Clinical Study On The Prognostic Value Of Pre-operative Neutrophil Lymphocyte Ratio And Platelet Lymphocyte Ratio In Patients Of Esophageal Squamous Cell Carcinoma

Background and objectives:Evidence is increasing that host-systemic inflammation markers neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) are associated with patients’ survival in several cancers. However, whether the NLR is associated with prognosis in patients with esophageal carcinoma is controversial. At the same time, it is not yet established whether systemic inflammatory marker PLR is a predictor of cancer survival in patients with esophageal carcinoma. So far, the study of the relationship between NLR, PLR and prognostic value in patients with esophageal carcinoma from high-prevalence areas of China has not been reported. The aim of the present study was to analysis the prognostic value of neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) in patients who undergone esophagectomy of esophageal squamous cell carcinoma (ESCC).Material and Methods:We performed a retrospective analysis of119patients who underwent surgical resection of esophageal cancer in Qilu hospital of Shandong university between1st January and31st December2007. The data of patients include, patients’basal characteristics pathology reports and laboratory results. The patients’ basal characteristics include sex, age at treatment and history of smoking. TNM pathological stage, tumor subsite, resection margin, differentiation grade, positive to total lymph node ratio (LNR) and adjuvant therapy history. White cell, neutrophil, lymphocyte and platelet counts were measured2-7days prior to surgery. NLR and PLR were calculated according to the laboratory results. NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count. PLR was defined as the absolute platelet count divided by the absolute lymphocyte count. NLR was divided to two groups. High and low group were defined as a ratio>5,<5respectively. The PLR was divided to three groups. The first, second and third group were defined as a ratio<150,150-300and>300, respectively. All follow-up information was collected until death or March2011. The follow-up results were compared between different NLR, PLR groups.Results:A total of119patients who underwent surgical resection were identified. The median age was60.0years old (range from42to78years). Of the119patients,94(79%) were male,63(53%) were less than60years old and all had ESCC. The post-operative stages were Ⅰ, Ⅱ, and Ⅲ in24,56, and39patients, respectively. The histological differentiation grades were well in37cases, moderate in48cases and poor in34cases. Tumor subsites were cervical in3patients, upper thoracic in11patients, mid-thoracic in67patients and lower thoracic in38patients.27(23%) patients had tumor length less than3cm.50(42%) patients received adjuvant treatment after surgery, include radiotherapy and/or chemotherapy.68patients had smoking history.111patients were considered as potentially curative resection. Univariate analyses showed that pathological stage (p<0.001), LNR (p=0.009) and tumor margin status (p=0.012) were associated with overall survival. Multivariable analyses showed that only pathological stage (p<0.001) was significantly associated with overall survival. NLR or PLR was not shown to be associated with overall survival.Conclusions:In ESCC, NLR or PLR was not shown to be an independent prognostic factor, TNM pathological stage, LNR and tumor margin status were associated with overall survival. Only TNM pathological stage was a significant prognosis factor.