Original Articles

Prognostic Role of Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio in the Survival of Patients with Esophageal Cancer


Background: Different factors can affect the future of a person with cancer. Patient’s systemic inflammatory response is an important factor. Several inflammatory markers have been evaluated for measuring the patient’s response to cancer. In this retrospective cohort study, we evaluated neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) as prognostic factors of surveillance in patients with pathologic approved esophageal cancer. Methods: In this retrospective cohort study, patients with pathologically approved esophageal cancer, who underwent surgical treatment in cancer institute of Iran, were included. Demographic, pathologic and laboratory data of patients were obtained from archive of medical records. Results: In this study 135 patients with esophageal cancer with mean age of 60 years were studied.The median time of follow-up period was 21 months. Mean NLR and PLR were 7.05 and 898 respectively. Patients’ survival had a significant relationship with patients’ age, gender, tumor’s diffrentiation, receiving chemotherapy, absolute neutrophil count, total bilirubin, direct bilirubin, and NLR. Conclusion: According to the results, in a multi variable investigation, it was demonstrated that a high NLR has a direct effect on patients’ poor survival.
1.Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013.CA: a cancer journal for clinicians. 2013;63(1):11-30.
2.Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA,Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians.2018;68(6):394-424.
3.Pohl H, Welch HG. The role of overdiagnosis and reclassification in the marked increase of esophageal adenocarcinoma incidence. Journal of the National Cancer Institute.2005;97(2):142-6.
4.Sohda M, Kuwano H. Current Status and Future Prospects for Esophageal Cancer Treatment. Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia.2017;23(1):1-11.
5.Yokota T, Kato K, Hamamoto Y, Tsubosa Y, Ogawa H, Ito Y, et al. Phase II study of chemoselection with docetaxel plus cisplatin and 5-fluorouracil induction chemotherapy and subsequent conversion surgery for locally advanced unresectable oesophageal cancer. British journal of cancer.
6.McLaren PJ, Bronson NW, Hart KD, Vaccaro GM, Gatter KM, Thomas CR, Jr., et al. Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios can Predict Treatment Response to Neoadjuvant Therapy in EsophagealCancer. Journal of gastrointestinal surgery : official journal
of the Society for Surgery of the Alimentary Tract.2017;21(4):607-13.
7.Lv L, Hu W, Ren Y, Wei X. Minimally invasive esophagectomy versus open esophagectomy for esophageal cancer: a meta-analysis. OncoTargets and therapy. 2016;9:6751-62.
8.Howlader N, Noone A, Krapcho M, Garshell J, Miller D,Altekruse S, et al. SEER Cancer Statistics Review, 1975-2012, National Cancer Institute. Bethesda, MD. 2015.
9.Pirozzolo G, Gisbertz SS, Castoro C, van Berge Henegouwen MI, Scarpa M. Neutrophil-to-lymphocyte ratio as prognostic marker in esophageal cancer: a systematic review and meta-analysis. Journal of thoracic disease.2019;11(7):3136-45.
10.Roxburgh CS, McMillan DC. Role of systemic inflammatory response in predicting survival in patients with primary operable cancer. Future oncology (London, England).2010;6(1):149-63.
11.Sato Y, Gonda K, Harada M, Tanisaka Y, Arai S, Mashi mo Y, et al. Increased neutrophil-to-lymphocyte ratio is a novel marker for nutrition, inflammation and chemotherapy outcome in patients with locally advanced and metastatic esophageal squamous cell carcinoma. Biomedical reports.
12.Guthrie GJ, Charles KA, Roxburgh CS, Horgan PG, McMillan DC, Clarke SJ. The systemic inflammation-based neutrophil-lymphocyte ratio: experience in patients with cancer.Critical reviews in oncology/hematology. 2013;88(1):218-30.
13.Luo G, Guo M, Liu Z, Xiao Z, Jin K, Long J, et al. Blood neutrophil-lymphocyte ratio predicts survival in patients with advanced pancreatic cancer treated with chemotherapy.Annals of surgical oncology. 2015;22(2):670-6.
