Predicting prognosis of locally advanced esophageal squamous cell carcinoma through early changes in neutrophil-to-lymphocyte ratio following neoadjuvant immunochemotherapy

The effectiveness of neoadjuvant immunochemotherapy (NAIC) in locally advanced esophageal squamous cell carcinoma (ESCC) remains unclear. This study aims to validate the relation between early alterations in neutrophil-to-lymphocyte ratio (NLR) and clinical outcomes among individuals diagnosed with locally advanced ESCC undergoing NAIC. We retrospectively enrolled a cohort of ESCC patients who underwent NAIC at least 1 cycle between May 2020 and October 2021 at Guangdong Provincial People's Hospital. Blood tests were conducted both at the baseline and following the initial treatment cycle. We examined the correlation between NLR-Δ [(cycle 1 NLR - baseline NLR)/baseline NLR × 100%] and overall survival (OS) in ESCC patients. Ninety-eight patients were enrolled in this study, with a median patient age of 62 years [interquartile range (IQR), 56.0-67.0 years]. The median baseline NLR was 2.63 (1.09-9.23). A total of 39 mortality events were observed after a median follow-up of 37.55 months. Thirty-three patients (33.67%) had NLR-Δ ≤-35%, while 65 patients (66.33%) had NLR-Δ >-35%, patients with NLR-Δ ≤-35% (N=33) exhibited significantly worse OS compared to patients with NLR-Δ >-35% (N=65) (median OS: 28.330 months vs. unreached, P=0.044). The independent prognostic factors for OS in this cohort of patients diagnosed with ESCC were NLR-Δ and the receipt of surgical treatment. Patients with a decrease in NLR value of more than 35% after the first cycle of immunochemotherapy may be associated with a worse clinical outcome in ESCC. NLR-Δ shows potential as an early-detection biomarker for NAIC-treated ESCC.