Neutrophil to lymphocyte ratio as a predictor of response to neoadjuvant chemotherapy and survival in oesophageal adenocarcinoma.

Background Inflammation has an important role in cancer survival, yet whether serum markers of inflammation predict response to potentially curative neoadjuvant chemotherapy (NAC) in oesophageal adenocarcinoma (OAC) is controversial. This study aimed to determine whether the systemic inflammatory response (SIR) is associated with response to NAC and survival. Methods Consecutive patients with OAC planned for surgery with curative intent received blood neutrophil and lymphocyte measurements at diagnosis to calculate the neutrophil to lymphocyte ratio (NLR). Pathological variables including pTNM stage, differentiation, vascular invasion and Mandard tumour regression grade (TRG) were recorded. TRGs 1 and 2 were taken to represent a good response, and the primary outcome was overall survival. Results During follow-up of 136 patients, 36 patients (26 center dot 5 per cent) had recurrence and 69 (50 center dot 7 per cent) died. Receiver operating characteristic (ROC) curve analysis of NLR before NAC predicted poor TRG (area under the ROC curve 0 center dot 71, 95 per cent c.i. 0 center dot 58 to 0 center dot 83; P = 0 center dot 002). In univariable analysis, pT category (P < 0 center dot 001), pN category (P < 0 center dot 001), poor differentiation (P = 0 center dot 006), margin positivity (P = 0 center dot 001), poor TRG (P = 0 center dot 014) and NLR (dichotomized at 2 center dot 25; P = 0 center dot 017) were associated with poor overall survival, and NLR retained independent significance in multivariable analysis (hazard ratio 2 center dot 26, 95 per cent c.i. 1 center dot 03 to 4 center dot 93; P = 0 center dot 042). Conclusion: The pretreatment NLR was associated with a pathological response to NAC and overall survival in patients with OAC.