14.van Verschuer VM, Hooning MJ, van Baare-Georgieva RD,Hollestelle A, Timmermans AM, Koppert LB, et al. Tumor-associated inflammation as a potential prognostic tool in BRCA1/2-associated breast cancer. Human pathology.2015;46(2):182-90.
15.Hirahara N, Matsubara T, Mizota Y, Ishibashi S, Tajima Y. Prognostic value of preoperative inflammatory response biomarkers in patients with esophageal cancer who undergo a curative thoracoscopic esophagectomy. BMC surgery.2016;16(1):66.
16.Sierzega M, Lenart M, Rutkowska M, Surman M, Mytar B, Matyja A, et al. Preoperative Neutrophil-Lymphocyte and Lymphocyte-Monocyte Ratios Reflect Immune Cell Population Rearrangement in Resectable Pancreatic Cancer. Annals of surgical oncology. 2017;24(3):808-15.
17.Yang Y, Xu H, Zhou L, Deng T, Ning T, Liu R, et al. Platelet to lymphocyte ratio is a predictive marker of prognosis and therapeutic effect of postoperative chemotherapy in non-metastatic esophageal squamous cell carcinoma. Clinica chimica acta; international journal of clinical chemistry.
18.Sato YU, Gonda K, Harada M, Tanisaka Y, Arai S, Mashimo Y, et al. Increased neutrophil-to-lymphocyte ratio is a novel marker for nutrition, inflammation and chemotherapy outcome in patients with locally advanced and metastatic esophageal squamous cell carcinoma. Biomedical reports.
19.Feng JF, Huang Y, Chen QX. A new inflammation index is useful for patients with esophageal squamous cell carcinoma. OncoTargets and therapy. 2014;7:1811-5.
20.Feng J-F, Huang Y, Liu J-S. Combination of neutrophil lymphocyte ratio and platelet lymphocyte ratio is a useful predictor of postoperative survival in patients with esophageal squamous cell carcinoma. OncoTargets and therapy. 2013;6:1605.
21.Yodying H, Matsuda A, Miyashita M, Matsumoto S,Sakurazawa N, Yamada M, et al. Prognostic Significance of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Oncologic Outcomes of Esophageal Cancer: A Systematic Review and Meta-analysis. Annals of surgical oncology.2016;23(2):646-54.
22.Gregory AD, Houghton AM. Tumor-associated neutrophils:new targets for cancer therapy. Cancer research.2011;71(7):2411-6.
23.An X, Ding P-R, Li Y-H, Wang F-H, Shi Y-X, Wang Z-Q, et al. Elevated neutrophil to lymphocyte ratio predicts survival in advanced pancreatic cancer. Biomarkers. 2010;15(6):516-22.
24.Jung J, Park SY, Park SJ, Park J. Prognostic value of the neutrophil- to-lymphocyte ratio for overall and disease-free survival in patients with surgically treated esophageal squamous cell carcinoma. Tumour biology : the journal of the International Society for Oncodevelopmental Biology and Medicine. 2016;37(6):7149-54.
25.Feng JF, Huang Y, Chen QX. Preoperative platelet lymphocyte ratio (PLR) is superior to neutrophil lymphocyte ratio (NLR) as a predictive factor in patients with esophageal squamous cell carcinoma. World journal of surgical oncology. 2014;12:58.
26.Grivennikov SI, Greten FR, Karin M. Immunity, inflammation, and cancer. Cell. 2010;140(6):883-99.
27.Berger AC, Farma J, Scott WJ, Freedman G, Weiner L,Cheng JD, et al. Complete response to neoadjuvant chemoradiotherapy in esophageal carcinoma is associated with significantly improved survival. Journal of clinical oncology.2005;23(19):4330-7.
28.Urabe M, Yamashita H, Seto Y. Pretreatment Neutrophil to Lymphocyte Ratio Independently Predicts Disease-specific Survival in Patients with Resectable Gastroesophageal Junction and Gastric Cancer. Annals of surgery.2017;266(6):e76-e7.
29.Noble F, Hopkins J, Curtis N, Kelly JJ, Bailey IS, Byrne JP, et al. The role of systemic inflammatory and nutritional bloodborne markers in predicting response to neoadjuvant chemotherapy and survival in oesophagogastric cancer. Medical oncology.2013;30(3):596
IssueVol 12 No 4 (2020) QRcode
SectionOriginal Articles
DOI https://doi.org/10.18502/bccr.v12i4.7981
esophageal cancer survival neutrophils lymphocytes platelets surgery esophagectomy

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Tajik M, Shirkhoda M, Hadji M, Seyyedsalehi M sadat, Saeidi E, Zendehdel K. Prognostic Role of Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio in the Survival of Patients with Esophageal Cancer. Basic Clin Cancer Res. 2021;12(4):184-192.