Skip to main content

Advertisement

SpringerLink
Log in

The role of systemic inflammatory and nutritional blood-borne markers in predicting response to neoadjuvant chemotherapy and survival in oesophagogastric cancer

  • Original Paper
  • Published:
Medical Oncology Aims and scope Submit manuscript

Abstract

The aim of this study was to interrogate whether blood-borne inflammatory and nutritional markers predict long-term survival and response to neoadjuvant chemotherapy in radically treated oesophagogastric cancer patients. This retrospective study included 246 patients who underwent oesophageal resection for high-grade dysplasia or carcinoma between 2005 and 2010. The predictive value of routine preoperative immunonutritional blood tests was assessed for their association with survival and response to chemotherapy. On multivariate analysis, higher neutrophil–lymphocyte ratio (NLR) (p < 0.0001), N stage (p < 0.0001) and perineural invasion (p < 0.0001) were associated with poor overall survival. Regarding disease-free survival, multivariate analysis showed reduced serum albumin (p = 0.034), N stage (p < 0.0001), M stage (p = 0.037), vascular invasion (p < 0.0001) and presence of R1 resection (p = 0.003) to correlate with earlier recurrence. In those who received neoadjuvant chemotherapy, analysis of prechemotherapy characteristics showed only serum albumin (p = 0.037) to predict pathological response to chemotherapy. Preoperative immunonutritional markers, NLR and albumin, were independent prognostic markers for overall survival and disease-free survival, respectively, after oesophageal cancer resection. Prospective studies evaluating the role of immunonutritional modulation to improve response to chemotherapy and long-term outcome are required.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Koppert LB, Wijnhoven BP, van Dekken H, Tilanus HW, Dinjens WN. The molecular biology of esophageal adenocarcinoma. J Surg Oncol. 2005;92(3):169–90.

    Article  PubMed  CAS  Google Scholar 

  2. Cunningham D, Allum WH, Stenning SP, Thompson JN, Van de Velde CJ, Nicolson M, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006;355(1):11–20.

    Article  PubMed  CAS  Google Scholar 

  3. Fridman WH, Galon J, Pages F, Tartour E, Sautes-Fridman C, Kroemer G. Prognostic and predictive impact of intra- and peritumoral immune infiltrates. Cancer Res. 2011;71(17):5601–5.

    Article  PubMed  CAS  Google Scholar 

  4. Bird-Lieberman EL, Fitzgerald RC. Early diagnosis of oesophageal cancer. Br J Cancer. 2009;101(1):1–6.

    Article  PubMed  CAS  Google Scholar 

  5. Proctor MJ, Morrison DS, Talwar D, Balmer SM, Fletcher CD, O’Reilly DS et al. A comparison of inflammation-based prognostic scores in patients with cancer. A Glasgow inflammation outcome study. Eur J Cancer. 2011;47(17):2633–41.

    Google Scholar 

  6. Balkwill F, Mantovani A. Inflammation and cancer: back to Virchow? Lancet. 2001;357(9255):539–45.

    Article  PubMed  CAS  Google Scholar 

  7. Sallusto F, Geginat J, Lanzavecchia A. Central memory and effector memory T cell subsets: function, generation, and maintenance. Annu Rev Immunol. 2004;22:745–63.

    Article  PubMed  CAS  Google Scholar 

  8. Galon J, Pages F, Marincola FM, Thurin M, Trinchieri G, Fox BA, et al. The immune score as a new possible approach for the classification of cancer. J Transl Med. 2012;10:1.

    Article  PubMed  Google Scholar 

  9. Deans DA, Tan BH, Wigmore SJ, Ross JA, de Beaux AC, Paterson-Brown S, et al. The influence of systemic inflammation, dietary intake and stage of disease on rate of weight loss in patients with gastro-oesophageal cancer. Br J Cancer. 2009;100(1):63–9.

    Article  PubMed  CAS  Google Scholar 

  10. Gao Y, Zhou S, Jiang W, Huang M, Dai X. Effects of ganopoly (a Ganoderma lucidum polysaccharide extract) on the immune functions in advanced-stage cancer patients. Immunol Invest. 2003;32(3):201–15.

