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Elevated Preoperative Neutrophil:Lymphocyte Ratio as a Predictor of Postoperative Disease Recurrence in Esophageal Cancer

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The prognosis for patients with esophageal cancer is poor, even among those who undergo potentially curative esophagectomy. The neutrophil:lymphocyte ratio (NLR) is hypothesized to reflect the systemic inflammatory response created by a tumor and is possibly predictive of tumor aggressiveness and propensity for metastasis.

Methods

We performed a single-center retrospective analysis of esophageal cancer patients who underwent attempted curative esophagectomy at Weill Cornell Medical Center between 1996 and 2009. We collected data on patient demographics, clinical characteristics, and receipt of neoadjuvant treatment. Preoperative blood tests were used to calculate NLR. Elevated NLR was defined a priori as ≥5.0. Logistic regression modeling was performed to analyze characteristics associated with elevated NLR. We conducted Kaplan-Meier analyses and Cox regression modeling to determine estimates and predictors of disease-free and overall survival.

Results

We identified a total of 295 patients who underwent esophagectomy. The median duration of follow-up was 31 months (interquartile range [IQR] 13–61). There were 56 patients (18.9%) who had elevated NLR preoperatively. Receipt of neoadjuvant therapy was independently associated with high NLR (odds ratio [OR] 2.14, 95% confidence interval [95% CI] 1.02–4.51). In multivariable analyses, elevated NLR was associated with significantly worse disease-free (hazard ratio [HR] 2.26, 95% CI 1.43–3.55) and overall survival (HR 2.31, 95% CI 1.53–3.50).

Conclusions

Preoperative NLR is a potential prognostic marker for recurrence and death after esophagectomy. It is unclear whether NLR reflects the degree of inflammatory response to the primary tumor or other patient-specific or tumor characteristics that predispose to recurrence. Further investigation is warranted to clarify the mechanisms explaining the observed associations between elevated NLR and poor outcomes in esophageal cancer.

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References

  1. American Cancer Society. Global cancer facts and figures. http://www.cancer.org/downloads/STT/Global_Facts_and_Figures_2007_rev2.pdf (2007). Accessed 30 Mar 2010.

  2. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin. 2009;59:225–49.

    Article  PubMed  Google Scholar 

  3. DeNardo DG, Johansson M, Coussens LM. Immune cells as mediators of solid tumor metastasis. Cancer Metastasis Rev. 2008;27:11–8.

    Article  PubMed  CAS  Google Scholar 

  4. Balkwill F, Mantovani A. Inflammation and cancer: back to Virchow? Lancet. 2001;357:539–45.

    Article  PubMed  CAS  Google Scholar 

  5. Roxburgh CS, McMillan DC. Role of systemic inflammatory response in predicting survival in patients with primary operable cancer. Future Oncol. 2010;6:149–63.

    Article  PubMed  CAS  Google Scholar 

  6. Halazun KJ, Aldoori A, Malik HZ, Al-Mukhtar A, Prasad KR, Toogood GJ, et al. Elevated preoperative neutrophil to lymphocyte ratio predicts survival following hepatic resection for colorectal liver metastases. Eur J Surg Oncol. 2008;34:55–60.

    Article  PubMed  CAS  Google Scholar 

  7. Malik HZ, Gomez D, Wong V, Al-Mukthar A, Toogood GJ, Lodge JP, et al. Predictors of early disease recurrence following hepatic resection for colorectal cancer metastasis. Eur J Surg Oncol. 2007;33:1003–9.

    Article  PubMed  CAS  Google Scholar 

  8. AJCC cancer staging manual, 6th edn. New York: Springer-Verlag; 2002.

  9. Walsh SR, Cook EJ, Goulder F, Justin TA, Keeling NJ. Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol. 2005;91:181–4.

    Article  PubMed  CAS  Google Scholar 

  10. Malik HZ, Prasad KR, Halazun KJ, Aldoori A, Al-Mukhtar A, Gomez D, et al. Preoperative prognostic score for predicting survival after hepatic resection for colorectal liver metastases. Ann Surg. 2007;246:806–14.

    Article  PubMed  Google Scholar 

  11. Kishi Y, Kopetz S, Chun YS, Palavecino M, Abdalla EK, Vauthey JN. Blood neutrophil-to-lymphocyte ratio predicts survival in patients with colorectal liver metastases treated with systemic chemotherapy. Ann Surg Oncol. 2009;16:614–22.

    Article  PubMed  Google Scholar 

  12. Halazun KJ, Hardy MA, Rana AA, Woodland DC IV, Luyten EJ, Mahadev S, et al. Negative impact of neutrophil-lymphocyte ratio on outcome after liver transplantation for hepatocellular carcinoma. Ann Surg. 2009;250:141–51.

    Article  PubMed  Google Scholar 

  13. Gomez D, Farid S, Malik HZ, Young AL, Toogood GJ, Lodge JP, et al. Preoperative neutrophil-to-lymphocyte ratio as a prognostic predictor after curative resection for hepatocellular carcinoma. World J Surg. 2008;32:1757–62.

    Article  PubMed  CAS  Google Scholar 

  14. Gomez D, Morris-Stiff G, Toogood GJ, Lodge JP, Prasad KR. Impact of systemic inflammation on outcome following resection for intrahepatic cholangiocarcinoma. J Surg Oncol. 2008;97:513–8.

