Prognostic value of neutrophil-to-lymphocyte ratio in peripheral blood and pathological tissue in patients with esophageal squamous cell carcinoma

Abstract

The aim of this study was to investigate the prognostic value of neutrophils-to-lymphocyte ratio in peripheral blood (NLR) and in cancer nest (iNLR) in patients with esophageal squamous cell carcinoma (ESCC). Totally 103 patients with ESCC treated with surgical radical surgery in the Shuyang People's Hospital from February 2010 to November 2014 were collected retrospectively. Peripheral blood routine test and immunohistochemistry examination of carcinoma nest were mainly performed. Survival rates were analyzed with Kaplan–Meier curves. Univariate analysis and multivariate analysis were also performed to explore potential prognostic factors of ESCC. The median survival time after surgery of low NLR group and high NLR group were 48 months and 30 months, respectively. The difference of overall survival between the 2 groups was statistically significant ( χ 2 = 7.435, P = .006). The median survival time after surgery of low iNLR group and high iNLR group were 37 months and 24.5 months, respectively. The difference between the 2 groups was also statistically significant ( χ 2 = 33.640, P = .000). Univariate analysis showed influence factors of postoperative survival in patients with ESCC included tumor-node-metastasis staging, NLR, iNLR, and grade of NLR score + iNLR score ( P ≤ .05). Multivariate analysis confirmed NLR, iNLR, and tumor-node-metastasis staging were independent influence factors of postoperative survival in patients with ESCC ( P ≤ .05). High level of NLR and iNLR implies a poor prognosis of ESCC. The application of both NLR and iNLR could guide clinicians to take aggressive treatments for high risk population.

Prognostic implications of preoperative systemic inflammatory markers in oral squamous cell carcinoma, and correlations with the local immune tumor microenvironment

“…According to our results, NLR, SII and LMR showed prognostic value in the univariate analysis; however, only NLR remained an independent prognostic biomarker in the multivariate analysis. Recent studies have demonstrated that NLR may comprehensively reflect the inflammation and immune status of cancer patients ( 26 ), thereby representing a balance between the protumor inflammation and the anti-tumor immune status ( 27 ). The NLR indicates relative neutrophilia and lymphopenia, which has been related to shorter survival rates ( 11 – 13 ).…”

Prediction of progression in Barrett’s esophagus: does inflammation hold the key?

“…Tissuelevel NLR needs to be further explored in a rigorous manner with validated and standardized techniques. Indeed, in a previous study, tissue-level NLR (assessed by immunohistochemistry for neutrophil-and lymphocyte-specific markers) in tumor nests, was shown to also predict clinical outcomes in patients with esophageal squamous cell carcinoma [5].…”

“…In systemic inflammatory states, elevation of the ANC and depression of the ALC leads to elevation of the NLR. Several stud-ies have associated an elevated NLR with poor outcomes (overall and cancer-free survival, poor response to chemotherapy) in a variety of cancers including esophageal carcinoma [5,6]. While the exact mechanism of this phenomenon is unknown, inhibition of antitumor lymphocytes and natural killer cells by neutrophilic peritumoral inflammation is postulated [7].…”

Immunohistochemistry assessment of tissue neutrophil-to-lymphocyte ratio (tNLR) predicts outcomes in melanoma patients treated with anti-programmed cell death 1 therapy

“…Although the well-established role of NLR in peripheral blood is known, the dynamics of this ratio in tissues are less explored. Its role was demonstrated in pancreatic cancer [15], esophageal squamous cell carcinoma [16], glioblastoma [17] and urothelial carcinoma [18], but not in melanoma.…”