Good prediction of treatment responses to neoadjuvant chemoradiotherapy for esophageal cancer based on preoperative inflammatory status and tumor glucose metabolism

Abstract

To develop a tool for predicting pathologic complete response (pCR) after neoadjuvant chemoradiotherapy (neoCRT) in patients with esophageal cancer by combining inflammatory status and tumor glucose metabolic activity. This study included 127 patients with locally advanced esophageal cancer who had received neoCRT followed by esophagectomy from 2007 to 2016. We collected their neutrophil–lymphocyte ratio (NLR) and standardized uptake value (SUV) obtained from fluorodeoxyglucose positron emission tomography (PET/CT) before and after neoCRT. Univariate and multivariate logistic regression analyses were performed to identify potential predictive factors for pCR. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of predictors were calculated. Between pCR and non-pCR groups, there were no statistically significant differences in patient characteristics, such as sex, age, site, and clinical T/N stage. Multivariate analyses identified four independent predictors for pCR, including pre-OP NLR < 5.4 [OR 11.179; 95% CI 8.385–13.495; p = 0.003], NLR change (ΔNLR) < 3 [OR 4.891; 95% CI 2.274–9.180; p = 0.005], changes in SUV (ΔSUV) > 7.2 [OR 3.033; 95% CI 1.354–6.791; p = 0.007], and SUV changes ratio (ΔSUV ratio) > 58% [OR 3.585; 95% CI 1.576–8.152; p = 0.002]. ΔNLR had the highest accuracy and NPV (84.3% and 90.3%, respectively). Combined factors of ΔNLR < 3 and ΔSUV ratio > 58% had the best PPV for pCR (84.8%). Inflammatory status (ΔNLR) and tumor glucose metabolic activity (ΔSUV ratio), when considered together, constitute a promising low-invasive tool with high efficacy for prediction of treatment response before surgery.

Survival and complications after neoadjuvant chemoradiotherapy versus neoadjuvant chemotherapy for esophageal squamous cell cancer: A meta-analysis

“…Non-responders had higher postoperative pulmonary morbidity, a higher 30-day mortality rate, and a lower survival rate compared to those of histopathologic responders (p<0.001). pCR was an independent significant predictor for EC, and patients who achieved pCR had better progression free survival(PFS) and OS than those without pCR [40]. The results of this meta-analysis showed that NCRT can result in better pCR rates in patients with ESCC than those achieved with CRT (OR = 5.21, 95% CI:2.85-9.50, p<0.00001), which means that it can provide better survival benefits.…”

Potential Predictive Immune and Metabolic Biomarkers of Tumor Microenvironment Regarding Pathological and Clinical Response in Esophageal Cancer After Neoadjuvant Chemoradiotherapy: A Systematic Review

“…Seventy-eight articles were included for full screening (31 congress abstracts, 47 original articles); 57 were excluded due to unclear description/criteria for groups and/or variables ( n = 34) or studies that did not assess PR and/or CR ( n = 23). Finally, we included 21 studies (20 original articles 21 – 40 and one study congress abstract 41 ). We identified 10 studies on biological immune and metabolic TME biomarkers without the presence of an 18 F-FDG-PET/CT scan (two studies on metabolic biomarkers, eight on immune biomarkers).…”

“…Three studies 26 , 32 , 37 were prospective and 18 studies were retrospective. 21 – 24 , 26 – 31 , 33 – 36 , 38 – 41 Eight studies assessed only EAC, 24 , 26 – 28 , 30 , 34 , 35 , 40 six studies assessed only ESCC, 21 , 23 , 25 , 36 – 38 and seven studies included both types. 18 – 21 , 27 , 35 , 37 …”

A Novel Predictor of Pathologic Complete Response for Neoadjuvant Immunochemotherapy in Resectable Locally Advanced Esophageal Squamous Cell Carcinoma

“…Several inflammatory indexes have been reported to be associated with pCR and prognosis after neoadjuvant therapy for esophageal cancer, such as lymphocyte (LY), 20 , 21 neutrophil to lymphocyte ratio (NLR), 21 , 22 platelet to lymphocyte ratio (PLR), 21 , 23 lymphocyte to monocyte ratio (LMR), 24 and systemic immune inflammation index (SII). 23 In this study, we explored the dynamics of inflammatory indexes at baseline, after two cycles of nICT and postoperative one month.…”