P1363 - Neutrophil to Lymphocyte Ratio: A Novel Circulating Biomarker, Predicts Progression in a Large Multicenter Barrett’s Esophagus Cohort

Award: Outstanding Research Award in the Esophagus Category
Award: Presidential Poster Award

Award: Outstanding Research Award in the Esophagus Category

Award: Presidential Poster Award

Siddharth Agarwal, MBBS¹, Lovekirat Singh, MD², D. Chamil Codipilly, MD³, Kenneth Wang, MD³, Cadman L. Leggett, MD³, Navtej Buttar, MD¹, Prasad G. Iyer, MD, MSc, FACG^3
1Mayo Clinic College of Medicine, Rochester, MN; ²Ochsner LSU Health Shreveport, Shreveport, LA; ³Mayo Clinic, Rochester, MN

Introduction: Prediction of progression in Barrett’s esophagus (BE) is challenging given low progression rates but has the potential to make surveillance more efficient. Carcinogenesis in BE is likely influenced by inflammation. The neutrophil to lymphocyte ratio (NLR), which can be calculated from routine CBC, reflects the relationship between innate and adaptive immune systems and has been reported to be an important prognostic factor in esophageal cancer. We aimed to determine if NLR can predict progression in BE patients from a prospective multicenter BE registry.

Methods: We analyzed data of BE patients enrolled in a BE registry, with a CBC within 1 year of BE diagnosis. The NLR was calculated as the ratio of the absolute neutrophil (ANC) to the absolute lymphocyte (ALC) count. Patients were classified as progressors (progressed from non-dysplastic BE (NDBE)/low grade dysplasia (LGD) at baseline to high grade dysplasia (HGD)/EAC ³ 1 year after index endoscopy) and non-progressors. Data on clinical, endoscopic, and histological variables were collected. Patients were excluded if they had HGD/EAC at index endoscopy, had baseline malignancy, active infection, or were on immunosuppressive medication. Multivariable regression analysis was used to assess predictors of progression.

Results: 284 patients (85 progressors and 169 non-progressors) were included in the study. Baseline characteristics (Figure 1) were largely similar except for statistically significant higher NLR and longer BE length, percentage of males and deaths in progressors compared to non-progressors. Progressors were followed up for a median (IQR) period of 6 (3-12) years as compared to non-progressors who were followed up for 8 (4.5-12) years. On a multivariate analysis, after adjusting for clinical, endoscopic, and histological variables, NLR and BE length were found to be a statistically significant predictor of progression (HR: 3.11, p=< 0.01) and (HR: 1.15, p=0.002), respectively (Table 1). Gender, smoking status, BMI, baseline histology (LGD vs NDBE), and age were not found to be significant predictors of progression. Area under the curve (AUC) of NLR in predicting progression was 0.75.

Discussion: In this large multicenter cohort study, we demonstrate that BE patients progressing to HGD/EAC had significantly higher NLR values compared to non-progressors and were an independent predictor of progression. Validation of these results in additional cohorts should be considered.




Disclosures:


Siddharth Agarwal, MBBS¹, Lovekirat Singh, MD², D. Chamil Codipilly, MD³, Kenneth Wang, MD³, Cadman L. Leggett, MD³, Navtej Buttar, MD¹, Prasad G. Iyer, MD, MSc, FACG³. P1363 - Neutrophil to Lymphocyte Ratio: A Novel Circulating Biomarker, Predicts Progression in a Large Multicenter Barrett’s Esophagus Cohort, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.