The relationship between systemic immune-inflammation indexes and treatment response in locally advanced esophageal cancer

Year 2023, Volume: 5 Issue: 1, 53 - 58, 20.01.2023

Esra Kekilli , Ebru Atasever Akkaş , Serab Uyar , Emre Yekedüz

https://doi.org/10.38053/acmj.1208368

Abstract

Aim: Systemic immune-inflammation indexes have been reported to be associated with clinical outcomes in several malignancies. Herein, we aimed to evaluate the potential relationship between prognostic nutritional index (PNI), systemic immune-inflammation index (SII), the neutrophil- to- lymphocyte ratio (NLR), the monocyte- to- lymphocyte ratio (MLR), the platelet-to-lymphocyte ratio (PLR) and the treatment response in patients with esophageal cancer who underwent neoadjuvant chemoradiotherapy (CRT).
Material and Method: Esophageal cancer (EC) patients who underwent neoadjuvant CRT were retrospectively enrolled in the study. Immune-inflammation indexes were calculated from pretreatment blood counts in samples obtained. The relationships between PNI, SII, NLR, MLR, PLR values, treatment response, and overall survival (OS) rates were examined.
Results: The data of 103 patients with EC who were referred to the Radiation Oncology Clinic of Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital were retrospectively analyzed. In the univariate analysis for OS, alcohol consumption, CRT agent, NLR, MLR, PLR, SII and PNI were found as prognostic factors. Also alcohol consumption was found as an independent prognostic factor in multivariate analyzes (HR:5.201, 95% CI:1.9-14.2, p=0.01).
Conclusion: In our study, high SII and low PNI values ​​were not found to be independent poor prognostic factors for OS, but lower OS rates were observed in patients with high SII and low PNI values. 

