Department of Gastrointestinal Surgery, Hospital de Clínicas de Porto Alegre, 2350 Ramiro Barcellos Street, Porto Alegre, RS, 90035-003, Brazil.
Postgraduate Program in Medicine: Surgical Sciences, Federal University of Rio Grande do Sul, 2400 Ramiro Barcelos Street, Porto Alegre, RS, 90035-007, Brazil.
J Gastrointest Surg. 2020 Jan;24(1):8-18. doi: 10.1007/s11605-019-04456-x. Epub 2019 Nov 19.
Immune imbalance and inflammation have been suggested as key factors of Barrett's esophagus (BE) pathway towards adenocarcinoma. The neutrophil-lymphocyte ratio (NLR) indirectly reflects the relation between innate and adaptive immune systems and has been studied in premalignant conditions as a biomarker for cancer diagnosis. Our aim was to investigate if increasing values of NLR correlated with advancing stages of BE progression to dysplasia and neoplasia.
We retrospectively analyzed data of patients with biopsies reporting BE between 2013 and 2017 and with a complete blood count within 6 months from the endoscopy, as well as patients with esophageal adenocarcinoma (EAC). NLR was calculated as neutrophil count/lymphocyte count. Cases (n = 113) were classified as non-dysplastic BE (NDBE, n = 72), dysplastic BE (DBE, n = 11) and EAC (n = 30).
NLR progressively increased across groups (NDBE, 1.92 ± 0.7; DBE, 2.92 ± 1.1; EAC 4.54 ± 2.9), with a significant correlation between its increasing value and the presence of dysplasia or neoplasia (r = 0.53, p < 0.001). NLR > 2.27 was able to diagnose EAC with 80% sensitivity and 71% specificity (area under the curve = 0.8).
NLR correlates with advancing stages of BE progression, a finding that reinforces the role of immune imbalance in EAC carcinogenesis and suggests a possible use of this marker for risk stratification on surveillance strategies.
免疫失衡和炎症被认为是巴雷特食管（BE）向腺癌发展的关键因素。中性粒细胞与淋巴细胞比值（NLR）间接反映了固有免疫和适应性免疫系统之间的关系，并已在癌前病变中作为癌症诊断的生物标志物进行了研究。我们的目的是研究 NLR 值的升高是否与 BE 进展为异型增生和肿瘤的阶段相关。
我们回顾性分析了 2013 年至 2017 年间活检报告为 BE 且在内镜检查后 6 个月内有完整的全血细胞计数的患者的数据，以及患有食管腺癌（EAC）的患者。NLR 计算为中性粒细胞计数/淋巴细胞计数。病例（n=113）分为非异型增生 BE（NDBE，n=72）、异型增生 BE（DBE，n=11）和 EAC（n=30）。
NLR 逐渐在各组中升高（NDBE，1.92±0.7；DBE，2.92±1.1；EAC 4.54±2.9），其值的增加与异型增生或肿瘤的存在呈显著相关（r=0.53，p<0.001）。NLR>2.27 能够诊断 EAC，其敏感性为 80%，特异性为 71%（曲线下面积=0.8）。
NLR 与 BE 进展的阶段相关，这一发现进一步证实了免疫失衡在 EAC 癌变中的作用，并提示该标志物可能用于监测策略的风险分层。
