Derived neutrophil-to-lymphocyte ratio and platelet to lymphocyte ratio as a prognostic marker for patients with esophageal squamous cell carcinoma treated with definitive chemoradiotherapy.

Abstract

e15575 Background: Increasing study indicates that inflammatory biomarkers play a important role in predicting prognosis and therapeutic effect in esophageal squamous cell carcinoma. This research is designed to evaluate prognostic value of inflammatory biomarkers at baseline including neutrophil to lymphocyte ratio (NLR), derived neutrophil to lymphocyte ratio (dNLR), monocyte to lymphocyte ratio (MLR), platelet to lymphocyte ratio (PLR), prognostic nutritional index (PNI) and fibrinogen to Albumin ratio (FAR) and the association between inflammatory biomarkers at baseline and symptomatic radiation pneumonitis in patients with esophageal squamous cell carcinoma (ESCC) treated with definitive chemoradiotherapy. Methods: Patients with ESCC treated with definitive chemoradiotherapy from 2011 to 2015 were enrolled retrospectively. The operating characteristic analysis was used to determine optimal cut-off values of NLR, dNLR, MLR and PLR. The Kaplan-Meier method with a log-rank test and Cox regression model were used to evaluate the prognostic role of these biomarkers and the logistic regression was performed to investigate the association berween NLR and radiation pneumonitis. Results: 311 patients were included with a median follow-up of 24 months. The three-year survival rate is 24.12%. The optimal cut-of values of NLR, dNLR, MLR, PLR were 2.77, 1.70, 0.5 and 168.35, respectively. Univariate analysis revealed that tumor length, smoking and drinking status, performance status, tumor stage, tumor location, albumin level, NLR, dNLR, MLR, PLR, PNI, and FAR were significantly associated with progression-free survival (PFS) and overall survival (OS) (p < 0.05), but only tumor length, smoking status, performance status, tumor stage, dNLR and PLR were independent predictors of PFS and OS in multivariate model. Compared with separate marker, the prognostic predictive value of combined dNLR and PLR (coPLR-dNLR) was increased, and it was also a prognostic indicator when patients were stratified into early and advanced TNM stage. None of inflammatory biomarkers was significantly associated with symptomatic radiation pneumonitis in univariate and multivariate analysis. Conclusions: dNLR and PLR were powerful biomarker to predict prognosis in patients with esophageal squamous cell carcinoma treated with definitive chemoradiotherapy, however inflammatory biomarkers could not predict the occurrence of symptomatic radiation pneumonitis.