Keywords

Esophageal cancer, treatment response, systemic immune-inflammation index

References

• Global Cancer Observatory: Cancer Today 2020. . Available from: https://gco.iarc.fr/today/data/factsheets/cancers/6-Oesophagus-fact-sheet.pdf.
• Uhlenhopp DJ, Then EO, Sunkara T, Gaduputi V. Epidemiology of esophageal cancer: update in global trends, etiology and risk factors. Clin J Gastroenterol 2020; 13: 1010-21.
• Rustgi AK, El-Serag HB. Esophageal carcinoma. N Engl J Med 2014; 371: 2499-509.
• van Heijl M, van Lanschot JJ, Koppert LB, et al. Neoadjuvant chemoradiation followed by surgery versus surgery alone for patients with adenocarcinoma or squamous cell carcinoma of the esophagus (CROSS). BMC Surg 2008; 8: 21.
• Donohoe CL, O’Farrell NJ, Grant T, et al. Classification of pathologic response to neoadjuvant therapy in esophageal and junctional cancer: assessment of existing measures and proposal of a novel 3-point standard. Ann Surg 2013; 258: 784-92.
• Noble F, Lloyd MA, Turkington R, et al. Multicentre cohort study to define and validate pathological assessment of response to neoadjuvant therapy in oesophagogastric adenocarcinoma. Br J Surg 2017; 104: 1816-28.
• Bekes EM, Schweighofer B, Kupriyanova TA, et al. Tumor-recruited neutrophils and neutrophil TIMP-free MMP-9 regulate coordinately the levels of tumor angiogenesis and efficiency of malignant cell intravasation. Am J Pathol 2011; 179: 1455-70.
• Liang W, Ferrara N. The complex role of neutrophils in tumor angiogenesis and metastasis. Cancer Immunol Res 2016; 4: 83-91.
• Moses K, Brandau S. Human neutrophils: Their role in cancer and relation to myeloid-derived suppressor cells. Semin Immunol 2016; 28: 187-96.
• Rabinowich H, Cohen R, Bruderman I, Steiner Z, Klajman A. Functional analysis of mononuclear cells infiltrating into tumors: lysis of autologous human tumor cells by cultured infiltrating lymphocytes. Cancer Res 1987; 47: 173-7.
• Lanitis E, Dangaj D, Irving M, Coukos G. Mechanisms regulating T-cell infiltration and activity in solid tumors. Ann Oncol 2017; 28: 18-32.
• Honn KV, Tang DG, Crissman JD. Platelets and cancer metastasis: a causal relationship? Cancer Metastasis Rev 1992; 11: 325-51.
• Gao QF, Qiu JC, Huang XH, et al. The predictive and prognostic role of a novel ADS score in esophageal squamous cell carcinoma patients undergoing esophagectomy. Cancer Cell Int 2018; 18: 153.
• Amin MB, Edge SB, Greene FL. AJCC cancer staging manual 8ed. New York: Springer; 2017.
• Zhao K, Wang C, Shi F, Li M, Yu J. Lymphocyte-monocyte ratio as a predictive marker for pathological complete response to neoadjuvant therapy in esophageal squamous cell carcinoma. Transl Cancer Res 2020; 9: 3842-53.
• Chen JH, Zhai ET, Yuan YJ, et al. Systemic immune-inflammation index for predicting prognosis of colorectal cancer. World J Gastroenterol 2017; 23: 6261-72.
• Gao Y, Guo W, Cai S, et al. Systemic immune-inflammation index (SII) is useful to predict survival outcomes in patients with surgically resected esophageal squamous cell carcinoma. J Cancer 2019; 10: 3188-96.
• Bogaerts J, Ford R, Sargent D, et al. Individual patient data analysis to assess modifications to the RECIST criteria. Eur J Cancer 2009; 45: 248-60.
• Buzby GP, Mullen JL, Matthews DC, Hobbs CL, Rosato EF. Prognostic nutritional index in gastrointestinal surgery. Am J Surg 1980; 139: 160-7.
• Onodera T, Goseki N, Kosaki G. [Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients]. Nihon Geka Gakkai Zasshi 1984; 85: 1001-5.
• Fu X, Li T, Dai Y, Li J. Preoperative systemic inflammation score (SIS) is superior to neutrophil to lymphocyte ratio (NLR) as a predicting indicator in patients with esophageal squamous cell carcinoma. BMC Cancer 2019; 19: 721.
• Cai G, Yu J, Meng X. Predicting prognosis and adverse events by hematologic markers in patients with locally advanced esophageal squamous cell carcinoma treated with neoadjuvant chemoradiotherapy. Cancer Manag Res 2020; 12: 8497-507.
• Asher V, Lee J, Innamaa A, Bali A. Preoperative platelet lymphocyte ratio as an independent prognostic marker in ovarian cancer. Clin Transl Oncol 2011; 13: 499-503.
• Hirahara N, Tajima Y, Fujii Y, et al. Preoperative prognostic nutritional index predicts long-term surgical outcomes in patients with esophageal squamous cell carcinoma. World J Surg 2018; 42: 2199-208.
• Wu Y, Chen J, Zhao L, et al. Prediction of pathologic response to neoadjuvant chemoradiotherapy in patients with esophageal squamous cell carcinoma incorporating hematological biomarkers. Cancer Res Treatment 2021; 53: 172-83.
• Koh HK, Park Y, Koo T, et al. Neutrophil-to-lymphocyte ratio after definitive concurrent chemoradiotherapy predicts survival in patients with esophageal squamous cell carcinoma. In Vivo 2021; 35: 1133-9.
• Herskovic A, Russell W, Liptay M, Fidler MJ, Al-Sarraf M. Esophageal carcinoma advances in treatment results for locally advanced disease: review. Ann Oncol 2012; 23: 1095-103.
• Yang H, Liu H, Chen Y, et al. Long-term efficacy of neoadjuvant chemoradiotherapy plus surgery for the treatment of locally advanced esophageal squamous cell carcinoma: the NEOCRTEC5010 randomized clinical trial. JAMA Surg 2021; 156: 721-9.