Clinical predictors of survival for elderly patients with esophageal squamous cell carcinoma

Abstract

Prognostic factors for poor survival have been proposed in esophageal squamous cell carcinoma (SCC) patients receiving concurrent chemoradiotherapy (CRT). However, little is known about the association of pretreatment platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte (NLR) levels and treatment outcomes in elderly SCC patients. We conducted a retrospective study of elderly patients with esophageal SCC to find out clinical factors affecting survival. From January 2008 to December 2017, a total of 106 esophageal SCC patients with age more than 65 years old were enrolled. All included patients had undergone either concurrent CRT or radiotherapy (RT). Complete blood count, differential count, NLR, and PLR were obtained before treatment. Univariate and multivariate Cox regression analyses were used to assess the association between survival and patient, disease, and treatment characteristics. Seventy-five patients received CRT, while the remaining 31 patients were treated with RT alone. Multivariate analysis showed that CRT (p = .03, hazard ratio [HR] [95% confidence interval, CI] = 0.589 [0.365–0.95]), female (p = .011, HR [95% CI] = 0.216 [0.066–0.703]), ECOG performance status 0–I (p < .001, HR [95% CI] = 3.514 [2.049–6.026]), hemoglobin (Hb) ≥12 g/dL (p < .01, HR [95% CI] = 0.57 [0.37–0.878]) were independent factors for predicting better overall survival (OS). Independent factors for predicting better disease-specific survival (DSS) included ECOG performance status 0–I (p < .001, HR [95% CI] = 3.147 [1.802–5.497]), Clinical staging I–II (p = .023, HR [95% CI] = 2.124 [1.112–4.060]) and, NLR <5.3 (p = .029, HR [95% CI] = 1.706 [1.058–2.752]). Our study showed that CRT, gender, ECOG performance status, Hb level, were independent predictors of OS; whereas ECOG performance status, clinical staging and NLR were independent predictors of DSS. Pretreatment NLR >5.3 is an independent poor prognostic factor for DSS of elderly esophageal SCC patients. Because our study is a retrospective analysis, further prospective studies are needed to validify the findings in our study.