Prognostic Significance of Baseline Neutrophil Count and Lactate Dehydrogenase Level in Patients With Esophageal Squamous Cell Cancer Treated With Radiotherapy

Abstract

Background: This present study aimed to explore the prognostic value of pretreatment neutrophil and lactate dehydrogenase (LDH) and to develop a prognostic risk scoring model to predict prognosis in esophageal squamous cell cancer (ESCC) patients treated with definitive radiotherapy. Methods: Retrospectively collected data of patients who received definitive radiotherapy for ESCC at Shantou Central Hospital between January 2009 and December 2015 were included for the analysis. The association between the level of LDH and neutrophil and clinicopathological characteristics were analyzed. We performed univariate and multivariate analyses to identify the prognostic predictors for patients with ESCC. Based on the results, we also developed a prognostic risk scoring model and assessed its predictive ability in the subgroups. Results: A total of 567 patients who received definitive radiotherapy for ESCC were included in the present study. The optimal cutoff values were 4.5 × 10 9 /L, 3.25, and 220 U/L for neutrophil, neutrophil-to-lymphocyte ratio (NLR), and LDH, respectively. A high level of LDH was significantly associated with advanced N stage (p = 0.031), and neutrophil count was significantly associated with gender (p = 0.001), T stage (p < 0.001), N stage (p = 0.019), clinical stage (p < 0.001), and NLR (p < 0.001). Multivariate survival analysis identified gender (p = 0.006), T stage (p < 0.001), N stage (p = 0.008), treatment modality (p < 0.001), LDH level (p = 0.012), and neutrophil count (p = 0.038) as independent prognostic factors for overall survival. Furthermore, a new prognostic risk scoring (PRS) model based on six prognostic factors was developed, in which the patients were divided into three groups with distinct prognosis (χ 2 = 67.94, p < 0.0001). Conclusions: Elevated baseline LDH level and neutrophil count predicted poor prognosis for ESCC patients treated with definitive radiotherapy. A PRS model comprised of LDH, neutrophil count, and other prognostic factors would help identify the patients who would benefit the most from definitive radiotherapy.

A New Risk Score Model Based on Lactate Dehydrogenase Predicting Prognosis in Esophageal Squamous Cell Carcinoma Treated With Chemoradiotherapy

“…Additionally, an investigation that recruited 567 ESCC patients by Luo HS et al has also demonstrated that an elevated LDH level was an independent indicator for poor prognosis. 20 To sum up, though no agreement regarding pretreatment serum LDH level was the predictor for prognosis in ESCC, it may be a reliable factor in predicting the therapeutic effect of chemoradiotherapy in patients with ESCC according to our results. More researches are warranted to further validation before widely used in clinical settings.…”

“…[8][9][10][11][12][13][14]25 Several studies also have evaluated the prognostic value of LDH in ESCC. [15][16][17][18][19][20] Nevertheless, the prognostic role for pretreatment serum LDH in ESCC remains uncertain until now. The current study demonstrated that lower LDH levels were associated with a better prognosis compared with higher LDH levels, as shown in both multivariable analysis based on the whole cohort of 614 patients and the propensity score-matched cohort of 256 patients.…”

“…Recently, Luo HS et al proposed a prognostic risk scoring model included the LDH level and neutrophil count to help verify the prognosis for ESCC patients. 20 However, there was no research about the role of the LDH level combined with tumor markers in the prognosis of ESCC patients treated with chemoradiotherapy. Based on the existing evidence in our study, we established a model based on serum LDH level, tumor biomarkers along with TNM staging system to choose ESCC patients who were most likely to bene t from chemoradiotherapy.…”

“…14 Several investigators also scrutinized the prognostic value of LDH in ESCC. [15][16][17][18][19][20] However, owing to the inconsistent conclusions, serum LDH is a controversial prognostic biomarker for prognosis in ESCC and needs to be further investigated. Furthermore, studies on the in uence of LDH on the prognosis are still lacking for patients with ESCC underwent chemoradiotherapy.…”

The volume of low-dose thoracic irradiation influences systemic inflammation-immunity status after chemoradiation in esophageal cancer

“…Neutrophils potentially promote cancer progression (30), and lymphocytes play a key role in mediating tumoricidal effects (26). NLR has been used as valuable biomarker to predict the survival outcomes of patients with esophageal cancer, regardless of whether they were treated surgically or with RT (20)(21)(22)31,32). We determined the OS correlation with NLR-b and NLR-h, and found the optimal cut-off value for NLR-b is 3.68.…”