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The prognostic significance of preoperative nutritional/inflammatory markers and clinicopathological features in resectable esophagectomy patients: possibility of nutritional intervention

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Abstract

Background

Preoperative inflammatory or nutritional biomarkers and clinicopathological features may be survival predictors in resectable esophageal squamous cell carcinoma.

Methods

We included 118 patients with resectable squamous esophageal carcinoma (stages I–IV), assessing preoperative CRP- and albumin-based modified Glasgow prognostic score, the modified controlling nutritional status score, C-reactive protein, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, pathologic stage, and tumor location(s), looking for correlation with overall survival and relapse-free survival. Using univariate and Cox analysis, we selected the most reliable prognostic factors.

Results

Five-year overall survival and recurrence-free survival were 54.9% and 48.5%, respectively. C-reactive protein values correlated negatively with hypoalbuminemia (P = 0.0036). On univariate analysis, tumor stage, invasion depth, location, nodal involvement, albumin, and modified Glasgow prognostic score were significant prognostic factors for overall and recurrence-free survival. Preoperative C-reactive protein was prognostic factor for overall survival, but not for relapse-free survival (P = 0.017, 0.063, respectively). The Cox proportional hazards model showed the modified Glasgow prognostic score to be an independent prognostic factor for relapse-free survival and overall survival after using the stepwise variable selection procedure. Cox analysis including clinicopathological factors and modified Glasgow prognostic scores showed that only tumor location(s) and pathologic stage were independent prognostic factors for overall survival and recurrence-free survival.

Conclusion

Although the modified Glasgow prognostic score is not superior to pathologic stage and tumor location as a biomarker of preoperative nutrition/inflammation and clinicopathological factors, it remains an important prognostic marker in resectable esophageal cancers. Preoperative decreased inflammatory response and improved nutritional status may contribute to prognosis in patients with esophageal cancer.

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Availability of data and materials

The datasets generated and/or analyzed during the current study are not publicly available because permission of our hospital and university was not given, but are available from the corresponding author on reasonable request.

Abbreviations

CRP:

C-reactive protein (CRP)

mGPS:

Modified Glasgow prognostic score

CONUT:

Controlling nutritional status

OS:

Overall survival

RFS:

Relapse-free survival

ESCC:

Esophageal squamous cell carcinoma

ROC:

Receiver operating characteristics

BMI:

Body mass index

NLR:

Neutrophil/lymphocyte ratio

PLR:

Platelet/ lymphocyte ratio

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Acknowledgements

We would like to thank Miss Saki and Mrs. Kimura for their assistance in collecting data. We thank Libby Cone, MD, MA, from DMC Corp. (www.dmed.co.jp <http://www.dmed.co.jp/ >) for editing a draft of this manuscript.

Funding

No funding of this study in all authors.

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Authors and Affiliations

  1. Department of Digestive Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan

    Yoshinori Fujiwara, Shunji Endo, Masaharu Higashida, Hisako Kubota, Kazuhiko Yoshimatsu & Tomio Ueno

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  1. Yoshinori Fujiwara
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  2. Shunji Endo
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  3. Masaharu Higashida
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Contributions

YF and SE: Statistical analysis and wrote Introduction, Methods and Discussion. MH and HK: Assisted data collections and clinical practice. Figure and Table formation. KY: Assisted statistical analysis and comprehensive check. TU: Final check of manuscript and suggested appropriate corrections. All authors have read and approved the manuscript for submission.

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Correspondence to Yoshinori Fujiwara.

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No COI (conflict of interest) disclosure of all authors in this study.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study, and it was obtained in writing prior to surgery.

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Fujiwara, Y., Endo, S., Higashida, M. et al. The prognostic significance of preoperative nutritional/inflammatory markers and clinicopathological features in resectable esophagectomy patients: possibility of nutritional intervention. Esophagus 20, 234–245 (2023). https://doi.org/10.1007/s10388-022-00961-2

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