Prognostic role of neutrophil-lymphocyte ratio in operable esophageal squamous cell carcinoma

AIM: To determine the prognostic significance of preoperative serum neutrophil-lymphocyte ratio(NLR) in esophageal squamous cell carcinoma(ESCC).METHODS: Data from 371 eligible patients with ESCC who had undergone surgery with curative intent at our institution between October 2000 and May 2007 were retrospectively recruited for analysis. The cutoff value of NLR was 3.0 as determined by the receiver operating characteristic curve, which discriminated between survival and death; the area under the curve was 0.709, and the sensitivity and specificity were 66.1% and 69.1%, respectively, at the cutoff point. The correlation between the NLR and clinicopathological characteristics was analyzed using a χ2 test. The prognostic influence of the NLR and other clinicopathological factors on cancer-specific survival(CSS) and recurrence-free survival(RFS) was studied using the Kaplan-Meier method. To evaluate the independent prognostic value of NLR, multivariate Cox regression models were applied.RESULTS:The median age of the patients was 57.0years,and 276/371(74.4%)patients were male.The NLR was≤3.0 in 80.1%(297/371)of the patients,and the remaining 19.9%(74/371)had an NLR>3.0.Median postoperative follow-up was 66.0 mo[interquartile range(IQR):49.0-76.0 mo],with a follow-up rate of 94%.Follow-up was not significantly different between patients with an NLR≤and>3.0(63.13±1.64 vs 61.52±3.66,P=0.711).However,higher preoperative serum NLR was associated with significantly increased risks of higher pathological tumor status(P=0.007).A significant,independent association between high preoperative serum NLR and poor clinical outcome was identified in a multivariate analysis for CSS(HR=1.591;P=0.007)and RFS(HR=1.525;P=0.013).Moreover,when patients were stratified by pathological tumor-node-metastasis(TNM)staging,the adverse effects of preoperative serum NLR on CSS(HR=2.294;P=0.008)and RFS(HR=2.273;P=0.008)were greatest in those patients with stageⅢA disease.CONCLUSION:Preoperative serum NLR is a useful prognostic marker to complement TNM staging for operable ESCC patients,particularly in patients with stageⅢA disease.

AIM:To explore the relationship of clinicopathological features and the distribution of neutrophils in the t umor mic roenvironment wi t h t he prognosis of cholangiocarcinoma.METHODS:Two hundred and fifty-four formalin-fixed and paraffin embedded tissue blocks were analyzed, including tissues from cholangiocarcinoma(n = 254), and tumor adjacent tissues(n = 238).Tissue sections were stained for CD15 using immunohistochemical staining.CD15 expression was detected to identify the distribution of neutrophils in the local tumor microenvironment.The neutrophil density of the tumor tissues and the adjacent tumor tissues was detected to reflect their inflammatory status.Clinical data and follow-up information of cholangiocarcinoma patients who underwent surgery from January 2004 to December 2010 were analyzed retrospectively.The relationship between clinicopathological features and the distribution of neutrophils with prognosis of the patients were analyzed.RESULTS:The positive expression level of CD15 was only significantly related to the TNM stage.CD15 expression was higher in tumor tissues than in adjacent tissues(73.6% vs 54.6%), with significant differences.Patients with high expression of CD15 had significantly shorter overall survival(OS) than those with low expression of CD15(median overall survival time 39.77 mo vs 16.87 mo, P = 0.008).Patients with high CD15 expression had significantly shorter disease free survival time(DFS) than those with low expression of CD15(median DFS 38.27 mo vs 16.83 mo, P = 0.029).COX multivariate analysis indicated that high CD15 expression in tumor tissues was an independent risk factor for predicting OS for patients with cholangiocarcinoma [P = 0.012, relative risk(RR) = 1.601], but it was not an independent risk factor for predicting DFS(P = 0.073, RR = 1.462).CONCLUSION:Patients with high CD15 expression in cancer tissues had shorter DFS and OS.High expression of CD15 is an independent risk factor for OS.