Ikeguchi Masahide, Kouno Yusuke, Kihara Kyoichi, Suzuki Kazunori, Endo Kanenori, Nakamura Seiichi, Sawada Takashi, Shimizu Tetsu, Matsunaga Tomoyuki, Fukumoto Yoji, Saito Hiroaki
Department of Surgery, Τottori Prefectural Central Hospital, Tottori 680-0901, Japan.
Department of Surgery, Division of Surgical Oncology, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan.
Mol Clin Oncol. 2016 Dec;5(6):767-772. doi: 10.3892/mco.2016.1073. Epub 2016 Nov 2.
The Glasgow Prognostic Score (GPS), neutrophil/lymphocyte ratio (NLR) and prognostic nutritional index (PNI) are prognostic parameters for malignancies. Additionally, serum squamous cell carcinoma antigen (SCC-Ag) and cytokeratin 19 fragments (CYFRA 21-1) are tumor markers for squamous cell carcinoma. In the present study, the prognostic importance of these markers in patients with resectable thoracic esophageal cancer was investigated. In this retrospective study, 84 enrolled patients diagnosed with resectable clinical stage I-III thoracic esophageal squamous cell carcinomas (ESCCs) underwent thoracic esophageal resection and three-field lymph node dissection at Tottori University Hospital between January 2007 and December 2013. The correlations among preoperative patient markers (GPS, NLR, PNI, SCC-Ag and CYFRA 21-1) and the occurrence of postoperative complications and patient survival were analyzed. The operative mortality was 2.4%, and morbidity was 42.9%. Strong correlations between occurrence of postoperative complications and open thoracotomy (P=0.083) and high-serum CYFRA 21-1 (P=0.007) were observed. In 15 patients with high-serum CYFRA 21-1, postoperative complications were detected in 11 of them (73.3%); on the other hand, complications occurred in 25 of 69 (36.2%) with low-serum CYFRA 21-1. The 5-year disease-free survival rate and 5-year overall survival rate of all the patients were 52.2 and 50.8%, respectively. Among the prognostic parameters, preoperative high NLR was determined to be a poor prognostic factor, independent of the tumor stage in the multivariate analysis. These results may indicate that, in patients with preoperative high-serum CYFRA 21-1, more attention should be paid to the occurrence of postoperative complications. Therefore, in such cases, anastomosis between blood vessels of the substitute esophagus and cervical vessels would be recommended. Furthermore, in patients with high preoperative NLR, effective adjuvant chemoradiotherapy should be considered to prolong the patients' survival, even of stage I or II patients.
格拉斯哥预后评分（GPS）、中性粒细胞/淋巴细胞比值（NLR）和预后营养指数（PNI）是恶性肿瘤的预后参数。此外，血清鳞状细胞癌抗原（SCC-Ag）和细胞角蛋白19片段（CYFRA 21-1）是鳞状细胞癌的肿瘤标志物。在本研究中，调查了这些标志物在可切除胸段食管癌患者中的预后重要性。在这项回顾性研究中，2007年1月至2013年12月期间，84例确诊为可切除临床I-III期胸段食管鳞状细胞癌（ESCC）的入组患者在鸟取大学医院接受了胸段食管切除术和三野淋巴结清扫术。分析了术前患者标志物（GPS、NLR、PNI、SCC-Ag和CYFRA 21-1）与术后并发症发生情况及患者生存之间的相关性。手术死亡率为2.4%，发病率为42.9%。观察到术后并发症的发生与开胸手术（P=0.083）和高血清CYFRA 21-1（P=0.007）之间存在强相关性。在15例高血清CYFRA 21-1患者中，其中11例（73.3%）检测到术后并发症；另一方面，低血清CYFRA 21-1的69例中有25例（36.2%）发生并发症。所有患者的5年无病生存率和5年总生存率分别为52.2%和50.8%。在预后参数中，术前高NLR被确定为不良预后因素，在多因素分析中独立于肿瘤分期。这些结果可能表明，对于术前高血清CYFRA 21-1的患者，应更关注术后并发症的发生。因此，在这种情况下，建议在替代食管血管与颈血管之间进行吻合。此外，对于术前NLR高的患者，即使是I期或II期患者，也应考虑有效的辅助放化疗以延长患者生存。
