Gastrointestinal Cancer

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SU_11_2106 - Prognostic Impact of Systemic Inflammatory Markers in Esophageal Squamous Cell Carcinoma treated with Chemoradiation

Sunday, October 21
1:15 PM - 2:45 PM
Location: Innovation Hub, Exhibit Hall 3

Prognostic Impact of Systemic Inflammatory Markers in Esophageal Squamous Cell Carcinoma treated with Chemoradiation
C. Yip, M. Wang, T. R. Siow, F. Lim, D. B. H. Tan, F. Chin, E. J. Chua, F. Q. Wang, S. Ho, and N. S. Khin; National Cancer Centre Singapore, Singapore, Singapore

Purpose/Objective(s): Tumor-associated inflammation is a recognized hallmark of malignancy. Hence, systemic inflammatory markers may be a surrogate for tumor aggressiveness. We aimed to evaluate the dynamic changes of serum inflammatory markers following chemoradiation (CRT) in esophageal cancer and their prognostic impact on survival.

Materials/Methods: We retrospectively evaluated all patients who were treated with CRT for primary esophageal squamous cell carcinoma (SCC) in our institution between 2006-2015. Baseline and post-CRT serum neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were derived. These parameters were dichotomized using median values. Clinical and treatment variables such as gender, age, RT dose and intent (radical/neoadjuvant) were obtained from medical notes. Overall survival (OS) was defined from the date of diagnosis to the date of death. The changes in NLR and PLR following CRT were evaluated using Wilcoxon Sign-Rank test. Univariate analysis was performed using Cox regression model and Kaplan-Meier analysis. Multivariate analysis was performed using Cox regression model. Bonferroni correction was applied; a p-value <0.01 was considered statistically significant.

Results: A total of 73 patients completed CRT of whom 55 (75%) patients had radical CRT and 18 (25%) patients had neoadjuvant CRT. Median age for all patients was 64 years (range 37-87) and the majority (95%) were males. Median RT dose delivered was 50.4Gy (range 41.4-70Gy). All patients received concurrent chemotherapy. Fifty-two (71%) patients died and 49 (67%) patients relapsed. Median follow-up and OS for the whole cohort were 20.1 and 20.8 months, respectively. Both PLR (median: baseline 166 vs. post-CRT 352, p<0.001) and NLR (median: baseline 3.1 vs. post-CRT 5.0, p<0.001) increased after CRT. Baseline PLR (HR 1.005, 95% CI 1.002-1.007, p=0.001) and post-CRT PLR (HR 1.001, 95% CI 1.001-1.002, p<0.001) were significant univariate parameters. A lower post-CRT PLR (median OS 32.7 months vs. 14.4 months, p=0.001) was associated with improved survival. Age (HR 1.019, 95% CI 0.992-1.047, p=0.176), NLR (baseline: HR 1.148, 95% CI 1.010-1.306, p=0.035; post-CRT: HR 1.000, 95% CI 1.001-1.000, p=0.225), RT dose (HR 0.967, 95% CI 0.933-1.003, p=0.069), and RT intent (radical 20.6 months vs. neoadjuvant 37.4 months, p=0.168) were not associated with OS. Post-CRT PLR remained a significant prognostic factor for OS after adjusting for age, gender and RT intent.

Conclusion: A significant increase in systemic inflammatory markers was observed following CRT in esophageal SCC. A lower post-treatment PLR was associated with improved overall survival. These systemic inflammatory markers warrant further clinical evaluation as they have potential for widespread clinical use as a quick and inexpensive adjunctive risk stratification tool to direct future patient management.

Author Disclosure: C. Yip: None. M. Wang: None. D.B. Tan: None. S. Ho: None.

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