Staging the tumour and staging the host: Pre-treatment combined Neutrophil Lymphocyte Ratio and modified Glasgow Prognostic Score is associated with overall survival in patients with oesophagogastric cancers undergoing treatment with curative intent

McSorley, S. T. , Lau, H. Y.N., McIntosh, D., Forshaw, M. J., McMillan, D. C. and Crumley, A. B. (2021) Staging the tumour and staging the host: Pre-treatment combined Neutrophil Lymphocyte Ratio and modified Glasgow Prognostic Score is associated with overall survival in patients with oesophagogastric cancers undergoing treatment with curative intent. Annals of Surgical Oncology, 28(2), pp. 722-731. (doi: 10.1245/s10434-020-09074-5) (PMID:32892266) (PMCID:PMC7801291)

Abstract

Background: This study examined whether an innate systemic inflammatory response (SIR) measured by combination neutrophil to lymphocyte ratio (NLR) and modified Glasgow Prognostic Score (mGPS) was associated with overall survival (OS) in patients with esophagogastric cancer (EC) undergoing neoadjuvant chemotherapy (NAC) followed by surgery. Methods: Patients diagnosed with EC, managed with NAC prior to surgery at a regional referral center, between January 2010 and December 2015, were included. The mGPS and NLR were calculated within 12 weeks before NAC. Patients were grouped by combined NLR/mGPS score into three groups of increasing SIR: NLR ≤ 3 (n = 152), NLR > 3 + mGPS = 0 (n = 55), and NLR > 3 + mGPS > 0 (n = 32). Univariable and multivariable Cox regression was used to analyse OS. Results: Overall, 337 NAC patients were included, with 301 (89%) proceeding to surgery and 215 (64%) having R0 resection. There were 203 deaths, with a median follow-up of those alive at censor of 69 months (range 44–114). Higher combined NLR/mGPS score (n = 239) was associated with poorer OS independent of clinical stage and performance status (hazard ratio 1.28, 95% confidence interval 1.02–1.61; p = 0.032), higher rate of progression on NAC (7% vs. 7% vs. 19%; p = 0.003), and lower proportion of eventual resection (80% vs. 84% vs. 53%; p = 0.003). Conclusions: The combined NLR/mGPS score was associated with OS and initial treatment outcomes in patients undergoing NAC prior to surgery for EC, stratifying survival in addition to clinical staging and performance status. The host SIR may be a useful adjunct to multidisciplinary decision making.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Forshaw, Mr Matthew and McSorley, Dr Stephen and McMillan, Professor Donald
• Authors: McSorley, S. T., Lau, H. Y.N., McIntosh, D., Forshaw, M. J., McMillan, D. C., and Crumley, A. B.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Annals of Surgical Oncology
• Publisher: Springer
• ISSN: 1068-9265
• ISSN (Online): 1534-4681
• Published Online: 05 September 2020
• Copyright Holders: Copyright © 2020 The Authors
• First Published: First published in Annals of Surgical Oncology 28(2): 722-731
• Publisher Policy: Reproduced under a Creative Commons license