    Article  PubMed  Google Scholar 

  11. Jung MR, Park YK, Jeong O, Seon JW, Ryu SY, Kim DY, et al. Elevated preoperative neutrophil to lymphocyte ratio predicts poor survival following resection in late stage gastric cancer. J Surg Oncol. 2011;104(5):504–10.

    Article  PubMed  Google Scholar 

  12. Bruckner HW, Lavin PT, Plaxe SC, Storch JA, Livstone EM. Absolute granulocyte, lymphocyte, and moncyte counts. Useful determinants of prognosis for patients with metastatic cancer of the stomach. JAMA. 1982;247(7):1004–6.

    Article  PubMed  CAS  Google Scholar 

  13. 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(2):197–201.

    Article  PubMed  CAS  Google Scholar 

  14. Hirashima M, Higuchi S, Sakamoto K, Nishiyama T, Okada H. The ratio of neutrophils to lymphocytes and the phenotypes of neutrophils in patients with early gastric cancer. J Cancer Res Clin Oncol. 1998;124(6):329–34.

    Article  PubMed  CAS  Google Scholar 

  15. Ikeda M, Furukawa H, Imamura H, Shimizu J, Ishida H, Masutani S, et al. Poor prognosis associated with thrombocytosis in patients with gastric cancer. Ann Surg Oncol. 2002;9(3):287–91.

    Article  PubMed  Google Scholar 

  16. Shimada H, Oohira G, Okazumi S, Matsubara H, Nabeya Y, Hayashi H, et al. Thrombocytosis associated with poor prognosis in patients with esophageal carcinoma. J Am Coll Surg. 2004;198(5):737–41.

    Article  PubMed  Google Scholar 

  17. 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(4):248–52.

    Article  PubMed  Google Scholar 

  18. Ikeda M, Natsugoe S, Ueno S, Baba M, Aikou T. Significant host- and tumor-related factors for predicting prognosis in patients with esophageal carcinoma. Ann Surg. 2003;238(2):197–202.

    PubMed  Google Scholar 

  19. 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(4):1060–5.

    Article  PubMed  Google Scholar 

  20. Shimada H, Takiguchi N, Kainuma O, Soda H, Ikeda A, Cho A, et al. High preoperative neutrophil–lymphocyte ratio predicts poor survival in patients with gastric cancer. Gastric Cancer. 2010;13(3):170–6.

    Article  PubMed  Google Scholar 

  21. Nozoe T, Ninomiya M, Maeda T, Matsukuma A, Nakashima H, Ezaki T. Prognostic nutritional index: a tool to predict the biological aggressiveness of gastric carcinoma. Surg Today. 2010;40(5):440–3.

    Article  PubMed  Google Scholar 

  22. Hardwick RH. A consensus view and recommendations on the development and practice of minimally invasive oesophagectomy AUGIS/ALSGBI. 2008.

  23. Saklad M. Grading of patients for surgical procedures. Anesthesiol. 1941;2:281–4.

    Article  Google Scholar 

  24. UICC. TNM classification of malignant tumours. 7th ed. New Jersey: Wiley-Blackwell; 2009.

    Google Scholar 

  25. Mandard AM, Dalibard F, Mandard JC, Marnay J, Henry-Amar M, Petiot JF, et al. Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Clinicopathologic correlations. Cancer. 1994;73(11):2680–6.

    Article  PubMed  CAS  Google Scholar 

  26. Bateman AC, Jaynes E, Bateman AR. Rectal cancer staging post neoadjuvant therapy: how should the changes be assessed? Histopathology. 2009;54(6):713–21.

    Article  PubMed  Google Scholar 

  27. Ide H, Nakamura T, Hayashi K, Endo T, Kobayashi A, Eguchi R, et al. Esophageal squamous cell carcinoma: pathology and prognosis. World J Surg. 1994;18(3):321–30.

