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The Impact of Pretherapeutic Naples Prognostic Score on Survival in Patients with Locally Advanced Esophageal Cancer

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

Abstract

Background

Naples prognostic score (NPS) is a scoring system based on albumin, cholesterol concentration, lymphocyte-to-monocyte ratio, and neutrophil-to-lymphocyte ratio reflecting host systemic inflammation, malnutrition, and survival for several malignancies. This study was designed to assess the prognostic significance of NPS in patients with locally advanced esophageal squamous cell carcinoma (ESCC) and to compare its prognostic accuracy with that of other systemic inflammatory and nutritional index.

Methods

We retrospectively examined 165 patients with locally advanced ESCC who underwent neoadjuvant therapy followed by curative resection between January 2011 and September 2019. Patients were divided into three groups based on their NPS before neoadjuvant therapy (Group 0: NPS = 0; Group 1: NPS = 1–2; Group 2: NPS = 3–4). We compared the clinicopathological characteristics and survival rates among the groups.

Results

The 5-year recurrence-free survival (RFS) and overall survival (OS) rates were significantly different between the groups (P < 0.001). The NPS was superior to other systemic inflammatory and nutritional index for predicting prognoses, as determined using area under the curves (P < 0.05). Multivariate analysis demonstrated that the NPS was a significant predictor of poor RFS (Group 1: hazard ratio [HR] 1.897, P = 0.049; Group 2: HR 3.979, P < 0.001) and OS (Group 1: HR 2.152, P = 0.033; Group 2: HR 3.239, P = 0.006).

Conclusions

The present study demonstrated that NPS was an independent prognostic factor in patients with locally advanced ESCC and more reliable and accurate than the other systemic inflammatory and nutritional index.

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References

  1. Ando N, Kato H, Igaki H, et al. A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907). Ann Surg Oncol. 2012;19:68–74.

    Article  Google Scholar 

  2. van Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012;366:2074–84.

    Article  Google Scholar 

  3. Kijima T, Arigami T, Uchikado Y, et al. Combined fibrinogen and neutrophil-lymphocyte ratio as a prognostic marker of advanced esophageal squamous cell carcinoma. Cancer Sci. 2017;108:193–9.

    Article  CAS  Google Scholar 

  4. Takeuchi H, Ikeuchi S, Kitagawa Y, et al. Pretreatment plasma fibrinogen level correlates with tumor progression and metastasis in patients with squamous cell carcinoma of the esophagus. J Gastroenterol Hepatol. 2007;22:2222–7.

    Article  CAS  Google Scholar 

  5. Tomimaru Y, Yano M, Takachi K, et al. Correlation between pretherapeutic d-dimer levels and response to neoadjuvant chemotherapy in patients with advanced esophageal cancer. Dis Esophagus. 2008;21:281–7.

    Article  CAS  Google Scholar 

  6. Sato H, Tsubosa Y, Kawano T. Correlation between the pretherapeutic neutrophil-to-lymphocyte ratio and the pathologic response to neoadjuvant chemotherapy in patients with advanced esophageal cancer. World J Surg. 2012;36:617–22.

    Article  Google Scholar 

  7. Noble F, Hopkins J, Curtis N, et al. The role of systemic inflammatory and nutritional blood-borne markers in predicting response to neoadjuvant chemotherapy and survival in oesophagogastric cancer. Med Oncol. 2013;30:596.

    Article  Google Scholar 

  8. Matsuda S, Takeuchi H, Fukuda K, et al. Clinical significance of plasma fibrinogen level as a predictive marker for postoperative recurrence of esophageal squamous cell carcinoma in patients receiving neoadjuvant treatment. Dis Esophagus. 2014;27:654–61.

    Article  CAS  Google Scholar 

  9. Feng JF, Huang Y, Chen QX. Preoperative platelet lymphocyte ratio (PLR) is superior to neutrophil-to-lymphocyte ratio (NLR) as a predictive factor in patients with esophageal squamous cell carcinoma. World J Surg Oncol. 2014;12:58.

    Article  Google Scholar 

  10. Matsuda S, Takeuchi H, Kawakubo H, et al. Cumulative prognostic scores based on plasma fibrinogen and serum albumin levels in esophageal cancer patients treated with transthoracic esophagectomy: comparison with the Glasgow prognostic score. Ann Surg Oncol. 2015;22:302–10.

