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

Objective: 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.