Pretreatment Neutrophil-to-Lymphocyte Ratio as an Independent Prognostic Biomarker in Esophageal Cancer Following Neoadjuvant Chemoradiotherapy
Author :
Abstract
ABSTRACT
Background:
The neutrophil-to-lymphocyte ratio (NLR) has emerged as a promising systemic inflammatory biomarker with potential prognostic value across various solid tumors. However, its prognostic significance in patients with esophageal cancer undergoing neoadjuvant chemoradiotherapy (nCRT) remains inconsistent. This study aimed to investigate the independent prognostic value of pretreatment NLR in patients with esophageal cancer treated with nCRT.
Methods:
This retrospective cohort study included 72 patients with stage II–IVA esophageal cancer who received nCRT between July 2020 and December 2023. Pretreatment NLR was calculated from complete blood count measurements obtained within one week before treatment initiation. The optimal NLR cutoff value was determined using maximally selected rank statistics. Overall survival (OS) and progression-free survival (PFS) were evaluated using the Kaplan–Meier method and Cox proportional hazards regression analyses.
Results:
The optimal pretreatment NLR cutoff was identified as 2.4 for both OS and PFS. Patients with an NLR >2.4 had significantly poorer PFS (p=0.013) and OS (p<0.001) than those with an NLR ≤2.4. In multivariable Cox regression analysis, pretreatment NLR >2.4 remained independently associated with worse PFS (HR=2.18, 95% CI: 1.09–4.37, p=0.028) and OS (HR=2.23, 95% CI: 1.11–4.49, p=0.024). In addition, poor response to nCRT was independently associated with inferior survival outcomes, whereas pretreatment NLR was not significantly associated with treatment response.
Conclusions:
Elevated pretreatment NLR was independently associated with poorer survival outcomes in patients with esophageal cancer treated with neoadjuvant chemoradiotherapy. Given the exploratory nature of the findings and the methodological limitations of the study, external validation using NLR as a continuous variable in adequately powered prospective cohorts is required before clinical implementation.
Keywords
Abstract
ABSTRACT
Background:
The neutrophil-to-lymphocyte ratio (NLR) has emerged as a promising systemic inflammatory biomarker with potential prognostic value across various solid tumors. However, its prognostic significance in patients with esophageal cancer undergoing neoadjuvant chemoradiotherapy (nCRT) remains inconsistent. This study aimed to investigate the independent prognostic value of pretreatment NLR in patients with esophageal cancer treated with nCRT.
Methods:
This retrospective cohort study included 72 patients with stage II–IVA esophageal cancer who received nCRT between July 2020 and December 2023. Pretreatment NLR was calculated from complete blood count measurements obtained within one week before treatment initiation. The optimal NLR cutoff value was determined using maximally selected rank statistics. Overall survival (OS) and progression-free survival (PFS) were evaluated using the Kaplan–Meier method and Cox proportional hazards regression analyses.
Results:
The optimal pretreatment NLR cutoff was identified as 2.4 for both OS and PFS. Patients with an NLR >2.4 had significantly poorer PFS (p=0.013) and OS (p<0.001) than those with an NLR ≤2.4. In multivariable Cox regression analysis, pretreatment NLR >2.4 remained independently associated with worse PFS (HR=2.18, 95% CI: 1.09–4.37, p=0.028) and OS (HR=2.23, 95% CI: 1.11–4.49, p=0.024). In addition, poor response to nCRT was independently associated with inferior survival outcomes, whereas pretreatment NLR was not significantly associated with treatment response.
Conclusions:
Elevated pretreatment NLR was independently associated with poorer survival outcomes in patients with esophageal cancer treated with neoadjuvant chemoradiotherapy. Given the exploratory nature of the findings and the methodological limitations of the study, external validation using NLR as a continuous variable in adequately powered prospective cohorts is required before clinical implementation.
Keywords
Esophageal cancer; Neutrophil-to-lymphocyte ratio; Neoadjuvant chemoradiotherapy; Prognosis; Survival