Sun Shu-Yan, Chen Ping-Ping, Meng Ling-Xin, Li Ling, Mo Zheng-Xia, Sun Cai-Hong, Wang Yu, Liang Fen-Hua
Department of Pathology, People's Hospital of Rizhao, Rizhao, Shandong, P. R. China.
Department of Oncology, People's Hospital of Rizhao, Rizhao, Shandong, P. R. China.
Dis Esophagus. 2019 Jan 1;32(1). doi: 10.1093/dote/doy057.
This study was performed to investigate the prognostic significance of a cumulative score based on the preoperative plasma fibrinogen and serum albumin (FA score) in operable esophageal squamous cell carcinoma (ESCC). Clinicopathologic characteristics, preoperative fibrinogen, and albumin concentrations were retrospectively reviewed in patients who underwent transthoracic esophagectomy. The optimal cutoff value was defined as 4.0 g/L for fibrinogen according to previous studies and as 41.0 g/L for albumin for the lower quartile. Subjects with elevated fibrinogen and decreased albumin levels were allocated a score of 2, those with only one of these two abnormalities were assigned a score of 1, and those with neither of the abnormalities were allocated a score of 0. The preoperative FA score was significantly associated with tumor length, depth of invasion, lymph node involvement, tumor-node-metastasis (TNM) stage, and the modified Glasgow Prognostic Score (mGPS). No significant differences in age, gender, tumor location, degree of differentiation, smoking or alcohol consumption were found between groups. Univariate survival analysis revealed that high preoperative FA score (1/2) was significantly associated with unfavorable disease-free survival (DFS) [hazard ratio (HR), 1.675; 95% confidence interval (CI), 1.278-2.195; P < 0.001] and overall survival (OS) (HR, 1.685; 95% CI, 1.268-2.239; P < 0.001). Furthermore, it remained an independent prognostic indicator for both DFS (HR, 1.394; 95% CI, 1.035-1.879; P = 0.029) and OS (HR, 1.369; 95% CI, 1.010-1.878; P = 0.048) in multivariable Cox regression analysis. A high preoperative FA score could significantly predict impaired long-term survival for ESCC patients who underwent transthoracic esophagectomy.
本研究旨在探讨基于术前血浆纤维蛋白原和血清白蛋白的累积评分（FA评分）在可手术切除的食管鳞状细胞癌（ESCC）中的预后意义。对接受经胸段食管癌切除术的患者的临床病理特征、术前纤维蛋白原和白蛋白浓度进行了回顾性分析。根据既往研究，纤维蛋白原的最佳临界值定义为4.0 g/L，白蛋白的最佳临界值为下四分位数的41.0 g/L。纤维蛋白原升高且白蛋白水平降低的受试者得分为2分，仅有这两种异常之一的受试者得分为1分，无异常的受试者得分为0分。术前FA评分与肿瘤长度、浸润深度、淋巴结受累情况、肿瘤-淋巴结-转移（TNM）分期以及改良格拉斯哥预后评分（mGPS）显著相关。各组之间在年龄、性别、肿瘤位置、分化程度、吸烟或饮酒方面未发现显著差异。单因素生存分析显示，术前高FA评分（1/2）与无病生存期（DFS）不良显著相关[风险比（HR），1.675；95%置信区间（CI），1.278 - 2.195；P < 0.001]和总生存期（OS）（HR，1.685；95% CI，1.268 - 2.239；P < 0.001）。此外，在多变量Cox回归分析中，它仍然是DFS（HR，1.394；95% CI，1.035 - 1.879；P = 0.029）和OS（HR，1.369；95% CI，1.010 - 1.878；P = 0.048）的独立预后指标。术前高FA评分可显著预测接受经胸段食管癌切除术的ESCC患者的长期生存受损。
