Skip to main content
Erschienen in: Journal of Gastrointestinal Surgery 4/2017

12.01.2017 | Original Article

Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios can Predict Treatment Response to Neoadjuvant Therapy in Esophageal Cancer

verfasst von: Patrick J. McLaren, Nathan W. Bronson, Kyle D. Hart, Gina M. Vaccaro, Ken M. Gatter, Charles R. Thomas Jr., John G. Hunter, James P. Dolan

Erschienen in: Journal of Gastrointestinal Surgery | Ausgabe 4/2017

Einloggen, um Zugang zu erhalten

Abstract

Introduction

We hypothesized that serum neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios may predict pathologic complete response to neoadjuvant chemoradiotherapy in esophageal cancer patients. The ability to predict favorable treatment response to therapy may aid in determining optimal treatment regimens.

Materials and Methods

A retrospective review of a prospective esophageal disease registry was conducted. Neutrophil-to-lymphocyte ratio was defined as the pre-chemoradiotherapy serum neutrophil count divided by lymphocyte count. Platelet-to-lymphocyte ratio was similarly defined. Logistic regression was applied to analyze these ratios and their effect on pathologic complete response. A Cox proportional-hazards model was used to analyze survival.

Results

Sixty patients were included. Elevated neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were both negative predictors of pathologic complete response (odds ratio: 0.62; 95% confidence interval: 0.37–0.89, P = 0.037 and odds ratio: 0.91; 95% confidence interval: 0.82–0.98, P = 0.028, respectively). Only platelet-to-lymphocyte ratio was predictive of decreased overall survival (hazard ratio: 1.05, 95% confidence interval: 0.94–1.16, P = 0.40).

