Cox Samantha, Hurt Christopher, Grenader Tal, Mukherjee Somnath, Bridgewater John, Crosby Thomas
Department of Oncology, Velindre Cancer Centre, Cardiff, United Kingdom.
Wales Cancer Trials Unit, Cardiff University, Cardiff, United Kingdom.
Radiother Oncol. 2017 Oct;125(1):154-159. doi: 10.1016/j.radonc.2017.08.023. Epub 2017 Sep 8.
The derived neutrophil-lymphocyte ratio (dNLR) is a validated prognostic biomarker for cancer survival but has not been extensively studied in locally-advanced oesophageal cancer treated with definitive chemoradiotherapy (dCRT). We aimed to identify the prognostic value of dNLR in patients recruited to the SCOPE1 trial.
258 patients were randomised to receive dCRT±cetuximab. Kaplan-Meier's curves and both univariable and multivariable Cox regression models were calculated for overall survival (OS), progression free survival (PFS), local PFS inside the radiation volume (LPFSi), local PFS outside the radiation volume (LPFSo), and distant PFS (DPFS).
An elevated pre-treatment dNLR≥2 was significantly associated with decreased OS in univariable (HR 1.74 [95% CI 1.29-2.35], p<0.001) and multivariable analyses (HR 1.64 [1.17-2.29], p=0.004). Median OS was 36months (95% CI 27.8-42.4) if dNLR<2 and 18.4months (95% CI 14.1-24.9) if dNLR≥2. All measures of PFS were also significantly reduced with an elevated dNLR. dNLR was prognostic for OS in cases of squamous cell carcinoma with a non-significant trend for adenocarcinoma/undifferentiated tumours.
An elevated pre-treatment dNLR may be an independent prognostic biomarker for OS and PFS in oesophageal cancer patients treated with definitive CRT. dNLR is a simple, inexpensive and readily available tool for risk-stratification and should be considered for use in future oesophageal cancer clinical trials. The SCOPE1 trial was an International Standard Randomised Controlled Trial [number 47718479].
衍生中性粒细胞与淋巴细胞比值（dNLR）是一种经过验证的癌症生存预后生物标志物，但在接受根治性放化疗（dCRT）的局部晚期食管癌中尚未得到广泛研究。我们旨在确定dNLR在SCOPE1试验招募患者中的预后价值。
258例患者被随机分配接受dCRT±西妥昔单抗治疗。计算总生存期（OS）、无进展生存期（PFS）、放射野内局部无进展生存期（LPFSi）、放射野外局部无进展生存期（LPFSo）和远处无进展生存期（DPFS）的Kaplan-Meier曲线以及单变量和多变量Cox回归模型。
治疗前dNLR≥2升高与单变量分析（HR 1.74 [95% CI 1.29 - 2.35]，p<0.001）和多变量分析（HR 1.64 [1.17 - 2.29]，p = 0.004）中OS降低显著相关。如果dNLR<2，中位OS为36个月（95% CI 27.8 - 42.4）；如果dNLR≥2，中位OS为18.4个月（95% CI 14.1 - 24.9）。随着dNLR升高，所有PFS指标也显著降低。dNLR对鳞状细胞癌患者的OS具有预后价值，对腺癌/未分化肿瘤患者有非显著趋势。
治疗前dNLR升高可能是接受根治性CRT治疗的食管癌患者OS和PFS的独立预后生物标志物。dNLR是一种简单、廉价且易于获得的风险分层工具，应考虑在未来的食管癌临床试验中使用。SCOPE1试验是一项国际标准随机对照试验[编号47718479]。
