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Survival Prediction Capabilities of Preoperative Inflammatory and Nutritional Status in Esophageal Squamous Cell Carcinoma Patients

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Abstract

Background

Studies have revealed the impacts of various inflammatory and nutritional markers in patients with esophageal squamous cell carcinoma (ESCC). We evaluated the prognostic values of multiple inflammation- or nutrition-based markers, either alone or in combination with pStage, in ESCC patients.

Methods

In total, 360 patients undergoing upfront surgery for ESCC were retrospectively reviewed. The prognostic capabilities of 7 inflammatory and 3 nutritional parameters were investigated. Furthermore, we devised new staging systems by adding these markers to pStage and examined the prognostic abilities of our new approach. Time-dependent receiver operating characteristic curves and the areas under the curve (AUCs) were estimated to compare prognostic capabilities among the parameters.

Results

The AUCs for predicting overall survival (OS) of the prognostic nutritional index (PNI), CRP to albumin ration (CAR), lymphocyte to CRP ratio (LCR) and the Naples prognostic score (NPS) were similar to that of pStage. Notably, CAR and LCR showed high predictive capabilities for OS (AUCs; 0.627 and 0.634 for 3-year OS, respectively). New staging systems combining inflammatory or nutritional markers with pStage provided higher AUCs for predicting OS than pStage alone. In particular, NPpStage (NPS and pStage) (P = 0.03), PNpStage (PNI and pStage) (P = 0.03) and LCpStage (LCR and pStage) (P = 0.05) showed significantly higher accuracy for predicting OS than pStage alone.

Conclusions

Various inflammatory or nutritional markers, especially those derived from CRP, are useful for predicting survival outcomes of ESCC patients. The predictive capabilities of these indices were augmented when used in combination with pStage.

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Abbreviations

ESCC:

Esophageal squamous cell carcinoma

EC:

Esophageal carcinoma

TNM:

Tumor-node-metastasis

SIR:

Systemic inflammatory response

NLR:

Neutrophil to lymphocyte ratio

PLR:

Platelet to lymphocyte ratio

CRP:

C-reactive protein

CAR:

CRP to albumin ratio

PNI:

Prognostic nutritional index

NPS:

Naples prognostic score

LCR:

Lymphocyte to CRP ratio

GPS:

Glasgow prognostic score

SII:

Systemic immune-inflammatory index

LMR:

Lymphocyte to monocyte ratio

CONUT:

Control of nutritional status

ROC:

Receiver operating characteristic

TTE:

Transthoracic esophagectomy

TME:

Transmediastinal esophagectomy

VATS:

Video-assisted transthoracic surgery

CCI:

Charlson comorbidity index

C–D:

Clavien–Dindo

OS:

Overall survival

DFS:

Disease-free survival

AUC:

Area under the curve

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Acknowledgements

I would like to thank Yukari Uemura for reviewing the statistical methodology.

Funding

None.

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Kotaro Sugawara, Koichi Yagi, Yasuhiro Okumura & Yasuyuki Seto

  2. Division of Frontier Surgery, Advanced Clinical Research Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan

    Susumu Aikou

  3. Department of Digestive Surgery, Surugadai Nihon University Hospital, Tokyo, Japan

    Hiroharu Yamashita

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  1. Kotaro Sugawara
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  2. Koichi Yagi
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  3. Yasuhiro Okumura
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  6. Yasuyuki Seto
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Correspondence to Koichi Yagi.

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Supplementary Information

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Supplementary Figure 1. Method for calculating each marker (TIFF 5130 KB)

268_2021_6398_MOESM2_ESM.tiff

Supplementary Figure 2. Definition of new staging systems. Patients were subdivided into 6 subgroups according to pStage and each parameter. New staging systems were devised such that groups with similar 3-year OS were integrated. (a) PNpStage (PNI and pStage), (b) LCpStage (LCR and pStage), (c) CApStage (CAR and pStage), (d) NLpStage (NLR and pStage) and (e) NPpStage (NPS and pStage). (TIFF 6153 KB)

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Sugawara, K., Yagi, K., Okumura, Y. et al. Survival Prediction Capabilities of Preoperative Inflammatory and Nutritional Status in Esophageal Squamous Cell Carcinoma Patients. World J Surg 46, 639–647 (2022). https://doi.org/10.1007/s00268-021-06398-5

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