Abstract
The present study was to establish a prognostic indicator based on preoperative fibrinogen and C-reactive protein (CRP) (FC score) in esophageal squamous cell carcinoma (ESCC). Clinicopathologic characteristics, preoperative plasma fibrinogen and serum CRP levels were reviewed in patients who underwent transthoracic esophagectomy. The optimal cut-off value for fibrinogen and CRP was defined as 4.0 g/dL and 10.0 mg/L according to previous reports. Patients with elevated fibrinogen and CRP levels were assigned a score of 2, those with only one of these two abnormalities were allocated a score of 1, and those with neither of the two abnormalities were assigned a score of 0. Preoperative FC score was significantly correlated with degree of differentiation, depth of invasion, tumor-node-metastasis (TNM) stage and modified Glasgow Prognostic Score (mGPS). No significant differences in age, gender, tumor length, tumor location, lymph node status or smoking were identified between groups. Univariate survival analysis demonstrated that high preoperative FC score (1/2) was significantly associated with impaired disease free survival (DFS) [hazard ratio (HR), 1.650; 95% confidence interval (CI), 1.181-2.303; P = 0.003] and overall survival (OS) (HR, 1.879; 95% CI, 1.333-2.648; P<0.001), and it remained an independent predictor for both DFS (HR, 1.468; 95% CI, 1.043-2.067; P=0.028) and OS (HR, 2.070; 95% CI, 1.266-3.385; P=0.004) in multivariate Cox regression analysis. Preoperative FC score might represent a new potential marker of worst prognosis that warrants further evaluation in prospective and large cohort studies among ESCC patients who underwent transthoracic esophagectomy.
Highlights
Esophageal cancer is the sixth most common cancer and fourth leading cause of cancer-related death in China [1]
Univariate survival analysis demonstrated that high preoperative fibrinogen and CRP (FC) score (1/2) was significantly associated with impaired disease free survival (DFS) [hazard ratio (HR), 1.650; 95% confidence interval (CI), 1.181-2.303; P=0.003] and overall survival (OS) (HR, 1.879; 95% CI, 1.3332.648; P
After adjusting for other confounding variables, we found that high FC score could serve as an independent predictor for OS (HR, 2.070; 95% CI, 1.266-3.385; P=0.004)
Summary
Esophageal cancer is the sixth most common cancer and fourth leading cause of cancer-related death in China [1]. In contrast to Western countries, esophageal squamous cell carcinoma (ESCC) continues to be the predominant subtype in Chinese population, with a high burden of morbidity and mortality [1,2,3]. Great progress has been made in the diagnosis and treatment of ESCC in last decades, the prognosis www.impactjournals.com/oncotarget remains unfavorable, with a 5-year overall survival (OS) rate of less than 40% [1]. The American Joint Committee on Cancer (AJCC), the Union for International Cancer Control (UICC) tumor-node-metastasis (TNM) staging system, and the histopathological findings are the most widely used prognostic factors to stratify survival in ESCC [4,5,6]. More accurate indicators are still desirable for risk classification and optimal management of ESCC patients
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