Sherry Alexander D, Newman Neil B, Anderson Joshua L, Osmundson Evan C
Vanderbilt University School of Medicine, Nashville, Tennessee.
Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee.
J Surg Oncol. 2020 Feb;121(2):303-312. doi: 10.1002/jso.25793. Epub 2019 Dec 4.
Lymphopenia associated with chemoradiotherapy predicts prognosis in esophageal carcinoma. The purpose of our study was to evaluate alterations in hematologic measures of inflammation during chemoradiation.
We performed an observational study evaluating adults treated with chemoradiation in the neoadjuvant or definitive setting for stage II-III esophageal carcinoma. Multivariable logistic regression evaluated predictors of pathologic response. Survival was analyzed by time-varying multivariable Cox proportional hazards regressions.
A total of 94 patients were included with median follow-up of 1.6 years. Elevated neutrophil:lymphocyte ratio (NLR) was predictive of incomplete pathologic response to neoadjuvant chemoradiation (OR, 1.07; P = .0030) as well as shorter distant metastasis-free survival (HR, 1.01; P = .0369) and reduced overall survival (HR, 1.01; P = .0448). An NLR > 5.55 in week two of chemoradiation predicted shorter overall survival (P = .0070). Upon adjusted analysis, NLR was independently associated with reduced probability of complete pathologic response (OR, 0.80; P = .0291), as well as poor histologic response to neoadjuvant chemoradiation (OR, 1.05; P = .0303), shorter disease-free survival (HR, 1.02; P = .0077), and reduced overall survival (HR, 1.02; P = .0070).
Dynamic time-dependent changes in NLR during chemoradiation predict response, relapse, metastasis, and survival in esophageal carcinoma. Prospective validation is warranted.
放化疗相关的淋巴细胞减少可预测食管癌的预后。本研究旨在评估放化疗期间血液炎症指标的变化。
我们进行了一项观察性研究，评估在新辅助或根治性治疗阶段接受放化疗的II - III期食管癌成人患者。多变量逻辑回归分析评估病理反应的预测因素。生存情况通过时变多变量Cox比例风险回归进行分析。
共纳入94例患者，中位随访时间为1.6年。中性粒细胞与淋巴细胞比值（NLR）升高可预测新辅助放化疗的病理反应不完全（比值比[OR]，1.07；P = 0.0030），以及远处无转移生存期缩短（风险比[HR]，1.01；P = 0.0369）和总生存期缩短（HR，1.01；P = 0.0448）。放化疗第二周时NLR > 5.55可预测总生存期缩短（P = 0.0070）。经校正分析，NLR与完全病理反应概率降低独立相关（OR，0.80；P = 0.0291），以及对新辅助放化疗的组织学反应不佳（OR，1.05；P = 0.0303）、无病生存期缩短（HR，1.02；P = 0.0077）和总生存期缩短（HR，1.02；P = 0.0070）。
放化疗期间NLR的动态时间依赖性变化可预测食管癌的反应、复发、转移和生存情况。有必要进行前瞻性验证。
