Annals of Surgical Oncology

, Volume 25, Issue 11, pp 3288–3299 | Cite as

Prognostic Value of Preoperative Systemic Immunoinflammatory Measures in Patients with Esophageal Cancer

  • Yusuke Ishibashi
  • Hironori Tsujimoto
  • Shuichi Hiraki
  • Isao Kumano
  • Yoshihisa Yaguchi
  • Hiroyuki Horiguchi
  • Shinsuke Nomura
  • Nozomi Ito
  • Eiji Shinto
  • Suefumi Aosasa
  • Junji Yamamoto
  • Hideki Ueno
Thoracic Oncology



It is reported that several systemic immunoinflammatory measures, including systemic immune-inflammatory index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, and C-reactive protein (CRP)-to-albumin ratio (CAR), are associated with survival in patients with various types of cancer.


The aim of the present study was to clear which systemic immunoinflammatory measures had the greatest prognostic values. In addition, we examined which component had the greatest prognostic power in patients with esophageal cancer.


Preoperative systemic immunoinflammatory measures were evaluated in 143 patients undergoing esophageal resection for esophageal cancer from 2009 to 2014. Univariate and multivariate analyses were performed to determine the prognostic significance of these markers. Receiver operating characteristic (ROC) curves were plotted, and the area under the ROC curves (AUROCs) were compared to verify the accuracy of each measure in predicting overall survival (OS).


In univariate analysis, preoperative SII, NLR, and CAR were the predictors of OS in patients who underwent esophagectomy for esophageal cancer (p < 0.05, respectively), whereas in multivariate analysis, CAR and pathological tumor depth were the significant predictors of OS (hazard ratio [HR] 1.994, p = 0.03 vs. HR 1.967, p = 0.02, respectively). According to AUROC, the CRP (0.66) and albumin levels (0.66) were more important systemic immunoinflammatory measures than neutrophil (0.58), lymphocyte (0.63), and platelet (0.56) levels.


Among systemic immunoinflammatory measures, CAR was the most significant predictor of OS in patients with esophageal cancer. CRP and albumin levels were more important components of systemic immunoinflammatory measures.



Yusuke Ishibashi, Hironori Tsujimoto, Shuichi Hiraki, Isao Kumano, Yoshihisa Yaguchi, Hiroyuki Horiguchi, Shinsuke Nomura, Nozomi Ito, Eiji Shinto, Suefumi Aosasa, Junji Yamamoto, and Hideki Ueno declare no conflicts of interest directly relevant to the content of this article.

Ethical Statements

Written informed consent was obtained from all patients who participated in this study.

Supplementary material

10434_2018_6651_MOESM1_ESM.tif (836 kb)
Fig. 1 Overall survival after esophagectomy for esophageal cancer according to the PLR. PLR platelet-to-lymphocyte ratio (TIFF 835 kb)
10434_2018_6651_MOESM2_ESM.docx (15 kb)
Table 1 Univariate and multivariate analyses that may affect overall survival of esophageal cancer patients. HR hazard ratio, CI confidence interval, SII systemic immune-inflammatory index, NLR neutrophil-to-lymphocyte ratio, PLR platelet-to-lymphocyte ratio, CAR C-reactive protein-to-albumin ratio (DOCX 14 kb)
10434_2018_6651_MOESM3_ESM.docx (11 kb)
Table 2 Platelet counts and AUROCs used to predict 5-year survival in patients who did or did not receive antiplatelet and/or anticoagulant therapies. Platelet counts are expressed as mean ± standard deviation. AUROC area under receiver operating characteristic curve (DOCX 11 kb)


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Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Yusuke Ishibashi
    • 1
  • Hironori Tsujimoto
    • 1
  • Shuichi Hiraki
    • 1
  • Isao Kumano
    • 1
  • Yoshihisa Yaguchi
    • 1
  • Hiroyuki Horiguchi
    • 1
  • Shinsuke Nomura
    • 1
  • Nozomi Ito
    • 1
  • Eiji Shinto
    • 1
  • Suefumi Aosasa
    • 1
  • Junji Yamamoto
    • 1
  • Hideki Ueno
    • 1
  1. 1.Department of SurgeryNational Defense Medical CollegeTokorozawaJapan

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