Skip to main content
Top
Published in: World Journal of Surgery 3/2012

01-03-2012

Correlation Between the Pretherapeutic Neutrophil to Lymphocyte Ratio and the Pathologic Response to Neoadjuvant Chemotherapy in Patients With Advanced Esophageal Cancer

Authors: Hiroshi Sato, Yasuhiro Tsubosa, Tatsuyuki Kawano

Published in: World Journal of Surgery | Issue 3/2012

Login to get access

Abstract

Background

An elevation in the neutrophil-to-lymphocyte ratio (NLR) has been shown to be associated with a poorer prognosis in patients with various tumors. The aim of this retrospective study was to clarify the correlation of the pretherapeutic NLR with the prognostic value of the pathologic response to neoadjuvant chemotherapy (NAC) in patients with advanced esophageal cancer.

Methods

This study was a retrospective review of 83 patients undergoing NAC for advanced esophageal cancer following esophagectomy. The NLR was measured before NAC, and the pathologic responses to NAC were evaluated.

Results

A comparison was performed for those whose pathology responded (responders) (G3/G2/G1b) and nonresponders (G1a/G0). In a univariate analysis, the cStage (P = 0.005), cN (P = 0.0001), and NLR (P = 0.005) were statistically significant parameters. A multivariate analysis revealed that the factors independently associated with pathologic responses were the pretreatment NLR (<2.2/≥2.2) (P = 0.043) and lymph nodes metastasis (P = 0.002). The pretreatment NLR (<2.2/≥2.2) was found to be a statistically significant useful predictive marker for a pathologic response (P = 0.001). The pathologic response rates were 56% in the patients with an NLR <2.2 and 21% in patients with an NLR of ≥2.2.

