Haematological Biomarkers and Prognosis in Locally Advanced and Metastatic Oesophago-gastric Adenocarcinoma

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Introduction

Survival outcomes in advanced oesophago-gastric adenocarcinoma are poor and there is a need to improve patient stratification to aid clinical decision-making.

Aims

We sought to evaluate neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and other haematological biomarkers in an advanced oesophago-gastric adenocarcinoma population.

Methods

183 patients with locally advanced or metastatic oesophago-gastric adenocarcinoma were treated with Epirubicin, Cisplatin and 5-Fluorouracil/Capecitabine (ECF/X) chemotherapy at the Northern Ireland Cancer Centre between 2007 and 2012. Haematological parameters were measured prior to administration of the first cycle of chemotherapy. Survival analysis was performed using the Kaplan-Meier method with Hazard ratios (HR) calculated using the log-rank test.

Results

High NLR was defined as a value above the median of 4.1 and was associated with poor overall survival (HR 1.44, 95% CI 1.07-1.94, p=0.016) (Figure 1). A median OS of 8.4 and 11.5 months was observed in the high and low NLR groups respectively. High PLR also correlated with poor survival (HR 1.58, 95% CI 1.17-2.14; p=0.003).
Other haematological parameters which predicted a poor prognosis included Haemoglobin (Hb) ≤10 (HR 2.17, 95% CI 1.27-3.71; p=0.005) with a median OS of 7.0 and 10.7 months for Hb ≤10 and >10 respectively and Alkaline Phosphatase (ALP) greater than the upper normal range (HR 2.33, 95% CI 1.46-3.71; p=0.0004) (Figure 2).

Conclusion

NLR, PLR and other haematological biomarkers measured prior to administration of palliative chemotherapy for oesophago-gastric adenocarcinoma are predictive of prognosis.