Abstract
BackgroundTo explore the postoperative prognosis of esophageal squamous cell carcinoma (ESCC) patients with stage IB/IIA, using a prognostic score (PS).MethodsStage IB/IIA ESCC patients who underwent esophagectomy from 1999 to 2010 were included. We retrospectively recruited 153 patients and extracted their medical records. Moreover, we analyzed the programmed death ligand-1 (PD-L1) expression of their paraffin tissue. The cohort were randomly divided into a training group (N = 123) and a validation group (N = 30). We selected overall survival (OS) as observed endpoint. Prognostic factors with a multivariable two-sided P < 0.05 met standard of covariate inclusion.ResultsUnivariable and multivariable analyses identified pTNM stage, the number of lymph nodes (NLNs) and PD-L1 expression as independent OS predictors. Primary prognostic score which comprised above three covariates adversely related with OS in two cohorts. PS discrimination of OS was comparable between the training and internal validation cohorts (C-index = 0.774 and 0.801, respectively). In addition, the PS system had an advantage over pTNM stage in the identification of high-risk patients (C-index = 0.774 vs. C-index = 0.570, P < 0.001). Based on PS cutoff, training and validation datasets generated low-risk and high-risk groups with different OS. Our three-factor PS predicted OS (low-risk subgroup vs. high-risk subgroup 60-month OS, 74% vs. 23% for training cohort and 83% vs. 45% for validation cohort).ConclusionOur study suggested a PS for significant clinical stratification of IB/IIA ESCC to screen out subgroups with poor prognosis.
Highlights
To explore the postoperative prognosis of esophageal squamous cell carcinoma (ESCC) patients with stage IB/IIA, using a prognostic score (PS)
The significance of programmed death ligand-1 (PD-L1) and number of lymph nodes (NLNs) in ESCC was verified by correlating the status of PD-L1 and NLNs in 123 ESCC cases with widely recognized clinicopathological features (Table 2)
Our results suggest that NLNs is correlated with surgical approach (Table 2)
Summary
To explore the postoperative prognosis of esophageal squamous cell carcinoma (ESCC) patients with stage IB/IIA, using a prognostic score (PS). It’s important to screen out the patients with poor prognosis. Both TNM stage and the number of lymph nodes (NLNs) dissected in surgery have been presented with clinical prognosis indicator in esophageal cancer [8]. Several previous studies reported that the expression of programmed death ligand-1(PDL1) in lung cancer, breast cancer, and other tumors has a relation with the clinical significance of patients [15,16,17,18,19,20,21,22]. PD-L1 is a member of the B7-CD28 family, which is related to the tumor cell immune escape, playing an important role in induced T cell apoptosis [15, 21]
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