Analysis of the Fibrinogen and Neutrophil–Lymphocyte Ratio in Esophageal Squamous Cell Carcinoma

Abstract

Esophageal squamous cell carcinoma (ESCC) is one of the most aggressive malignancies in gastrointestinal tract cancers and even patients with early ESCC have a high metastatic potential. Difficulties are associated with clinically predicting tumor progression and prognosis based on conventional tumor markers determined from preoperative blood examinations. The aim of the present study was to measure plasma fibrinogen levels and the neutrophil–lymphocyte ratio (NLR) in blood and compare the clinical impacts of their combined values (fibrinogen and neutrophil–lymphocyte ratio score—F-NLR score) and the modified Glasgow Prognostic Score (mGPS) in patients with ESCC.We classified 238 patients with ESCC based on cut-off values for hyperfibrinogenemia (>400 mg/dL) and high NLR (>3.0) as F-NLR scores of 2 (both of these hematological abnormalities), 1 (one of these abnormalities), or 0 (neither abnormality). We also categorized patients based on cut-off values for high C-reactive protein (CRP) (>0.5 mg/dL) and hypoalbuminemia (<3.8 g/dL) as mGPS of 2 (elevated CRP and hypoalbuminemia), 1 (either elevated CRP or hypoalbuminemia), or 0 (neither elevated CRP nor hypoalbuminemia).The F-NLR score correlated with the depth of tumor invasion, lymph node metastasis, lymphovascular invasion, tumor size, and stage (all P < 0.05). Prognoses among the groups based on the F-NLR score and mGPS significantly differed (all P < 0.001). A multivariate analysis identified the depth of tumor invasion, lymph node metastasis, and F-NLR score as independent prognostic factors (P = 0.002, P = 0.007, and P = 0.037, respectively).The results of the present study showed that the F-NLR score is a promising blood predictor for tumor progression and outcomes in patients with ESCC.

A Novel Scoring System Based on Fibrinogen and the Neutrophil-Lymphocyte Ratio as a Predictor of Chemotherapy Response and Prognosis in Patients with Advanced Gastric Cancer

“…We previously showed that the F-NLR score is an important predictor of the progression of esophageal squamous cell carcinomas that are not treated with neoadjuvant remedies and of the prognosis of patients [16]. Hence, we speculated that the F-NLR score could serve as a novel predictor of the responses of advanced gastric cancer to chemotherapy or chemoradiotherapy and patient outcomes.…”

“…We established cutoff values for plasma fibrinogen concentrations and NLR set at 400 mg/dl and 3.0, respectively, based on published reports [11,12,13,14,15,16]. The F-NLR scores were classified as 2 [both hyperfibrinogenemia (>400 mg/dl) and high NLR (>3.0)], 1 [one of these hematological abnormalities], or 0 [neither hyperfibrinogenemia nor high NLR].…”

“…A low NLR correlates with tumor suppression and a favorable prognosis for patients with various types of malignant neoplasms [13,14,15]. We previously showed the clinical value of the F-NLR score, which is based on combined plasma fibrinogen (F) levels and NLR, in patients with esophageal cancer who were not preoperatively treated [16]. Many studies have demonstrated a relationship between a high Glasgow Prognostic Score (GPS), an established blood marker calculated from C-reactive protein (CRP) and albumin levels that is associated with a host inflammatory response [17], and a worse prognosis among patients with numerous malignancies including gastric cancers that were not preoperatively treated [18,19,20].…”

A cumulative score based on preoperative fibrinogen and the neutrophil&ndash;lymphocyte ratio to predict outcomes in resectable gastric cancer

“…Many investigators have demonstrated the clinical utility of fibrinogen as a prognostic predictor in various types of malignancies 12,13. Recently, a new scoring system combining preoperative fibrinogen and the NLR (F-NLR) has been demonstrated as a promising prognostic marker for esophageal squamous cell carcinoma 14,15. However, the prognostic role of F-NLR in GC remains unclear.…”

Low expression of microRNA-202 is associated with the metastasis of esophageal squamous cell carcinoma

“…However, five-year survival rates for patients with ESCC remain low at ~10%, due to the invasive and metastatic potential of ESCC (3,4). Earlier diagnosis of ESCC may reduce the probability of tumor cell metastasis and markedly improve the prognosis of patients (5,6). Therefore, the identification of novel molecular markers for ESCC has potential clinical application for the early diagnosis of patients with ESCC.…”