    Article  PubMed  CAS  Google Scholar 

  28. Lieberman MD, Shriver CD, Bleckner S, Burt M. Carcinoma of the esophagus. Prognostic significance of histologic type. J Thorac Cardiovasc Surg. 1995;109(1):130–8. discussion 9.

    Article  PubMed  CAS  Google Scholar 

  29. Robey-Cafferty SS, el-Naggar AK, Sahin AA, Bruner JM, Ro JY, Cleary KR. Prognostic factors in esophageal squamous carcinoma. A study of histologic features, blood group expression, and DNA ploidy. Am J Clin Pathol. 1991;95(6):844–9.

    PubMed  CAS  Google Scholar 

  30. Paraf F, Flejou JF, Pignon JP, Fekete F, Potet F. Surgical pathology of adenocarcinoma arising in Barrett’s esophagus. analysis of 67 cases. Am J Surg Pathol. 1995;19(2):183–91.

    Article  PubMed  CAS  Google Scholar 

  31. Theunissen PH, Borchard F, Poortvliet DC. Histopathological evaluation of oesophageal carcinoma: the significance of venous invasion. Br J Surg. 1991;78(8):930–2.

    Article  PubMed  CAS  Google Scholar 

  32. Peters CJ, Hardwick RH, Vowler SL, Fitzgerald RC. Generation and validation of a revised classification for oesophageal and junctional adenocarcinoma. Br J Surg. 2009;96(7):724–33.

    Article  PubMed  CAS  Google Scholar 

  33. Tanaka A, Matsumura E, Yosikawa H, Uchida T, Machidera N, Kubo R, et al. An evaluation of neural invasion in esophageal cancer. Surg Today. 1998;28(9):873–8.

    Article  PubMed  CAS  Google Scholar 

  34. Zafirellis K, Dolan K, Fountoulakis A, Dexter SP, Martin IG, Sue-Ling HM. Multivariate analysis of clinical, operative and pathologic features of esophageal cancer: who needs adjuvant therapy? Dis Esophagus. 2002;15(2):155–9.

    Article  PubMed  CAS  Google Scholar 

  35. Sagar PM, Johnston D, McMahon MJ, Dixon MF, Quirke P. Significance of circumferential resection margin involvement after oesophagectomy for cancer. Br J Surg. 1993;80(11):1386–8.

    Article  PubMed  CAS  Google Scholar 

  36. Dexter SP, Sue-Ling H, McMahon MJ, Quirke P, Mapstone N, Martin IG. Circumferential resection margin involvement: an independent predictor of survival following surgery for oesophageal cancer. Gut. 2001;48(5):667–70.

    Article  PubMed  CAS  Google Scholar 

  37. Gibson PH, Croal BL, Cuthbertson BH, Small GR, Ifezulike AI, Gibson G, et al. Preoperative neutrophil–lymphocyte ratio and outcome from coronary artery bypass grafting. Am Heart J. 2007;154(5):995–1002.

    Article  PubMed  CAS  Google Scholar 

  38. Duffy BK, Gurm HS, Rajagopal V, Gupta R, Ellis SG, Bhatt DL. Usefulness of an elevated neutrophil to lymphocyte ratio in predicting long-term mortality after percutaneous coronary intervention. Am J Cardiol. 2006;97(7):993–6.

    Article  PubMed  Google Scholar 

  39. Bhutta H, Agha R, Wong J, Tang TY, Wilson YG, Walsh SR. Neutrophil–lymphocyte ratio predicts medium-term survival following elective major vascular surgery: a cross-sectional study. Vasc Endovasc Surg. 2011;45(3):227–31.

    Article  Google Scholar 

  40. Fock RA, Blatt SL, Beutler B, Pereira J, Tsujita M, de Barros FE, et al. Study of lymphocyte subpopulations in bone marrow in a model of protein-energy malnutrition. Nutrition. 2010;26(10):1021–8.

    Article  PubMed  CAS  Google Scholar 

  41. Lissoni P, Brivio F, Fumagalli L, Messina G, Ghezzi V, Frontini L, et al. Efficacy of cancer chemotherapy in relation to the pretreatment number of lymphocytes in patients with metastatic solid tumors. Int J Biol Markers. 2004;19(2):135–40.

