Abstract
BackgroundRecent studies have shown that the presence of systemic inflammation correlates with poor survival in various cancers. The aim of this study was to determinate the prognostic value of the neutrophil lymphocyte ratio (NLR) and the platelet lymphocyte ratio (PLR) in patients with esophageal squamous cell carcinoma (ESCC).MethodsPreoperative NLR and PLR were evaluated in 483 patients undergoing esophagectomy for ESCC from January 2005 to December 2008. The prognostic significance of both markers was then determined by both uni- and multivariate analytical methods. Receiver operating characteristic (ROC) curves were also plotted to verify the accuracy of NLR and PLR for survival prediction.ResultsHigh preoperative NLR (≥3.5 versus < 3.5, P = 0.039) and PLR (≥150 versus < 150, P < 0.001) were significantly associated with poor overall survival in multivariate analysis. However, our study demonstrated a better discrimination for the PLR in terms of hazard ratio(HR) than the NLR (HR = 1.840 versus HR = 1.339). Patients with NLR ≥3.5 had significantly poorer overall survival compared to NLR <3.5 (35.4% versus 57.7%, P < 0.001). Patients with PLR ≥150 also had significantly poorer overall survival compared to patients with PLR <150 (32.7% versus 63.5%, P < 0.001). The area under the curve (AUC) was 0.658 (95% confidence interval (CI): 0.610 to 0.706, P < 0.001) for NLR and 0.708 (95% CI: 0.662 to 0.754, P < 0.001) for PLR, indicating that PLR was superior to NLR as a predictive factor in ESCC.ConclusionsPreoperative NLR and PLR were significant predictors of overall survival in patients with ESCC. However, PLR is superior to NLR as a predictive factor in patients with ESCC.
Highlights
Recent studies have shown that the presence of systemic inflammation correlates with poor survival in various cancers
Prognostic factors Univariate analyses showed that tumor length, differentiation, vessel involvement, perineural invasion, depth of invasion, nodal metastasis, neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) were predictive of survival
We demonstrated that differentiation (P = 0.015), depth of invasion (P = 0.024), nodal metastasis (P < 0.001), NLR and PLR evaluation Data on preoperative blood cell counts were extracted in a retrospective fashion from the medical records
Summary
Recent studies have shown that the presence of systemic inflammation correlates with poor survival in various cancers. The aim of this study was to determinate the prognostic value of the neutrophil lymphocyte ratio (NLR) and the platelet lymphocyte ratio (PLR) in patients with esophageal squamous cell carcinoma (ESCC). Esophageal cancer (EC) is the eighth most common type of cancer worldwide. There is increasing evidence that a systemic inflammatory response is of prognostic value in various cancers [7,8]. C-reactive protein is one index of systemic inflammation. The neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are other markers, and some studies have shown elevated NLR or PLR to be a significant prognostic factor in cancers [9,10,11]. Few studies regarding NLR and PLR in EC are available, and their rolesare still controversial
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