    Article  Google Scholar 

  11. Hanahan, D, Weinberg RA. Hallmarks of cancer: the next generation. Cell. 2011;144:646–74.

    Article  CAS  Google Scholar 

  12. Li KJ, Xia XF, Su M, Zhang H, Chen WH, Zou CL. Predictive value of lymphocyte-to-monocyte ratio (LMR) and neutrophil-to-lymphocyte ratio (NLR) in patients with oesophageal cancer undergoing concurrent chemoradiotherapy. BMC Cancer. 2019;19:1004.

    Article  Google Scholar 

  13. Liu Z, Shi H, Chen L. Prognostic role of pre-treatment C-reactive protein/albumin ratio in esophageal cancer: a meta-analysis. BMC Cancer. 2019;19:1161.

    Article  CAS  Google Scholar 

  14. Yoshida N, Harada K, Baba Y, et al. Preoperative Controlling Nutritional Status (CONUT) is useful to estimate the prognosis after esophagectomy for esophageal cancer. Langenbecks Arch Surg. 2017;402:333–41.

    Article  Google Scholar 

  15. Nakatani M, Migita K, Matsumoto S, et al. Prognostic significance of the prognostic nutritional index in esophageal cancer patients undergoing neoadjuvant chemotherapy. Dis Esophagus. 2017;30:1–7.

    Article  CAS  Google Scholar 

  16. Vashist YK, Loos J, Dedow J, et al. Glasgow prognostic score is a predictor of perioperative and long-term outcome in patients with only surgically treated esophageal cancer. Ann Surg Oncol. 2011;18:1130–8.

    Article  Google Scholar 

  17. Galizia G, Lieto E, Auricchio A, et al. Naples prognostic score, based on nutritional and inflammatory status, is an independent predictor of long-term outcome in patients undergoing surgery for colorectal cancer. Dis Colon Rectum. 2017;60:1273–84.

    Article  Google Scholar 

  18. Miyamoto Y, Hiyoshi Y, Daitoku N, et al. Naples prognostic score is a useful prognostic marker in patients with metastatic colorectal cancer. Dis Colon Rectum. 2019;62:1485–93.

    Article  Google Scholar 

  19. Nakagawa N, Yamada S, Sonohara F, et al. Clinical implications of Naples prognostic score in patients with resected pancreatic cancer. Ann Surg Oncol. 2020;27:887–95.

    Article  Google Scholar 

  20. Brierley JD, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumors, 8th edn. Hoboken, NJ: Wiley-Blackwell; 2017.

    Google Scholar 

  21. Nakamura K, Kato K, Igaki H, et al. Three-arm phase III trial comparing cisplatin plus 5-FU (CF) versus docetaxel, cisplatin plus 5-FU (DCF) versus radiotherapy with CF (CF-RT) as preoperative therapy for locally advanced esophageal cancer (JCOG1109, NExT study). Jpn J Clin Oncol. 2013;43:752–5.

    Article  Google Scholar 

  22. Toiyama Y, Miki C, Inoue Y, et al. Evaluation of an inflammation-based prognostic score for the identification of patients requiring postoperative adjuvant chemotherapy for stage II colorectal cancer. Exp Ther Med. 2011;2:95–101.

    Article  Google Scholar 

  23. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  Google Scholar 

  24. Japan Esophageal Society. Japanese classification of esophageal cancer, 11th edn: part I. Esophagus. 2017;14:1–36.

    Article  Google Scholar 

  25. Tibshirani R. The lasso method for variable selection in the Cox model. Stat Med. 1997;16:385–95.

    Article  CAS  Google Scholar 

  26. Kanda Y. Investigation of the freely-available easy-to-use software “EZR” (Easy R) for medical statistics. Bone Marrow Transplant. 2013;48:452–8.

    Article  CAS  Google Scholar 

  27. Karin M. Nuclear factor-κB in cancer development and progression. Nature. 2006;441:431–6.

    Article  CAS  Google Scholar 

  28. Yu H, Kortylewski M, Pardoll D. Crosstalk between cancer and immune cells: role of STAT3 in the tumour microenvironment. Nat Rev Immunol. 2007;7:41–51.

    Article  CAS  Google Scholar 

  29. Tokunaga R, Sakamoto Y, Nakagawa S, et al. CONUT: a novel independent predictive score for colorectal cancer patients undergoing potentially curative resection. Int J Colorectal Dis. 2017;32:99–106.

    Article  Google Scholar 

  30. Chen P, Han L, Wang C, et al. Preoperative serum lipids as prognostic predictors in esophageal squamous cell carcinoma patients with esophagectomy. Oncotarget. 2017;8:41605–19.