    PubMed  CAS  Google Scholar 

  42. Wang GY, Yang Y, Li H, Zhang J, Jiang N, Li MR, et al. A scoring model based on neutrophil to lymphocyte ratio predicts recurrence of HBV-associated hepatocellular carcinoma after liver transplantation. PLoS ONE. 2011;6(9):e25295.

    Article  PubMed  CAS  Google Scholar 

  43. Grivennikov SI, Greten FR, Karin M. Immunity, inflammation, and cancer. Cell. 2010;140(6):883–99.

    Article  PubMed  CAS  Google Scholar 

  44. Mantovani A, Romero P, Palucka AK, Marincola FM. Tumour immunity: effector response to tumour and role of the microenvironment. Lancet. 2008;371(9614):771–83.

    Article  PubMed  CAS  Google Scholar 

  45. Roxburgh CS, Salmond JM, Horgan PG, Oien KA, McMillan DC. The relationship between the local and systemic inflammatory responses and survival in patients undergoing curative surgery for colon and rectal cancers. J Gastrointest Surg. 2009;13(11):2011–8. discussion 8-9.

    Article  PubMed  Google Scholar 

  46. Roxburgh CS, McMillan DC. Role of systemic inflammatory response in predicting survival in patients with primary operable cancer. Future Oncol. 2010;6(1):149–63.

    Article  PubMed  CAS  Google Scholar 

  47. Sharaiha RZ, Halazun KJ, Mirza F, Port JL, Lee PC, Neugut AI, et al. Elevated preoperative neutrophil: lymphocyte ratio as a predictor of postoperative disease recurrence in esophageal cancer. Ann Surg Oncol. 2011;18(12):3362–9.

    Article  PubMed  Google Scholar 

  48. Crumley AB, Stuart RC, McKernan M, McDonald AC, McMillan DC. Comparison of an inflammation-based prognostic score (GPS) with performance status (ECOG-ps) in patients receiving palliative chemotherapy for gastroesophageal cancer. J Gastroenterol Hepatol. 2008;23(8 Pt 2):e325–9.

    Article  PubMed  CAS  Google Scholar 

  49. Crumley AB, McMillan DC, McKernan M, McDonald AC, Stuart RC. Evaluation of an inflammation-based prognostic score in patients with inoperable gastro-oesophageal cancer. Br J Cancer. 2006;94(5):637–41.

    PubMed  CAS  Google Scholar 

  50. Hwang JE, Kim HN, Kim DE, Choi HJ, Jung SH, Shim HJ, et al. Prognostic significance of a systemic inflammatory response in patients receiving first-line palliative chemotherapy for recurred or metastatic gastric cancer. BMC Cancer. 2011;11:489.

    Article  PubMed  CAS  Google Scholar 

  51. Vashist YK, Loos J, Dedow J, Tachezy M, Uzunoglu G, Kutup A, et al. Glasgow prognostic score is a predictor of perioperative and long-term outcome in patients with only surgically treated esophageal cancer. Ann Surg Oncol. 2011;18(4):1130–8.

    Article  PubMed  Google Scholar 

  52. Altman DG, Royston P. The cost of dichotomising continuous variables. BMJ. 2006;332(7549):1080.

    Article  PubMed  Google Scholar 

  53. Royston P, Altman DG, Sauerbrei W. Dichotomizing continuous predictors in multiple regression: a bad idea. Stat Med. 2006;25(1):127–41.

    Article  PubMed  Google Scholar 

  54. Muscaritoli M, Bossola M, Aversa Z, Bellantone R, Rossi Fanelli F. Prevention and treatment of cancer cachexia: new insights into an old problem. Eur J Cancer. 2006;42(1):31–41.

    Article  PubMed  CAS  Google Scholar 

  55. Chua W, Charles KA, Baracos VE, Clarke SJ. Neutrophil/lymphocyte ratio predicts chemotherapy outcomes in patients with advanced colorectal cancer. Br J Cancer. 2011;104(8):1288–95.

