title: Prognostic role of neutrophil-lymphocyte ratio in operable esophageal squamous cell carcinoma.
abstract: OBJECTIVE
  To determine the prognostic significance of preoperative serum neutrophil-lymphocyte ratio (NLR) in esophageal squamous cell carcinoma (ESCC).
  
  
  METHODS
  Data from 371 eligible patients with ESCC who had undergone surgery with curative intent at our institution between October 2000 and May 2007 were retrospectively recruited for analysis. The cutoff value of NLR was 3.0 as determined by the receiver operating characteristic curve, which discriminated between survival and death; the area under the curve was 0.709, and the sensitivity and specificity were 66.1% and 69.1%, respectively, at the cutoff point. The correlation between the NLR and clinicopathological characteristics was analyzed using a χ(2) test. The prognostic influence of the NLR and other clinicopathological factors on cancer-specific survival (CSS) and recurrence-free survival (RFS) was studied using the Kaplan-Meier method. To evaluate the independent prognostic value of NLR, multivariate Cox regression models were applied.
  
  
  RESULTS
  The median age of the patients was 57.0 years, and 276/371 (74.4%) patients were male. The NLR was ≤ 3.0 in 80.1% (297/371) of the patients, and the remaining 19.9% (74/371) had an NLR > 3.0. Median postoperative follow-up was 66.0 mo [interquartile range (IQR): 49.0-76.0 mo], with a follow-up rate of 94%. Follow-up was not significantly different between patients with an NLR ≤ and > 3.0 (63.13 ± 1.64 vs 61.52 ± 3.66, P = 0.711). However, higher preoperative serum NLR was associated with significantly increased risks of higher pathological tumor status (P = 0.007). A significant, independent association between high preoperative serum NLR and poor clinical outcome was identified in a multivariate analysis for CSS (HR = 1.591; P = 0.007) and RFS (HR = 1.525; P = 0.013). Moreover, when patients were stratified by pathological tumor-node-metastasis (TNM) staging, the adverse effects of preoperative serum NLR on CSS (HR = 2.294; P = 0.008) and RFS (HR = 2.273; P = 0.008) were greatest in those patients with stage IIIA disease.
  
  
  CONCLUSIONS
  Preoperative serum NLR is a useful prognostic marker to complement TNM staging for operable ESCC patients, particularly in patients with stage IIIA disease.
authors.affiliation: Hao Duan, Xu Zhang, Fei-Xiang Wang, Guo-Wei Ma, Hong Yang, Jian-Hua Fu, Zi-Hui Tan, Yu-Qi Meng, Xia-Yu Fu, Qi-Long Ma, Peng Lin, Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong Province, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Duan
authors.affiliation: Hao Duan, Xu Zhang, Fei-Xiang Wang, Guo-Wei Ma, Hong Yang, Jian-Hua Fu, Zi-Hui Tan, Yu-Qi Meng, Xia-Yu Fu, Qi-Long Ma, Peng Lin, Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong Province, China.
authors.forename: Xu
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Hao Duan, Xu Zhang, Fei-Xiang Wang, Guo-Wei Ma, Hong Yang, Jian-Hua Fu, Zi-Hui Tan, Yu-Qi Meng, Xia-Yu Fu, Qi-Long Ma, Peng Lin, Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong Province, China.
authors.forename: Fei-Xiang
authors.initials: FX
authors.lastname: Wang
authors.affiliation: Hao Duan, Xu Zhang, Fei-Xiang Wang, Guo-Wei Ma, Hong Yang, Jian-Hua Fu, Zi-Hui Tan, Yu-Qi Meng, Xia-Yu Fu, Qi-Long Ma, Peng Lin, Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong Province, China.
authors.forename: Mu-Yan
authors.initials: MY
authors.lastname: Cai
authors.affiliation: Hao Duan, Xu Zhang, Fei-Xiang Wang, Guo-Wei Ma, Hong Yang, Jian-Hua Fu, Zi-Hui Tan, Yu-Qi Meng, Xia-Yu Fu, Qi-Long Ma, Peng Lin, Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong Province, China.
authors.forename: Guo-Wei
authors.initials: GW
authors.lastname: Ma
authors.affiliation: Hao Duan, Xu Zhang, Fei-Xiang Wang, Guo-Wei Ma, Hong Yang, Jian-Hua Fu, Zi-Hui Tan, Yu-Qi Meng, Xia-Yu Fu, Qi-Long Ma, Peng Lin, Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong Province, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Yang
authors.affiliation: Hao Duan, Xu Zhang, Fei-Xiang Wang, Guo-Wei Ma, Hong Yang, Jian-Hua Fu, Zi-Hui Tan, Yu-Qi Meng, Xia-Yu Fu, Qi-Long Ma, Peng Lin, Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong Province, China.
authors.forename: Jian-Hua
authors.initials: JH
authors.lastname: Fu
authors.affiliation: Hao Duan, Xu Zhang, Fei-Xiang Wang, Guo-Wei Ma, Hong Yang, Jian-Hua Fu, Zi-Hui Tan, Yu-Qi Meng, Xia-Yu Fu, Qi-Long Ma, Peng Lin, Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong Province, China.
authors.forename: Zi-Hui
authors.initials: ZH
authors.lastname: Tan
authors.affiliation: Hao Duan, Xu Zhang, Fei-Xiang Wang, Guo-Wei Ma, Hong Yang, Jian-Hua Fu, Zi-Hui Tan, Yu-Qi Meng, Xia-Yu Fu, Qi-Long Ma, Peng Lin, Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong Province, China.
authors.forename: Yu-Qi
authors.initials: YQ
authors.lastname: Meng
authors.affiliation: Hao Duan, Xu Zhang, Fei-Xiang Wang, Guo-Wei Ma, Hong Yang, Jian-Hua Fu, Zi-Hui Tan, Yu-Qi Meng, Xia-Yu Fu, Qi-Long Ma, Peng Lin, Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong Province, China.
authors.forename: Xia-Yu
authors.initials: XY
authors.lastname: Fu
authors.affiliation: Hao Duan, Xu Zhang, Fei-Xiang Wang, Guo-Wei Ma, Hong Yang, Jian-Hua Fu, Zi-Hui Tan, Yu-Qi Meng, Xia-Yu Fu, Qi-Long Ma, Peng Lin, Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong Province, China.
authors.forename: Qi-Long
authors.initials: QL
authors.lastname: Ma
authors.affiliation: Hao Duan, Xu Zhang, Fei-Xiang Wang, Guo-Wei Ma, Hong Yang, Jian-Hua Fu, Zi-Hui Tan, Yu-Qi Meng, Xia-Yu Fu, Qi-Long Ma, Peng Lin, Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong Province, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Lin
mesh_terms: D019540:Area Under Curve; D002294:Carcinoma, Squamous Cell / Q000097:blood / Q000175:diagnosis* / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000601:surgery; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000601:surgery; D000077277:Esophageal Squamous Cell Carcinoma; D016629:Esophagectomy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D018655:Lymphocyte Count; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009504:Neutrophils; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Esophageal squamous cell carcinoma; Neutrophil-lymphocyte ratio; Prognosis; Radical esophagectomy