Conclusion

Elevated neutrophil and platelet-to-lymphocyte ratios were significant predictors of a poor treatment response to neoadjuvant therapy. Only elevated platelet-to-lymphocyte ratio was predictive of worse overall survival. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios may offer a simple serum test to assess the likelihood of a pathologic complete response after neoadjuvant therapy in esophageal cancer.
Literatur
1.
Zurück zum Zitat Howlader N, N.A., Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA. SEER Cancer Statistics Review, 1975-2012. 2015 January 24, 2016 [cited 2016 Jan 24, 2016]; April 2015:[Based on November 2014 SEER data submission, posted to the SEER web site, April 2015]. Available from: http://seer.cancer.gov/csr/1975_2012/. Howlader N, N.A., Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA. SEER Cancer Statistics Review, 1975-2012. 2015 January 24, 2016 [cited 2016 Jan 24, 2016]; April 2015:[Based on November 2014 SEER data submission, posted to the SEER web site, April 2015]. Available from: http://​seer.​cancer.​gov/​csr/​1975_​2012/​.
2.
Zurück zum Zitat Brown, L.M., S.S. Devesa, and W.H. Chow, Incidence of adenocarcinoma of the esophagus among white Americans by sex, stage, and age. J Natl Cancer Inst, 2008. 100(16): p. 1184-7.CrossRefPubMedPubMedCentral Brown, L.M., S.S. Devesa, and W.H. Chow, Incidence of adenocarcinoma of the esophagus among white Americans by sex, stage, and age. J Natl Cancer Inst, 2008. 100(16): p. 1184-7.CrossRefPubMedPubMedCentral
3.
Zurück zum Zitat van Hagen, P., M.C. Hulshof, J.J. van Lanschot, E.W. Steyerberg, M.I. van Berge Henegouwen, B.P. Wijnhoven, D.J. Richel, G.A. Nieuwenhuijzen, G.A. Hospers, J.J. Bonenkamp, M.A. Cuesta, R.J. Blaisse, O.R. Busch, F.J. ten Kate, G.J. Creemers, C.J. Punt, J.T. Plukker, H.M. Verheul, E.J. Spillenaar Bilgen, H. van Dekken, M.J. van der Sangen, T. Rozema, K. Biermann, J.C. Beukema, A.H. Piet, C.M. van Rij, J.G. Reinders, H.W. Tilanus, A. van der Gaast, and C. Group, Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med, 2012. 366(22): p. 2074-84.CrossRefPubMed van Hagen, P., M.C. Hulshof, J.J. van Lanschot, E.W. Steyerberg, M.I. van Berge Henegouwen, B.P. Wijnhoven, D.J. Richel, G.A. Nieuwenhuijzen, G.A. Hospers, J.J. Bonenkamp, M.A. Cuesta, R.J. Blaisse, O.R. Busch, F.J. ten Kate, G.J. Creemers, C.J. Punt, J.T. Plukker, H.M. Verheul, E.J. Spillenaar Bilgen, H. van Dekken, M.J. van der Sangen, T. Rozema, K. Biermann, J.C. Beukema, A.H. Piet, C.M. van Rij, J.G. Reinders, H.W. Tilanus, A. van der Gaast, and C. Group, Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med, 2012. 366(22): p. 2074-84.CrossRefPubMed
4.
Zurück zum Zitat Nabavizadeh, N., R. Shukla, D.A. Elliott, T. Mitin, G.M. Vaccaro, J.P. Dolan, R.J. Maggiore, P.H. Schipper, J.G. Hunter, C.R. Thomas, Jr., and J.M. Holland, Preoperative carboplatin and paclitaxel-based chemoradiotherapy for esophageal carcinoma: results of a modified CROSS regimen utilizing radiation doses greater than 41.4 Gy. Dis Esophagus, 2015. Nabavizadeh, N., R. Shukla, D.A. Elliott, T. Mitin, G.M. Vaccaro, J.P. Dolan, R.J. Maggiore, P.H. Schipper, J.G. Hunter, C.R. Thomas, Jr., and J.M. Holland, Preoperative carboplatin and paclitaxel-based chemoradiotherapy for esophageal carcinoma: results of a modified CROSS regimen utilizing radiation doses greater than 41.4 Gy. Dis Esophagus, 2015.
5.