Conclusions

Our study is the first to demonstrate that the pretherapeutic NLR can be used as a predictor for chemosensitivity of thoracic esophageal cancer. Preoperative evaluation based on the clinical N stage and NLR may be easily used in routine clinical practice.
Literature
2.
go back to reference Sugimachi K, Inokuchi K, Kuwano H et al (1983) Patterns of recurrence after curative resection for carcinoma of the thoracic part of the esophagus. Surg Gynecol Obstet 157:537–540PubMed Sugimachi K, Inokuchi K, Kuwano H et al (1983) Patterns of recurrence after curative resection for carcinoma of the thoracic part of the esophagus. Surg Gynecol Obstet 157:537–540PubMed
3.
go back to reference Medical Research Council Oesophageal Cancer Working Party (2002) Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomized controlled trial. Lancet 359:1727–1733CrossRef Medical Research Council Oesophageal Cancer Working Party (2002) Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomized controlled trial. Lancet 359:1727–1733CrossRef
4.
go back to reference Kaklamanos IG, Walker GR, Ferry K et al (2003) Neoadjuvant treatment for resectable cancer of the esophagus and the gastroesophageal junction: a meta-analysis of randomized clinical trials. Ann Surg Oncol 10:754–761PubMedCrossRef Kaklamanos IG, Walker GR, Ferry K et al (2003) Neoadjuvant treatment for resectable cancer of the esophagus and the gastroesophageal junction: a meta-analysis of randomized clinical trials. Ann Surg Oncol 10:754–761PubMedCrossRef
5.
go back to reference Igaki H, Kato H, Ando N, et al (2008) A randomized trial of postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus neoadjuvant chemotherapy for clinical stage II/III squamous cell carcinoma of the thoracic esophagus (JCOG 9907). Proc Am Soc Oncol 26:4510 (abstract) Igaki H, Kato H, Ando N, et al (2008) A randomized trial of postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus neoadjuvant chemotherapy for clinical stage II/III squamous cell carcinoma of the thoracic esophagus (JCOG 9907). Proc Am Soc Oncol 26:4510 (abstract)
6.
go back to reference Law S, Fok M, Chow S et al (1997) Preoperative chemotherapy versus surgical therapy alone for squamous cell carcinoma of the esophagus: a prospective randomized trial. J Thorac Cardiovasc Surg 114:210–217PubMedCrossRef Law S, Fok M, Chow S et al (1997) Preoperative chemotherapy versus surgical therapy alone for squamous cell carcinoma of the esophagus: a prospective randomized trial. J Thorac Cardiovasc Surg 114:210–217PubMedCrossRef
7.
go back to reference Duhaylongsod FG, Gottfried MR, Iglehart JD et al (1995) The significance of c-erb B-2 and p53 immunoreactivity in patients with adenocarcinoma of the esophagus. Ann Surg 221:677–683PubMedCrossRef Duhaylongsod FG, Gottfried MR, Iglehart JD et al (1995) The significance of c-erb B-2 and p53 immunoreactivity in patients with adenocarcinoma of the esophagus. Ann Surg 221:677–683PubMedCrossRef
8.
go back to reference Hickey K, Grehan D, Reid IM et al (1994) Expression of epidermal growth factor receptor and proliferating cell nuclear antigen predicts response of esophageal squamous cell carcinoma to chemoradiotherapy. Cancer 74:1693–1698PubMedCrossRef Hickey K, Grehan D, Reid IM et al (1994) Expression of epidermal growth factor receptor and proliferating cell nuclear antigen predicts response of esophageal squamous cell carcinoma to chemoradiotherapy. Cancer 74:1693–1698PubMedCrossRef
9.
go back to reference Imdahl A, Bognar G, Schulte-Monting J et al (2002) Predictive factors for response to neoadjuvant therapy in patients with oesophageal cancer. Eur J Cardiothorac Surg 21:657–663PubMedCrossRef Imdahl A, Bognar G, Schulte-Monting J et al (2002) Predictive factors for response to neoadjuvant therapy in patients with oesophageal cancer. Eur J Cardiothorac Surg 21:657–663PubMedCrossRef
10.
go back to reference Tomimaru Y, Yano M, Takachi K et al (2008) Correlation between pretherapeutic D-dimer levels and response to neoadjuvant chemotherapy in patients with advanced esophageal cancer. Dis Esophagus 21:281–287PubMedCrossRef Tomimaru Y, Yano M, Takachi K et al (2008) Correlation between pretherapeutic D-dimer levels and response to neoadjuvant chemotherapy in patients with advanced esophageal cancer. Dis Esophagus 21:281–287PubMedCrossRef
11.
go back to reference Hara M, Matsuzaki Y, Shimizu T et al (2007) Preoperative serum C-reactive protein level in non-small cell lung cancer. Anticancer Res 27:3001–3004PubMed Hara M, Matsuzaki Y, Shimizu T et al (2007) Preoperative serum C-reactive protein level in non-small cell lung cancer. Anticancer Res 27:3001–3004PubMed
