Baseline neutrophil–lymphocyte ratio holds no prognostic value for esophageal and junctional adenocarcinoma in patients treated with neoadjuvant chemotherapy

Abstract

SUMMARY Background: Several studies have reported that neutrophil–lymphocyte ratio (NLR) can predict survival in esophageal and gastroesophageal junction adenocarcinoma, as it reflects systemic inflammation. Hence, we aimed to determine whether baseline NLR holds prognostic value for esophageal adenocarcinoma patients treated with neoadjuvant chemotherapy (nCT) followed by surgery. Methods: We studied the data of 139 patients that received nCT before undergoing esophagectomy with curative intent, all identified from a prospectively maintained database (1998–2016). Pretreatment hematology reports were used to calculate the baseline NLR. A receiver operating characteristic curve (ROC-curve) was plotted to determine an optimal cutoff value. NLR quartiles were used to display possible differences between groups in relation to overall survival (OS) and disease-free survival (DFS) using the method of Kaplan–Meier. Cox regression analysis was performed to assess the prognostic value of NLR. Results: The median OS and DFS times were 46 months (interquartile range [IQR]: 19–166) and 30 months (IQR: 13–166], respectively, for the entire cohort. The ROC-curve showed that NLR has no discriminating power for survival status (area under the curve = 0.462) and therefore no optimal cutoff value could be determined. There were no statistically significant differences in median OS times for NLR quartiles: 65 (Q1), 32 (Q2), 45 (Q3), and 46 months (Q4) (P = 0.926). Similarly, DFS showed no difference between quartile groups, with median survival times of 27 (Q1), 19 (Q2), 36 (Q3), and 20 months (Q4) (P = 0.973). Age, pN, pM, and resection margin were independent prognostic factors for both OS and DFS. On the contrary, NLR was not associated with OS or DFS in univariable and multivariable analyses. Conclusion: Baseline NLR holds no prognostic value for esophageal and gastroesophageal junction adenocarcinoma patients treated with nCT in this study, in contrast to other recently published papers. This result questions the validity of NLR as a reliable prognostic indicator and its clinical usefulness in these patients.

Pre-therapy serum albumin-to-globulin ratio in patients treated with neoadjuvant chemotherapy and radical nephroureterectomy for upper tract urothelial carcinoma

“…Nevertheless, many other prognostic serum-based biomarkers have been assessed before NAC, but their prognostic value in this specific setting remains unclear. For example, the neutrophil-to-lymphocyte ratio (NLR) which has been largely assessed, did not predict complete response to NAC despite its good predictive value on oncological outcome in patients without NAC in other cancers such as breast, esophageal [32], or cervical cancer [33] [34,35]. It was only a potential predictor in association with other markers such as the platelet-to-lymphocyte ratio [35].…”

Biomarker evaluation in radically resectable locally advanced gastric cancer treated with neoadjuvant chemotherapy: an evidence reappraisal

“…Twenty-three articles were selected and included in our review. 12–33 These studies were published between 2006 and 2020, properly reflecting the current clinical scenario. Ten studies (43.5%) were prospective, whereas 13 were retrospective.…”

“…All the main characteristics of the population enrolled in the selected studies are reported in Table 1. 12–33…”

“…Twelve studies of the total (52.2%) analyzed tissue biomarkers 12,8,16,[18][19][20]26,[28][29][30][31]33 four studies performed the determination on the endoscopic biopsy and the surgical sample, other four only on the endoscopic biopsy and the last four just on surgical specimen. Ten studies (43.5%) looked at circulating biomarkers, [13][14][15]17,21,22,24,25,27,32 in the vast majority assessed pre-NAC (80%, 8/10). Only one examined both circulating and tissue biomarkers, but exclusively on samples obtained post-NAC.…”

“…11 Starting from that, we searched the literature for articles investigating biomarkers in LAGC and 23 articles were finally included in our review. 12–33 The population evaluated in the analysis was homogeneous in terms of clinical setting, since all patients had a gastric or EGJ cancer, received NAC, and underwent radical surgery. The main characteristics of the population were well balanced among the different studies, with a slight predominance of Asiatic patients, since 13 studies out of 23 were conducted in Eastern countries.…”