title: Combination of neutrophil lymphocyte ratio and platelet lymphocyte ratio is a useful predictor of postoperative survival in patients with esophageal squamous cell carcinoma.
abstract: BACKGROUND
  Recent studies have shown that the presence of systemic inflammation correlates with poor survival in various types of cancers. This study investigated the usefulness of a novel inflammation-based prognostic system, using the combination of neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR), collectively named the CNP, for predicting survival in patients with esophageal squamous cell carcinoma (ESCC).
  
  
  METHODS
  THE CNP WAS CALCULATED ON THE BASIS OF DATA OBTAINED ON THE DAY OF ADMISSION: patients with both elevated NLR (>3.45) and PLR (>166.5) were allocated a score of 2, and patients showing one or neither were allocated a score of 1 or 0, respectively.
  
  
  RESULTS
  The CNP was associated with tumor length (P<0.001), differentiation (P=0.021), depth of invasion (P<0.001), and nodal metastasis (P<0.001). No significant differences were found between the CNP and morbidity. However, significant differences were found between the CNP and mortality (P,0.001). The overall survival in the CNP 0, CNP 1, and CNP 2 groups were 63.4%, 50.0%, and 20.2%, respectively (CNP 0 versus CNP 1, P=0.014; CNP 1 versus CNP 2, P<0.001). Multivariate analyses showed that CNP was a significant predictor of overall survival. CNP 1-2 had a hazard ratio (HR) of 1.964 (95% confidence interval [CI]: 1.371-2.814, P<0.001) for overall survival. CNP (HR =1.964, P<0.001) is superior to NLR (HR =1.310, P=0.053) or PLR (HR =1.751, P<0.001) as a predictive factor.
  
  
  CONCLUSIONS
  The CNP is considered a useful predictor of postoperative survival in patients with ESCC. The CNP is superior to NLR or PLR as a predictive factor in patients with ESCC.
authors.affiliation: Department of Thoracic Surgery, Hangzhou, People's Republic of China.
authors.forename: Ji-Feng
authors.initials: JF
authors.lastname: Feng
authors.affiliation: Department of Operating Theatre, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Department of Thoracic Surgery, Hangzhou, People's Republic of China.
authors.forename: Jin-Shi
authors.initials: JS
authors.lastname: Liu
keywords: esophageal squamous cell carcinoma (ESCC); neutrophil lymphocyte ratio (NLR); overall survival; platelet lymphocyte ratio (PLR)