Back to Program | 2010 Program and Abstracts Overview | 2010 Posters

Background: The prognosis for patients with esophageal cancer is poor, even among those who undergo potentially curative esophagectomy. There are few predictors of disease recurrence after surgery for esophageal cancer. Neutrophil:lymphocyte ratio (NLR) is hypothesized to reflect the extent of systemic inflammatory response created by a tumor, and possibly provides an indication of tumor aggressiveness and propensity for metastasis. Elevated NLR has been associated with disease recurrence after hepatic resection for colorectal cancer metastases, cholangiocarcinoma, and hepatocellular carcinoma. We aim to evaluate the potential utility of NLR as a predictor of outcomes in esophageal cancer.Methods: We performed a single-center retrospective analysis of esophageal cancer patients who underwent esophagectomy at a single institution between 1989-2009. Data were collected on patient demographics and clinical characteristics, receipt of neoadjuvant treatment and tumor characteristics. Preoperative white blood cell count and differential were used to calculate NLR. Elevated NLR was defined a priori as >5.0. Logistic regression modeling was performed to analyze characteristics associated with elevated NLR. Kaplan-Meier analyses and Cox regression modeling were performed for disease-free and overall survival.Results: A total of 212 patients underwent esophagectomy and had available preoperative lab values to calculate NLR. The mean age was 62.7 years, and 83.0% were male. The median duration of follow-up was 32 months (IQR 13-56). Forty patients (18.9%) had elevated NLR preoperatively. No patient or tumor characteristics were significantly associated with elevated NLR. In Kaplan-Meier analyses, elevated NLR was associated with significantly worse disease-free (p=0.03) and overall survival (p=0.03); however, these associations were not significant after adjustment for potential confounders. In multivariable stratified analysis, elevated NLR was associated with significantly increased risk of disease recurrence among patients who received neoadjuvant treatment (HR 2.13, 95%CI 1.09-4.15).Conclusions: Preoperative neutrophil:lymphocyte ratio is a potential prognostic marker for tumor recurrence after esophagectomy, particularly in patients who receive neoadjuvant treatment. It is unclear whether NLR reflects the degree of inflammatory response to the primary tumor or perhaps other patient-specific characteristics that predispose to recurrence. Further investigations are warranted to clarify the mechanisms that explain the observed associations between elevated NLR and poor outcomes in esophageal cancer.