Evaluation of Neutrophil-to-Lymphocyte Ratio and Clinical Outcomes for Esophagus Cancer Patients Undergoing Trimodality Therapy

Abstract

Listen

Translate article

A high ratio of neutrophils-to-lymphocytes (NLR) in peripheral blood may represent immune dysfunction. Some reports suggest decreased survival in solid tumors for patients with a high NLR, although results are conflicting for esophagus cancer (EC). We investigated the impact of elevated NLR for patients with EC who received trimodality therapy. Between 2007 and 2012, 188 patients received trimodality therapy for EC at our institution. Of these, 176 had complete blood counts available and were included in this retrospective review. Pre-chemoradiation (CRT) NLR was determined from lab testing that occurred immediately before or within 7 days after initiation of CRT. Preoperative NLR was determined from the most recent timepoint prior to surgery and after pre-CRT baseline. The temporal change in NLR was defined as difference between baseline and preoperative NLR and was calculated as an absolute value. Potential association between NLR and clinical outcomes was analyzed as a continuous and dichotomized variable (< or ≥5.0). A univariate Cox proportional hazard model was performed for overall survival (OS). Fine and Grays extension of the Cox model incorporating death as a competing risk was performed for additional outcomes including disease free survival (DFS) and perioperative morbidity. The median follow up was 3.3 years (range, 8 days to 7.4 years). Tumor histology was adenocarcinoma (89%) and squamous cell carcinoma (11%). NLR was ≥ 5 in 15% of patients prior to CRT and ≥ 5 in 64% of patients at the preoperative timepoint. Male gender was the only baseline characteristic associated with NLR >= 5 (p=0.01). The median OS was 39.3 months with 5 year OS of 41.3%. On univariable analysis, the only factor found to be associated with OS was patient age (HR 1.5 per 10 years, p=.001). Baseline pre-CRT, pre-operative, and change in NLR when analyzed as a dichotomized and continuous variable were not associated with OS, DFS, perioperative morbidity/mortality, or pathologic response. In this single institutional analysis of patients with EC who received trimodality therapy, we did not observe an association between NLR and clinical outcomes. This is in contrast to other studies which observed poorer outcomes in patients with a high NLR. Further investigation in a prospective manner is warranted.