Staging the Tumor and Staging the Host: Pretreatment Combined Neutrophil Lymphocyte Ratio and Modified Glasgow Prognosti
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ORIGINAL ARTICLE – PANCREATIC TUMORS
Staging the Tumor and Staging the Host: Pretreatment Combined Neutrophil Lymphocyte Ratio and Modified Glasgow Prognostic Score Is Associated with Overall Survival in Patients with Esophagogastric Cancers Undergoing Treatment with Curative Intent Stephen T. McSorley, PhD, MRCS1 , Hiu Y. N. Lau, BSc1, David McIntosh, FRCP2, Matthew J. Forshaw, FRCS3, Donald C. McMillan, PhD1, and Andrew B. Crumley, MD, FRCS4 1
Academic Unit of Surgery, New Lister Building, Glasgow Royal Infirmary, University of Glasgow, Glasgow, UK; Beatson West of Scotland Cancer Centre, Glasgow, UK; 3Department of Upper GI Surgery, Queen Elizabeth Building, Glasgow Royal Infirmary, Glasgow, UK; 4Forth Valley Royal Hospital, Larbert, UK
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ABSTRACT Background. This study examined whether an innate systemic inflammatory response (SIR) measured by combination neutrophil to lymphocyte ratio (NLR) and modified Glasgow Prognostic Score (mGPS) was associated with overall survival (OS) in patients with esophagogastric cancer (EC) undergoing neoadjuvant chemotherapy (NAC) followed by surgery. Methods. Patients diagnosed with EC, managed with NAC prior to surgery at a regional referral center, between January 2010 and December 2015, were included. The mGPS and NLR were calculated within 12 weeks before NAC. Patients were grouped by combined NLR/mGPS score into three groups of increasing SIR: NLR B 3 (n = 152), NLR [ 3 ? mGPS = 0 (n = 55), and NLR [ 3 ? mGPS [ 0 (n = 32). Univariable and multivariable Cox regression was used to analyse OS.
Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-020-09074-5) contains supplementary material, which is available to authorized users. Ó The Author(s) 2020 First Received: 25 February 2020 Accepted: 14 July 2020 S. T. McSorley, PhD, MRCS e-mail: [email protected]
Results. Overall, 337 NAC patients were included, with 301 (89%) proceeding to surgery and 215 (64%) having R0 resection. There were 203 deaths, with a median follow-up of those alive at censor of 69 months (range 44–114). Higher combined NLR/mGPS score (n = 239) was associated with poorer OS independent of clinical stage and performance status (hazard ratio 1.28, 95% confidence interval 1.02–1.61; p = 0.032), higher rate of progression on NAC (7% vs. 7% vs. 19%; p = 0.003), and lower proportion of eventual resection (80% vs. 84% vs. 53%; p = 0.003). Conclusions. The combined NLR/mGPS score was associated with OS and initial treatment outcomes in patients undergoing NAC prior to surgery for EC, stratifying survival in addition to clinical staging and performance status. The host SIR may be a useful adjunct to multidisciplinary decision making.
Esophagogastric cancers (ECs) are associated with poor survival,1 varying between 40% and 50% at 3 years for squamous cell carcinoma and adenocarcinoma, respectively, when treated with curative intent.2 Many patients present with advanced disease at diagnosis, decreasing the overall 5-year survival from 39% for localiz
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