Changes in neutrophil-to-lympocyte and platelet-to-lymphocyte ratios to predict survival and pathologic complete response in esophageal cancer patients who receive trimodality therapy.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 170-170
Author(s):  
Jalal Hyder ◽  
Drexell Boggs ◽  
Andrew Hanna ◽  
Mohan Suntharalingam ◽  
Michael David Chuong
Keyword(s):  
Esophageal Cancer ◽  
Cancer Patients ◽  
Cox Regression ◽  
Locally Advanced ◽  
Pathologic Complete Response ◽  
Prognostic Significance ◽  
Progression Free Survival ◽  
Complete Response ◽  
Trimodality Therapy ◽  
Lymphocyte Ratio

170 Background: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) predict for survival in cancer patients. In patients receiving multi-modality therapy, the effect of each specific therapy on the NLR and PLR is not well understood. We therefore evaluated changes in NLR and PLR among locally advanced esophageal cancer patients who received trimodality therapy. Methods: We performed a retrospective analysis of non-metastatic patients with esophageal cancer who received neoadjuvant chemoradiation (CRT) followed by esophagectomy at our institution between March 2000 and April 2012. NLR and PLR values were obtained the following time points (TP): 1) at diagnosis before CRT, 2) after CRT prior to surgery, and 3) after surgery. We also evaluated change in NLR and PLR using the difference and ratio between TPs. Overall survival (OS) was evaluated by Kaplan-Meier analysis. Univariate and multivariate Cox regression models were applied to evaluate the independent prognostic significance of NLR and PLR. Results: 83 patients with stage II-IV esophageal cancer and median age 60 years were included. Median follow up was 29.3 months. Median dose of 50.4 Gy (50.4-59.4) in 28 fractions (28-33) was used. Median NLR and PLR at the each TP: 1) 3.3 and 157.2, 2) 12 and 645, and 11.5 and 391.7, respectively. On multivariate analysis, inferior OS was associated with PLR ≥250 at TP 3 (p=.03), PLR decrease ≥609.2 from TP 2-3 (p=.02), and PLR ratio (TP 1/TP3) ≥1.08 (p=.03). Inferior progression free survival (PFS) was associated with NLR at TP 2 ≥36 (p=.0008), NLR increase ≥28.3 from TP 1-2 (p=.0005), PLR increase from TP 1-3 ≥19 (p=.01), and PLR ratio (TP 2/TP 3) ≥0.34 (p=0.1). Pathologic complete response (pCR) was less likely for adenocarcinoma histology (p=.03), NLR at TP 2 ≥10.6 (p=.04), and NLR increase from TP 1 to TP 2 ≥4.6 (p=.03). Conclusions: This is the first study to demonstrate that changes in NLR and PLR throughout trimodality therapy for esophageal cancer correlate with OS, PFS, and pCR. Further evaluation is warranted to better define which of the identified cut-off values are most clinically significant.

Blood-based-inflammation-markers, body mass index, and survival of nonmetastatic esophageal cancer.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 324-324
Author(s):  
Wanning Wang ◽  
Joelle Soriano ◽  
Tyler Soberano ◽  
Katrina Hueniken ◽  
M. Catherine Brown ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Esophageal Cancer ◽  
Body Mass ◽  
Cox Regression ◽  
Locally Advanced ◽  
Continuous Variables ◽  
Inflammation Markers ◽  
Lymphocyte Ratio ◽  
Risk Of Death ◽  
High Bmi

