Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China.
Cancer Hospital of Shantou University Medical College, Shantou City, People's Republic of China.
Ann Surg Oncol. 2022 Sep;29(9):5626-5633. doi: 10.1245/s10434-022-11415-5. Epub 2022 Feb 18.
The aim was to systematically select blood markers routinely tested in clinical settings, which are independently associated with overall survival (OS) and are able to stratify prognosis of esophageal squamous cell carcinoma (ESCC) patients undergoing esophagectomy.
We selected optimal blood markers for prognostic stratification from 60 candidates in a clinical cohort of 1819 consecutive patients with resectable ESCC in China. Selection was carried out using two-step multivariable Cox proportional hazards regression adjusted for multifaceted confounders. A composite index was developed by multiplying risk factors and dividing them by protective factors.
With a median follow-up of 48.07 months, 641 deaths occurred in the 1819 patients and the 5-year OS was 56.30%. Two risk factors (mean corpuscular hemoglobin, fibrinogen) and a protective factor (albumin), all dichotomized and assigned values 1 and 2, were used to construct the composite index marker "MF-A". Three risk groups were created based on the MF-A score including low- (0.5), moderate- (1), and high-risk groups (2 and 4). Compared with patients in the low-risk group (1184/1778, 66.59%), those in the moderate- (488, 27.45%), and high-risk (106, 5.96%) groups were at elevated risk of death (adjusted HR: 1.32, 95% CI: 1.11-1.57; adjusted HR: 2.08, 95% CI: 1.56-2.75; P < 10). Within each TNM stage grouping, OS also trended to be significantly worse as the MF-A score increased.
"MF-A" is a novel independent predictor which may be used to estimate and stratify prognosis for ESCC patients undergoing esophagectomy.
本研究旨在系统性地选择临床常规检测的血液标志物，这些标志物与总生存（OS）独立相关，并能够对接受食管癌切除术的食管鳞癌（ESCC）患者进行预后分层。
我们在中国的一个包含 1819 例可切除 ESCC 患者的临床队列中，从 60 种候选标志物中选择了用于预后分层的最佳血液标志物。采用两步多变量 Cox 比例风险回归法，根据多方面混杂因素进行调整。通过相乘风险因素和相除保护因素来开发复合指数。
中位随访时间为 48.07 个月，1819 例患者中共有 641 例死亡，5 年 OS 为 56.30%。使用两个风险因素（平均红细胞血红蛋白、纤维蛋白原）和一个保护因素（白蛋白），均进行二分类并赋值 1 和 2，构建了复合指数标志物“MF-A”。根据 MF-A 评分，将患者分为低危组（0.5）、中危组（1）和高危组（2 和 4）。与低危组（1184/1778，66.59%）相比，中危组（488/1778，27.45%）和高危组（106/1778，5.96%）患者死亡风险更高（校正 HR：1.32，95%CI：1.11-1.57；校正 HR：2.08，95%CI：1.56-2.75；P<10）。在每个 TNM 分期分组内，随着 MF-A 评分的增加，OS 也呈显著下降趋势。
“MF-A”是一种新的独立预测因子，可用于估计和分层接受食管癌切除术的 ESCC 患者的预后。
