Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan.
Division of Minimally Invasive Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan.
Ann Surg Oncol. 2022 Apr;29(4):2663-2671. doi: 10.1245/s10434-021-11012-y. Epub 2021 Nov 22.
Multidisciplinary treatment for esophageal squamous cell carcinoma (ESCC) has improved outcomes, but the prognosis for ESCC remains poor. Nutritional and inflammatory indicators are reported to be associated with cancer prognosis. The combination of albumin and the derived neutrophil-to-lymphocyte ratio (Alb-dNLR) score was established to measure the immune system and nutritional status. The authors hypothesized that the Alb-dNLR score could be a new reliable prognostic factor for ESCC patients.
The study evaluated 269 patients who underwent esophagectomy between April 2010 and March 2018, including 185 patients who received neoadjuvant chemotherapy. The Alb-dNLR score was calculated using serum albumin and the dNLR. The dNLR was calculated as neutrophils to (leukocyte-neutrophil count). The cutoff values of the albumin and dNLR for overall survival (OS) were determined using the receiver operating characteristic curve. Patients were divided into "high" and "low" groups according to the Alb-dNLR score.
A high Alb-dNLR score was found in 61 cases (22.7%). The 5-year OS was 34% in the high Alb-dNLR group and 66.2% in the low Alb-dNLR group (p < 0.0001). The 5-year cause-specific survival (CSS) was 51.5% in the high Alb-dNLR group and 74.7% in the low Alb-dNLR group (p < 0.0001). Multivariate analyses demonstrated that the Alb-dNLR score was an independent prognostic factor for OS (hazard ratio [HR], 2.198; 95% confidence interval [CI], 1.460-3.263; p = 0.0002) and CSS (HR, 1.733; 95% CI, 1.035-2.835; p = 0.0371).
The Alb-dNLR score is an extremely useful, easy-to-use parameter to predict OS and CSS for ESCC patients.
多学科治疗食管鳞状细胞癌（ESCC）已经改善了预后，但 ESCC 的预后仍然很差。营养和炎症指标与癌症预后有关。白蛋白和衍生的中性粒细胞与淋巴细胞比值（Alb-dNLR）评分的组合被建立来衡量免疫系统和营养状况。作者假设 Alb-dNLR 评分可以成为 ESCC 患者新的可靠预后因素。
本研究评估了 2010 年 4 月至 2018 年 3 月期间接受食管切除术的 269 例患者，其中 185 例接受了新辅助化疗。Alb-dNLR 评分通过血清白蛋白和 dNLR 计算得出。dNLR 计算为中性粒细胞与（白细胞-中性粒细胞计数）的比值。使用接受者操作特征曲线确定白蛋白和 dNLR 对总生存期（OS）的截断值。根据 Alb-dNLR 评分将患者分为“高”和“低”两组。
在 61 例（22.7%）中发现 Alb-dNLR 评分较高。高 Alb-dNLR 组的 5 年 OS 为 34%，低 Alb-dNLR 组为 66.2%（p<0.0001）。高 Alb-dNLR 组的 5 年特异性生存（CSS）为 51.5%，低 Alb-dNLR 组为 74.7%（p<0.0001）。多变量分析表明，Alb-dNLR 评分是 OS（风险比[HR]，2.198；95%置信区间[CI]，1.460-3.263；p=0.0002）和 CSS（HR，1.733；95%CI，1.035-2.835；p=0.0371）的独立预后因素。
Alb-dNLR 评分是预测 ESCC 患者 OS 和 CSS 的非常有用且易于使用的参数。
