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Usefulness of Neutrophil to Lymphocyte Ratio at Recurrence for Predicting Long-Term Outcomes in Patients with Recurrent Esophageal Squamous Cell Carcinoma

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Although radical esophagectomy with multifield lymph node dissection is a promising treatment to achieve long-term survival for resectable esophageal cancer, survival after postoperative recurrence remains poor. To select the optimal treatment for patients with recurrent esophageal cancer, simple, objective indicators for predicting of long-term outcomes are needed.

Patients and Methods

We conducted a single-institution, retrospective cohort study between 2004 and 2019, wherein 586 patients underwent transthoracic esophagectomy for primary esophageal squamous cell carcinoma. Of these, 133 patients with postoperative recurrence were included in this analysis. Several predictors of survival after recurrence were investigated.

Results

Among all patients, the 1- and 3-year survival rates after recurrence were 48.0% and 23.1%, respectively. On multivariate analysis, the neutrophil to lymphocyte ratio (NLR) at recurrence was identified as a significant predictor of death after recurrence (hazard ratio 1.061; 95% confidence interval 1.002–1.125; p = 0.043). Time-dependent receiver operating characteristics curves showed that the area under the curve value of the NLR at recurrence was superior to the modified Glasgow Prognostic Score at recurrence in all terms. To simulate the clinical decision process, we set the cut-off NLR at recurrence for survival using survival classification and regression tree (CART) and defined the optimal cut-off value as 3.374.

Conclusions

NLR at recurrence was a significant indicator of survival after recurrence in patients with recurrent esophageal cancer. CART analysis was used to determine the optimal cut-off value for the prediction of survival, allowing the NLR to be used clinically to facilitate decision making.

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Acknowledgments

The authors thank Kumiko Motooka, a staff member at the Department of Surgery in Keio University School of Medicine, for her help in the preparation of this manuscript.

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Author notes

  1. Shota Hoshino and Masashi Takeuchi have contributed equally to this work.

Authors and Affiliations

  1. Department of Surgery, Keio University School of Medicine, Tokyo, Japan

    Shota Hoshino MD, Masashi Takeuchi MD, PhD, Hirofumi Kawakubo MD, PhD, Satoru Matsuda MD, PhD, Shuhei Mayanagi MD, PhD, Tomoyuki Irino MD, PhD, Kazumasa Fukuda PhD, Rieko Nakamura MD, PhD, Norihito Wada MD, PhD & Yuko Kitagawa MD, PhD

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  1. Shota Hoshino MD
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  2. Masashi Takeuchi MD, PhD
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  3. Hirofumi Kawakubo MD, PhD
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Corresponding author

Correspondence to Hirofumi Kawakubo MD, PhD.

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Disclosure

Dr. Kitagawa reports grants from TAIHO PHARMACEUTICAL CO., LTD., CHUGAI PHARMACEUTICAL CO., LTD., Yakult Honsha Co. Ltd, DAIICHI SANKYO COMPANY, Merck Serono Co., Ltd, AsahiKASEI Co., Ltd, EA Pharma Co., Ltd., Otsuka Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co., Ltd., Otsuka Pharmaceutical Factory Inc., SHIONOGI & CO., LTD., KAKEN PHARMACEUTICAL CO., LTD., Kowa Pharmaceutical Co., Ltd., Astellas Pharma Inc, MEDICON INC., DAINIPPON SUMITOMO PHARMA Co., Ltd., Taisho Toyama Pharmaceutical Co., Ltd., Kyouwa Hakkou Kirin Co., Ltd., Pfizer Japan Inc., ONO PHARMACEUTICAL CO., LTD., NIHON PHARMACEUTICAL CO., LTD., Japan Blood Products Organization, Medtronic Japan Co., Ltd., Sanofi K.K., Eisai Co., Ltd, TSUMURA & CO., KCI Licensing, Inc., ABBOTT JAPAN CO., LTD, and FUJIFILM Toyama Chemical Co., Ltd. outside the submitted work. Dr. Fukuda belongs to the Keio University School of Medicine Endowed Chair in Cancer Research (funded by CHUGAI PHARMACEUTICAL CO., LTD and TAIHO PHARMACEUTICAL CO., LTD).

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Hoshino, S., Takeuchi, M., Kawakubo, H. et al. Usefulness of Neutrophil to Lymphocyte Ratio at Recurrence for Predicting Long-Term Outcomes in Patients with Recurrent Esophageal Squamous Cell Carcinoma. Ann Surg Oncol 28, 3001–3008 (2021). https://doi.org/10.1245/s10434-021-09637-0

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