Comparison of Blood Inflammation Scores and Their Prognostic Value in Elderly Unresectable Esophageal Squamous Cell Carcinoma Patients Treated with Radiotherapy/Chemoradiotherapy

Yu Zhang, Jidong Wang, Di Cui, Lei Kong, Peng Wang, Zhixue Fu, Li Lin, Chuanhao Tang, Jun Liang Department of Oncology Center, Peking University International Hospital, Beijing, People’s Republic of ChinaCorrespondence: Yu Zhang, Department of Oncology Center, Peking University International Hospital, No.1 of Life Park Road, Life Science Park of Zhong Guancun, Changping District, Beijing, 102206, People’s Republic of China, Email [email protected]: To investigate the predictive value of inflammation-based prognostic scores (IBs) on overall survival (OS) in elderly unresectable esophageal squamous cell carcinoma (ESCC) patients treated with radiotherapy (RT) or chemoradiotherapy (CRT).Methods: This retrospective study included 120 elderly ESCC patients who received RT/CRT. IBs, including neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), prognostic nutritional index (PNI), systemic immune-inflammation index (SII), and systemic immune response index (SIRI), were calculated within one week before treatment and within two weeks after treatment.Results: A total of 120 patients were included. The median age was 76 years. Significant differences were found between survivors (n=29) and non-survivors (n=91) in tumor size (p=0.018), T stage (p=0.006), and pre-treatment lymphocyte count (p=0.002). At the study endpoint, 75.8% of patients (91/120) had died, and 24.2% (29/120) remained alive. The median overall survival (OS) and progression-free survival (PFS) were 18 months and 15 months, respectively. The 1-year, 3-year, and 5-year OS rates were 61.7%, 18.3%, and 5.8%, respectively, and the corresponding PFS rates were 40.8%, 7.5%, and 1.7%. Pre-treatment NLR, SIRI, and SII were associated with OS. Post-treatment NLR and PLR were also predictors. However, in multivariate analysis, only age (p=0.002) and adverse events (p=0.003) remained independent predictors of OS.Conclusion: High NLR, SII, and SIRI before treatment, and NLR and PLR after treatment, were associated with poorer OS in elderly ESCC patients undergoing RT/CRT. However, none of these IBs remained independent predictors in multivariate analysis, suggesting that their prognostic value may be influenced by confounding factors.Keywords: esophageal squamous cell carcinoma, chemoradiotherapy, prognostic biomarkers, inflammation, elderly patients