Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2015; 21(18): 5591-5597
Published online May 14, 2015. doi: 10.3748/wjg.v21.i18.5591
Prognostic role of neutrophil-lymphocyte ratio in operable esophageal squamous cell carcinoma
Hao Duan, Xu Zhang, Fei-Xiang Wang, Mu-Yan Cai, Guo-Wei Ma, Hong Yang, Jian-Hua Fu, Zi-Hui Tan, Yu-Qi Meng, Xia-Yu Fu, Qi-Long Ma, Peng Lin
Hao Duan, Xu Zhang, Fei-Xiang Wang, Guo-Wei Ma, Hong Yang, Jian-Hua Fu, Zi-Hui Tan, Yu-Qi Meng, Xia-Yu Fu, Qi-Long Ma, Peng Lin, Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
Mu-Yan Cai, Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
Hong Yang, Jian-Hua Fu, Guangdong Esophageal Cancer Research Institute, Guangzhou 510060, Guangdong Province, China
Author contributions: Duan H, Wang FX and Zhang X contributed equally to this article; Duan H, Zhang X and Lin P designed the study; Duan H, Cai MY and Wang FX collected the patient’s clinical data; Duan H and Wang FX analyzed the data and drafted the manuscript; Zhang X, Cai MY, Ma GW, Yang H, Fu JH, Tan ZH, Meng YQ, Fu XY, Ma QL and Lin P diagnosed and treated the patient; Zhang X and Lin P revised the manuscript for important intellectual content; all authors have read and approved the final version to be published.
Supported by Research funding from the Science and Technology Planning Project of Guangdong Province, China, No. 2012B031800462 (to Zhang X); and the Sun Yat-Sen University Clinical Research 5010 Program (to Lin P).
Ethics approval: The study was reviewed and approved by the Sun Yat-Sen University Cancer Center Institutional Review Board.
Informed consent: All study participants, or their legal guardian, provided informed written consent prior to inclusion in the study.
Conflict-of-interest: None.
Data sharing: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Peng Lin, MD, Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Guangdong Province, China. dr_penglin@sina.cn
Telephone: +86-20-87343628 Fax: +86-20-87343628
Received: November 18, 2014
Peer-review started: November 19, 2014
First decision: December 26, 2014
Revised: January 19, 2015
Accepted: February 11, 2015
Article in press: February 11, 2015
Published online: May 14, 2015
Processing time: 180 Days and 19.2 Hours
Abstract

AIM: To determine the prognostic significance of preoperative serum neutrophil-lymphocyte ratio (NLR) in esophageal squamous cell carcinoma (ESCC).

METHODS: Data from 371 eligible patients with ESCC who had undergone surgery with curative intent at our institution between October 2000 and May 2007 were retrospectively recruited for analysis. The cutoff value of NLR was 3.0 as determined by the receiver operating characteristic curve, which discriminated between survival and death; the area under the curve was 0.709, and the sensitivity and specificity were 66.1% and 69.1%, respectively, at the cutoff point. The correlation between the NLR and clinicopathological characteristics was analyzed using a χ2 test. The prognostic influence of the NLR and other clinicopathological factors on cancer-specific survival (CSS) and recurrence-free survival (RFS) was studied using the Kaplan-Meier method. To evaluate the independent prognostic value of NLR, multivariate Cox regression models were applied.

RESULTS: The median age of the patients was 57.0 years, and 276/371 (74.4%) patients were male. The NLR was ≤ 3.0 in 80.1% (297/371) of the patients, and the remaining 19.9% (74/371) had an NLR > 3.0. Median postoperative follow-up was 66.0 mo [interquartile range (IQR): 49.0-76.0 mo], with a follow-up rate of 94%. Follow-up was not significantly different between patients with an NLR ≤ and > 3.0 (63.13 ± 1.64 vs 61.52 ± 3.66, P = 0.711). However, higher preoperative serum NLR was associated with significantly increased risks of higher pathological tumor status (P = 0.007). A significant, independent association between high preoperative serum NLR and poor clinical outcome was identified in a multivariate analysis for CSS (HR = 1.591; P = 0.007) and RFS (HR = 1.525; P = 0.013). Moreover, when patients were stratified by pathological tumor-node-metastasis (TNM) staging, the adverse effects of preoperative serum NLR on CSS (HR = 2.294; P = 0.008) and RFS (HR = 2.273; P = 0.008) were greatest in those patients with stage IIIA disease.

CONCLUSION: Preoperative serum NLR is a useful prognostic marker to complement TNM staging for operable ESCC patients, particularly in patients with stage IIIA disease.

Keywords: Esophageal squamous cell carcinoma; Neutrophil-lymphocyte ratio; Prognosis; Radical esophagectomy

Core tip: From a relatively large cohort of esophageal squamous cell carcinoma patients who underwent esophagectomy without neoadjuvant treatment and extended follow-up, we determined that an elevated preoperative serum neutrophil-lymphocyte ratio (NLR) is a negative prognostic factor. When stratified by pathological tumor-node-metastasis staging, the adverse effects of NLR were greatest in patients with stage IIIA disease.