The value of cellular components of blood in the setting of trimodal therapy for esophageal cancer

Abstract

Background Inflammation status plays an important role in the natural history of malignancy. Consequently, hematological markers of systemic inflammation may predict prognosis in neoplasms. This study evaluated the value of cellular blood components changes during neoadjuvant chemoradiotherapy followed by esophagectomy for cancer in predicting prognosis. Methods A cohort of 149 patients was analyzed. Cellular components of blood were assessed before neoadjuvant therapy (A); before surgery (B); and 3 to 5 months after surgery (C); for the following outcomes: pathological response, overall survival (OS), and disease‐free survival (DFS). Univariate and multivariate Cox regression models were applied to evaluate the independent prognostic significance of blood count variables. Results Low hematocrit (Ht) (C) (HR, 0.85; 95% CI, 0.79‐0.92) and high neutrophil‐to‐lymphocyte ratio (NLR) (C) (HR, 1.07; 95% CI, 1.07‐1.10) were related to poor OS. Low Hb (C) (HR, 0.72; 95% CI, 0.58‐0.88), red cell distribution width (RDW) (C‐A) (HR, 1.16; 95% CI, 1.02‐1.31), and NLR (C‐A) (1.06; 95% CI, 1.03‐1.09) were related to poor DFS. RDW (B‐A) (HR, 1.15; 95% CI, 1.08‐1.22), RDW (C) (HR, 1.12; 95% CI, 1.04‐1.2), NLR (C) (HR, 1.12; 95% CI, 1.08‐1.17) were related to systemic recurrence. Conclusion Variables of routine blood count are easily assessable and their changes throughout trimodal therapy for esophageal carcinoma provide important information for cancer patient's prognosis.

Nomogram for predicting pathologic complete response to neoadjuvant chemoradiotherapy in patients with esophageal squamous cell carcinoma

“…For example, two studies that said that pre-nCRT NLR and PLR were not related to pCR had sample sizes of 84 and 101 ESCC patients, respectively. 15,31 Second, the confounding factors were not excluded by multivariate analysis. A study involving 365 patients with ESCC reported that low pre-nCRT PLR levels were linked to achieving pCR, whereas there was no link between pre-nCRT NLR and MLR and pCR.…”

“…A study enrolling 306 ESCC patients found that cases with pre‐nCRT NLR >2.1 showed a significantly lower pCR rate than those with lower value 14 . Nevertheless, another study including 44 esophageal adenocarcinoma, 101 ESCC, and 4 undifferentiated carcinoma patients reported that baseline NLR was related to OS and RFS but not pCR, but PLR after surgery was associated with pCR 15 . Surprisingly, the analysis of 311 patients with ESCC showed that pre‐nCRT PLR was significantly associated with pCR, but pre‐nCRT NLR and MLR were not associated with pCR 16 .…”

Nomogram for Predicting Pathologic Response Following Neoadjuvant Chemotherapy or Chemoradiotherapy in Patients with Esophageal Cancer

“…7 Nomograms incorporating clinical data; dynamic hematological indicators, before and after treatment; image analysis from baseline and post therapy, such as conventional parameters derived from computed tomography (CT) or integrated positron emission tomography to estimate treatment response; or radiomics; together with future integration of molecular markers in the nomogram will hopefully improve its clinical utility for assessing patient risk and the ability to predict treatment response after NACRT or immunotherapy. [13][14][15][16] DISCLOSURE I do not have any conflicts of interest.…”

Parâmetros metabólicos prognósticos do PET/TC 18F-FDG em pacientes com carcinoma de esôfago submetidos a terapia trimodal

“…A investigação dos fatores prognósticos em câncer de estômago, transição esôfago-gástrica e esôfago é uma das linhas de pesquisa do grupo no Departamento de Gastroenterologia no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo e Instituto do Câncer de São Paulo (HC-FMUSP/ICESP). Diversos trabalhos publicados pelo presente grupo têm revelado fatores de prognóstico relacionados a biomarcadores séricos [14][15][16][17] achados histopatológicos, 18,19 achados endoscópicos, 20 relacionados a cirurgia, 21,22 entre outros. O conhecimento de marcadores prognósticos se faz importante por ajudar a avaliar a chance de sucesso do manejo da doença, individualizando o atendimento ao paciente.…”

“…Ainda em relação à terapia neoadjuvante, alguns biomarcadores séricos relacionados a inflamação sistêmica, como a diminuição no número de linfócitos, o aumento da relação Neutrófilo/Linfócito, e plaquetose podem estar relacionados a pior prognóstico a curto ou longo prazo. 16,17 Estudos realizados fora de nosso Departamento corroboram tais achados. 26-28…”