The Prognostic Value Of Hematological Inflammatory Marker In Esophageal Squamous Carcinoma Patients Receiving Chemoradiotherapy

Objective: Esophageal squamous cell carcinoma(ESCC)is one of the most common malignant tumors in China.Most of the patients are diagnosed locally advanced and lost opportunity for surgery.However,chemoradiotherapy(CRT)have become the standard treatment of locally advanced ESCC.Hematologic examination has gradually become a focal point in curative effect monitoring and prognosis evaluation.Hematological indicators including inflammation index Neutrophil-to-lymphocyte ratio(NLR),Platelet-to-lymphocyte ratio(PLR)and Nutrition index Hemoglobin(Hb)content.Studies have found that NLR,PLR could predict the postoperative patients’ short-term curative effect and prognosis.However,it is not clear whether the sensitivity and prognosis can be predicted in CRT patients.The objective of this study was to evaluate the value of hematological markers in patients with locally advanced ESCC receiving CRT,at the same time,to better monitor the prognosis of patients,and provide a new way to explore the accuracy and individuation of ESCC.Method: This study retrospectively analyzed the clinical data of 168 ESCC patients who received CRT from June 2007 to June 2013 in our hospital.The follow-up ended up to June 2016 or to the death of the patient.Statistical analysis of systemic inflammatory response(SIR)of the hematologic index NLR,PLR,combined neutrophil-platelet(CNP)and nutritional status of HB level was studied.ROC curve was used to determine the cut-off point.The data were analyzed by chi-square test,and the indexes with statistical difference in univariate analysis were included in multivariate Logistic regression analysis.Kaplan-Meier Analysis was used to drawing survival curve.Multivariate Cox regression model was used to evaluate the effects of hematological and clinicopathological factors on 3-year OS.Result: In this study,the analysis showed that smoking history,tumor location,clinical stage,NLR,PLR,CNP and Hb were correlated with CRT sensitivity(p <0.05).Multivariate analysis showed that the CNP is an independent predictor(OR = 2.066,p = 0.021)that the higher the socre,the worse the sensitivity to radiotherapy and chemotherapy.Survival analysis showed that the level of PLR,CNP,Hb was correlated with 3-year OS(p <0.05).COX multivariate analysis showed that CNP(HR=2.039,p=0.029)and Hb(HR=0.568,p=0.028)were independent predictors of 3 year OS.The higher the CNP score,the lower the HB level,the worse the 3 years OS.Conclusion: The study found that CNP score can be used as an independent predictor of CRT sensitivity in patients with ESCC.CNP and Hb can independently predict the prognosis of ESCC patients.Systemic inflammatory response index and Hb as a cheap and easily available hematological markers need more research to further verify its clinical value.