Predictive value of neutrophil-lymphocyte ratio in preoperative neoadjuvant chemoradiotherapy for esophageal squamous cell carcinoma

• Main Authors: XIONG Kai, XIAO He, ZHENG Jijun, XIE Wei, YE Yunfei, WANG Ge
• Format: Article
• Language: zho
• Published: Editorial Office of Journal of Third Military Medical University 2021-01-01
• Series: Di-san junyi daxue xuebao
• Subjects: neutrophil lymphocyte ratio; esophageal squamous cell carcinoma; neoadjuvant chemoradiotherapy; remission
• Online Access: https://aammt.tmmu.edu.cn/Upload/rhtml/202008047.htm

Objective To explore the value of neutrophil lymphocyte ratio (NLR) in predicting the efficacy of neoadjuvant chemoradiotherapy for esophageal squamous cell carcinoma (ESCC). Methods Clinical data of 104 patients (92 males and 12 females) with esophageal squamous cell carcinoma undergoing preoperative neoadjuvant therapy in our center from January 2016 to June 2020 were collected and analyzed. Blood routine test was carried out in 3 d before neoadjuvant chemoradiotherapy, including neutrophil count, lymphocyte count, monocyte count and platelet count. Then NLR, platelet lymphocyte ratio (PLR) and lymphocyte monocyte ratio (LMR) were calculated respectively. Iodine water radiography and chest enhanced CT scanning were carried out before and after neoadjuvant treatment, so as to determine the regression grade of tumor. The survival status of all patients was followed up for 4~53 months. Mann Whitney U test was used to analyze the difference of continuous variables between groups. Receiver operating characteristic (ROC) curve was applied to evaluate the predictive effect and the best cut-off value of NLR. Chi-square test was performed to analyze the correlation between NLR and clinical characteristics. Logistic regression and Cox regression analyses were adopted respectively to investigate the independent predictors of neoadjuvant remission as well as the independent prognostic factors of overall survival (OS). Results Among the 104 enrolled patients, there were 0, 38, 54 and 12 cases who achieved complete remission (CR), partial remission (PR), stable disease (SD) and progression disease (PD) criteria respectively after neoadjuvant therapy. NLR before treatment was revealed to be an independent predictor of neoadjuvant chemoradiotherapy remission (OR=0.404, 95%CI: 0.208~0.787, P=0.008). ROC curve showed that NLR had a moderate predictive effect on neoadjuvant chemoradiotherapy remission (AUC=0.737, 95% CI: 0.631~0.844, P < 0.001), and the optimal cut-off value was 2.77, with the corresponding sensitivity and specificity of 0.712 and 0.737, respectively. However, multivariate Cox regression analysis showed that only surgery following neoadjuvant therapy was an independent prognostic factor for OS (HR=0.258, 95% CI: 0.068~0.983, P=0.047). Conclusion NLR before treatment may be an independent predictor of clinical remission after neoadjuvant therapy for ESCC patients, but it may not be suitable for OS prediction.