Zurück zum Zitat Berger, A.C., J. Farma, W.J. Scott, G. Freedman, L. Weiner, J.D. Cheng, H. Wang, and M. Goldberg, Complete response to neoadjuvant chemoradiotherapy in esophageal carcinoma is associated with significantly improved survival. J Clin Oncol, 2005. 23(19): p. 4330-7.CrossRefPubMed Berger, A.C., J. Farma, W.J. Scott, G. Freedman, L. Weiner, J.D. Cheng, H. Wang, and M. Goldberg, Complete response to neoadjuvant chemoradiotherapy in esophageal carcinoma is associated with significantly improved survival. J Clin Oncol, 2005. 23(19): p. 4330-7.CrossRefPubMed
6.
Zurück zum Zitat Hanahan, D. and R.A. Weinberg, Hallmarks of cancer: the next generation. Cell, 2011. 144(5): p. 646-74.CrossRefPubMed Hanahan, D. and R.A. Weinberg, Hallmarks of cancer: the next generation. Cell, 2011. 144(5): p. 646-74.CrossRefPubMed
7.
Zurück zum Zitat Carruthers, R., L.M. Tho, J. Brown, S. Kakumanu, E. McCartney, and A.C. McDonald, Systemic inflammatory response is a predictor of outcome in patients undergoing preoperative chemoradiation for locally advanced rectal cancer. Colorectal Dis, 2012. 14(10): p. e701-7.CrossRefPubMed Carruthers, R., L.M. Tho, J. Brown, S. Kakumanu, E. McCartney, and A.C. McDonald, Systemic inflammatory response is a predictor of outcome in patients undergoing preoperative chemoradiation for locally advanced rectal cancer. Colorectal Dis, 2012. 14(10): p. e701-7.CrossRefPubMed
8.
Zurück zum Zitat Hasegawa, S., H. Eguchi, A. Tomokuni, Y. Tomimaru, T. Asaoka, H. Wada, N. Hama, K. Kawamoto, S. Kobayashi, S. Marubashi, M. Konnno, H. Ishii, M. Mori, Y. Doki, and H. Nagano, Pre-treatment neutrophil to lymphocyte ratio as a predictive marker for pathological response to preoperative chemoradiotherapy in pancreatic cancer. Oncol Lett, 2016. 11(2): p. 1560-1566.PubMed Hasegawa, S., H. Eguchi, A. Tomokuni, Y. Tomimaru, T. Asaoka, H. Wada, N. Hama, K. Kawamoto, S. Kobayashi, S. Marubashi, M. Konnno, H. Ishii, M. Mori, Y. Doki, and H. Nagano, Pre-treatment neutrophil to lymphocyte ratio as a predictive marker for pathological response to preoperative chemoradiotherapy in pancreatic cancer. Oncol Lett, 2016. 11(2): p. 1560-1566.PubMed
9.
Zurück zum Zitat Jung, J., S.Y. Park, S.J. Park, and J. Park, Prognostic value of the neutrophil-to-lymphocyte ratio for overall and disease-free survival in patients with surgically treated esophageal squamous cell carcinoma. Tumour Biol, 2015. Jung, J., S.Y. Park, S.J. Park, and J. Park, Prognostic value of the neutrophil-to-lymphocyte ratio for overall and disease-free survival in patients with surgically treated esophageal squamous cell carcinoma. Tumour Biol, 2015.
10.
Zurück zum Zitat Pang, W., N. Lou, C. Jin, C. Hu, C. Arvine, G. Zhu, and X. Shen, Combination of preoperative platelet/lymphocyte and neutrophil/lymphocyte rates and tumor-related factors to predict lymph node metastasis in patients with gastric cancer. Eur J Gastroenterol Hepatol, 2016. Pang, W., N. Lou, C. Jin, C. Hu, C. Arvine, G. Zhu, and X. Shen, Combination of preoperative platelet/lymphocyte and neutrophil/lymphocyte rates and tumor-related factors to predict lymph node metastasis in patients with gastric cancer. Eur J Gastroenterol Hepatol, 2016.
11.
Zurück zum Zitat Mantovani, A., P. Allavena, A. Sica, and F. Balkwill, Cancer-related inflammation. Nature, 2008. 454(7203): p. 436-44.CrossRefPubMed Mantovani, A., P. Allavena, A. Sica, and F. Balkwill, Cancer-related inflammation. Nature, 2008. 454(7203): p. 436-44.CrossRefPubMed
12.
Zurück zum Zitat Xie, X., K.J. Luo, Y. Hu, J.Y. Wang, and J. Chen, Prognostic value of preoperative platelet-lymphocyte and neutrophil-lymphocyte ratio in patients undergoing surgery for esophageal squamous cell cancer. Dis Esophagus, 2016. 29(1): p. 79-85.CrossRefPubMed Xie, X., K.J. Luo, Y. Hu, J.Y. Wang, and J. Chen, Prognostic value of preoperative platelet-lymphocyte and neutrophil-lymphocyte ratio in patients undergoing surgery for esophageal squamous cell cancer. Dis Esophagus, 2016. 29(1): p. 79-85.CrossRefPubMed
