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Combined Mean Corpuscular Hemoglobin, Fibrinogen, and Albumin (MF-A) Is a Novel Prognostic Marker in Patients with Resectable Esophageal Squamous Cell Carcinoma

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The aim was to systematically select blood markers routinely tested in clinical settings, which are independently associated with overall survival (OS) and are able to stratify prognosis of esophageal squamous cell carcinoma (ESCC) patients undergoing esophagectomy.

Methods

We selected optimal blood markers for prognostic stratification from 60 candidates in a clinical cohort of 1819 consecutive patients with resectable ESCC in China. Selection was carried out using two-step multivariable Cox proportional hazards regression adjusted for multifaceted confounders. A composite index was developed by multiplying risk factors and dividing them by protective factors.

Results

With a median follow-up of 48.07 months, 641 deaths occurred in the 1819 patients and the 5-year OS was 56.30%. Two risk factors (mean corpuscular hemoglobin, fibrinogen) and a protective factor (albumin), all dichotomized and assigned values 1 and 2, were used to construct the composite index marker “MF-A”. Three risk groups were created based on the MF-A score including low- (0.5), moderate- (1), and high-risk groups (2 and 4). Compared with patients in the low-risk group (1184/1778, 66.59%), those in the moderate- (488, 27.45%), and high-risk (106, 5.96%) groups were at elevated risk of death (adjusted HR: 1.32, 95% CI: 1.11–1.57; adjusted HR: 2.08, 95% CI: 1.56–2.75; Ptrend < 10-7). Within each TNM stage grouping, OS also trended to be significantly worse as the MF-A score increased.

Conclusions

“MF-A” is a novel independent predictor which may be used to estimate and stratify prognosis for ESCC patients undergoing esophagectomy.

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Acknowledgments

This work was supported by the National Science & Technology Fundamental Resources Investigation Program of China (2019FY101102), the National Natural Science Foundation of China (82073626), the National Key R&D Program of China (2016YFC0901404), Sanming Project of Shenzhen (SZSM201612061), the Beijing-Tianjin-Hebei Basic Research Cooperation Project (J200016), the Digestive Medical Coordinated Development Center of Beijing Hospitals Authority (XXZ0204), and the Natural Science Foundation of Beijing Municipality (7182033). We gratefully acknowledge Dr. Michael A. McNutt for editing and correction of this manuscript.

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Authors and Affiliations

  1. Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, People’s Republic of China

    Linlin Liang MS, Fangfang Liu PhD, Wenlei Yang PhD, Zhen Liu PhD, Mengfei Liu PhD, Yaqi Pan MS, Ying Liu PhD, Zhe Hu BS, Huanyu Chen BS, Zhonghu He PhD & Yang Ke MD

  2. Cancer Hospital of Shantou University Medical College, Shantou City, People’s Republic of China

    Wei Yang MS, Lei Chen BS, Liqun Zhang BS, Fan Zhang MS, Fen Cai MS, Huawen Xu MS & Miaoping Lin BS

  3. Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK

    Yu He PhD

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Correspondence to Zhonghu He PhD or Yang Ke MD.

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Linlin Liang, Fangfang Liu, Wenlei Yang, Wei Yang and Lei Chen have contributed equally to this paper.

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Liang, L., Liu, F., Yang, W. et al. Combined Mean Corpuscular Hemoglobin, Fibrinogen, and Albumin (MF-A) Is a Novel Prognostic Marker in Patients with Resectable Esophageal Squamous Cell Carcinoma. Ann Surg Oncol 29, 5626–5633 (2022). https://doi.org/10.1245/s10434-022-11415-5

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