    Article  PubMed  Google Scholar 

  15. Nakahara K, Monden Y, Ohno K, Fujii Y, Hashimoto J, Kitagawa Y, et al. Importance of biologic status to the postoperative prognosis of patients with stage III nonsmall cell lung cancer. J Surg Oncol. 1987;36:155–60.

    Article  PubMed  CAS  Google Scholar 

  16. Sarraf KM, Belcher E, Raevsky E, Nicholson AG, Goldstraw P, Lim E. Neutrophil/lymphocyte ratio and its association with survival after complete resection in non-small cell lung cancer. J Thorac Cardiovasc Surg. 2009;137:425–8.

    Article  PubMed  Google Scholar 

  17. Gomez D, Morris-Stiff G, Wyatt J, Toogood GJ, Lodge JP, Prasad KR. Surgical technique and systemic inflammation influences long-term disease-free survival following hepatic resection for colorectal metastasis. J Surg Oncol. 2008;98:371–6.

    Article  PubMed  Google Scholar 

  18. Cho H, Hur HW, Kim SW, Kim SH, Kim JH, Kim YT, et al. Pre-treatment neutrophil to lymphocyte ratio is elevated in epithelial ovarian cancer and predicts survival after treatment. Cancer Immunol Immunother. 2009;58:15–23.

    Article  PubMed  CAS  Google Scholar 

  19. Rashid F, Waraich N, Bhatti I, Saha S, Khan RN, Ahmed J, et al. A pre-operative elevated neutrophil: lymphocyte ratio does not predict survival from oesophageal cancer resection. World J Surg Oncol. 2010;8:1.

    Google Scholar 

  20. Aliustaoglu M, Bilici A, Ustaalioglu BB, Konya V, Gucun M, Seker M, et al. The effect of peripheral blood values on prognosis of patients with locally advanced gastric cancer before treatment. Med Oncol. 2010;27:1060–5.

    Article  PubMed  Google Scholar 

  21. Liao Q, Zhao YP, Yang YC, Li LJ, Long X, Han SM. Combined detection of serum tumor markers for differential diagnosis of solid lesions located at the pancreatic head. Hepatobiliary Pancreat Dis Int. 2007;6:641–5.

    PubMed  CAS  Google Scholar 

  22. Nozoe T, Saeki H, Sugimachi K. Significance of preoperative elevation of serum C-reactive protein as an indicator of prognosis in esophageal carcinoma. Am J Surg. 2001;182:197–201.

    Article  PubMed  CAS  Google Scholar 

  23. Shimada H, Nabeya Y, Okazumi S, Matsubara H, Shiratori T, Aoki T, et al. Elevation of preoperative serum C-reactive protein level is related to poor prognosis in esophageal squamous cell carcinoma. J Surg Oncol. 2003;83:248–52.

    Article  PubMed  Google Scholar 

  24. Guillem P, Triboulet JP. Elevated serum levels of C-reactive protein are indicative of a poor prognosis in patients with esophageal cancer. Dis Esophagus. 2005;18:146–50.

    Article  PubMed  CAS  Google Scholar 

  25. Kobayashi T, Teruya M, Kishiki T, Kaneko S, Endo D, Takenaka Y, et al. Inflammation-based prognostic score, prior to neoadjuvant chemoradiotherapy, predicts postoperative outcome in patients with esophageal squamous cell carcinoma. Surgery. 2008;144:729–35.

    Article  PubMed  Google Scholar 

  26. Fridlender ZG, Sun J, Kim S, Kapoor V, Cheng G, Ling L, et al. Polarization of tumor-associated neutrophil phenotype by TGF-beta: “N1” versus “N2” TAN. Cancer Cell. 2009;16:183–94.

    Article  PubMed  CAS  Google Scholar 

  27. AJCC cancer staging manual, 7th ed. New York: Springer-Verlag; 2010.

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Acknowledgment

Dr. Abrams is supported in part by a career development award from the National Cancer Institute (K07 CA132892). Dr. Sharaiha is supported in part by a training grant from the National Cancer Institute (T32-CA 09529).

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Authors and Affiliations

  1. Department of Medicine, Columbia University Medical Center, New York, NY, USA

    Reem Z. Sharaiha MD, MS, Alfred I. Neugut MD, PhD & Julian A. Abrams MD, MS

  2. Department of Surgery, Columbia University Medical Center, New York, NY, USA

    Karim J. Halazun MD

  3. Division of Thoracic Surgery, Weill Cornell Medical Center, New York, NY, USA

    Farooq Mirza MD, Jeffrey L. Port MD, Paul C. Lee MD & Nasser K. Altorki MD

  4. Department of Epidemiology, Mailman School of Public Health, New York, NY, USA

    Alfred I. Neugut MD, PhD

  5. Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA

    Alfred I. Neugut MD, PhD, Nasser K. Altorki MD & Julian A. Abrams MD, MS

Authors
  1. Reem Z. Sharaiha MD, MS
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  2. Karim J. Halazun MD
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  3. Farooq Mirza MD
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  4. Jeffrey L. Port MD
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  6. Alfred I. Neugut MD, PhD
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  8. Julian A. Abrams MD, MS
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Correspondence to Julian A. Abrams MD, MS.

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Sharaiha, R.Z., Halazun, K.J., Mirza, F. et al. Elevated Preoperative Neutrophil:Lymphocyte Ratio as a Predictor of Postoperative Disease Recurrence in Esophageal Cancer. Ann Surg Oncol 18, 3362–3369 (2011). https://doi.org/10.1245/s10434-011-1754-8

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  • DOI: https://doi.org/10.1245/s10434-011-1754-8

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