Dynamic Alteration of Neutrophil-to-Lymphocyte Ratio over Treatment Trajectory is Associated with Survival in Esophageal
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ORIGINAL ARTICLE – THORACIC ONCOLOGY
Dynamic Alteration of Neutrophil-to-Lymphocyte Ratio over Treatment Trajectory is Associated with Survival in Esophageal Adenocarcinoma Y. Al Lawati, MD, J. Cools-Lartigue, MD, PhD, J. L. Ramirez-GarciaLuna, MD, MSc, J. C. Molina-Franjola, MD, D. Pham, MD, E. Skothos, MD, C. Mueller, MD, MEd, J. Spicer, MD, PhD, and L. Ferri, MD, PhD Department of Thoracic and Upper Gastrointestinal Surgery, McGill University, Montreal, Canada
ABSTRACT Background. Neutrophil-to-lymphocyte ratio (NLR) has been identified as a biomarker for multiple malignancies. There is emerging evidence that implicates neutrophils in cancer progression. Alterations of neutrophil counts and NLR during treatment may reflect a change in oncologic outcome that is more important than baseline values. The aim of this study is to investigate the prognostic role of NLR changes during the treatment trajectory of patients with esophageal adenocarcinoma. Patients and Methods. NLR values of patients with esophageal adenocarcinoma who underwent surgery between 2005 and 2016 were measured at baseline and in the late postoperative period. Primary outcomes were overall survival (OS) and disease-free survival (DFS). The secondary outcome was pathological response to neoadjuvant chemotherapy. Results. 330 patients were included; mean age was 65.6 years, and 82% were male. Most patients had cT3 (74.8%), cN-positive (59.7%) disease. Two-thirds (65.2%) received neoadjuvant chemotherapy. The independent predictors of OS were pathological N-stage, size of primary
Y. Al Lawati and J. Cools-Lartigue contributed equally to this manuscript and should both be considered as first coauthors.
Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-020-08521-7) contains supplementary material, which is available to authorized users. Ó Society of Surgical Oncology 2020 First Received: 16 March 2020 L. Ferri, MD, PhD e-mail: [email protected]
tumor, and delta NLR (late – baseline NLR). Patients with persistently elevated NLR did worse than those with decreasing NLR trends between baseline and postoperative time points (3-year OS 43.4% versus 71.3%, p \ 0.0001, 3-year DFS 29.7% versus 61.9%, p \ 0.0001). High baseline and postoperative NLR were associated with significantly worse OS and DFS. Patients with complete pathological response had lower mean baseline NLR. Conclusion. Dynamic changes in NLR during treatment are associated with survival and may be more informative than static baseline values.
Adenocarcinoma of the esophagus is the fastest rising malignancy in North America1. The overall survival for esophageal cancer still hovers around 15%2. This has been attributed to its late presentation, aggressive nature, and higher rate of metastasis. There is emerging data to suggest an active role of neutrophils in cancer progression. We and others have demonstrated in experimental models that neutrophils promote metastasis by a number of mechanisms including increased adherence of metastat
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