Value of the preoperative neutrophil-to-lymphocyte ratio as a prognostic factor for long-term survival in postoperative esophageal squamous cell carcinoma patients

Background This study investigated the relationship between the neutrophil-to-lymphocyte ratio (NLR) and clinicopathological features and prognosis in patients with postoperative esophageal squamous cell carcinoma (ESCC). Methods The preoperative NLR was evaluated in 419 patients who underwent esophagectomy for ESCC. A receiver operating characteristic (ROC) curve was plotted to verify the accuracy of the NLR for predicting survival. Correlation between the NLR and clinicopathological characteristics was analyzed using the chi(2) test. Prognostic influence was calculated by using the Kaplan-Meier method and the difference was assessed by log-rank test. Multivariate Cox regression models were applied to evaluate the independent prognostic value. Results The cutoff value of the NLR was 2.998, the area under the curve was 0.735, and the sensitivity and specificity were 69.3% and 69.3%, respectively. Tumor length (P = 0.0317), lymph node metastasis (P = 0.0352), pathological tumor node metastasis (pTNM) stage (P = 0.0271), and postoperative radiotherapy (P = 0.0385) were significantly different between the groups. Multivariate analysis showed that pTNM stage (P = 0.0098), lymph node metastasis (P = 0.001), and NLR (P = 0.0022) were independent prognostic factors for survival. Moreover, when patients were stratified by TNM stage, the adverse effects of preoperative NLR on cancer-specific survival were greater in patients with stage II and III ESCC and in patients with lymph node metastasis. Conclusions The preoperative NLR is significantly correlated with long-term prognosis in postoperative patients with ESCC, particularly in patients with lymph node metastasis and stage II and III ESCC.