Predictive value of pretreatment peripheral blood N/CD4 and N/CD8 ratios for the efficacy of radiotherapy for esophageal cancer.

Background: This study aimed to explore the predictive value of pretreatment peripheral blood immune cell subsets in analyzing the outcomes of patients who underwent radiation therapy for esophageal cancer at their first visit.

Patients and methods: This study included 72 patients with esophageal cancer (EC) treated at Jiangsu University Hospital from December 2021 to December 2023. Among them, 48 were males and 24 were females, with a median age of 64 years (range: 52-98 years). Comprehensive clinical data, laboratory results, and imaging findings were collected to analyze survival differences. The log-rank test was used for univariate analysis to assess the sensitivity of these patients to radiotherapy. The statistically significant and clinically relevant factors identified from the univariate analysis were subsequently incorporated into a Cox proportional hazards regression model for multivariate analysis to investigate the associations between pretreatment peripheral blood immune cell subsets and patient survival.

Results: Univariate Cox regression analysis revealed that the Eastern Cooperative Oncology Group (ECOG) score, CD4⁺ T-cell ratio, neutrophil-to-CD4⁺ T-cell ratio (N/CD4), neutrophil-to-CD8⁺ T-cell ratio (N/CD8), and neutrophil-to-B-cell ratio (N/B) were significantly correlated with survival outcomes in patients receiving radiotherapy for tumors. Furthermore, multivariate Cox regression analysis identified N/CD4⁺ T cells and N/CD8⁺ T cells as critical prognostic indicators for these patients. Receiver operating characteristic curve analysis was employed to evaluate the work characteristics of the subjects, resulting in area under the curve values of 0.763 for both N/CD4 and N/CD8. The analysis also revealed that the optimal cutoff values for N/CD4⁺ T cells and N/CD8⁺ T cells were 0.01053329 and 0.01184294, respectively.

Conclusions: N/CD4 and N/CD8 have emerged as viable prognostic predictors for patients undergoing radiotherapy for EC, offering valuable insights for clinicians to strategize further treatment options. However, the retrospective nature of this study introduces potential bias in assessment, underscoring the necessity for large-scale, prospective, randomized controlled trials to substantiate and validate these findings.