Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Division of Frontier Surgery, Advanced Clinical Research Center, Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
World J Surg. 2022 Mar;46(3):639-647. doi: 10.1007/s00268-021-06398-5. Epub 2022 Jan 9.
Studies have revealed the impacts of various inflammatory and nutritional markers in patients with esophageal squamous cell carcinoma (ESCC). We evaluated the prognostic values of multiple inflammation- or nutrition-based markers, either alone or in combination with pStage, in ESCC patients.
In total, 360 patients undergoing upfront surgery for ESCC were retrospectively reviewed. The prognostic capabilities of 7 inflammatory and 3 nutritional parameters were investigated. Furthermore, we devised new staging systems by adding these markers to pStage and examined the prognostic abilities of our new approach. Time-dependent receiver operating characteristic curves and the areas under the curve (AUCs) were estimated to compare prognostic capabilities among the parameters.
The AUCs for predicting overall survival (OS) of the prognostic nutritional index (PNI), CRP to albumin ration (CAR), lymphocyte to CRP ratio (LCR) and the Naples prognostic score (NPS) were similar to that of pStage. Notably, CAR and LCR showed high predictive capabilities for OS (AUCs; 0.627 and 0.634 for 3-year OS, respectively). New staging systems combining inflammatory or nutritional markers with pStage provided higher AUCs for predicting OS than pStage alone. In particular, NPpStage (NPS and pStage) (P = 0.03), PNpStage (PNI and pStage) (P = 0.03) and LCpStage (LCR and pStage) (P = 0.05) showed significantly higher accuracy for predicting OS than pStage alone.
Various inflammatory or nutritional markers, especially those derived from CRP, are useful for predicting survival outcomes of ESCC patients. The predictive capabilities of these indices were augmented when used in combination with pStage.
多项研究揭示了不同炎症和营养标志物在食管鳞状细胞癌（ESCC）患者中的影响。我们评估了多种炎症或营养标志物单独或与 pStage 联合在 ESCC 患者中的预后价值。
回顾性分析了 360 例接受 ESCC 根治性手术的患者。研究了 7 种炎症和 3 种营养参数的预后能力。此外，我们通过添加这些标志物来构建新的分期系统，并检验我们新方法的预后能力。通过时间依赖性接受者操作特征曲线和曲线下面积（AUC）来比较参数之间的预后能力。
预后营养指数（PNI）、C 反应蛋白与白蛋白比值（CAR）、淋巴细胞与 C 反应蛋白比值（LCR）和那不勒斯预后评分（NPS）的 AUC 预测总生存期（OS）的能力与 pStage 相似。值得注意的是，CAR 和 LCR 对 OS 具有较高的预测能力（AUC 分别为 3 年 OS 的 0.627 和 0.634）。将炎症或营养标志物与 pStage 相结合的新分期系统提供了比 pStage 单独预测 OS 更高的 AUC。特别是，NPpStage（NPS 和 pStage）（P=0.03）、PNpStage（PNI 和 pStage）（P=0.03）和 LCpStage（LCR 和 pStage）（P=0.05）在预测 OS 方面明显优于 pStage 单独预测。
各种炎症或营养标志物，尤其是源自 C 反应蛋白的标志物，可用于预测 ESCC 患者的生存结果。这些指标的预测能力在与 pStage 联合使用时得到增强。
