The role of systemic inflammatory and nutritional blood-borne markers in predicting response to neoadjuvant chemotherapy and survival in oesophagogastric cancer

Abstract

The aim of this study was to interrogate whether blood-borne inflammatory and nutritional markers predict long-term survival and response to neoadjuvant chemotherapy in radically treated oesophagogastric cancer patients. This retrospective study included 246 patients who underwent oesophageal resection for high-grade dysplasia or carcinoma between 2005 and 2010. The predictive value of routine preoperative immunonutritional blood tests was assessed for their association with survival and response to chemotherapy. On multivariate analysis, higher neutrophil-lymphocyte ratio (NLR) (p < 0.0001), N stage (p < 0.0001) and perineural invasion (p < 0.0001) were associated with poor overall survival. Regarding disease-free survival, multivariate analysis showed reduced serum albumin (p = 0.034), N stage (p < 0.0001), M stage (p = 0.037), vascular invasion (p < 0.0001) and presence of R1 resection (p = 0.003) to correlate with earlier recurrence. In those who received neoadjuvant chemotherapy, analysis of prechemotherapy characteristics showed only serum albumin (p = 0.037) to predict pathological response to chemotherapy. Preoperative immunonutritional markers, NLR and albumin, were independent prognostic markers for overall survival and disease-free survival, respectively, after oesophageal cancer resection. Prospective studies evaluating the role of immunonutritional modulation to improve response to chemotherapy and long-term outcome are required.

Strategies to improve outcomes in esophageal adenocarcinoma

“…The stage at diagnosis of EAC is the key factor in determining prognosis. The depth of invasion through the esophageal wall determines the risk of lymph node (LN) metastasis, which, in keeping with other reports, in our cohort is the most prognostic pathological finding for poor outcome [40,41]. Unfortunately, in EAC, the majority of tumors have invaded through the esophageal wall at the time of diagnosis.…”

“…We have proposed predictive markers of response to chemotherapy, and like many other groups have shown potential biomarkers [40]. Serum albumin was shown to be the only predictor of pathological response to chemotherapy.…”

Prognostic Factors in Patients Receiving Neoadjuvant 5-Fluorouracil plus Cisplatin for Advanced Esophageal Cancer (JCOG9907)

“…During surgical treatment of patients with gastrointestinal tumors, the prognostic nutritional index, which is based on serum Alb and total lymphocyte count in peripheral blood, was used to assess the perioperative nutritional conditions and postoperative complications [21]. Furthermore, a study by Noble et al [22] on patients with esophagogastric cancer receiving neoadjuvant chemotherapy demonstrated that serum Alb was the only characteristic that could reliably predict pathological response to neoadjuvant chemotherapy. Although their analysis mainly included patients with adenocarcinomas, and neoadjuvant chemotherapy comprised an epirubicin-based regimen, the study suggests that malnutrition was associated with the lack of response to chemotherapy.…”

Prognostic impact of preoperative platelets to lymphocytes ratio (PLR) on survival for oesophageal and junctional carcinoma treated with neoadjuvant chemotherapy: A retrospective monocentric study on 153 patients

“…As emphasized by Noble et al, 12 additional studies would reinforce the oncological impact of PLR in oesophageal cancer. Interestingly, for palliative treatment of gastric cancer with FOLFOX regimen, normalization of PLR after one cycle of chemotherapy was associated with longer OS, with a 6 month gain from 10.9 to 16.9 months, p ¼ 0.002.…”