Department of Medicine, Columbia University Medical Center, New York, NY, USA.
Ann Surg Oncol. 2011 Nov;18(12):3362-9. doi: 10.1245/s10434-011-1754-8. Epub 2011 May 6.
The prognosis for patients with esophageal cancer is poor, even among those who undergo potentially curative esophagectomy. The neutrophil:lymphocyte ratio (NLR) is hypothesized to reflect the systemic inflammatory response created by a tumor and is possibly predictive of tumor aggressiveness and propensity for metastasis.
We performed a single-center retrospective analysis of esophageal cancer patients who underwent attempted curative esophagectomy at Weill Cornell Medical Center between 1996 and 2009. We collected data on patient demographics, clinical characteristics, and receipt of neoadjuvant treatment. Preoperative blood tests were used to calculate NLR. Elevated NLR was defined a priori as ≥5.0. Logistic regression modeling was performed to analyze characteristics associated with elevated NLR. We conducted Kaplan-Meier analyses and Cox regression modeling to determine estimates and predictors of disease-free and overall survival.
We identified a total of 295 patients who underwent esophagectomy. The median duration of follow-up was 31 months (interquartile range [IQR] 13-61). There were 56 patients (18.9%) who had elevated NLR preoperatively. Receipt of neoadjuvant therapy was independently associated with high NLR (odds ratio [OR] 2.14, 95% confidence interval [95% CI] 1.02-4.51). In multivariable analyses, elevated NLR was associated with significantly worse disease-free (hazard ratio [HR] 2.26, 95% CI 1.43-3.55) and overall survival (HR 2.31, 95% CI 1.53-3.50).
Preoperative NLR is a potential prognostic marker for recurrence and death after esophagectomy. It is unclear whether NLR reflects the degree of inflammatory response to the primary tumor or other patient-specific or tumor characteristics that predispose to recurrence. Further investigation is warranted to clarify the mechanisms explaining the observed associations between elevated NLR and poor outcomes in esophageal cancer.
即使是接受潜在根治性食管切除术的食管癌患者，预后也较差。中性粒细胞与淋巴细胞比值（NLR）被认为反映了肿瘤引起的全身炎症反应，并且可能预测肿瘤侵袭性和转移倾向。
我们对 1996 年至 2009 年期间在威尔康奈尔医学中心接受根治性食管切除术的食管癌患者进行了单中心回顾性分析。我们收集了患者人口统计学、临床特征和新辅助治疗的数据。术前血液检查用于计算 NLR。预先定义 NLR 升高为≥5.0。采用逻辑回归模型分析与 NLR 升高相关的特征。我们进行 Kaplan-Meier 分析和 Cox 回归模型分析，以确定无病和总生存的估计值和预测因素。
我们共确定了 295 例接受食管切除术的患者。中位随访时间为 31 个月（四分位距 [IQR] 13-61）。术前 NLR 升高的患者有 56 例（18.9%）。接受新辅助治疗与 NLR 升高独立相关（优势比 [OR] 2.14，95%置信区间 [95%CI] 1.02-4.51）。多变量分析显示，NLR 升高与无病生存（危险比 [HR] 2.26，95%CI 1.43-3.55）和总生存（HR 2.31，95%CI 1.53-3.50）显著相关。
术前 NLR 是食管切除术后复发和死亡的潜在预后标志物。目前尚不清楚 NLR 是反映对原发性肿瘤的炎症反应程度，还是反映其他患者特异性或肿瘤特征，这些特征使肿瘤易于复发。需要进一步研究以阐明解释观察到的 NLR 升高与食管癌不良结局之间关联的机制。
