Preoperative neutrophil-to-lymphocyte ratio predicts postoperative pulmonary complications in patients with esophageal squamous cell carcinoma receiving preoperative chemoradiotherapy

Abstract

Objectives: Esophagectomy after chemoradiotherapy is associated with an increased risk of surgical complications. The significance of preoperative neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in predicting pulmonary complications after esophagectomy in esophageal squamous cell carcinoma patients receiving preoperative chemoradiotherapy remains unknown. We aimed to investigate the utility of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in predicting the pulmonary complications of esophagectomy after preoperative chemoradiotherapy. Methods: We retrospectively reviewed 111 consecutive patients with stage III esophageal squamous cell carcinoma who received preoperative chemoradiotherapy followed by esophagectomy between January 2009 and December 2017. Laboratory data were collected before the operation and surgical outcomes and complications were recorded. We calculated neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio and correlated them with the clinical parameters, postoperative complications, overall survival, and disease-free survival.Results: Postoperative complications were observed in 75 (68%) patients, including 32 (29%) with pulmonary complications. The neutrophil-to-lymphocyte ratio of ≥3 (P = 0.008), clinical T4 carcinoma (P = 0.007), and advanced stage IIIC (P = 0.012) were significantly associated with pulmonary complications. Pulmonary complication rates were 15% and 38% in patients with neutrophil-to-lymphocyte ratio of <3 and ≥3, respectively. The 3-year overall survival rates were 70% and 34% in patients with neutrophil-to-lymphocyte ratio of <3 and ≥3, respectively (P = 0.0026). The 3-year disease-free survival rates were 57% and 29% in patients with neutrophil-to-lymphocyte ratio of <3 and ≥3, respectively (P = 0.0055). The neutrophil-to-lymphocyte ratio of ≥3 was independently associated with more pulmonary complications, inferior overall survival, and worse disease-free survival.Conclusions: Neutrophil-to-lymphocyte ratio is routinely available in clinical practice and can be used as a predictor for pulmonary complications after esophagectomy in patients with esophageal squamous cell carcinoma receiving preoperative chemoradiotherapy.