Systemic inflammatory dynamics during chemoradiotherapy predict response, relapse, metastasis, and survival in esophageal carcinoma

Background and Objectives: Lymphopenia associated with chemoradiotherapy predicts prognosis in esophageal carcinoma. The purpose of our study was to evaluate alterations in hematologic measures of inflammation during chemoradiation. Methods: We performed an observational study evaluating adults treated with chemoradiation in the neoadjuvant or definitive setting for stage II-III esophageal carcinoma. Multivariable logistic regression evaluated predictors of pathologic response. Survival was analyzed by time-varying multivariable Cox proportional hazards regressions. Results: A total of 94 patients were included with median follow-up of 1.6 years. Elevated neutrophil:lymphocyte ratio (NLR) was predictive of incomplete pathologic response to neoadjuvant chemoradiation (OR, 1.07; P =.0030) as well as shorter distant metastasis-free survival (HR, 1.01; P =.0369) and reduced overall survival (HR, 1.01; P =.0448). An NLR > 5.55 in week two of chemoradiation predicted shorter overall survival (P =.0070). Upon adjusted analysis, NLR was independently associated with reduced probability of complete pathologic response (OR, 0.80; P =.0291), as well as poor histologic response to neoadjuvant chemoradiation (OR, 1.05; P =.0303), shorter disease-free survival (HR, 1.02; P =.0077), and reduced overall survival (HR, 1.02; P =.0070). Conclusions: Dynamic time-dependent changes in NLR during chemoradiation predict response, relapse, metastasis, and survival in esophageal carcinoma. Prospective validation is warranted.