Perioperative Predictive Markers for Recurrence of Esophageal Cancer after Esophagectomy

Abstract

Introduction: We studied whether perioperative nutritional, immunological factors or postoperative inflammatory responses predicted esophageal cancer (EC) progression and prognosis in patients who received esophagectomies. Methods: We evaluated preoperative prognostic nutritional index (PNI), BMI, neutrophil-to-lymphocyte ratio (NLR), intraoperative blood loss, postoperative C-reactive protein (CRP) max, recurrence-free survival (RFS), and overall survival (OS) in 111 patients with pStage I–IV squamous cell EC who received esophagectomies. Optimal cutoff values for each continuous parameter were determined by receiver operating characteristic curves and Youden indices. Univariate and multivariate Cox analyses were used to derive independent prognostic factors. Propensity score matching using inverse probability of treatment weighting was used in groups divided by Youden indices, as appropriate. Results: Cutoff values of continuous variables were NLR: 2.27, PNI: 44.2, blood loss: 159 mL, and CRPmax: 21.7 mg/dL. In multivariate analyses, PNI, CRPmax, and intraoperative blood loss were independent prognostic factors for OS and RFS. Among patients with stage II–IV disease, low PNI was associated with shorter RFS. Postoperative respiratory complications were associated with both higher CRP and shorter RFS. Discussion/Conclusions: Low preoperative PNI and high postoperative inflammatory response were associated with postoperative EC progression after esophagectomy. Preoperative nutritional interventions or suppression of postoperative inflammatory response, including respiratory complications, may improve patient prognosis.

Prognostic prediction by a novel integrative inflammatory and nutritional score based on least absolute shrinkage and selection operator in esophageal squamous cell carcinoma

“…Inflammatory and nutritional status is closely associated with carcinogenesis, cancer growth and progression ( 8 , 9 ). Moreover, prognostic values of several preoperative inflammatory and nutritional indicators have been explored in ESCC patients in the past few years ( 13 , 14 , 16 ). A meta-analysis conducted by Ishibashi et al ( 13 ) aimed to explore the correlations between PLT associated markers and overall survival (OS) in ESCC.…”

“…Based on 14 retrospective studies, they demonstrated that low PLR level was significantly associated with well OS. Fujiwara et al ( 14 ) analyzed several indexes based on inflammation and nutrition in 111 ESCC patients and the results revealed low PNI was associated with shorter recurrence-free survival (RFS). Geng et al ( 16 ) revealed that SIRI was significantly related to OS and served as an independent prognostic score in 916 ESCC patients with radical resection.…”

“…In fact, a single inflammatory and nutritional indicator has some limitations and can’t fully reflect the overall status of inflammation and nutrition ( 28 ). Moreover, most of published studies incorporated these inflammatory and nutritional indicators in multivariate analyses to explore independent prognostic factors ( 14 – 16 ), but ignore the strong collinearity and correlation between these indicators, causing variables interference and some statistical problems. In addition, an integrated prognostic indicator consisting of multiple dimensions may help to reflect the real and complicated inflammatory and nutritional status ( 29 ).…”

“…The hematological indicators, such as CRP, ALB, NEU, LYM, PLT, NLR, PLR, LMR, hemoglobin (HB), PLT to HB ratio (PHR), NEU to HB ratio (NHR), CRP to HB ratio (CHR), CRP to prealbumin (PALB) ratio (CPR), total protein (TP), globulin (GLO), and so on, were tested within 1 week before the surgery. The other variables (SII, SIRI, and PNI) were calculated by the following formula based on published studies: PNI = ALB (g/L) + 5 × LYM (10 9 /L), SII = PLT × NEU/LYM, and SIRI = MON × NEU/LYM ( 14 – 16 ).…”

“…Moreover, researchers were not satisfied with the single indicator and sought to more and more integrative indicators. A variety of studies published in recent years also revealed that several integrative indicators, such as systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and prognostic nutritional index (PNI) were prognostic factors for cancer prognosis ( 14 – 16 ). However, the results for these above indexes are still controversial in cancers.…”