12.
go back to reference Beer TM, Lalani AS, Lee S et al (2008) C-reactive protein as a prognostic marker for men with androgen-independent prostate cancer: results from the ASCENT trial. Cancer 112:2377–2383PubMedCrossRef Beer TM, Lalani AS, Lee S et al (2008) C-reactive protein as a prognostic marker for men with androgen-independent prostate cancer: results from the ASCENT trial. Cancer 112:2377–2383PubMedCrossRef
13.
go back to reference Hefler LA, Concin N, Hofstetter G et al (2008) Serum C-reactive protein as a independent prognostic variable in patients with ovarian cancer. Clin Cancer Res 14:710–714PubMedCrossRef Hefler LA, Concin N, Hofstetter G et al (2008) Serum C-reactive protein as a independent prognostic variable in patients with ovarian cancer. Clin Cancer Res 14:710–714PubMedCrossRef
14.
go back to reference Shimada H, Nabeya Y, Okazumi S et al (2003) Elevation of preoperative serum C-reactive protein level is related to poor prognosis in esophageal squamous cell carcinoma. J Surg Oncol 83:248–252PubMedCrossRef Shimada H, Nabeya Y, Okazumi S et al (2003) Elevation of preoperative serum C-reactive protein level is related to poor prognosis in esophageal squamous cell carcinoma. J Surg Oncol 83:248–252PubMedCrossRef
15.
go back to reference Nozoe T, Iguchi T, Adachi E et al (2011) Preoperative elevation of serum C-reactive protein as an independent prognostic indicator for gastric cancer. Surg Today 41:510–513PubMedCrossRef Nozoe T, Iguchi T, Adachi E et al (2011) Preoperative elevation of serum C-reactive protein as an independent prognostic indicator for gastric cancer. Surg Today 41:510–513PubMedCrossRef
16.
go back to reference Crumley AB, McMillan DC, McKernan M et al (2006) Evaluation of an inflammation-based prognostic score in patients with inoperative gastro-oesophageal cancer. Br J Cancer 94:637–641PubMed Crumley AB, McMillan DC, McKernan M et al (2006) Evaluation of an inflammation-based prognostic score in patients with inoperative gastro-oesophageal cancer. Br J Cancer 94:637–641PubMed
17.
go back to reference McMillan DC, Canna K, McArdle CS (2003) Systemic inflammatory response predicts survival following curative resection of colorectal cancer. Br J Surg 90:215–219PubMedCrossRef McMillan DC, Canna K, McArdle CS (2003) Systemic inflammatory response predicts survival following curative resection of colorectal cancer. Br J Surg 90:215–219PubMedCrossRef
18.
go back to reference McMillan DC, Elahi MM, Sattar N et al (2001) Measurement of the systemic inflammatory response predicts cancer-specific and non-cancer survival in patients with cancer. Nutr Cancer 41:64–69PubMed McMillan DC, Elahi MM, Sattar N et al (2001) Measurement of the systemic inflammatory response predicts cancer-specific and non-cancer survival in patients with cancer. Nutr Cancer 41:64–69PubMed
19.
go back to reference Kobayashi T, Teruya M, Kishiki T et al (2008) Inflammation-based prognostic score, prior to neoadjuvant chemoradiotherapy, predicts postoperative outcome in patients with esophageal squamous cell carcinoma. Surgery 144:729–735PubMedCrossRef Kobayashi T, Teruya M, Kishiki T et al (2008) Inflammation-based prognostic score, prior to neoadjuvant chemoradiotherapy, predicts postoperative outcome in patients with esophageal squamous cell carcinoma. Surgery 144:729–735PubMedCrossRef
20.
go back to reference Duffy BK, Gurm HS, Rajagopal V et al (2006) Usefulness of an elevated neutrophil to lymphocyte ratio in predicting long-term mortality after percutaneous coronary intervention. Am J Cardiol 97:993–996PubMedCrossRef Duffy BK, Gurm HS, Rajagopal V et al (2006) Usefulness of an elevated neutrophil to lymphocyte ratio in predicting long-term mortality after percutaneous coronary intervention. Am J Cardiol 97:993–996PubMedCrossRef
21.
go back to reference Walsh SR, Cook EJ, Goulder F et al (2005) Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol 91:181–184PubMedCrossRef Walsh SR, Cook EJ, Goulder F et al (2005) Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol 91:181–184PubMedCrossRef
22.
go back to reference Halazun KJ, Aldoori A, Malik HZ et al (2008) Elevated preoperative neutrophil to lymphocyte ratio predicts survival following hepatic resection for colorectal liver metastases. Eur J Surg Oncol 34:55–60PubMedCrossRef Halazun KJ, Aldoori A, Malik HZ et al (2008) Elevated preoperative neutrophil to lymphocyte ratio predicts survival following hepatic resection for colorectal liver metastases. Eur J Surg Oncol 34:55–60PubMedCrossRef
