Haematological Biomarkers and Prognosis in Resectable Oesophageal Adenocarcinoma

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Introduction

Despite the use of neo-adjuvant therapy prior to surgical resection in oesophageal adenocarcinoma survival remains poor. Selection of patients for surgery and adequate stratification are required to inform clinical decision making.

Aims

We sought to evaluate neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and other haematological biomarkers in resectable oesophageal adenocarcinoma.

Methods

166 patients with oesophageal adenocarcinoma were treated with Epirubicin, Cisplatin and 5-Fluorouracil/Capecitabine (ECF/X) chemotherapy prior to surgical resection at the Northern Ireland Cancer Centre between 2004 and 2012. Haematological parameters were measured prior to surgery. Survival analysis was performed using the Kaplan-Meier method with Hazard ratios (HR) calculated using the log-rank test.

Results

High NLR was associated with poor overall survival (HR 2.07, 95% CI 1.01-4.21, p=0.046) (Figure 1). A median OS of 32.6 and 38.4 months was observed in the high and low NLR groups respectively. High PLR correlated with poor survival (HR 1.79, 95% CI 1.08-2.98; p=0.024) with a median OS of 20.9 and 38.9 months in the high and low PLR groups respectively.

A poor prognosis was associated with a Haemoglobin (Hb) ≤12 (HR 1.95, 95% CI 1.25-3.04; p=0.003) with a median OS of 23.4 and 52.7 months for Hb>12 and ≤12 respectively (Figure 2). Patients with a pre-operative Albumin <40 also had poor survival following resection (HR 2.61, 95% CI 1.40-4.87; p=0.002).

Conclusion

Haematological biomarkers measured prior to surgical resection for oesophageal adenocarcinoma are predictive of postoperative survival.