with NACRT .  Results : Univariate analysis showed a significantly higher probability of CPR  to NACRT in patients with clinical stage ( CS ) III LARC who had SAL > 3.5 mg/dl ( OR = 2.39 ; p = 0.04 ) and a neutrophil-to-lymphocyte ratio ( NLR ) value < 5 ( OR = 2.86 ; p = 0.03 ) . The relation of CPR with SAL ( OR = 2.11 ; p = 0.048 ) and NLR ( OR = 2.54 ; p = 0.04 ) was confirmed by multivariate analysis in the same subset of patients . None of the parameters studied predicted CPR in patients with CS II disease . Patients who achieved CPR  to NACRT had a higher probability of 5-year overall survival ( HR 0.48 ; p = 0.01 ) and 5-year disease-free survival ( HR 0.33 ; p = 0.003 ) . Conclusions : Our data indicate that SAL > 3.5 mg/dl and NLR < 5 may be positively related to CPR after NACRT in patients with CS III LARC . Hypoalbuminemia and a high NLR may be considered an indication for a more aggressive approach to NACRT and postoperative adjuvant chemotherapy in this subset of patients . This hypothesis requires confirmation in a r and omized study Background : Inflammation contributes to the pathogenesis of colorectal cancer ( CRC ) , and cytokine levels are altered during colorectal carcinogenesis . Methods : The serum levels of 13 cytokines and their relation to clinical and pathological parameters , and systemic inflammatory response ( mGPS , CRP and neutrophil – lymphocyte ratio ) , were analysed from a prospect i ve series of 148 CRC patients and 86 healthy age- and sex-matched controls . Results : CRC patients had higher serum platelet-derived growth factor , interleukin (IL)-6 , IL-7 , and IL-8 levels and lower monocyte chemotactic protein-1 ( MCP-1 ) levels than the controls . A logistic regression model for discriminating the patients from the controls – including the five most predictive cytokines ( high IL-8 , high IL-6 , low MCP-1 , low IL-1ra , and low IP-10 ) – yielded an area under curve value of 0.890 in receiver operating characteristics analysis . Serum cytokines showed distinct correlation with other markers of systemic inflammatory response , and advanced CRCs were associated with higher levels of IL-8 , IL-1ra , and IL-6 . A metastasised disease was accompanied by an orientation towards Th2 cytokine milieu . Conclusion : CRC is associated with extensive alterations in serum cytokine environment , highlighting the importance of study ing relative cytokine level alterations . Serum cytokine profile shows promise in separating CRC patients from healthy controls but its clinical value is yet to be confirmed Summary Background Observational studies report reduced colorectal cancer  in regular aspirin consumers . R and omised controlled trials have shown reduced risk of adenomas but none have employed prevention of colorectal cancer as a primary endpoint . The CAPP2 trial aim ed to investigate the antineoplastic effects of aspirin and a resistant starch in carriers of Lynch syndrome , the major form of hereditary colorectal cancer ; we now report long-term follow-up of participants r and omly assigned to aspirin or placebo .  Methods In the CAPP2 r and omised trial , carriers of Lynch syndrome were r and omly assigned in a two-by-two factorial design to 600 mg aspirin or aspirin placebo or 30 g resistant starch or starch placebo , for up to 4 years . R and omisation was in blocks of 16 with provision for optional single-agent r and omisation and extended postintervention double-blind follow-up ; participants and investigators were masked to treatment allocation . The primary endpoint was development of colorectal cancer . Analysis was by intention to treat and per protocol . This trial is registered , IS RCT N59521990 . Results 861 participants were r and omly assigned to aspirin or aspirin placebo .  