13.
Zurück zum Zitat Yodying, H., A. Matsuda, M. Miyashita, S. Matsumoto, N. Sakurazawa, M. Yamada, and E. Uchida, Prognostic Significance of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Oncologic Outcomes of Esophageal Cancer: A Systematic Review and Meta-analysis. Ann Surg Oncol, 2016. 23(2): p. 646-54.CrossRefPubMed Yodying, H., A. Matsuda, M. Miyashita, S. Matsumoto, N. Sakurazawa, M. Yamada, and E. Uchida, Prognostic Significance of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Oncologic Outcomes of Esophageal Cancer: A Systematic Review and Meta-analysis. Ann Surg Oncol, 2016. 23(2): p. 646-54.CrossRefPubMed
14.
Zurück zum Zitat Chang, E.Y., C.A. Smith, C.L. Corless, C.R. Thomas, Jr., J.G. Hunter, and B.A. Jobe, Accuracy of pathologic examination in detection of complete response after chemoradiation for esophageal cancer. Am J Surg, 2007. 193(5): p. 614-7; discussion 617.CrossRefPubMed Chang, E.Y., C.A. Smith, C.L. Corless, C.R. Thomas, Jr., J.G. Hunter, and B.A. Jobe, Accuracy of pathologic examination in detection of complete response after chemoradiation for esophageal cancer. Am J Surg, 2007. 193(5): p. 614-7; discussion 617.CrossRefPubMed
15.
Zurück zum Zitat Hosmer, D.W. and S. Lemeshow, Applied logistic regression. 2nd ed. Wiley series in probability and statistics Texts and references section. 2000, New York: Wiley. xii, 373 p. Hosmer, D.W. and S. Lemeshow, Applied logistic regression. 2nd ed. Wiley series in probability and statistics Texts and references section. 2000, New York: Wiley. xii, 373 p.
16.
Zurück zum Zitat Lorente, D., J. Mateo, A.J. Templeton, Z. Zafeiriou, D. Bianchini, R. Ferraldeschi, A. Bahl, L. Shen, Z. Su, O. Sartor, and J.S. de Bono, Baseline neutrophil-lymphocyte ratio (NLR) is associated with survival and response to treatment with second-line chemotherapy for advanced prostate cancer independent of baseline steroid use. Ann Oncol, 2015. 26(4): p. 750-5.CrossRefPubMed Lorente, D., J. Mateo, A.J. Templeton, Z. Zafeiriou, D. Bianchini, R. Ferraldeschi, A. Bahl, L. Shen, Z. Su, O. Sartor, and J.S. de Bono, Baseline neutrophil-lymphocyte ratio (NLR) is associated with survival and response to treatment with second-line chemotherapy for advanced prostate cancer independent of baseline steroid use. Ann Oncol, 2015. 26(4): p. 750-5.CrossRefPubMed
18.
Zurück zum Zitat Dhungel, B., B.S. Diggs, J.G. Hunter, B.C. Sheppard, J.T. Vetto, and J.P. Dolan, Patient and peri-operative predictors of morbidity and mortality after esophagectomy: American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), 2005-2008. J Gastrointest Surg, 2010. 14(10): p. 1492-501.CrossRefPubMed Dhungel, B., B.S. Diggs, J.G. Hunter, B.C. Sheppard, J.T. Vetto, and J.P. Dolan, Patient and peri-operative predictors of morbidity and mortality after esophagectomy: American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), 2005-2008. J Gastrointest Surg, 2010. 14(10): p. 1492-501.CrossRefPubMed
19.
Zurück zum Zitat McCulloch, P., J. Ward, P.P. Tekkis, A.g.o. surgeons, and G. British Oesophago-Gastric Cancer, Mortality and morbidity in gastro-oesophageal cancer surgery: initial results of ASCOT multicentre prospective cohort study. BMJ, 2003. 327(7425): p. 1192-7.CrossRefPubMedPubMedCentral McCulloch, P., J. Ward, P.P. Tekkis, A.g.o. surgeons, and G. British Oesophago-Gastric Cancer, Mortality and morbidity in gastro-oesophageal cancer surgery: initial results of ASCOT multicentre prospective cohort study. BMJ, 2003. 327(7425): p. 1192-7.CrossRefPubMedPubMedCentral
