A pre-operative elevated neutrophil: lymphocyte ratio does not predict survival from oesophageal cancer resection
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RESEARCH
WORLD JOURNAL OF SURGICAL ONCOLOGY
Open Access
A pre-operative elevated neutrophil: lymphocyte ratio does not predict survival from oesophageal cancer resection Farhan Rashid1,3*, Naseem Waraich1, Imran Bhatti1,3, Shopan Saha1, Raheela N Khan1,2, Javed Ahmed1, Paul C Leeder1, Mike Larvin1,3, Syed Y Iftikhar1,3
Abstract Background: Elevated pre-operative neutrophil: lymphocyte ratio (NLR) has been identified as a predictor of survival in patients with hepatocellular and colorectal cancer. The aim of this study was to examine the prognostic value of an elevated preoperative NLR following resection for oesophageal cancer. Methods: Patients who underwent resection for oesophageal carcinoma from June 1997 to September 2007 were identified from a local cancer database. Data on demographics, conventional prognostic markers, laboratory analyses including blood count results, and histopathology were collected and analysed. Results: A total of 294 patients were identified with a median age at diagnosis of 65.2 (IQR 59-72) years. The median pre-operative time of blood sample collection was three days (IQR 1-8). The median neutrophil count was 64.2 × 10-9/litre, median lymphocyte count 23.9 × 10-9/litre, whilst the NLR was 2.69 (IQR 1.95-4.02). NLR did not prove to be a significant predictor of number of involved lymph nodes (Cox regression, p = 0.754), disease recurrence (p = 0.288) or death (Cox regression, p = 0.374). Furthermore, survival time was not significantly different between patients with high (≥ 3.5) or low (< 3.5) NLR (p = 0.49). Conclusion: Preoperative NLR does not appear to offer useful predictive ability for outcome, disease-free and overall survival following oesophageal cancer resection.
Introduction Human oesophageal carcinoma is considered one of the most aggressive malignancies and is associated with a poor prognosis [1]. Despite recent advancement in surgical and oncological treatment the five year survival remains very poor [2-4]. Oesophagectomy for oesophageal cancer is a major operative intervention which carries a high risk of complications. Hence any means of predicting patients with an inherently poor prognosis or high risk from surgery would be valuable in making treatment recommendations. Generally agreed prognostic factors for most gastrointestinal cancers include tumour size, marginal resection line involvement, lymph node metastases and tumour differentiation [5]. During the last fifteen years there has been debate about the interaction between * Correspondence: [email protected] 1 Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, UK
cancer and host inflammatory responses, in particular whether cancer may alter regulation leading to further DNA damage, promotion of angiogenesis, inhibition of apoptosis and increased metastastic susceptibility [6-10]. It is clear that the response of the immune system plays a vital role in the control and progression of many disease states including cancer. Simple measures of immune responsiveness include simple routine biochem
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