Abstract
ObjectiveTo investigate the predictive value of preoperative complete blood count for the survival of patients with esophageal squamous cell carcinoma.MethodsA total of 1587 patients with pathologically confirmed esophageal squamous cell carcinoma who underwent esophagectomy in the Cancer Hospital Affiliated to Xinjiang Medical University from January 2010 to December 2019 were collected by retrospective study. A total of 359 patients were as the validation cohort from January 2015 to December 2016, and the remaining 1228 patients were as the training cohort. The relevant clinical data were collected by the medical record system, and the patients were followed up by the hospital medical record follow-up system. The follow-up outcome was patient death. The survival time of all patients was obtained. The Cox proportional hazards regression model and nomogram were established to predict the survival prognosis of esophageal squamous cell carcinoma by the index, their cut-off values obtained the training cohort by the ROC curve. The Kaplan-Meier survival curve was established to express the overall survival rate. The 3-year and 5-year calibration curves and C-index were used to determine the accuracy and discrimination of the prognostic model. The decision curve analysis was used to predict the potential of clinical application. Finally, the validation cohort was used to verify the results of the training cohort.ResultsThe cut-off values of NLR, NMR, LMR, RDW and PDW in complete blood count of the training cohort were 3.29, 12.77, 2.95, 15.05 and 13.65%, respectively. All indicators were divided into high and low groups according to cut-off values. Univariate Cox regression analysis model showed that age (≥ 60), NLR (≥3.29), LMR (< 2.95), RDW (≥15.05%) and PDW (≥13.65%) were risk factors for the prognosis of esophageal squamous cell carcinoma; multivariate Cox regression analysis model showed that age (≥ 60), NLR (≥3.29) and LMR (< 2.95) were independent risk factors for esophageal squamous cell carcinoma. Kaplan-Meier curve indicated that age < 60, NLR < 3.52 and LMR ≥ 2.95 groups had higher overall survival (p < 0.05). The 3-year calibration curve indicated that its predictive probability overestimate the actual probability. 5-year calibration curve indicated that its predictive probability was consistent with the actual probability. 5 c-index was 0.730 and 0.737, respectively, indicating that the prognostic model had high accuracy and discrimination. The decision curve analysis indicated good potential for clinical application. The validation cohort also proved the validity of the prognostic model.ConclusionNLR and LMR results in complete blood count results can be used to predict the survival prognosis of patients with preoperative esophageal squamous cell carcinoma.
Highlights
Malignancy is a major public health problem in the world, according to the 2019 global cancer data report, esophageal cancer incidence and mortality rank the 7th and 6th in all cancer, respectively [1]
Esophageal cancer could be divided into two categories according to histological types, including esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EAC)
The middle-aged and elderly had high incidence of esophageal cancer, the early clinical manifestations are mainly dysphagia, burning sensation under the sword, weight loss and other atypical symptoms, the later could be manifested as progressive dysphagia, so the early symptoms are easy to miss the diagnosis, most of the diagnosis is advanced, the fiveyear survival rate is only 10–20% [4, 5], early and midterm esophageal cancer should be treated by surgery, but the overall survival rate has not changed significantly, so how to evaluate the prognosis of patients before surgery has important clinical significance for clinicians and patients, which could help clinicians to change the treatment plan, while improving the survival confidence of patients
Summary
A total of 1587 patients with pathologically confirmed esophageal squamous cell carcinoma who underwent esophagectomy in the Cancer Hospital Affiliated to Xinjiang Medical University from January 2010 to December 2019 were collected by retrospective study. A total of 359 patients were as the validation cohort from January 2015 to December 2016, and the remaining 1228 patients were as the training cohort. The relevant clinical data were collected by the medical record system, and the patients were followed up by the hospital medical record follow-up system. The survival time of all patients was obtained. The Cox proportional hazards regression model and nomogram were established to predict the survival prognosis of esophageal squamous cell carcinoma by the index, their cut-off values obtained the training cohort by the ROC curve. The validation cohort was used to verify the results of the training cohort
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