Department of Surgical Gastroenterology, JIPMER, Room no 5442, Fourth floor, Superspeciality block, Puducherry, 605006, India.
General surgery, JIPMER, Puducherry, India.
J Gastrointest Cancer. 2021 Jun;52(2):659-665. doi: 10.1007/s12029-020-00445-5.
Neoadjuvant chemoradiotherapy (nCRT), followed by surgery, is the current standard of care for patients with locally advanced esophageal squamous cell carcinoma. However, up to 30% of the patients do not respond to nCRT. Hence, a simple, cost-effective marker to predict response before initiation of nCRT is needed. Neutrophil-to-lymphocyte ratio (NLR) has been reported as a prognostic marker in various cancers. However, its role as a predictive marker in patients with esophageal SCC planned for nCRT has not been prospectively analyzed.
All consecutive patients with locally advanced (T1N1 and T2-T4a with or without nodal involvement) SCC planned for nCRT (CROSS protocol) followed by esophagectomy with total two field lymphadenectomy between December 2013 and December 2019 were included in this prospective analytical cohort study. NLR was calculated 1 week before starting the nCRT and was correlated with the histopathological response [Mandard tumor regression grade (TRG)].
Of the 216 patients with esophageal cancer evaluated during the study period, 57 patients with SCC who fulfilled the inclusion criteria were included. A good pathologic response (TRG 1 and 2) to nCRT was seen in 28 (49.1%) patients. Using a ROC curve, the optimal cutoff value of pretherapy NLR for predicting good pathologic response was 2.33. With an NLR cutoff value of 2.33, 53.3% of patients had a good pathologic response to nCRT compared with 47.6% patients with NLR ≥ 2.33 (P = 0.77).
In patients with locally advanced esophageal SCC, NLR is not a useful marker to predict pathologic response to nCRT.
新辅助放化疗（nCRT）后再行手术是局部晚期食管鳞癌的标准治疗方法。然而，多达 30%的患者对 nCRT 无反应。因此，需要一种简单、经济有效的标志物来预测 nCRT 前的反应。中性粒细胞与淋巴细胞比值（NLR）已被报道为多种癌症的预后标志物。然而，其作为计划接受 nCRT 的食管鳞癌患者的预测标志物的作用尚未被前瞻性分析。
所有连续局部晚期（T1N1 和 T2-T4a 伴或不伴淋巴结受累）计划接受 nCRT（CROSS 方案）后行根治性食管切除术和全二野淋巴结清扫的患者均纳入本前瞻性分析队列研究。在开始 nCRT 前 1 周计算 NLR，并与组织病理学反应[Mandard 肿瘤消退分级（TRG）]相关。
在研究期间评估的 216 例食管癌患者中，有 57 例符合 SCC 纳入标准。28 例（49.1%）患者对 nCRT 有良好的病理反应（TRG 1 和 2）。使用 ROC 曲线，预测良好病理反应的 NLR 最佳截断值为 2.33。当 NLR 截断值为 2.33 时，53.3%的患者对 nCRT 有良好的病理反应，而 NLR≥2.33 的患者有 47.6%（P=0.77）。
在局部晚期食管鳞癌患者中，NLR 不是预测 nCRT 病理反应的有用标志物。
