基线中性粒细胞与淋巴细胞比值对接受新辅助化疗的食管及交界部腺癌患者无预后价值。
Baseline neutrophil-lymphocyte ratio holds no prognostic value for esophageal and junctional adenocarcinoma in patients treated with neoadjuvant chemotherapy.
机构信息
Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, The Netherlands.
The University of Queensland, Diamantina Institute, Translational Research Institute, Woolloongabba, Queensland, Australia.
出版信息
Dis Esophagus. 2020 Jun 15;33(6). doi: 10.1093/dote/doz082.
BACKGROUND
Several studies have reported that neutrophil-lymphocyte ratio (NLR) can predict survival in esophageal and gastroesophageal junction adenocarcinoma, as it reflects systemic inflammation. Hence, we aimed to determine whether baseline NLR holds prognostic value for esophageal adenocarcinoma patients treated with neoadjuvant chemotherapy (nCT) followed by surgery.
METHODS
We studied the data of 139 patients that received nCT before undergoing esophagectomy with curative intent, all identified from a prospectively maintained database (1998-2016). Pretreatment hematology reports were used to calculate the baseline NLR. A receiver operating characteristic curve (ROC-curve) was plotted to determine an optimal cutoff value. NLR quartiles were used to display possible differences between groups in relation to overall survival (OS) and disease-free survival (DFS) using the method of Kaplan-Meier. Cox regression analysis was performed to assess the prognostic value of NLR.
RESULTS
The median OS and DFS times were 46 months (interquartile range [IQR]: 19-166) and 30 months (IQR: 13-166], respectively, for the entire cohort. The ROC-curve showed that NLR has no discriminating power for survival status (area under the curve = 0.462) and therefore no optimal cutoff value could be determined. There were no statistically significant differences in median OS times for NLR quartiles: 65 (Q1), 32 (Q2), 45 (Q3), and 46 months (Q4) (P = 0.926). Similarly, DFS showed no difference between quartile groups, with median survival times of 27 (Q1), 19 (Q2), 36 (Q3), and 20 months (Q4) (P = 0.973). Age, pN, pM, and resection margin were independent prognostic factors for both OS and DFS. On the contrary, NLR was not associated with OS or DFS in univariable and multivariable analyses.
CONCLUSION
Baseline NLR holds no prognostic value for esophageal and gastroesophageal junction adenocarcinoma patients treated with nCT in this study, in contrast to other recently published papers. This result questions the validity of NLR as a reliable prognostic indicator and its clinical usefulness in these patients.
背景
多项研究报告称，中性粒细胞与淋巴细胞比值（NLR）可预测食管和胃食管交界处腺癌患者的生存情况，因为它反映了全身炎症。因此，我们旨在确定基线 NLR 是否对接受新辅助化疗（nCT）后行根治性手术的食管腺癌患者具有预后价值。
方法
我们研究了 139 例接受 nCT 治疗后行根治性食管切除术的患者的数据，这些患者均来自前瞻性维护的数据库（1998-2016 年）。使用预处理的血液学报告来计算基线 NLR。绘制受试者工作特征曲线（ROC 曲线）以确定最佳截断值。使用 Kaplan-Meier 方法，根据 NLR 四分位数显示总体生存（OS）和无病生存（DFS）方面的组间差异。使用 Cox 回归分析评估 NLR 的预后价值。
结果
整个队列的中位 OS 和 DFS 时间分别为 46 个月（四分位距 [IQR]：19-166）和 30 个月（IQR：13-166）。ROC 曲线显示 NLR 对生存状态没有区分能力（曲线下面积=0.462），因此无法确定最佳截断值。 NLR 四分位数的中位 OS 时间无统计学差异：65（Q1）、32（Q2）、45（Q3）和 46 个月（Q4）（P=0.926）。同样，DFS 在四分位组之间也没有差异，中位生存时间分别为 27（Q1）、19（Q2）、36（Q3）和 20 个月（Q4）（P=0.973）。年龄、pN、pM 和切缘是 OS 和 DFS 的独立预后因素。相反，在单变量和多变量分析中，NLR 与 OS 或 DFS 均无相关性。
结论
与其他最近发表的论文相比，在本研究中，基线 NLR 对接受 nCT 治疗的食管和胃食管交界处腺癌患者无预后价值。这一结果质疑了 NLR 作为可靠预后指标的有效性及其在这些患者中的临床应用价值。
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