Preoperative maximal voluntary ventilation, hemoglobin, albumin, lymphocytes and platelets predict postoperative survival in esophageal squamous cell carcinoma.

BACKGROUND

Preoperative pulmonary function plays an important role in selecting surgical candidates and assessing postoperative complications. Reduced pulmonary function is associated with poor survival in several cancers, but the prognostic value of preoperative pulmonary function in esophageal squamous cell carcinoma (ESCC) is unclear. Nutritional and systemic inflammation parameters are vital to cancer survival, and the combination of these parameters improves the prognostic value. The hemoglobin, albumin, lymphocytes and platelets (HALP) score is a novel prognostic indicator to reflect the nutritional and inflammation status, but the clinical effects of the HALP score combined with maximal voluntary ventilation (MVV), an important parameter of pulmonary function, have not been well studied in ESCC.

AIM

To investigate the prognostic value of MVV and HALP score for assessing postoperative survival of ESCC patients.

METHODS

Data from 834 ESCC patients who underwent radical esophagectomy with R0 resection were collected and retrospectively analyzed. Preoperative MVV and HALP data were retrieved from medical archives. The HALP score was calculated by the formula: Hemoglobin (g/L) × albumin (g/L) × lymphocytes (/L)/platelets (/L). The optimal cut-off values of MVV and HALP score were calculated by the receiver operating characteristic curve analysis. The Kaplan-Meier method with log-rank test was used to draw the survival curves for the variables tested. Multivariate Cox proportional hazard regression models were used to analyze the independent prognostic factors for overall survival.

RESULTS

MVV was significantly associated with gender ( < 0.001), age at diagnosis ( < 0.001), smoking history ( < 0.001), drinking history ( < 0.001), tumor length ( = 0.013), tumor location ( = 0.037) and treatment type ( = 0.001). The HALP score was notably associated with gender ( < 0.001), age at diagnosis ( = 0.035), tumor length ( < 0.001) and invasion depth ( = 0.001). Univariate Cox regression analysis showed that low MVV and low HALP score were associated with worse overall survival (all < 0.001). Multivariate analysis showed that low MVV and the HALP score were both independent risk factors for overall survival (all < 0.001). The combination of MVV and HALP score improved the prediction performance for overall survival than tumor-node-metastasis. Also, low combination of MVV and HALP score was an independent risk factor for poor overall survival ( < 0.001).

CONCLUSION

MVV, HALP score and their combination are simple and promising clinical markers to predict overall survival of ESCC patients.