    Article  PubMed  CAS  Google Scholar 

  56. Crumley AB, Stuart RC, McKernan M, McMillan DC. Is hypoalbuminemia an independent prognostic factor in patients with gastric cancer? World J Surg. 2010;34(10):2393–8.

    Article  PubMed  Google Scholar 

  57. McMillan DC, Scott HR, Watson WS, Preston T, Milroy R, McArdle CS. Longitudinal study of body cell mass depletion and the inflammatory response in cancer patients. Nutr Cancer. 1998;31(2):101–5.

    Article  PubMed  CAS  Google Scholar 

  58. Sato H, Tsubosa Y, Kawano T. Correlation between the pretherapeutic neutrophil to lymphocyte ratio and the pathologic response to neoadjuvant chemotherapy in patients with advanced esophageal cancer. World J Surg. 2012;36(3):617–22.

    Article  PubMed  Google Scholar 

  59. van Eys J. Effect of nutritional status on responses to therapy. Cancer Res. 1982;42(2 Suppl):747s–53s.

    PubMed  Google Scholar 

  60. Belghiti J, Langonnet F, Bourstyn E, Fekete F. Surgical implications of malnutrition and immunodeficiency in patients with carcinoma of the oesophagus. Br J Surg. 1983;70(6):339–41.

    Article  PubMed  CAS  Google Scholar 

  61. Saito T, Zeze K, Kuwahara A, Miyahara M, Kobayashi M. Correlations between preoperative malnutrition and septic complications of esophageal cancer surgery. Nutrition. 1990;6(4):303–8.

    PubMed  CAS  Google Scholar 

  62. Kao SC, Pavlakis N, Harvie R, Vardy JL, Boyer MJ, van Zandwijk N, et al. High blood neutrophil-to-lymphocyte ratio is an indicator of poor prognosis in malignant mesothelioma patients undergoing systemic therapy. Clin Cancer Res. 2010;16(23):5805–13.

    Article  PubMed  CAS  Google Scholar 

  63. Stratton RJ, Hackston A, Longmore D, Dixon R, Price S, Stroud M, et al. Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the ‘malnutrition universal screening tool (MUST) for adults. Br J Nutr. 2004;92(5):799–808.

    Article  PubMed  CAS  Google Scholar 

  64. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003;22(4):415–21.

    Article  PubMed  CAS  Google Scholar 

  65. Gupta D, Lis CG. Pretreatment serum albumin as a predictor of cancer survival: a systematic review of the epidemiological literature. Nutr J. 2010;9:69.

    Article  PubMed  Google Scholar 

  66. McMillan DC, Watson WS, O’Gorman P, Preston T, Scott HR, McArdle CS. Albumin concentrations are primarily determined by the body cell mass and the systemic inflammatory response in cancer patients with weight loss. Nutr Cancer. 2001;39(2):210–3.

    Article  PubMed  CAS  Google Scholar 

  67. Don BR, Kaysen G. Serum albumin: relationship to inflammation and nutrition. Semin Dial. 2004;17(6):432–7.

    Article  PubMed  Google Scholar 

  68. Proctor MJ, Morrison DS, Talwar D, Balmer SM, Fletcher CD, O’Reilly DS, et al. A comparison of inflammation-based prognostic scores in patients with cancer. A Glasgow inflammation outcome study. Eur J Cancer. 2011;47(17):2633–41.

    Article  PubMed  Google Scholar 

  69. Oh BS, Jang JW, Kwon JH, You CR, Chung KW, Kay CS, et al. Prognostic value of C-reactive protein and neutrophil-to-lymphocyte ratio in patients with hepatocellular carcinoma. BMC Cancer. 2013;13(1):78.

    Article  PubMed  CAS  Google Scholar 

  70. Farreras N, Artigas V, Cardona D, Rius X, Trias M, Gonzalez JA. Effect of early postoperative enteral immunonutrition on wound healing in patients undergoing surgery for gastric cancer. Clin Nutr. 2005;24(1):55–65.

