Abstract
BackgroundThe aim of this study was to assess the relative prognostic value of biomarkers to measure the systemic inflammatory response (SIR) and potentially improve prognostic modeling in patients undergoing potentially curative surgery for esophageal adenocarcinoma (EC).MethodsConsecutive 330 patients undergoing surgery for EC between 2004 and 2018 within a regional UK cancer network were identified. Serum measurements of haemoglobin, C-reactive protein, albumin, modified Glasgow Prognostic Score (mGPS), and differential neutrophil to lymphocyte ratio (NLR) were obtained before surgery, and correlated with histopathological factors and outcomes. Primary outcome measures were disease-free (DFS) and overall survival (OS).ResultsOf 330 OC patients, 294 underwent potentially curative esophagectomy. Univariable DFS analysis revealed pT, pN, pTNM stage (all p < 0.001), poor differentiation (p = 0.001), vascular invasion (p < 0.001), R1 status (p < 0.001), perioperative chemotherapy (p = 0.009), CRP (p = 0.010), mGPS (p = 0.011), and NLR (p < 0.001), were all associated with poor survival. Multivariable Cox regression analysis of DFS revealed only NLR [Hazard Ratio (HR) 3.63, 95% Confidence Interval (CI) 2.11–6.24, p < 0.001] retained significance. Multivariable Cox regression analysis of OS revealed similar findings: NLR [HR 2.66, (95% CI 1.58–4.50), p < 0.001].ConclusionNLR is an important SIR prognostic biomarker associated with DFS and OS in EC.
Highlights
Biomarkers, at their best, deliver data in three important domains
On multivariable binary logistical regression analysis of factors associated with poor survival on univariable analysis, modified Glasgow Prognostic Score (mGPS) (Odds Ratio (OR) 2.29 (95% Confidence Interval 1.44–3.62), p < 0.001), thrombophilia (OR 4.76 (1.26–18.06), p = 0.022) and neoadjuvant therapy (OR 3.72 (1.10–11.57), p = 0.023) were independently associated with inoperability
The area under the curve (AUC) for neoadjuvant therapy was 0.59, AUC for thrombophilia 0.59, and AUC for mGPS 0.64
Summary
Biomarkers, at their best, deliver data in three important domains. First, to help diagnose conditions (identifying early stage cancers—diagnostic); second, to forecast aggressiveThe members of South East Wales Oesophagogastric Cancer Collaborative are listed in acknowledgements.conditions (prognostic); and third, to predict how well a patient will respond to treatment (predictive) [1].Esophageal cancer (EC) is the sixth leading worldwide cause of cancer related death, accounting for some half a million deaths annually [2]. The aim of this study was to assess the relative prognostic value of biomarkers to measure the systemic inflammatory response (SIR) and potentially improve prognostic modeling in patients undergoing potentially curative surgery for esophageal adenocarcinoma (EC). C-reactive protein, albumin, modified Glasgow Prognostic Score (mGPS), and differential neutrophil to lymphocyte ratio (NLR) were obtained before surgery, and correlated with histopathological factors and outcomes. Univariable DFS analysis revealed pT, pN, pTNM stage (all p < 0.001), poor differentiation (p = 0.001), vascular invasion (p < 0.001), R1 status (p < 0.001), perioperative chemotherapy (p = 0.009), CRP (p = 0.010), mGPS (p = 0.011), and NLR (p < 0.001), were all associated with poor survival. Conclusion NLR is an important SIR prognostic biomarker associated with DFS and OS in EC
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