    Article  Google Scholar 

  31. Lee H, Jeong CW, Kwak C, et al. Preoperative cholesterol level is associated with worse pathological outcomes and postoperative survival in localized renal cell carcinoma patients: a propensity score-matched study. Clin Genitourin Cancer. 2017;15:e935–41.

    Article  Google Scholar 

  32. Oliver MF. Serum cholesterol: the knave of hearts and the joker. Lancet. 1981;2:1090–5.

    Article  CAS  Google Scholar 

  33. Kritchevsky SB, Kritchevsky D. Serum cholesterol and cancer risk: an epidemiologic perspective. Annu Rev Nutr. 1992;12:391–416.

    Article  CAS  Google Scholar 

  34. Coussens LM, Werb Z. Inflammation and cancer. Nature. 2002;420:860–7.

    Article  CAS  Google Scholar 

  35. Von Bernstorff W, Voss M, Freichel S, et al. Systemic and local immunosuppression in pancreatic cancer patients. Clin Cancer Res. 2001;7:925s–32s.

    Google Scholar 

  36. Fogar P, Sperti C, Basso D, et al. Decreased total lymphocyte counts in pancreatic cancer: an index of adverse outcome. Pancreas. 2006;32:22–8.

    Article  Google Scholar 

  37. Roland CL, Dineen SP, Toombs JE, et al. Tumor-derived intercellular adhesion molecule-1 mediates tumor-associated leukocyte infiltration in orthotopic pancreatic xenografts. Exp Biol Med (Maywood). 2010;235:263–70.

    Article  CAS  Google Scholar 

  38. Liang W, Ferrara N. The complex role of neutrophils in tumor angiogenesis and metastasis. Cancer Immunol Res. 2016;4:83–91.

    Article  CAS  Google Scholar 

  39. Tsutsui S, Yasuda K, Suzuki K, et al. Macrophage infiltration and its prognostic implications in breast cancer: the relationship with VEGF expression and microvessel density. Oncol Rep. 2005;14:425–31.

    CAS  PubMed  Google Scholar 

  40. Steidl C, Lee T, Shah SP, et al. Tumor-associated macrophages and survival in classic Hodgkin’s lymphoma. N Engl J Med. 2010;362:875–85.

    Article  CAS  Google Scholar 

Download references

Acknowledgment

The authors express their sincere gratitude to Ms. Rika Takahashi for her excellent data management in this study.

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan

    Kazuki Kano MD, PhD, Takanobu Yamada MD, PhD, Keisuke Komori MD, Hayato Watanabe MD, Kosuke Takahashi MD, Hirohito Fujikawa MD, PhD, Takashi Ogata MD, PhD & Takashi Oshima MD, PhD

  2. Department of Surgery, Yokohama City University, Yokohama, Kanagawa, Japan

    Kazuki Kano MD, PhD, Takanobu Yamada MD, PhD, Keisuke Komori MD, Hayato Watanabe MD, Hirohito Fujikawa MD, PhD, Toru Aoyama MD, PhD, Masakatsu Numata MD, PhD, Hiroshi Tamagawa MD, PhD, Norio Yukawa MD, PhD, Yasushi Rino MD, PhD & Munetaka Masuda MD, PhD

  3. Department of Biostatistics, Yokohama City University, Yokohama, Kanagawa, Japan

    Kouji Yamamoto PhD

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  1. Kazuki Kano MD, PhD
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  2. Takanobu Yamada MD, PhD
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Corresponding author

Correspondence to Takashi Oshima MD, PhD.

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Disclosure

Yasushi Rino—Speakers’ Bureau & Research Funding: Daiichi Sankyo, Johnson & Johnson, Otsuka, Lilly, Taiho Pharmaceutical, Ono Pharmaceutical, Bristol-Myers Squibb, Abbott Nutrition, Asahi Kasei, Tsumura & Co., Covidien, Zeria Pharmaceutical, EA Pharma, Kaken Pharmaceutical.

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Kano, K., Yamada, T., Yamamoto, K. et al. The Impact of Pretherapeutic Naples Prognostic Score on Survival in Patients with Locally Advanced Esophageal Cancer. Ann Surg Oncol 28, 4530–4539 (2021). https://doi.org/10.1245/s10434-020-09549-5

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  • DOI: https://doi.org/10.1245/s10434-020-09549-5

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