World Journal of Surgery

, Volume 36, Issue 3, pp 617–622 | Cite as

Correlation Between the Pretherapeutic Neutrophil to Lymphocyte Ratio and the Pathologic Response to Neoadjuvant Chemotherapy in Patients With Advanced Esophageal Cancer




An elevation in the neutrophil-to-lymphocyte ratio (NLR) has been shown to be associated with a poorer prognosis in patients with various tumors. The aim of this retrospective study was to clarify the correlation of the pretherapeutic NLR with the prognostic value of the pathologic response to neoadjuvant chemotherapy (NAC) in patients with advanced esophageal cancer.


This study was a retrospective review of 83 patients undergoing NAC for advanced esophageal cancer following esophagectomy. The NLR was measured before NAC, and the pathologic responses to NAC were evaluated.


A comparison was performed for those whose pathology responded (responders) (G3/G2/G1b) and nonresponders (G1a/G0). In a univariate analysis, the cStage (P = 0.005), cN (P = 0.0001), and NLR (P = 0.005) were statistically significant parameters. A multivariate analysis revealed that the factors independently associated with pathologic responses were the pretreatment NLR (<2.2/≥2.2) (P = 0.043) and lymph nodes metastasis (P = 0.002). The pretreatment NLR (<2.2/≥2.2) was found to be a statistically significant useful predictive marker for a pathologic response (P = 0.001). The pathologic response rates were 56% in the patients with an NLR <2.2 and 21% in patients with an NLR of ≥2.2.


Our study is the first to demonstrate that the pretherapeutic NLR can be used as a predictor for chemosensitivity of thoracic esophageal cancer. Preoperative evaluation based on the clinical N stage and NLR may be easily used in routine clinical practice.


Esophageal Cancer Esophageal Squamous Cell Carcinoma Pathologic Response Glasgow Prognostic Score Total Lymphocyte Count 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors declare no financial or any other type of support.


