Influence of pretreatment hematological inflammatory markers for patients with esophageal squamous cell carcinoma receiving chemoradiotherapy

Objective: The purpose of this study was to investigate the influence of pre-treatment inflammatory markers on the therapeutic effect and survival outcome in patients with esophageal squamous cell carcinoma (ESCC) who received chemoradiotherapy (CRT) or radiotherapy (RT) alone. Methods: A total of 107 patients who were diagnosed with ESCC were retrospectively analysed. They were treated with radical radiotherapy alone or concurrent chemoradiotherapy in the Affiliated Taixing People's Hospital of Yangzhou University between January 2013 and December 2014. According to the median values of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and CRP/Alb ratio before treatment, the patients were divided into NLR < 3.06 group (54 cases) and NLR ≥ 3.06 group (53 cases), PLR < 145.26 group (54 cases) and PLR ≥ 145.26 (53 cases), CRP/Alb < 0.13 group (52 cases) and CRP/Alb ≥ 0.13 (55 cases), respectively. The relationships between the response to treatment and these markers were analysed by univariate and multivariate logistic analyses. The Kaplan-Meier method and logrank test were adopted to calculate and compare associations of the progression-free survival (PFS) rates with these blood markers. Cox proportional hazards models were used for the univariate and multivariate analyses. Results: The therapeutic effects of chemoradiotherapy, NLR < 3.06, PLR < 145.26 and CRP/ Alb < 0.13 were better than those of radiotherapy alone, NLR ≥ 3.06, PLR ≥ 145.26 and CRP/Alb ≥ 0.13, respectively, and the differences were statistically significant (HR = 2.118, 4.138, 2.297, 3.784, P < 0.05). Further analysis showed that chemoradiotherapy (HR = 1.342, 95% CI 1.023 ∼ 2.467, P < 0.05) and CRP/Alb ratio < 0.13 (HR = 7.004, 95% CI 2.088 ∼ 23.496, P < 0.05) were independent risk factors for good tumour response. In addition, TNM stage, treatment modality, NLR, PLR and CRP/Alb ratio were significantly associated with PFS by the univariate analysis (P < 0.05 for all). Furthermore, the multivariate Cox proportional hazard regression model analysis showed that only TNM stage (HR = 1.326, 95% CI 1.070-1.833 P < 0.05), treatment modality (HR = 0.400, 95% CI 0.230-0.694, P < 0.05) and CRP/Alb ratio (HR = 3.518, 95% CI 1.975-6.266, P < 0.05) were considered independent prognostic factors for PFS. And according to TNM staging and treatment subgroup analysis, CRP/Alb < 0.13 had better progression-free survival time than CRP/Alb ≥ 0.13 ESCC patients. Finally, the ROC curve also confirmed that CRP/Alb was superior to NLR and PLR in predicting short-term efficacy and progression-free survival in ESCC patients receiving chemoradiotherapy. Conclusions: Our study demonstrated that CRP/Alb ratio was promising as a predictive marker for the therapeutic effect and survival outcome in ESCC patients receiving CRT or RT alone. (authors)