title: Increased Neutrophil-Lymphocyte Ratio Is a Poor Prognostic Factor in Patients with Esophageal Cancer in a High Incidence Area in China.
abstract: OBJECTIVE
  Neutrophil-lymphocyte ratio (NLR) and the platelet-lymphocyte ratio (PLR) have been assumed to be a marker to predict the survival of patients with different types of cancer. We undertook this study to verify the prognostic value of the NLR and the PLR for predicting the survival rate of patients with esophageal cancer in a high incidence area in China.
  
  
  METHODS
  In total, 820 cases from a high incidence area that had pathologically confirmed esophageal cancers initially diagnosed at the Fourth Hospital of Hebei Medical University from 2007-2008 were analyzed. The medical record system was used to collect patient information regarding personal details, cancer type, treatment, and routine blood examinations at the time of admission. Follow-up evaluations were conducted by the established follow-up system at the hospital. We used Kaplan-Meier method to calculate overall survival (OS) rate. We used Cox regression analysis to analyze the factors that may affect the OS rate of the patients. SPSS 13.0 and Excel software packages were used for statistical analysis.
  
  
  RESULTS
  In total, 864 cases were consistent with the inclusion criterion. At the end of the study, 820 cases received follow-up evaluation. Follow-up rate was 94.91%. Among the 820 cases, 334 died of esophageal cancer, whereas 486 remain alive as of March 15, 2014. Five-year OS rate of the patients with esophageal cancer was 40.66%. Patients in the NLR ≥3.5 group demonstrated shorter OS than patients in the NLR <3.5 group (53.2 vs. 33.4 months, p = 0.001). Multivariate analysis indicated that age, pathological type, TNM stage, surgery and NLR were all independent risk factors for esophageal cancer. OR of NLR ≥3.5 group was 1.287 (1.049-1.580).
  
  
  CONCLUSIONS
  NLR may be an independent prognostic factor for esophageal cancer in high incidence areas.
authors.affiliation: The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China.
authors.forename: He
authors.initials: H
authors.lastname: Yutong
authors.affiliation: The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China.
authors.forename: Xu
authors.initials: X
authors.lastname: Xiaoli
authors.affiliation: The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China.
authors.forename: Li
authors.initials: L
authors.lastname: Shumei
authors.affiliation: The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China.
authors.forename: Song
authors.initials: S
authors.lastname: Shan
authors.affiliation: The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Di
authors.affiliation: The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China. Electronic address: baoenshan@hbydsy.com.
authors.forename: Shan
authors.initials: S
authors.lastname: Baoen
mesh_terms: D000328:Adult; D000368:Aged; D001792:Blood Platelets / Q000166:cytology / Q000276:immunology; D002681:China / Q000453:epidemiology; D004938:Esophageal Neoplasms / Q000097:blood / Q000276:immunology* / Q000401:mortality*; D005260:Female; D006801:Humans; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000166:cytology* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000166:cytology* / Q000276:immunology; D010976:Platelet Count; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
keywords: Esophageal cancer; Neutrophil-lymphocyte ratio (NLR); Platelet-lymphocyte ratio (PLR); Prognosis; Survival rate