Introduction Neoadjuvant chemotherapy (NAC) before resection is now standard of care in oesophageal adenocarcinoma. Neutrophil-lymphocyte ratio (NLR) is recognised as a prognostic indicator in this disease. There is increasing evidence that staging post neo-adjuvant chemotherapy is more accurate than at time of diagnosis. We wished to assess neutrophil lymphocyte ratio at time of diagnosis and after neo-adjuvant chemotherapy in our cohort of patients.
Method Consecutive patients who underwent oesophageal resection after NAC for oesophageal adenocarcinoma between 2008–2013, were identified from our prospectively collected database. In these patients systemic inflammation was assessed by modified Glasgow Prognostic Score (mGPS) and NLR and the electronic patient record was accessed to obtain blood results required (albumin, CRP, neutrophils and lymphocytes). These results were obtained at time of diagnosis and immediatly prior to resection. NLR was calculated and stratified as < 2.5, 2.5–5, and >5. Modified Glasgow Prognostic Score was assigned as 0, 1 or 2, CRP <10 scoring 0; CRP >10 and albumin >35 scoring 1; and CRP >10 and albumin <35 scoring 2. Survival analysis was performed by Kaplan Meier and compared by log rank with the aid of SPSS.
Results 169 patients undergoing neo-adjuvant chemotherapy and resection for oesophageal adenocarcinoma were included in the analysis. As shown in the table below neither mGPS or NLR measured at time of diagnosis, before neo-adjuvant chemotherapy, predicted survival following oesophagectomy. Only 12 of the 98 patients in whom mGPS could be calculated scored either 1 or 2 at this point. Post-NAC again mGPS did not show any significant effect on survival (p = 0.524). When NLR was used to stratify patients at this time, this did significantly predict outcome following resection, with median survival of 38 months in the low NLR group compared to 15 months in the high NLR group (P = 0.003).
Conclusion Neutrophil lymphocyte ratio post-neo adjuvant chemotherapy is a predictor of survival following oesophageal resection for oesophageal adenocarcinoma. This supports recent findings that suggest staging investigations post-NAC best determine patients’ outcomes for resectional surgery.
Disclosure of interest None Declared.