Systemic Immune Inflammation Index, Lowest Total Lymphocyte Count and Hemoglobin Level Are Prognostic Factors in Patients with Postoperative Recurrence of Esophageal Carcinoma Treated with Salvage Radiotherapy and Chemotherapy

Abstract

To analyze the effects of clinical features, chemoradiotherapy related factors, hematological different nutritional indexes, and inflammatory indexes on the survival of postoperative recurrence of esophageal carcinoma treated with salvage chemoradiotherapy, and to explore the predictive factors of treatment-related toxic and side effects. A total of 242 postoperative esophageal carcinoma patients with local/regional recurrence during January 2008 to December 2016 treated with chemoradiotherapy were analyzed. Recurrence included anastomotic recurrence and regional lymph node metastasis (supraclavicular, mediastinal, and abdominal lymph node metastasis involved). The clinical features (sex, age, tumor location, T stage, N stage, TNM stage, regional recurrence site, number of recurrence areas, postoperative recurrence time), chemoradiotherapy related factors (post-recurrence treatment, radiotherapy target area, radiotherapy dose, chemotherapy regimen, chemotherapy cycle), hematological inflammation related indicators, including the absolute monocyte count (AMC), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), lymphocyte monocyte ratio (LMR), systemic immune-inflammation index (SII), systemic inflammation score (SIS), and hematological nutrition-related indicators, including total lymphocyte count (TLC), hemoglobin (HB), albumin (ALB), prognostic nutritional index (PNI)，body mass index (BMI) on survival, toxic and side effects were analyzed. The median survival time was 16.6 months, and the 1-, 2-, 3-and 5-year survival rates were 65.6%, 36.7%, 25.5% and 11.5%, respectively. Univariate analysis showed that T stage, N stage, TNM stage, chemotherapy cycle, NLR level, PLR level, LMR level, SII level, HB level, PNI level before chemoradiotherapy, and the minimum level of TLC during chemoradiotherapy were the influencing factors of OS. Multivariate analysis showed that the minimum level of TLC during chemoradiotherapy, SII and HB level before chemoradiotherapy were independent influencing factors of OS (P=0.001; P=0.009; P=0.009, respectively). AMC level, HB level and TLC minimum level were the main factors affecting hematological toxicity. The incidence of grade 2 hematological toxicity in the high AMC group was similar to that in the low AMC group, and the incidence of the non-anemia group and the G0-2 group in the lowest TLC was even lower than that in the corresponding group. No factors affecting hematological toxicity and radiation pneumonia were found in hematology. The minimum level of TLC during chemoradiotherapy, the level of SII and HB before chemoradiotherapy were the independent prognostic factors for postoperative esophageal carcinoma patients treated with salvage chemoradiotherapy.