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2021 Volume 8
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RESEARCH ARTICLE   Open Access    

Perioperative Predictive Markers for Recurrence of Esophageal Cancer after Esophagectomy

  • Department of Digestive Surgery, Kawasaki Medical School, Kurashiki, Japan

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  • Corresponding author: Yoshinori Fujiwara Department of Digestive Surgery, Kawasaki Medical School 577 Matsushima Kurashiki 701-0192 (Japan) yyfujiwara@nifty.com 
  • Introduction: We studied whether perioperative nutritional, immunological factors or postoperative inflammatory responses predicted esophageal cancer (EC) progression and prognosis in patients who received esophagectomies.
    Methods: We evaluated preoperative prognostic nutritional index (PNI), BMI, neutrophil-to-lymphocyte ratio (NLR), intraoperative blood loss, postoperative C-reactive protein (CRP) max, recurrence-free survival (RFS), and overall survival (OS) in 111 patients with pStage Ⅰ–Ⅳ squamous cell EC who received esophagectomies. Optimal cutoff values for each continuous parameter were determined by receiver operating characteristic curves and Youden indices. Univariate and multivariate Cox analyses were used to derive independent prognostic factors. Propensity score matching using inverse probability of treatment weighting was used in groups divided by Youden indices, as appropriate.
    Results: Cutoff values of continuous variables were NLR: 2.27, PNI: 44.2, blood loss: 159 mL, and CRPmax: 21.7 mg/dL. In multivariate analyses, PNI, CRPmax, and intraoperative blood loss were independent prognostic factors for OS and RFS. Among patients with stage Ⅱ–Ⅳ disease, low PNI was associated with shorter RFS. Postoperative respiratory complications were associated with both higher CRP and shorter RFS.
    Discussion/Conclusions: Low preoperative PNI and high postoperative inflammatory response were associated with postoperative EC progression after esophagectomy. Preoperative nutritional interventions or suppression of postoperative inflammatory response, including respiratory complications, may improve patient prognosis.

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    Yoshinori Fujiwara, Masaharu Higashida, Hisako Kubota, Yuko Okamoto, Shumei Mineta, Shunji Endo, Tomio Ueno. 2021. Perioperative Predictive Markers for Recurrence of Esophageal Cancer after Esophagectomy. Gastrointestinal Tumors. 8:61 doi: 10.1159/000513961
    Yoshinori Fujiwara, Masaharu Higashida, Hisako Kubota, Yuko Okamoto, Shumei Mineta, Shunji Endo, Tomio Ueno. 2021. Perioperative Predictive Markers for Recurrence of Esophageal Cancer after Esophagectomy. Gastrointestinal Tumors. 8:61 doi: 10.1159/000513961
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Research Article   Open Access    

Perioperative Predictive Markers for Recurrence of Esophageal Cancer after Esophagectomy

  • Department of Digestive Surgery, Kawasaki Medical School, Kurashiki, Japan

  • Corresponding author: Yoshinori Fujiwara Department of Digestive Surgery, Kawasaki Medical School 577 Matsushima Kurashiki 701-0192 (Japan) yyfujiwara@nifty.com 
  • Received: 28 August 2020
  • Accepted: 21 December 2020
  • Published online: 17 March 2021
Gastrointestinal Tumors  8,  Article number: 10.1159/000513961  (2021)  |  Cite this article

Abstract: 

Introduction: We studied whether perioperative nutritional, immunological factors or postoperative inflammatory responses predicted esophageal cancer (EC) progression and prognosis in patients who received esophagectomies.
Methods: We evaluated preoperative prognostic nutritional index (PNI), BMI, neutrophil-to-lymphocyte ratio (NLR), intraoperative blood loss, postoperative C-reactive protein (CRP) max, recurrence-free survival (RFS), and overall survival (OS) in 111 patients with pStage Ⅰ–Ⅳ squamous cell EC who received esophagectomies. Optimal cutoff values for each continuous parameter were determined by receiver operating characteristic curves and Youden indices. Univariate and multivariate Cox analyses were used to derive independent prognostic factors. Propensity score matching using inverse probability of treatment weighting was used in groups divided by Youden indices, as appropriate.
Results: Cutoff values of continuous variables were NLR: 2.27, PNI: 44.2, blood loss: 159 mL, and CRPmax: 21.7 mg/dL. In multivariate analyses, PNI, CRPmax, and intraoperative blood loss were independent prognostic factors for OS and RFS. Among patients with stage Ⅱ–Ⅳ disease, low PNI was associated with shorter RFS. Postoperative respiratory complications were associated with both higher CRP and shorter RFS.
Discussion/Conclusions: Low preoperative PNI and high postoperative inflammatory response were associated with postoperative EC progression after esophagectomy. Preoperative nutritional interventions or suppression of postoperative inflammatory response, including respiratory complications, may improve patient prognosis.

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    Cite this article
    Yoshinori Fujiwara, Masaharu Higashida, Hisako Kubota, Yuko Okamoto, Shumei Mineta, Shunji Endo, Tomio Ueno. 2021. Perioperative Predictive Markers for Recurrence of Esophageal Cancer after Esophagectomy. Gastrointestinal Tumors. 8:61 doi: 10.1159/000513961
    Yoshinori Fujiwara, Masaharu Higashida, Hisako Kubota, Yuko Okamoto, Shumei Mineta, Shunji Endo, Tomio Ueno. 2021. Perioperative Predictive Markers for Recurrence of Esophageal Cancer after Esophagectomy. Gastrointestinal Tumors. 8:61 doi: 10.1159/000513961
    shu

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