    Article  PubMed  Google Scholar 

  71. Senkal M, Zumtobel V, Bauer KH, Marpe B, Wolfram G, Frei A, et al. Outcome and cost-effectiveness of perioperative enteral immunonutrition in patients undergoing elective upper gastrointestinal tract surgery: a prospective randomized study. Arch Surg. 1999;134(12):1309–16.

    Article  PubMed  CAS  Google Scholar 

  72. Lobo DN, Williams RN, Welch NT, Aloysius MM, Nunes QM, Padmanabhan J, et al. Early postoperative jejunostomy feeding with an immune modulating diet in patients undergoing resectional surgery for upper gastrointestinal cancer: a prospective, randomized, controlled, double-blind study. Clin Nutr. 2006;25(5):716–26.

    Article  PubMed  Google Scholar 

  73. Sultan J, Griffin SM, Di Franco F, Kirby JA, Shenton BK, Seal CJ, et al. Randomized clinical trial of omega-3 fatty acid-supplemented enteral nutrition versus standard enteral nutrition in patients undergoing oesophagogastric cancer surgery. Br J Surg. 2012;99(3):346–55.

    Article  PubMed  CAS  Google Scholar 

  74. Calder PC. n-3 polyunsaturated fatty acids, inflammation, and inflammatory diseases. Am J Clin Nutr. 2006;83(6 Suppl):1505S–19S.

    PubMed  CAS  Google Scholar 

  75. Das D, Chilton AP, Jankowski JA. Chemoprevention of oesophageal cancer and the AspECT trial. Recent Results Cancer Res. 2009;181:161–9.

    Article  PubMed  CAS  Google Scholar 

  76. Rodrigues HG, Vinolo MA, Magdalon J, Vitzel K, Nachbar RT, Pessoa AF, et al. Oral administration of oleic or linoleic Acid accelerates the inflammatory phase of wound healing. J Invest Dermatol. 2012;132(1):208–15.

    Article  PubMed  CAS  Google Scholar 

  77. Calder PC. Immunonutrition in surgical and critically ill patients. Br J Nutr. 2007;98(Suppl 1):S133–9.

    PubMed  CAS  Google Scholar 

  78. Bonatto SJ, Oliveira HH, Nunes EA, Pequito D, Iagher F, Coelho I et al. Fish oil supplementation improves neutrophil function during cancer chemotherapy. Lipids. 2011;47(4):383–9.

    Google Scholar 

  79. Mudge L, Isenring E, Jamieson GG. Immunonutrition in patients undergoing esophageal cancer resection. Dis Esophagus. 2011;24(3):160–5.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

F. Noble is supported by a clinical research training fellowship from Cancer Research UK. J. Hopkins is supported by a NIHR clinical lectureship. T. J. Underwood is supported by a MRC clinician scientist fellowship.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, Hampshire, SO16 6YD, UK

    Fergus Noble, James Hopkins, Nathan Curtis, Jamie J. Kelly, Ian S. Bailey, James P. Byrne & Timothy J. Underwood

  2. Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Somers Cancer Research Building, MP824, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK

    Fergus Noble, James Hopkins, Nathan Curtis, Andrew R. Bateman & Timothy J. Underwood

  3. Department of Cellular Pathology, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK

    Adrian C. Bateman

Authors
  1. Fergus Noble
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. James Hopkins
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nathan Curtis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jamie J. Kelly
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ian S. Bailey
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. James P. Byrne
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Adrian C. Bateman
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Andrew R. Bateman
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Timothy J. Underwood
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Timothy J. Underwood.

Additional information

On behalf of the South Coast Cancer Collaboration—Oesophago-Gastric (SC-OG).

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 112 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Noble, F., Hopkins, J., Curtis, N. et al. The role of systemic inflammatory and nutritional blood-borne markers in predicting response to neoadjuvant chemotherapy and survival in oesophagogastric cancer. Med Oncol 30, 596 (2013). https://doi.org/10.1007/s12032-013-0596-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s12032-013-0596-6

Keywords

Search

Navigation