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

Annals of Surgical Oncology volume 18, pages 3362–3369 (2011)Cite this article

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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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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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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  5. Paul C. Lee MD
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  6. Alfred I. Neugut MD, PhD
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  7. Nasser K. Altorki MD
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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

Keywords

  • Overall Survival
  • Esophageal Cancer
  • Glasgow Prognostic Score
  • Curative Esophagectomy
  • Host Inflammatory Cell