Correlation between the pretherapeutic neutrophil to lymphocyte ratio and the pathologic response to neoadjuvant chemotherapy in patients with advanced esophageal cancer

World J Surg. 2012 Mar;36(3):617-22. doi: 10.1007/s00268-011-1411-1.


Background: An elevation in the neutrophil-to-lymphocyte ratio (NLR) has been shown to be associated with a poorer prognosis in patients with various tumors. The aim of this retrospective study was to clarify the correlation of the pretherapeutic NLR with the prognostic value of the pathologic response to neoadjuvant chemotherapy (NAC) in patients with advanced esophageal cancer.

Methods: This study was a retrospective review of 83 patients undergoing NAC for advanced esophageal cancer following esophagectomy. The NLR was measured before NAC, and the pathologic responses to NAC were evaluated.

Results: A comparison was performed for those whose pathology responded (responders) (G3/G2/G1b) and nonresponders (G1a/G0). In a univariate analysis, the cStage (P = 0.005), cN (P = 0.0001), and NLR (P = 0.005) were statistically significant parameters. A multivariate analysis revealed that the factors independently associated with pathologic responses were the pretreatment NLR (<2.2/≥2.2) (P = 0.043) and lymph nodes metastasis (P = 0.002). The pretreatment NLR (<2.2/≥2.2) was found to be a statistically significant useful predictive marker for a pathologic response (P = 0.001). The pathologic response rates were 56% in the patients with an NLR <2.2 and 21% in patients with an NLR of ≥2.2.

Conclusions: Our study is the first to demonstrate that the pretherapeutic NLR can be used as a predictor for chemosensitivity of thoracic esophageal cancer. Preoperative evaluation based on the clinical N stage and NLR may be easily used in routine clinical practice.

MeSH terms

  • Adenocarcinoma / blood
  • Adenocarcinoma / drug therapy*
  • Adenocarcinoma / pathology*
  • Adenocarcinoma / surgery
  • Adult
  • Aged
  • Blood Cell Count
  • Carcinoma, Squamous Cell / blood
  • Carcinoma, Squamous Cell / drug therapy*
  • Carcinoma, Squamous Cell / pathology*
  • Carcinoma, Squamous Cell / surgery
  • Chemotherapy, Adjuvant
  • Esophageal Neoplasms / blood
  • Esophageal Neoplasms / drug therapy*
  • Esophageal Neoplasms / pathology*
  • Esophageal Neoplasms / surgery
  • Female
  • Head and Neck Neoplasms / blood
  • Head and Neck Neoplasms / drug therapy*
  • Head and Neck Neoplasms / pathology*
  • Head and Neck Neoplasms / surgery
  • Humans
  • Lymphocytes / pathology*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Neoadjuvant Therapy*
  • Neutrophils / pathology*
  • Prognosis
  • Retrospective Studies
  • Squamous Cell Carcinoma of Head and Neck
  • Treatment Outcome