ASO Author Reflections: The Trilogy of Cancer, Inflammation, and Survival
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: The Trilogy of Cancer, Inflammation, and Survival Yaseen Al Lawati1, and Lorenzo Ferri2 Department of Thoracic and Upper Gastrointestinal Surgery, McGill University, Montreal, Canada; 2Division of Thoracic Surgery, Montreal General Hospital, Montreal, Canada
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PAST Esophageal adenocarcinoma has been associated with poor overall survival despite advances in systemic therapy, radiation therapy, and surgical techniques.1 This can be attributed to multiple factors, such as delayed presentation, aggressive biology, and the risk of recurrences. Although most of the latter are distant, surveillance guidelines recommend cross-sectional imaging and endoscopy based solely on clinical symptoms.2 Along with that, the most reliable prognostic factors are obtained postoperatively, such as pathological staging. All of these highlight the need to identify a prognostic marker that can be obtained before any form of therapy and be monitored during treatment. There is particular interest in inflammatory biomarkers; previously these have been shown in other cancers to be associated with survival. Neutrophils have been implicated in cancer initiation, progression, and metastasis through various mechanisms.3 PRESENT The current study investigates the prognostic role of neutrophil-to-lymphocyte ratio (NLR) during the treatment of esophageal adenocarcinoma.4 High NLR at baseline was associated with worse overall and disease-free survival. However, normalization of NLR during the treatment trajectory was associated with ‘‘salvage,’’ given the improved survival. On the other hand, persistently elevated NLR
Ó Society of Surgical Oncology 2020 First Received: 22 April 2020 L. Ferri e-mail: [email protected]
throughout treatment was associated with poor survival outcomes. This study demonstrates the dynamic aspect of NLR in predicting outcomes and highlights a crucial step in appropriately interpreting baseline NLR. It also demonstrates the important role of inflammation in cancer biology. FUTURE This study sets the path for future trials that can potentially look into the effects of tailoring systemic therapy according to the NLR status and the role of utilizing NLR to investigate recurrences. In fact, our data suggest that NLR and neutrophils are not solely prognostic but also ‘‘functional’’ biomarkers, making them potentially amenable to therapeutic interventions as suggested by multiple experimental studies.3 Our group has previously described the impact of neutrophil elastase inhibitors and DNAse in targeting neutrophil extracellular traps, which have been associated with cancer dissemination.5 Such potential uses are highly promising. DISCLOSURES
The authors declare no conflicts of interest.
REFERENCES 1. Canadian Cancer Society’s Advisory Committee on Cancer Statistics. Canadian cancer statistics 2016. Toronto, ON: Canadian Cancer Society; 2016. 2. Ajani JA, D’Amico TA, Bentrem DJ, Chao J, Corvera C, Das P, et al. Esophageal and esophagogastric junction cancers, Version 22019,
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