Ohsawa Manato, Hamai Yoichi, Emi Manabu, Ibuki Yuta, Kurokawa Tomoaki, Yoshikawa Toru, Hirohata Ryosuke, Kitasaki Nao, Okada Morihito
Department of Surgical Oncology, Hiroshima University, Hiroshima 734-0037, Japan.
Dis Esophagus. 2022 Dec 31;36(1). doi: 10.1093/dote/doac042.
Accurate preoperative evaluation of lymph node (LN) metastasis is important for determining the treatment strategy for superficial esophageal cancer. Blood biomarkers, such as the neutrophil-lymphocyte, platelet-lymphocyte, and lymphocyte-monocyte ratios (NLR, PLR, and LMR, respectively), have clinical applications as predictors of LN metastasis for different cancers. Here, we investigated the use of these ratios as predictors of pathological LN metastasis and prognosis in patients with clinical stage T1N0M0 esophageal squamous cell carcinoma (ESCC). Patients (n = 185) with cT1N0M0 ESCC who underwent esophagectomy with R0 resection between April 2003 and August 2021 were enrolled. We investigated the ability of pretreatment NLR, PLR, and LMR to predict pathological LN metastasis. The optimal cutoff values of NLR, PLR, and LMR to predict pathological LN metastasis were 2.1, 122, and 4.8, respectively. Univariate and multivariate analyses revealed that the primary tumor length, depth of invasion, and NLR were significant predictors of LN metastasis. Furthermore, similar to the 5-year overall survival, the 5-year relapse-free survival was significantly better in the low NLR group than in the high NLR group. The NLR was the most useful predictor of pathological LN metastasis. Patients diagnosed with clinical stage I ESCC and with a high NLR require adequate LN dissection and may be good candidates for preoperative adjuvant therapy.
准确的术前淋巴结（LN）转移评估对于确定浅表食管癌的治疗策略至关重要。血液生物标志物，如中性粒细胞与淋巴细胞比值、血小板与淋巴细胞比值以及淋巴细胞与单核细胞比值（分别为NLR、PLR和LMR），在不同癌症的LN转移预测中具有临床应用价值。在此，我们研究了这些比值作为临床分期为T1N0M0的食管鳞状细胞癌（ESCC）患者病理性LN转移和预后预测指标的应用情况。纳入了2003年4月至2021年8月期间接受R0切除食管切除术的cT1N0M0 ESCC患者（n = 185）。我们研究了术前NLR、PLR和LMR预测病理性LN转移的能力。NLR、PLR和LMR预测病理性LN转移的最佳临界值分别为2.1、122和4.8。单因素和多因素分析显示，原发肿瘤长度、浸润深度和NLR是LN转移的重要预测指标。此外，与5年总生存率相似，低NLR组的5年无复发生存率显著高于高NLR组。NLR是病理性LN转移最有用的预测指标。诊断为临床I期ESCC且NLR高的患者需要进行充分的淋巴结清扫，可能是术前辅助治疗的良好候选者。