23.
go back to reference Sharaiha RZ, Halazun KJ, Mirza F et al (2011) Elevated preoperative neutrophil:lymphocyte ratio as a predictor of postoperative disease recurrence in esophageal cancer. Ann Surg Oncol 18:3362–3369PubMedCrossRef Sharaiha RZ, Halazun KJ, Mirza F et al (2011) Elevated preoperative neutrophil:lymphocyte ratio as a predictor of postoperative disease recurrence in esophageal cancer. Ann Surg Oncol 18:3362–3369PubMedCrossRef
24.
go back to reference Rashid F, Waraich N, Bhatti I et al (2010) A pre-operative elevated neutrophil:lymphocyte ratio does not predict survival from oesophageal cancer resection. World J Surg Oncol 8:1 (abstract) Rashid F, Waraich N, Bhatti I et al (2010) A pre-operative elevated neutrophil:lymphocyte ratio does not predict survival from oesophageal cancer resection. World J Surg Oncol 8:1 (abstract)
25.
go back to reference International Union Against Cancer (2002) TNM classification of malignant tumors, 6th edn. Wiley-Liss, New York, pp 60–64 International Union Against Cancer (2002) TNM classification of malignant tumors, 6th edn. Wiley-Liss, New York, pp 60–64
26.
go back to reference Roth JA, Pass HI, Flanagan MM et al (1988) Randomized clinical trial of preoperative and postoperative adjuvant chemotherapy with cisplatin, vindesine, and bleomycin for carcinoma of the esophagus. J Thorac Cardiovasc Surg 96:242–248PubMed Roth JA, Pass HI, Flanagan MM et al (1988) Randomized clinical trial of preoperative and postoperative adjuvant chemotherapy with cisplatin, vindesine, and bleomycin for carcinoma of the esophagus. J Thorac Cardiovasc Surg 96:242–248PubMed
27.
go back to reference Baba M, Natsugoe S, Shimada M et al (2000) Prospective evaluation of preoperative chemotherapy in resectable squamous cell carcinoma of the thoracic esophagus. Dis Esophagus 13:136–141PubMedCrossRef Baba M, Natsugoe S, Shimada M et al (2000) Prospective evaluation of preoperative chemotherapy in resectable squamous cell carcinoma of the thoracic esophagus. Dis Esophagus 13:136–141PubMedCrossRef
28.
go back to reference Pennathur A, Luketich JD, Landreneau RJ et al (2008) Long-term results of a phase II trial of neoadjuvant chemotherapy followed by esophagectomy for locally advanced esophageal neoplasm. Ann Thorac Surg 85:1930–1937PubMedCrossRef Pennathur A, Luketich JD, Landreneau RJ et al (2008) Long-term results of a phase II trial of neoadjuvant chemotherapy followed by esophagectomy for locally advanced esophageal neoplasm. Ann Thorac Surg 85:1930–1937PubMedCrossRef
29.
go back to reference Hinrich AW, Björn LD, Brücher M, Zimmermann F et al (2004) Time course of tumor metabolic activity during chemoradiotherapy of esophageal squamous cell carcinoma and response to treatment. J Clin Oncol 22:900–908CrossRef Hinrich AW, Björn LD, Brücher M, Zimmermann F et al (2004) Time course of tumor metabolic activity during chemoradiotherapy of esophageal squamous cell carcinoma and response to treatment. J Clin Oncol 22:900–908CrossRef
30.
go back to reference Akbarshahi H, Andersson B, Norden M et al (2008) Perioperative nutrition in elective gastrointestinal surgery: potential for improvement? Dig Surg 25:165–174PubMedCrossRef Akbarshahi H, Andersson B, Norden M et al (2008) Perioperative nutrition in elective gastrointestinal surgery: potential for improvement? Dig Surg 25:165–174PubMedCrossRef
31.
go back to reference Schilling J, Vranjes N, Fierz W et al (1996) Clinical outcome and immunology of postoperative arginine, omega-3 fatty acids, and nucleotide enriched enteral feeding: a randomized prospective comparison with standard enteral and low calorie/low fat intravenous solutions. Nutrition 12:423–429PubMedCrossRef Schilling J, Vranjes N, Fierz W et al (1996) Clinical outcome and immunology of postoperative arginine, omega-3 fatty acids, and nucleotide enriched enteral feeding: a randomized prospective comparison with standard enteral and low calorie/low fat intravenous solutions. Nutrition 12:423–429PubMedCrossRef
Metadata
Title
Correlation Between the Pretherapeutic Neutrophil to Lymphocyte Ratio and the Pathologic Response to Neoadjuvant Chemotherapy in Patients With Advanced Esophageal Cancer
Authors
Hiroshi Sato
Yasuhiro Tsubosa
Tatsuyuki Kawano
Publication date
01-03-2012
Publisher
Springer-Verlag
Published in
World Journal of Surgery / Issue 3/2012
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-011-1411-1

Other articles of this Issue 3/2012

World Journal of Surgery 3/2012 Go to the issue