324 Background: Blood-based-inflammation-markers (BBIM) and Body Mass Index (BMI) have been associated with overall survival (OS) in a number of cancers. Inflammation and obesity have biological interactions. We evaluated the role of Neutrophil-to-Lymphocyte-Ratio (NLR), Platelet-to-Lymphocyte-Ratio (PLR) and Systemic-Inflammation-Index (SII) in conjunction with BMI as predictors of OS in localized/locally-advanced-esophageal cancer (LEC/LAEC). Methods: LEC/LAEC patients treated from 2006-2014 had the following variables analyzed both as continuous and categorical: BMI (low <25 kg/m2, high ≥25 kg/m2), NLR (low <4, high ≥4), PLR (low <232, high ≥232), and SII (low <1375, high ≥1375), with OS. Univariate (UVA) and Multivariate analysis (MVA) were analyzed using Cox regression (adjusted hazard ratios, aHR; 95% Confidence Intervals, CI). MVA models of OS were built, assessing different categorical combinations of BBIM factors with and without BMI. Results: Of 411 pts, 79% were males, median age was 63.5 years, 67% were adenocarcinomas; Stage I/II/III: 14%, 28%, 59%; Median BMI was 26.5kg/m2 and BMI distribution was: 3% underweight, 40% normal weight, 37% overweight and 20% obese. After a median follow-up of 87 months, 204 pts recurred, and 257 died. In MVA, BMI alone had no impact on OS (aHR 0.89, CI 0.7-1.1, p=0.15); individually as continuous variables, higher SII (p=0.03) and higher NLR (p=0.006) were inversely associated with OS whereas higher PLR was not (p=0.10). In an MVA of categorical combinations of BMI and BBIM on OS, patients in the high-BMI/low-PLR group were at lower risk of death when compared to all other groups (aHR=0.65, 95%CI:0.5-0.8, p=0.007). Similar non-statistically significant trends were shown when SII and NLR were individually combined with BMI (aHR=0.77, 95%CI:0.6-1.0, p=0.09; aHR=0.74, 95%CI:0.5-1.0, p=0.05, respectively). Conclusions: Our results suggest that in LEC/LAEC pts, high BMI and low PLR together are associated with improved OS when compared to pts with low BMI and/or high PLR. NLR and SII alone were associated with OS. Further studies evaluating the underlying mechanisms of BBMI, in particular PLR and inflammation/obesity are warranted.

ECX as neoadjvuant chemotherapy for gastric cancer in South America.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e15190-e15190
Author(s):  
Leandro Machado Colli ◽  
Antonio Carlos Godoy ◽  
Bruno Filardi ◽  
Jose Marcio Barros Figueiredo ◽  
José Sebastião Santos ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Disease Progression ◽  
Locally Advanced ◽  
Pathologic Complete Response ◽  
Neoadjuvant Treatment ◽  
Progression Free Survival ◽  
Complete Response ◽  
Brazilian Population ◽  
South American ◽  
South American Population

e15190 Background: Gastric cancer is a common malignant disease with a high mortality rate. Neoadjuvant treatment is efficient, but not the first option for treatment in all countries. Studies of neadjuvant chemotherapy in gastric cancer in South American countries are lacking. The aim of this retrospective analysis was to investigate the use of the ECX (epirubicin, cisplatin, and capecitabine) regimen in the neoadjuvant therapy in a Brazilian population. Methods: 25 patients (median age, 61; range 36-78 years; 14 pts >60 years) with locally advanced gastric adenocarcinoma received three courses of preoperative chemotherapy with epirubicin 50 mg/m², day 1, cisplatin 60 mg/m², day 1, and capecitabine 625 mg/m² bid, days 2-21, of a 21-day cycle. Toxicity was assessed by the Common Toxicity Criteria (CTC) after every cycle. Progression-free survival (PFS) was defined as time from diagnosis to disease progression assessed by CT. Results: 21 pts completed all three planned cycles of neoadjuvant chemotherapy. Four patients receiced surgery earlier than planned due to bleeding (1), toxicity (1), abdominal infection (1), and non-adherence to treatment (1). Three patients could not be operated due to disease progression. 70% of operated patients had curative resection with two pathologic complete response. Only six out 25 patients had disease progression and only two died after a median follow-up of 11.5 months (range 3.4-20.2). Median PFS and overall survival were not reached. Toxicities grade 3-4 were neutropenia (28%), febrile neutropenia (8%), bleeding (8%), and heart failure (6,2%). Conclusions: ECX is a efficacious neoadjuvant treatment in the Brazilian population and also well tolerated and safe. However, more studies with a larger South American population are needed.

Outcomes of recurrence after complete response to definitive chemoradiotherapy for stage II/III (non–T4) esophageal squamous cell carcinoma.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 179-179
Author(s):  
Hiroki Kuwabara ◽  
Ken Kato ◽  
Yusuke Sasaki ◽  
Naoki Takahashi ◽  
Hirokazu Shoji ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Survival Time ◽  
Cox Regression ◽  
Performance Status ◽  
Locally Advanced ◽  
Complete Response ◽  
Advanced Esophageal Cancer ◽  
Locoregional Failure ◽  
Distant Failure ◽  
Locally Advanced Esophageal Cancer

