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Systemic inflammatory dynamics during chemoradiotherapy predict response, relapse, metastasis, and survival in esophageal carcinoma
Author(s) -
Sherry Alexander D.,
Newman Neil B.,
Anderson Joshua L.,
Osmundson Evan C.
Publication year - 2020
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.25793
Subject(s) - medicine , chemoradiotherapy , oncology , proportional hazards model , carcinoma , nasopharyngeal carcinoma , neoadjuvant therapy , stage (stratigraphy) , gastroenterology , t stage , esophageal cancer , prospective cohort study , esophagectomy , radiation therapy , cancer , breast cancer , paleontology , biology
Background and Objectives Lymphopenia associated with chemoradiotherapy predicts prognosis in esophageal carcinoma. The purpose of our study was to evaluate alterations in hematologic measures of inflammation during chemoradiation. Methods We performed an observational study evaluating adults treated with chemoradiation in the neoadjuvant or definitive setting for stage II‐III esophageal carcinoma. Multivariable logistic regression evaluated predictors of pathologic response. Survival was analyzed by time‐varying multivariable Cox proportional hazards regressions. Results A total of 94 patients were included with median follow‐up of 1.6 years. Elevated neutrophil:lymphocyte ratio (NLR) was predictive of incomplete pathologic response to neoadjuvant chemoradiation (OR, 1.07; P = .0030) as well as shorter distant metastasis‐free survival (HR, 1.01; P = .0369) and reduced overall survival (HR, 1.01; P = .0448). An NLR > 5.55 in week two of chemoradiation predicted shorter overall survival ( P = .0070). Upon adjusted analysis, NLR was independently associated with reduced probability of complete pathologic response (OR, 0.80; P = .0291), as well as poor histologic response to neoadjuvant chemoradiation (OR, 1.05; P = .0303), shorter disease‐free survival (HR, 1.02; P = .0077), and reduced overall survival (HR, 1.02; P = .0070). Conclusions Dynamic time‐dependent changes in NLR during chemoradiation predict response, relapse, metastasis, and survival in esophageal carcinoma. Prospective validation is warranted.