20.
Zurück zum Zitat Bedenne, L., P. Michel, O. Bouche, C. Milan, C. Mariette, T. Conroy, D. Pezet, B. Roullet, J.F. Seitz, J.P. Herr, B. Paillot, P. Arveux, F. Bonnetain, and C. Binquet, Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus: FFCD 9102. J Clin Oncol, 2007. 25(10): p. 1160-8.CrossRefPubMed Bedenne, L., P. Michel, O. Bouche, C. Milan, C. Mariette, T. Conroy, D. Pezet, B. Roullet, J.F. Seitz, J.P. Herr, B. Paillot, P. Arveux, F. Bonnetain, and C. Binquet, Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus: FFCD 9102. J Clin Oncol, 2007. 25(10): p. 1160-8.CrossRefPubMed
21.
Zurück zum Zitat Stahl, M., M. Stuschke, N. Lehmann, H.J. Meyer, M.K. Walz, S. Seeber, B. Klump, W. Budach, R. Teichmann, M. Schmitt, G. Schmitt, C. Franke, and H. Wilke, Chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the esophagus. J Clin Oncol, 2005. 23(10): p. 2310-7.CrossRefPubMed Stahl, M., M. Stuschke, N. Lehmann, H.J. Meyer, M.K. Walz, S. Seeber, B. Klump, W. Budach, R. Teichmann, M. Schmitt, G. Schmitt, C. Franke, and H. Wilke, Chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the esophagus. J Clin Oncol, 2005. 23(10): p. 2310-7.CrossRefPubMed
22.
Zurück zum Zitat Piessen, G., M. Messager, X. Mirabel, N. Briez, W.B. Robb, A. Adenis, and C. Mariette, Is there a role for surgery for patients with a complete clinical response after chemoradiation for esophageal cancer? An intention-to-treat case-control study. Ann Surg, 2013. 258(5): p. 793-9; discussion 799-800.CrossRefPubMed Piessen, G., M. Messager, X. Mirabel, N. Briez, W.B. Robb, A. Adenis, and C. Mariette, Is there a role for surgery for patients with a complete clinical response after chemoradiation for esophageal cancer? An intention-to-treat case-control study. Ann Surg, 2013. 258(5): p. 793-9; discussion 799-800.CrossRefPubMed
23.
Zurück zum Zitat Trotter, J.L., G.E. Rodey, and H.M. Gebel, Azathioprine decreases suppressor T cells in patients with multiple sclerosis. N Engl J Med, 1982. 306(6): p. 365-6.PubMed Trotter, J.L., G.E. Rodey, and H.M. Gebel, Azathioprine decreases suppressor T cells in patients with multiple sclerosis. N Engl J Med, 1982. 306(6): p. 365-6.PubMed
24.
Zurück zum Zitat Poppe, D., I. Tiede, G. Fritz, C. Becker, B. Bartsch, S. Wirtz, D. Strand, S. Tanaka, P.R. Galle, X.R. Bustelo, and M.F. Neurath, Azathioprine suppresses ezrin-radixin-moesin-dependent T cell-APC conjugation through inhibition of Vav guanosine exchange activity on Rac proteins. J Immunol, 2006. 176`(1): p. 640-51.CrossRefPubMedPubMedCentral Poppe, D., I. Tiede, G. Fritz, C. Becker, B. Bartsch, S. Wirtz, D. Strand, S. Tanaka, P.R. Galle, X.R. Bustelo, and M.F. Neurath, Azathioprine suppresses ezrin-radixin-moesin-dependent T cell-APC conjugation through inhibition of Vav guanosine exchange activity on Rac proteins. J Immunol, 2006. 176`(1): p. 640-51.CrossRefPubMedPubMedCentral
Metadaten
Titel
Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios can Predict Treatment Response to Neoadjuvant Therapy in Esophageal Cancer
verfasst von
Patrick J. McLaren
Nathan W. Bronson
Kyle D. Hart
Gina M. Vaccaro
Ken M. Gatter
Charles R. Thomas Jr.
John G. Hunter
James P. Dolan
Publikationsdatum
12.01.2017
Verlag
Springer US
Erschienen in
Journal of Gastrointestinal Surgery / Ausgabe 4/2017
Print ISSN: 1091-255X
Elektronische ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-016-3351-4

Weitere Artikel der Ausgabe 4/2017

Journal of Gastrointestinal Surgery 4/2017 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.