Division of Gastroenterology, Rabin Medical Center, Petah-Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Endoscopy. 2021 Aug;53(8):774-781. doi: 10.1055/a-1292-8747. Epub 2020 Dec 16.
Patient's with Barrett's esophagus (BE) are at risk of progression to esophageal adenocarcinoma (EAC). Neutrophil to lymphocyte ratio (NLR) was found to be a predictor of poor prognosis in patients with EAC; however, its performance in premalignant esophageal lesions is vague. We aimed to evaluate the utility of NLR as a predictor of histologic progression in patients with BE. METHODS : A prospective cohort of patients with proven BE in a tertiary referral center was retrospectively analyzed. All biopsies were reviewed by an expert gastrointestinal pathologist. The discriminatory capacity of NLR was evaluated by area under the receiver operating characteristic (AUC) curve analysis and Cox regression analysis.
324 patients (mean age 62.3 years, 241 [74.4 %] males) were included in the final analysis. Overall, 13 patients demonstrated histologic progression to neoplasia over a mean follow-up of 3.7 years (progression risk 1.0 % per year). The AUC of NLR for progression to high grade dysplasia (HGD) or EAC was 0.88 (95 % confidence interval [CI] 0.83 - 0.96), and baseline NLR was associated with a 3-fold increase of progression to HGD and EAC during follow-up (hazard ratio [HR] 3.2, 95 %CI 1.5 - 5.8; < 0.001). Notably, in a subgroup analysis of patients with nondysplastic BE (NDBE) at presentation, NLR was also a risk factor for histologic progression (HR 2.4, 95 %CI 1.7 - 3.4; < 0.001).
NLR predicted histologic progression in patients with BE. Patients with NDBE and NLR above 2.4 can be considered for specific surveillance programs with shorter intervals between sessions.
巴雷特食管（BE）患者有进展为食管腺癌（EAC）的风险。中性粒细胞与淋巴细胞比值（NLR）已被发现可预测 EAC 患者的预后不良；然而，其在癌前食管病变中的表现尚不清楚。我们旨在评估 NLR 作为预测 BE 患者组织学进展的指标的效用。
对一家三级转诊中心确诊的 BE 患者进行了前瞻性队列研究。所有活检均由一位经验丰富的胃肠病学病理学家进行审查。通过接受者操作特征（ROC）曲线分析和 Cox 回归分析评估 NLR 的判别能力。
最终分析纳入 324 例患者（平均年龄 62.3 岁，241 例[74.4%]为男性）。总体而言，13 例患者在平均 3.7 年的随访中表现出组织学进展为肿瘤（每年进展风险为 1.0%）。NLR 对高级别上皮内瘤变（HGD）或 EAC 进展的 AUC 为 0.88（95%置信区间 [CI] 0.83-0.96），基线 NLR 与随访期间进展为 HGD 和 EAC 的风险增加 3 倍相关（风险比 [HR] 3.2，95%CI 1.5-5.8； <0.001）。值得注意的是，在 NDBE 患者的亚组分析中，NLR 也是组织学进展的危险因素（HR 2.4，95%CI 1.7-3.4； <0.001）。
NLR 可预测 BE 患者的组织学进展。NDBE 患者和 NLR 高于 2.4 的患者可考虑进行特定的监测计划，随访间隔更短。
