Good prediction of treatment responses to neoadjuvant chemoradiotherapy for esophageal cancer based on preoperative inflammatory status and tumor glucose metabolism

To develop a tool for predicting pathologic complete response (pCR) after neoadjuvant chemoradiotherapy (neoCRT) in patients with esophageal cancer by combining inflammatory status and tumor glucose metabolic activity. This study included 127 patients with locally advanced esophageal cancer who had received neoCRT followed by esophagectomy from 2007 to 2016. We collected their neutrophil-lymphocyte ratio (NLR) and standardized uptake value (SUV) obtained from fluorodeoxyglucose positron emission tomography (PET/CT) before and after neoCRT. Univariate and multivariate logistic regression analyses were performed to identify potential predictive factors for pCR. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of predictors were calculated. Between pCR and non-pCR groups, there were no statistically significant differences in patient characteristics, such as sex, age, site, and clinical T/N stage. Multivariate analyses identified four independent predictors for pCR, including pre-OP NLR < 5.4 [OR 11.179; 95% CI 8.385-13.495; p = 0.003], NLR change (Delta NLR) < 3 [OR 4.891; 95% CI 2.274-9.180; p = 0.005], changes in SUV (Delta SUV) > 7.2 [OR 3.033; 95% CI 1.354-6.791; p = 0.007], and SUV changes ratio (Delta SUV ratio) > 58% [OR 3.585; 95% CI 1.576-8.152; p = 0.002]. Delta NLR had the highest accuracy and NPV (84.3% and 90.3%, respectively). Combined factors of Delta NLR < 3 and Delta SUV ratio > 58% had the best PPV for pCR (84.8%). Inflammatory status (Delta NLR) and tumor glucose metabolic activity (Delta SUV ratio), when considered together, constitute a promising low-invasive tool with high efficacy for prediction of treatment response before surgery.

Automated summary

This study identified four independent predictors for pCR by combining inflammatory status and tumor glucose metabolic activity. Delta NLR had the highest accuracy and NPV, while the combination of Delta NLR <3 and Delta SUV ratio > 58% had the best PPV for pCR. Inflammatory status (Delta NLR) and tumor glucose metabolic activity (Delta SUV ratio) together constitute a promising low-invasive tool with high efficacy for predicting treatment response before surgery.