179 Background: Recurrence after definitive chemoradiotherapy (dCRT) for locally advanced esophageal cancer is associated with poor outcome. We examined patterns of recurrence and clinical outcomes in patients with recurrence after complete response (CR) to dCRT. Methods: We retrospectively investigated 238 patients who had achieved initial CR after dCRT for locally advanced esophageal cancer between January 2000 and December 2010. From among these patients we selected 95 who had developed disease recurrence after CR. Overall survival was defined as survival time from recurrence to death and was calculated by using the Kaplan-Meier method. Univariate and multivariate analyses were performed with the Cox regression model to determine prognostic factors for survival. Results: The characteristics of the 95 patients were as follows: male: female = 84:11; median age = 64 years (range 46 to 80); clinical stage at diagnosis (UICC 6th edition) IIA/IIB/III = 20/31/44; and performance status at recurrence (0/1) = (51/44). Primary CRT consisted of 5-FU+cisplatin (n = 87), 5-FU+nedaplatin (n = 3), S-1+cisplatin (n = 3), 5-FU+cisplatin+ nimotuzumab (n = 1), or docetaxel (n = 1). The pattern of recurrence was locoregional failure (n = 53) or any distant failure (n = 42). Median time from the start of dCRT to recurrence was 13.0 months, and median survival time from recurrence to death was 19.6 months. Median survival time according to the pattern of failure was 34.7 months (locoregional failure) or 17.0 months (any distant failure). Application of the Cox regression model, including the additional prognostic variables of age, ECOG performance status, number of organs in which metastases were present, and LDH, revealed that any distant failure (hazard ratio [HR] 2.2; 95% confidence interval [CI] 1.2 to 4.1; P = 0.01) and recurrence before 13.0 months (HR 2.1; 95% CI 1.2 to 3.6; P = 0.01) were predictors of poor overall survival. Conclusions: Early recurrence and any distant failure were associated with poor prognosis after CR to dCRT for locally advanced esophageal cancer.

Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios at the time of chemoradiation to predict survival in resected pancreatic cancer patients.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 452-452
Author(s):  
Vanessa Xu ◽  
Enid Choi ◽  
Alexandra Hanlon ◽  
William Regine ◽  
Michael David Chuong
Keyword(s):  
Pancreatic Cancer ◽  
Cancer Patients ◽  
Clinical Outcomes ◽  
Significant Relationship ◽  
Cox Regression ◽  
Prognostic Significance ◽  
Cox Proportional Hazards ◽  
Borderline Resectable ◽  
Curative Intent ◽  
Lymphocyte Ratio

452 Background: Higher pre-treatment neutrophil-to-lymphocyte ratio (NLR) and lower platelet-to-lymphocyte ratio (PLR) are independent predictors for worse survival in cancer patients. The effect of chemoradiation (CRT) on NLR and PLR in pancreatic cancer patients who also undergo surgical resection has not been reported. Methods: A retrospective review was performed of pancreatic cancer patients treated at our institution with CRT either prior to or after surgery with curative intent. Overall survival was evaluated using Kaplan-Meier method. Univariate and multivariate Cox regression models were applied to evaluate the independent prognostic significance of NLR and PLR. Results: After excluding patients who did not have surgery, who received palliative radiation doses, or who had incomplete medical records, 81 out of 282 patients remained with median age 62 years (35-86). Of these, 24 (29.6%) were borderline resectable (BR) and received preoperative CRT while 57 (70.4%) received adjuvant CRT. Median total dose and number of fractions were 50.4 Gy (30-59.4) and 28 (5-33), respectively. Median pre-CRT and post-CRT NLR were 2.9 and 7.8, respectively. Median pre-CRT and post-CRT PLR were 211.3 and 457.5, respectively. Most patients had a decrease in NLR (85.2%) and PLR (72.8%) after CRT, with median changes of -4.95 for NLR and -178.33 for PLR. Cox proportional hazards analysis showed a trend towards significance for pre-CRT NLR (p=.08) regarding OS. A significant relationship was found between relapse free survival and both pre-CRT NLR (p=0.02) and PLR (p=0.01). The difference or percent change of neither NLR nor PLR was found to correlate with clinical outcomes. Conclusions: This is the first study to evaluate the effect of CRT on NLR and PLR in resected pancreas cancer patients. Similar to other reports, our data indicate that a significant relationship exists between NLR, PLR, and clinical outcomes. Identification of clinically meaningful NLR and PLR cut-off points for resected pancreatic cancer patients who also receive CRT is needed.

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