title: Systemic inflammatory markers and outcome in patients with locally advanced adenocarcinoma of the oesophagus and gastro-oesophageal junction.
abstract: BACKGROUND
  Raised levels of systemic inflammatory markers are associated with poor survival in patients with cancer. The aim of this study was to assess the prognostic value of markers of systemic inflammation in patients with adenocarcinoma of the oesophagus or gastro-oesophageal junction.
  
  
  METHODS
  Data from a consecutive series of patients undergoing transthoracic oesophagectomy following neoadjuvant therapy at a single centre were analysed. Fibrinogen, albumin, C-reactive protein, leucocyte differential and platelet counts were measured before surgery. The upper quartile (75th percentile) was used as a cut-off for dichotomization. Multivariable regression analysis was performed to identify independent prognostic factors.
  
  
  RESULTS
  A series of 199 patients underwent transthoracic oesophagectomy following neoadjuvant therapy. Univariable analysis indicated that reduced median survival was associated with a raised platelet : lymphocyte ratio (158 or above; 25.6 versus 44·4 months for patients with a normal ratio, P = 0·038) and increased fibrinogen levels (4·9 g/l or above; 22·8 versus 59·9 months for those with a normal level, P = 0·005). On multivariable analysis a combination of one or more markers of systemic inflammation was associated with poorer overall survival (hazard ratio 2·12, 95 per cent c.i. 1·20 to 3·74; P = 0·010).
  
  
  CONCLUSIONS
  Preoperative markers of systemic inflammation predict poor outcome in patients undergoing curative treatment for locally advanced oesophageal and gastro-oesophageal adenocarcinoma.
authors.affiliation: Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK.
authors.forename: V P
authors.initials: VP
authors.lastname: Jagadesham
authors.affiliation: Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK.|Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
authors.forename: S M
authors.initials: SM
authors.lastname: Lagarde
authors.affiliation: Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK.
authors.forename: A
authors.initials: A
authors.lastname: Immanuel
authors.affiliation: Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK.
authors.forename: S M
authors.initials: SM
authors.lastname: Griffin
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D015415:Biomarkers / Q000378:metabolism*; D001772:Blood Cell Count; D002097:C-Reactive Protein / Q000378:metabolism; D017024:Chemotherapy, Adjuvant; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods* / Q000401:mortality; D004943:Esophagogastric Junction / Q000601:surgery*; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D055815:Young Adult
chemical_list: D015415:Biomarkers; D005340:Fibrinogen; D002097:C-Reactive Protein