Matsuda Satoru, Takeuchi Hiroya, Kawakubo Hirofumi, Fukuda Kazumasa, Nakamura Rieko, Suda Koichi, Wada Norihito, Kitagawa Yuko
Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan.
World J Surg. 2017 Nov;41(11):2788-2795. doi: 10.1007/s00268-017-4074-8.
For resectable advanced esophageal cancer, a transthoracic esophagectomy following preoperative treatment is recognized as one of the standard treatments. Therefore, predictive markers which can be identified before surgery need to be established to identify patients with a poor prognosis.
We retrospectively reviewed 102 consecutive patients who underwent curative transthoracic esophagectomy following preoperative treatment in our institution between 2004 and 2013. Based on plasma fibrinogen and serum albumin levels, the pretreatment and preoperative fibrinogen and albumin score (FA score) were investigated and the prognostic significance of the FA score change was compared with RECIST.
The patients were classified according to whether the FA score had remained unchanged or decreased (n = 77) or the FA score increased (n = 25). When the correlation between the response rate and change in the FA score was investigated, the response rate was significantly lower in the group with the increased FA score. In the survival analysis, patients in the increased FA score group exhibited a significantly worse recurrence-free survival (RFS) (P = 0.038). A multivariate analysis using the clinical stage and the change in the FA score as covariates revealed that a change in the FA score (HR 1.802; P = 0.047; 95% CI 1.008-3.221) was shown to be a significant independent predictive factor for RFS.
A change in the FA score was shown to be an independent prognostic factor for postoperative recurrence in esophageal cancer patients who have undergone transthoracic esophagectomy following preoperative treatment.
对于可切除的进展期食管癌，术前治疗后经胸食管切除术被认为是标准治疗方法之一。因此，需要建立术前可识别的预测标志物，以鉴别预后不良的患者。
我们回顾性分析了2004年至2013年间在我院接受术前治疗后行根治性经胸食管切除术的102例连续患者。基于血浆纤维蛋白原和血清白蛋白水平，研究术前及术前纤维蛋白原和白蛋白评分（FA评分），并将FA评分变化的预后意义与RECIST进行比较。
根据FA评分是否保持不变或降低（n = 77）或FA评分升高（n = 25）对患者进行分类。研究FA评分变化与缓解率之间的相关性时，FA评分升高组的缓解率显著较低。在生存分析中，FA评分升高组的患者无复发生存期（RFS）明显更差（P = 0.038）。以临床分期和FA评分变化作为协变量的多因素分析显示，FA评分变化（HR 1.802；P = 0.047；95%CI 1.008 - 3.221）是RFS的显著独立预测因素。
对于术前治疗后接受经胸食管切除术的食管癌患者，FA评分变化是术后复发的独立预后因素。
