The Prognostic Role of the Neutrophil to Lymphocyte Ratio at Recurrence in Esophageal Squamous Cell Carcinoma: Challenges and Future Directions

Abstract

Esophageal cancer is the eighth most commonly diagnosed malignancy worldwide and is the sixth leading cause of cancer-related mortality. Globally, esophageal squamous cell carcinoma (ESCC) is the most common histologic subtype and has been linked primarily to tobacco use, alcohol intake, and malnutrition. ESCC is most prevalent in East and Central Asia, where it comprises greater than 90% of esophageal cancers. Despite advances in multimodality treatment over the years, the prognosis of ESCC remains poor with a 5-year overall survival rate of 15–25%. The prognosis of ESCC patients has been tied to a variety of inflammatory biomarkers across several studies. The systemic inflammatory response plays an integral role in DNA damage, cell proliferation, angiogenesis, and metastasis. Inflammatory biomarkers, such as neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), and platelet to lymphocyte ratio (PLR), have shown to predict survival in ESCC in multiple retrospective studies. –9 The change in NLR (delta NLR) from time of diagnosis also has shown to predict response to neoadjuvant therapy, time to recurrence, and survival. Several meta-analyses also have confirmed the role of NLR as a prognostic biomarker in ESCC. –12 In addition to the NLR, the modified Glasgow Prognostic Score (mGPS), which combines albumin and C-reactive protein (CRP), has been demonstrated to predict survival in retrospective studies across multiple cancers, including ESCC. 13