Huang Wei, Wu Leilei, Liu Xuan, Long Hao, Rong Tiehua, Ma Guowei
The Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangdong Esophageal Cancer Institute, State Key Laboratory of Oncology in South China, 651 Dongfengdong Road, Guangzhou, Post Code: 510060, China.
J Cardiothorac Surg. 2019 Sep 18;14(1):167. doi: 10.1186/s13019-019-0981-0.
This study tested the relationship between preoperative serum C-reactive protein (CRP) levels and cancer-specific prognosis in patients with esophageal squamous cell carcinoma who have undergone curative resection.
We conducted a retrospective study on 961 patients with esophageal squamous cell cancer who underwent curative esophagectomy from 2006 to 2012 at the Sun Yat-sen University Cancer Center. Preoperative serum CRP levels were determined, and a cutoff value of 5.0 mg/mL was established. Propensity score matching (PSM) was performed to reduce the selection bias between patients with low CRP (≤ 5.0 mg/mL) and those with high CRP (> 5.0 mg/mL) levels based on age, tumor-lymph node-metastasis (TNM) stage, and tumor grade. The prognostic value of preoperative CRP levels was determined using life table, Kaplan-Meier, and Cox proportional hazards analyzes.
In the unmatched cohort, the 3-year and 5-year survival rates were 57 and 53%, respectively, in patients with high preoperative CRP levels (> 5.0 mg/mL) and 68 and 56%, respectively, in those with low preoperative CRP levels (≤ 5.0 mg/mL). The difference in the survival rates of the 2 groups was significant (p = 0.004). Univariate survival analysis revealed that the preoperative CRP levels, TNM stage, tumor grade, drinking history, and anastomosis method were prognostic factors for overall survival (OS). Before conducting PSM, the low-CRP group had a lower age (p = 0.001), lower histological grade (p = 0.086), and lower TNM stage (p = 0.254). After PSM, 176 patients with low CRP levels and 176 of those with high CRP levels were enrolled in the analysis. In the matched cohort, the 3-year and 5-year survival rates were 56 and 50%, respectively, in patients with high preoperative CRP levels (> 5.0 mg/mL) and 68 and 56%, respectively, in those with low preoperative CRP levels (≤ 5.0 mg/mL). The difference in the survival rates between the low- and high-CRP groups was significant (p = 0.044). Multivariate analysis of the matched patients revealed that the TNM stage and preoperative CRP level were independent prognostic factors for OS.
A high preoperative CRP level (> 5.0 mg/mL) predicts worse survival prognosis in patients who have undergone curative resection for esophageal squamous cell cancer.
本研究检测了接受根治性切除的食管鳞状细胞癌患者术前血清C反应蛋白（CRP）水平与癌症特异性预后之间的关系。
我们对2006年至2012年在中山大学肿瘤防治中心接受根治性食管切除术的961例食管鳞状细胞癌患者进行了一项回顾性研究。测定术前血清CRP水平，并设定临界值为5.0mg/mL。基于年龄、肿瘤-淋巴结-转移（TNM）分期和肿瘤分级，进行倾向评分匹配（PSM）以减少低CRP（≤5.0mg/mL）和高CRP（>5.0mg/mL）水平患者之间的选择偏倚。使用生命表、Kaplan-Meier和Cox比例风险分析确定术前CRP水平的预后价值。
在未匹配队列中，术前CRP水平高（>5.0mg/mL）的患者3年和5年生存率分别为57%和53%，术前CRP水平低（≤5.0mg/mL）的患者分别为68%和56%。两组生存率差异有统计学意义（p=0.004）。单因素生存分析显示，术前CRP水平、TNM分期、肿瘤分级、饮酒史和吻合方法是总生存（OS）的预后因素。在进行PSM之前，低CRP组年龄较低（p=0.001）、组织学分级较低（p=0.086）、TNM分期较低（p=0.254）。PSM后，176例低CRP水平患者和176例高CRP水平患者纳入分析。在匹配队列中，术前CRP水平高（>5.0mg/mL）的患者3年和5年生存率分别为56%和50%，术前CRP水平低（≤5.0mg/mL）的患者分别为68%和56%。低CRP组和高CRP组生存率差异有统计学意义（p=0.044）。对匹配患者的多因素分析显示，TNM分期和术前CRP水平是OS的独立预后因素。
术前CRP水平高（>5.0mg/mL）预示着接受食管鳞状细胞癌根治性切除的患者生存预后较差。
