Host Determinants of Adjuvant Chemotherapy Initiation and Survival in Upper Gastrointestinal Adenocarcinoma
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Background
Successive advances in perioperative systemic therapy have improved outcomes in gastroesophageal adenocarcinoma, yet a substantial proportion of patients fail to complete treatment, and omission of postoperative therapy has been associated with poorer survival. We assessed whether perioperative changes in CBC-derived neutrophil-to-lymphocyte ratio (cNLR) and albumin added information about treatment initiation beyond tumour pathology and whether initiation was associated with survival.
Methods
This retrospective cohort included 243 patients undergoing resection at the McGill University Health Centre from 2006 to 2025. Sequential logistic models evaluated pathological characteristics, pretreatment host variables and perioperative changes in cNLR and albumin. Postoperative measurements preceded adjuvant initiation. Nested comparisons used matched complete cases. Day-90 landmark and time-varying Cox models assessed associations with overall survival (OS) and disease-free survival (DFS).
Results
Seventy-eight patients (32.1%) did not initiate adjuvant therapy. Adding host variables improved discrimination beyond pathology (AUC 0.672 to 0.763; P=.002). Greater perioperative cNLR increase was associated with lower odds of initiation (adjusted OR 0.67 per unit increase in Δlog₂ cNLR, 95% CI 0.47–0.95), whereas more favourable albumin change was associated with higher odds (OR 1.07 per g/L, 95% CI 1.01–1.13). Neither marker remained independently associated when modelled together. Initiation by day 90 was associated with longer OS (HR 0.53, 95% CI 0.36–0.78) and DFS (HR 0.57, 95% CI 0.39–0.84).
Conclusions
Host inflammatory and albumin changes added information about adjuvant initiation beyond tumour pathology, and initiation was associated with longer survival. Prospective evaluation should determine whether host-directed perioperative strategies improve postoperative treatment delivery.
