Abstract
Abstract Background Previous studies have shown that serum tumor markers and systematic inflammatory and nutritional indicators, including Cytokeratin fragments (CYFRA) 21–1 and the lymphocyte-to-monocyte ratio (LMR), are associated with the prognosis of esophageal malignancies. However, their individual prognostic sensitivity and specificity are not yet sufficient. This study aims to investigate the potential of a combined score (CA-LMR) based on CYFRA 21-1 levels and LMR as a novel prognostic predictor for patients with esophageal squamous cell carcinoma (ESCC). Methods A total of 460 consecutive patients underwent oesophagectomy were enrolled, and three groups were established based on CA-LMR score. Overall survival (OS) and recurrence-free survival (RFS) were evaluated using the Kaplan–Meier analysis, and associated factors were analyzed by multivariate Cox analysis. Additionally, modified-pStage (mpStage) was developed based on CA-LMR score, the discriminatory ability, monotonicity, homogeneity and prognosis prediction ability were measured by log-rank χ2, linear-trend χ2, likelihood-ratio χ2 test and Akaike Information Criterion. Results The allocation of CA-LMR score of 0, 1 and 2 were 107 (23.3%), 280 (60.9%), and 73 (15.9%). There was a significant association between CA-LMR and male gender (P = 0.001), smaller BMI (P = 0.035), longer tumor lesions (P = 0.002), and high pT, pN, pStage (P < 0.001, P = 0.011, P = 0.001). The 5-year OS for CA-LMR scores of 0, 1, and 2 were 75.4%, 60.2%, and 32.8%, respectively (P < 0.001) (Fig. 1A,B). Multivariate analysis indicated CA-LMR score (P = 0.011) was an independent prognostic factor for OS (Fig. 1C-E). Furthermore, the proposed mpStage system demonstrated superior discriminatory ability, monotonicity, homogeneity and prognosis prediction ability over AJCC 8th pStage system. Conclusions The CA-LMR score, combined with tumor marker and inflammatory index, could use as a potential prognostic indicator, moreover, our modified pStage system exhibited superior stratification and prognostic accuracy for patients with ESCC, making it possible to serve as novel reference for clinical management.
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
