Neoadjuvant carboplatin and paclitaxel with radiotherapy (CROSS) is widely used for gastro-oesophageal junction (GOJ) and oesophageal cancers (OC), but validated prognostic markers are lacking. Dynamic haematological and nutritional markers have been evaluated for their predictive value. This study evaluates dynamic neutrophil-lymphocyte ratios (NLR), platelet-lymphocyte ratios (PLR), albumin and body mass index (BMI) as predictors of survival outcomes and response.
In this multi-centre retrospective observational study across 5 hospitals in Sydney, patients treated with CROSS were identified from 2015 to 2021. Haematological results and BMI were recorded prior to treatment and pre-operatively. An NLR of ≥2 and a PLR of ≥200 was used to stratify patients into high and low groups. Sustained NLR or PLR was defined as patients who had high values at both pre-treatment and pre-surgery time points. Univariate and multivariate analyses were performed to determine the influence of these parameters on overall survival (OS), recurrence free survival (RFS) and rates of pathological complete response (pCR).
95 patients were included, with median age of 68. Baseline NLR of ≥2 was associated with reduced RFS (HR 3.72, 95% CI 1.31 – 10.5, p<0.01) and OS (HR 2.28, 95% CI 1.02 – 5.13, p=0.04). For patients who had a pCR, the mean baseline NLR was 2.1 compared to 3.1 in those without a pCR (p<0.01). A sustained NLR of ≥2 after neoadjuvant treatment was associated with reduced OS (HR 1.4, 95% CI 1.01 – 2.05, p=0.04) and trended towards association with reduced RFS (HR 1.4, 95%CI 0.99 – 2.13, p=0.051). Baseline and post-treatment PLR, albumin and BMI as well as their dynamic changes were not associated with RFS or OS.
We have demonstrated that a baseline NLR ≥2 is associated with worse RFS, OS and response. PLR, albumin and BMI or their post-treatment changes were not shown to predict survival outcomes.