Cancer Res Treat.  2021 Jan;53(1):172-183. 10.4143/crt.2020.594.

Prediction of Pathologic Response to Neoadjuvant Chemoradiotherapy in Patients with Esophageal Squamous Cell Carcinoma Incorporating Hematological Biomarkers

• Wu Y
• Chen J
• Zhao L
• Li Q
• Zhu J
• Yang H
• Guo S
• Xi M

• KMID: 2510659
• DOI: http://doi.org/10.4143/crt.2020.594

Abstract

Purpose
This study aimed to develop a nomogram for predicting pathologic complete response (pCR) after neoadjuvant chemoradiotherapy (CRT) in patients with esophageal squamous cell carcinoma (ESCC) by integrating hematological biomarkers and clinicopathological characteristics.
Materials and Methods
Between 2003 and 2017, 306 ESCC patients who underwent neoadjuvant CRT followed by esophagectomy were analyzed. Besides clinicopathological factors, hematological parameters before, during, and after CRT were collected. Univariate and multivariate logistic regression analyses were performed to identify predictive factors for pCR. A nomogram model was built and internally validated.
Results
Absolute lymphocyte count (ALC), lymphocyte to monocyte ratio, albumin, hemoglobin, white blood cell, neutrophil, and platelet count generally declined, whereas neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) increased significantly following neoadjuvant CRT. After surgery, 124 patients (40.5%) achieved a pCR. The pCR group demonstrated significantly more favorable survival than the non-pCR group. On multivariate analysis, significant factors associated with pCR included sex, chemotherapy regimen, post-CRT endoscopic finding, pre-CRT NLR, ALC nadir during CRT, and post-CRT PLR, which were incorporated into the prediction model. The nomogram indicated good accuracy in predicting pCR, with a C-index of 0.75 (95% confidence interval, 0.71 to 0.78).
Conclusion
Female, chemotherapy regimen of cisplatin/vinorelbine, negative post-CRT endoscopic finding, pre-CRT NLR (≤ 2.1), ALC nadir during CRT (> 0.35 ×10⁹/L), and post-CRT PLR (≤ 83.0) were significantly associated with pCR in ESCC patients treated with neoadjuvant CRT. A nomogram incorporating hematological biomarkers to predict pCR was developed and internally validated, showing good predictive performance.

Keyword

Esophageal squamous cell carcinoma; Neoadjuvant chemoradiotherapy; Pathologic response; Prediction model; Hematological biomarker

Figure

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  Fig. 1 Comparison of hematological parameters before and after neoadjuvant chemoradiotherapy. ALC, absolute lymphocyte count; CRT, chemoradiotherapy; LDH, lactate dehydrogenase; LMR, lymphocyte to monocyte ratio; NLR, neutrophil to lymphocyte ratio; PLR, platelet to lymphocyte ratio; WBC, white blood cell.

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  Fig. 2 Kaplan-Meier curves for overall survival (A), disease-free survival (B), locoregional failure–free survival (C), and distant metastasis–free survival (D) in patients with and without pathologic complete response (pCR).

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  Fig. 3 Model to represent the estimated probability of pathologic complete response (pCR) as a function of different hematological parameters based on logistic regression analysis. Shaded regions represent 95% point-wise confidence intervals. ALC, absolute lymphocyte count; CRT, chemoradiotherapy; LMR, lymphocyte to monocyte ratio; NLR, neutrophil to lymphocyte ratio; PLR, platelet to lymphocyte ratio.

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  Fig. 4 Nomogram for predicting pathologic complete response (pCR) after neoadjuvant chemoradiotherapy (CRT) in patients with esophageal squamous cell carcinoma. For each patient, six lines are drawn upward to determine the points received from the six variables in the nomogram. The sum of these points is located on the “Total Points” axis, then a line is drawn downward to predict the probability of pCR. ALC, absolute lymphocyte count; EGD, esophagogastroduodenoscopy; NLR, neutrophil to lymphocyte ratio; NP, cisplatin/vinorelbine; PF, cisplatin/fluorouracil; PLR, platelet to lymphocyte ratio; TP, cisplatin/taxane.

Reference

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