  1. 1.
    Anonymous (2011) Center for Cancer Control and Information Services, National Cancer Center, Japan. Cancer mortality (1958–2009). xls. Accessed on 3 June, 2011
  2. 2.
    Sugimachi K, Inokuchi K, Kuwano H et al (1983) Patterns of recurrence after curative resection for carcinoma of the thoracic part of the esophagus. Surg Gynecol Obstet 157:537–540PubMedGoogle Scholar
  3. 3.
    Medical Research Council Oesophageal Cancer Working Party (2002) Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomized controlled trial. Lancet 359:1727–1733CrossRefGoogle Scholar
  4. 4.
    Kaklamanos IG, Walker GR, Ferry K et al (2003) Neoadjuvant treatment for resectable cancer of the esophagus and the gastroesophageal junction: a meta-analysis of randomized clinical trials. Ann Surg Oncol 10:754–761PubMedCrossRefGoogle Scholar
  5. 5.
    Igaki H, Kato H, Ando N, et al (2008) A randomized trial of postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus neoadjuvant chemotherapy for clinical stage II/III squamous cell carcinoma of the thoracic esophagus (JCOG 9907). Proc Am Soc Oncol 26:4510 (abstract)Google Scholar
  6. 6.
    Law S, Fok M, Chow S et al (1997) Preoperative chemotherapy versus surgical therapy alone for squamous cell carcinoma of the esophagus: a prospective randomized trial. J Thorac Cardiovasc Surg 114:210–217PubMedCrossRefGoogle Scholar
  7. 7.
    Duhaylongsod FG, Gottfried MR, Iglehart JD et al (1995) The significance of c-erb B-2 and p53 immunoreactivity in patients with adenocarcinoma of the esophagus. Ann Surg 221:677–683PubMedCrossRefGoogle Scholar
  8. 8.
    Hickey K, Grehan D, Reid IM et al (1994) Expression of epidermal growth factor receptor and proliferating cell nuclear antigen predicts response of esophageal squamous cell carcinoma to chemoradiotherapy. Cancer 74:1693–1698PubMedCrossRefGoogle Scholar
  9. 9.
    Imdahl A, Bognar G, Schulte-Monting J et al (2002) Predictive factors for response to neoadjuvant therapy in patients with oesophageal cancer. Eur J Cardiothorac Surg 21:657–663PubMedCrossRefGoogle Scholar
  10. 10.
    Tomimaru Y, Yano M, Takachi K et al (2008) Correlation between pretherapeutic D-dimer levels and response to neoadjuvant chemotherapy in patients with advanced esophageal cancer. Dis Esophagus 21:281–287PubMedCrossRefGoogle Scholar
  11. 11.
    Hara M, Matsuzaki Y, Shimizu T et al (2007) Preoperative serum C-reactive protein level in non-small cell lung cancer. Anticancer Res 27:3001–3004PubMedGoogle Scholar
  12. 12.
    Beer TM, Lalani AS, Lee S et al (2008) C-reactive protein as a prognostic marker for men with androgen-independent prostate cancer: results from the ASCENT trial. Cancer 112:2377–2383PubMedCrossRefGoogle Scholar
  13. 13.
    Hefler LA, Concin N, Hofstetter G et al (2008) Serum C-reactive protein as a independent prognostic variable in patients with ovarian cancer. Clin Cancer Res 14:710–714PubMedCrossRefGoogle Scholar
  14. 14.
    Shimada H, Nabeya Y, Okazumi S et al (2003) Elevation of preoperative serum C-reactive protein level is related to poor prognosis in esophageal squamous cell carcinoma. J Surg Oncol 83:248–252PubMedCrossRefGoogle Scholar
  15. 15.
    Nozoe T, Iguchi T, Adachi E et al (2011) Preoperative elevation of serum C-reactive protein as an independent prognostic indicator for gastric cancer. Surg Today 41:510–513PubMedCrossRefGoogle Scholar
  16. 16.
    Crumley AB, McMillan DC, McKernan M et al (2006) Evaluation of an inflammation-based prognostic score in patients with inoperative gastro-oesophageal cancer. Br J Cancer 94:637–641PubMedGoogle Scholar
  17. 17.
    McMillan DC, Canna K, McArdle CS (2003) Systemic inflammatory response predicts survival following curative resection of colorectal cancer. Br J Surg 90:215–219PubMedCrossRefGoogle Scholar
  18. 18.
    McMillan DC, Elahi MM, Sattar N et al (2001) Measurement of the systemic inflammatory response predicts cancer-specific and non-cancer survival in patients with cancer. Nutr Cancer 41:64–69PubMedGoogle Scholar
  19. 19.
    Kobayashi T, Teruya M, Kishiki T et al (2008) Inflammation-based prognostic score, prior to neoadjuvant chemoradiotherapy, predicts postoperative outcome in patients with esophageal squamous cell carcinoma. Surgery 144:729–735PubMedCrossRefGoogle Scholar
  20. 20.
    Duffy BK, Gurm HS, Rajagopal V et al (2006) Usefulness of an elevated neutrophil to lymphocyte ratio in predicting long-term mortality after percutaneous coronary intervention. Am J Cardiol 97:993–996PubMedCrossRefGoogle Scholar
  21. 21.
    Walsh SR, Cook EJ, Goulder F et al (2005) Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol 91:181–184PubMedCrossRefGoogle Scholar
  22. 22.
    Halazun KJ, Aldoori A, Malik HZ et al (2008) Elevated preoperative neutrophil to lymphocyte ratio predicts survival following hepatic resection for colorectal liver metastases. Eur J Surg Oncol 34:55–60PubMedCrossRefGoogle Scholar
  23. 23.
    Sharaiha RZ, Halazun KJ, Mirza F et al (2011) Elevated preoperative neutrophil:lymphocyte ratio as a predictor of postoperative disease recurrence in esophageal cancer. Ann Surg Oncol 18:3362–3369PubMedCrossRefGoogle Scholar
  24. 24.
    Rashid F, Waraich N, Bhatti I et al (2010) A pre-operative elevated neutrophil:lymphocyte ratio does not predict survival from oesophageal cancer resection. World J Surg Oncol 8:1 (abstract)Google Scholar
  25. 25.
    International Union Against Cancer (2002) TNM classification of malignant tumors, 6th edn. Wiley-Liss, New York, pp 60–64Google Scholar
  26. 26.
    Roth JA, Pass HI, Flanagan MM et al (1988) Randomized clinical trial of preoperative and postoperative adjuvant chemotherapy with cisplatin, vindesine, and bleomycin for carcinoma of the esophagus. J Thorac Cardiovasc Surg 96:242–248PubMedGoogle Scholar
  27. 27.
    Baba M, Natsugoe S, Shimada M et al (2000) Prospective evaluation of preoperative chemotherapy in resectable squamous cell carcinoma of the thoracic esophagus. Dis Esophagus 13:136–141PubMedCrossRefGoogle Scholar
  28. 28.
    Pennathur A, Luketich JD, Landreneau RJ et al (2008) Long-term results of a phase II trial of neoadjuvant chemotherapy followed by esophagectomy for locally advanced esophageal neoplasm. Ann Thorac Surg 85:1930–1937PubMedCrossRefGoogle Scholar
  29. 29.
    Hinrich AW, Björn LD, Brücher M, Zimmermann F et al (2004) Time course of tumor metabolic activity during chemoradiotherapy of esophageal squamous cell carcinoma and response to treatment. J Clin Oncol 22:900–908CrossRefGoogle Scholar
  30. 30.
    Akbarshahi H, Andersson B, Norden M et al (2008) Perioperative nutrition in elective gastrointestinal surgery: potential for improvement? Dig Surg 25:165–174PubMedCrossRefGoogle Scholar
  31. 31.
    Schilling J, Vranjes N, Fierz W et al (1996) Clinical outcome and immunology of postoperative arginine, omega-3 fatty acids, and nucleotide enriched enteral feeding: a randomized prospective comparison with standard enteral and low calorie/low fat intravenous solutions. Nutrition 12:423–429PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2012

Authors and Affiliations

  • Hiroshi Sato
    • 1
    • 2
  • Yasuhiro Tsubosa
    • 1
  • Tatsuyuki Kawano
    • 2
  1. 1.Division of Esophageal SurgeryShizuoka Cancer Center HospitalShizuokaJapan
  2. 2.Department of Esophago-Gastric SurgeryTokyo Medical and Dental UniversityTokyoJapan

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