Systemic inflammatory dynamics during chemoradiotherapy predict response, relapse, metastasis, and survival in esophageal carcinoma. Issue 2 (4th December 2019)

• Record Type: Journal Article
• Authors: Sherry, Alexander D.; Newman, Neil B.; Anderson, Joshua L.; Osmundson, Evan C.
• Is Part Of: Journal of surgical oncology. Volume 121:Issue 2(2020)
• Page Start: 303
• Page End: 312
• Publication Date: 2019-12-04
• Subjects: cancer‐related inflammation -- chemoradiation -- esophageal carcinoma -- neutrophil:lymphocyte ratio -- prognostic biomarkers; Cancer -- Surgery -- Periodicals; Neoplasms -- Periodicals; 616
• DOI: 10.1002/jso.25793
• Languages: English
• ISSNs: 0022-4790

Abstract

Abstract: Background and Objectives: Lymphopenia associated with chemoradiotherapy predicts prognosis in esophageal carcinoma. The purpose of our study was to evaluate alterations in hematologic measures of inflammation during chemoradiation. Methods: We performed an observational study evaluating adults treated with chemoradiation in the neoadjuvant or definitive setting for stage II‐III esophageal carcinoma. Multivariable logistic regression evaluated predictors of pathologic response. Survival was analyzed by time‐varying multivariable Cox proportional hazards regressions. Results: A total of 94 patients were included with median follow‐up of 1.6 years. Elevated neutrophil:lymphocyte ratio (NLR) was predictive of incomplete pathologic response to neoadjuvant chemoradiation (OR, 1.07; P = .0030) as well as shorter distant metastasis‐free survival (HR, 1.01; P = .0369) and reduced overall survival (HR, 1.01; P = .0448). An NLR > 5.55 in week two of chemoradiation predicted shorter overall survival ( P = .0070). Upon adjusted analysis, NLR was independently associated with reduced probability of complete pathologic response (OR, 0.80; P = .0291), as well as poor histologic response to neoadjuvant chemoradiation (OR, 1.05; P = .0303), shorter disease‐free survival (HR, 1.02; P = .0077), and reduced overall survival (HR, 1.02; P = .0070). Conclusions: Dynamic time‐dependent changes in NLR during chemoradiation predict response, relapse, metastasis, and survival in esophageal carcinoma. Prospective validation is warranted.