At a mean follow-up of 55·7 months , 48 participants had developed 53 primary colorectal cancers ( 18 of 427 r and omly assigned to aspirin , 30 of 434 to aspirin placebo ) . Intention-to-treat analysis of time to first colorectal cancer showed a hazard ratio ( HR ) of 0·63 ( 95 % CI 0·35–1·13 , p=0·12 ) . Poisson regression taking account of multiple primary events gave an incidence rate ratio ( IRR ) of 0·56 ( 95 % CI 0·32–0·99 , p=0·05 ) . For participants completing 2 years of intervention ( 258 aspirin , 250 aspirin placebo ) , per- protocol analysis yielded an HR of 0·41 ( 0·19–0·86 , p=0·02 ) and an IRR of 0·37 ( 0·18–0·78 , p=0·008 ) . No data for adverse events were available postintervention ; during the intervention , adverse events did not differ between aspirin and placebo groups . Interpretation 600 mg aspirin per day for a mean of 25 months substantially reduced cancer incidence after 55·7 months in carriers of hereditary colorectal cancer . Further studies are needed to establish the optimum dose and duration of aspirin treatment . Funding European Union ; Cancer Research UK ; Bayer Corporation ; National Starch and Chemical Co ; UK Medical Research Council ; Newcastle Hospitals trustees ; Cancer Council of Victoria Australia ; THRIPP South Africa ; The Finnish Cancer Foundation ; SIAK Switzerl and ; Bayer Pharma National Surgical Adjuvant Breast and Bowel Project ( NSABP ) Protocol B-18 was initiated in 1988 to determine whether four cycles of doxorubicin/cyclophosphamide given preoperatively improve survival and disease-free survival ( DFS ) when compared with the same chemotherapy given postoperatively . Secondary aims included the evaluation of preoperative chemotherapy in downstaging the primary breast tumor and involved axillary lymph nodes , the comparison of lumpectomy rates and rates of ipsilateral breast tumor recurrence ( IBTR ) in the two treatment groups , and the assessment of the correlation between primary tumor response and outcome . Initially published findings were based on a follow-up of 5 years ; this report up date s results through 9 years of follow-up . There continue to be no statistically significant overall differences in survival or DFS between the two treatment groups . Survival at 9 years is 70 % in the postoperative group and 69 % in the preoperative group ( P = .80 ) . DFS is 53 % in postoperative patients and 55 % in preoperative patients ( P = .50 ) . A statistically significant correlation persists between primary tumor response and outcome , and this correlation has become statistically stronger with longer follow-up . Patients assigned to preoperative chemotherapy  received notably more lumpectomies than postoperative patients , especially among patients with tumors greater than 5 cm at study entry . Although the rate of IBTR was slightly higher in the preoperative group ( 10.7 % versus 7.6 % ) , this difference was not statistically significant . Marginally statistically significant treatment-by-age interactions appear to be emerging for survival and DFS , suggesting that younger patients may benefit from preoperative therapy , whereas the reverse may be true for older patients Abstract Background The neutrophil/lymphocyte ratio ( NLR ) has been reportedly associated with prognosis in cancer patients by influencing both cancer progression and chemosensitivity . However , the correlation between NLR and the outcome of neoadjuvant chemotherapy ( NAC ) in breast cancer patients remains unclear . Methods NLR was evaluated in 177 patients with breast cancer treated with NAC with 5-fluorouracil , epirubicin , and cyclophosphamide , followed by weekly paclitaxel and subsequent curative surgery .  The correlation between NLR and prognosis , including the efficacy of NAC , was evaluated retrospectively . Results NLR ranged from 0.5 to 10.6 . Fifty-eight patients with low NLR ( < 3.0 ) had a higher pathological complete response ( pCR ) rate ( p < 0.001 ) and were more frequently diagnosed with ER-negative/progesterone receptor (PR)-negative/HER2-negative ( triple-negative ) breast cancer ( TNBC ; p < 0.001 ) compared with patients with high NLR ( ≥3.0 ) . Among TNBC patients who achieved pCR , disease-free survival ( p = 0.006 ) and overall survival ( p < 0.001 ) were significantly longer in patients with low NLR than in those with high NLR . Low NLR was associated with a significantly favorable prognosis in TNBC patients who achieved pCR , according to univariate analysis ( p = 0.044 , hazard ratio = 0.06 ) . Conclusions Low NLR may indicate high efficacy and favorable outcome  after NAC in patients with TNBC Background In 
    Output:
    
Conclusion : Overall , an NLR lower than the cut-off value indicated a greater chance for pCR and may predict good survival outcomes after  NAC for patients with solid tumours .