Influential factors on radiotherapy efficacy and prognosis in patients with secondary lymph node metastasis after esophagectomy of thoracic esophageal squamous cell carcinoma

Abstract

BackgroundThe purpose of this study was to clarify whether pretreatment tumor burden-related index, including the gross tumor volume (GTV) of metastatic lymph nodes (VLN) and maximum diameter of metastatic lymph nodes (DLN), and inflammatory markers, consisting of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), are useful for assessing the therapeutic effects and prognosis with secondary lymph node metastasis (LNM) receiving chemoradiotherapy (CRT) or radiotherapy (RT) alone after resection of esophageal squamous cell carcinoma (ESCC).Patients and methodsA total of 119 patients with secondary LNM after resection of ESCC were recruited and received curative RT only or CRT. The enrolled patients were grouped according to the median values of NLR, PLR, VLN, and DLN. The relationship between the responsiveness to treatment and these markers was analyzed by logistic analysis. The Kaplan–Meier method and log-rank test were adopted to calculate and compare the overall survival (OS) rates with these markers. The Cox models were used to carry out multivariate analyses.ResultsUnivariate logistic regression analysis showed that the responses to treatment were highly associated with treatment method (P=0.011), NLR (P=0.000), PLR (P=0.003), VLN (P=0.000), and DLN (P=0.000). Next, multivariate logistic regression analysis showed that therapeutic method (hazard ratio [HR]=1.225, P=0.032), NLR (HR=2.697, P=0.019), and VLN (HR=4.607, P=0.034) were independent risk factors for tumor response. Additionally, Kaplan–Meier survival analysis of this cohort revealed that NLR (χ2=27.298, P=0.000), PLR (χ2=16.719, P=0.000), VLN (χ2=48.823, P=0.000), DLN (χ2=40.724, P=0.000), and treatment methods (χ2=18.454, P=0.018) were significantly associated with OS. Furthermore, multivariate analysis was performed, and the results showed that therapeutic method (HR=1.223, P=0.048), NLR (HR=2.000, P=0.018), VLN (HR=2.379, P=0.020), and DLN (HR=2.901, P=0.002) were considered independent prognostic factors for OS.ConclusionThis study found that NLR and VLN were promising as predictive markers for therapeutic effects, and NLR combined with VLN and with DLN might be useful biomarkers in predicting outcomes in patients with secondary LNM receiving CRT or single RT after esophagectomy.

Prognostic value of inflammatory markers and clinical features for survival in advanced or metastatic esophageal squamous cell carcinoma patients receiving anti-programmed death 1 treatment

“…The clinical features of the patients, such as age, ECOG PS, metastatic sites, treatment line, drug differences and so on, may be also associated with the treatment response and prognosis. Our results indicated that patients with lymph node metastasis negative had significantly better survival than those with lymph node metastasis positive, which supported the previous findings that lymph node metastasis was a worse prognostic indicator in EC patients accepting surgery ( 39 , 40 ), radiotherapy or radiochemotherapy ( 41 ). Notably, previous studies demonstrated that patients with liver metastases were insensitive to immunotherapy in various cancers such as melanoma ( 42 ), NSCLC ( 43 ), and urothelial carcinoma ( 44 , 45 ).…”

Regulation of radiosensitivity by 4‑methylumbelliferone via the suppression of interleukin‑1 in fibrosarcoma cells

“…Combining chemotherapy (e.g. cisplatin, 5-fluorouracil, and paclitaxel) with targeted inhibitors can potentially overcome radioresistance and extend progression-free and overall survival (7)(8)(9)(10)(11)(12). However, few studies have examined the efficacy of combined treatments in preventing distant metastasis (10).…”

Application Value of Gastroenterography Combined With CT in the Evaluation of Short-Term Efficacy and Prognosis in Patients With Esophageal Cancer Radiotherapy

“…Zhou's team found that the maximum diameter of metastatic lymph nodes may be an effective biomarker to predict the prognosis of patients who received radiotherapy after esophagectomy ( 19 ). Wu's team believed that the AUC for the minimum diameter of lymph nodes and the maximum diameter of lymph nodes for diagnosing lymph node metastasis were 0.679 and 0.666, respectively.…”