Influence of preoperative Naples prognostic score on prognosis of patients with thoracic esophageal squamous cell carcinoma

Abstract

Abstract:

ObjectiveTo explore the impact of preoperative Naples prognostic score (NPS) on the survival prognosis of patients with thoracic esophageal squamous cell carcinoma (ESCC).MethodsFrom December 2014 to December 2020, a total of 134 patients who underwent radical esophagectomy in Department of Thoracic Surgery, Affiliated Taixing People's Hospital of Yangzhou University were retrospectively analyzed. The NPS was calculated by the median values of preoperative serum albumin, total cholesterol, neutrophil to lymphocyte ratio (NLR) and lymphocyte to monocyte ratio (LMR), and then the enrolled patients were divided into NPS 0 group (20 cases), NPS 1 or 2 group (62 cases) and NPS 3 or 4 group (52 cases). Kaplan-Meier method was used to calculate survival rate and survival comparison was performed by log-rank test. The univa-riate and multivariate Cox models were used to analyze the relationship between NPS and survival prognosis.ResultsThe 1-, 3- and 5-year progression free survival (PFS) rates were 95.0%, 70.0% and 60.0% in the NPS 0 group, 66.1%, 24.2% and 24.2% in the NPS 1 or 2 group, and 48.1%, 3.8% and 1.9% in the NPS 3 or 4 group respectively, with a statistically significant difference (χ²=31.27,P<0.001). In the NPS 0 group, the 1-, 3- and 5-year overall survival (OS) rates were 100.0%, 80.0% and 70.0% respectively. In the NPS 1 or 2 group, the 1-, 3- and 5-year OS rates were 96.8%, 36.7% and 32.3% respectively, while in the NPS 3 or 4 group, the 1-, 3- and 5-year OS rates were 90.4%, 32.7% and 5.8% respectively, and there was a statistically significant difference (χ²=29.70,P<0.001). Univariate analysis found that sex, T stage, N stage, TNM stage and NPS were closely related to PFS and OS of patients with thoracic ESCC (allP<0.05). Furthermore, multivariate Cox regression analysis showed that T stage (HR=1.46, 95%CI: 1.07-2.00,P=0.019), N stage (HR=1.34, 95%CI: 1.02-1.76,P=0.037) and NPS (set NPS 0 group as the subvariable, NPS 1 or 2 group:HR=3.35, 95%CI: 1.58-7.11,P=0.002; NPS 3 or 4 group:HR=6.15, 95%CI: 2.89-13.11,P=0.001) were independent prognostic factors for PFS. Additionally, T stage (HR=1.67, 95%CI: 1.01-2.77,P=0.046), N stage (HR=1.44, 95%CI: 1.00-2.20,P=0.048) and NPS (set NPS 0 group as the subvariable, NPS 1 or 2 group:HR=3.10, 95%CI: 1.31-7.32,P=0.010; NPS 3 or 4 group:HR=5.09, 95%CI: 2.14-12.11,P=0.001) were independent prognostic factors for OS.ConclusionPreoperative NPS plays an important role in predicting the survival prognosis of patients with thoracic ESCC.

Key words:Esophageal neoplasms,Naples prognostic score,Prognosis

Guo Xinwei, Zhang Han, Ye Hongxun, Liu Yangchen, Ji Shengjun, Zhou Shaobing, Zhou Juying. Influence of preoperative Naples prognostic score on prognosis of patients with thoracic esophageal squamous cell carcinoma[J]. Journal of International Oncology, 2022, 49(2): 89-94.

Figures/Tables6

临床病理特征	NPS 0分组 (n=20)	NPS 1或 2分组 (n=62)	NPS 3或 4分组 (n=52)	χ²值
性别
男	15	49	48	4.98	0.087
女	5	13	4
年龄(岁)
<62	7	25	27	2.32	0.313
≥62	13	37	25
肿瘤位置
胸中上段	11	43	31	2.25	0.325
胸下段	9	19	21
分化程度
中高分化	10	41	29	2.18	0.336
低分化	10	21	23
T分期
T_1-2期	9	17	12	3.47	0.177
T_3-4期	11	45	40
N分期
N₀期	14	36	21	6.28	0.043
N_1-2期	6	26	31
TNM分期
Ⅰ~Ⅱ期	14	32	22	4.47	0.107
Ⅲ~Ⅳ期	6	30	30
复发
无	16	10	2	52.27	<0.001
有	4	52	50

因素	PFS				OS
因素	HR值	95%CI	P值		HR值	95%CI	P值
年龄(<62岁/≥62岁)	0.82	0.56~1.21	0.315	0.92		0.62~1.37	0.677
性别(男/女)	2.12	1.18~3.79	0.012	2.18		1.16~4.09	0.015
位置(中上段/下段)	1.18	0.81~1.71	0.394	1.14		0.76~1.70	0.525
分化(中高/差)	0.92	0.63~1.35	0.681	0.99		0.66~1.48	0.950
T分期(T₁+T₂/T₃+T₄)	1.78	1.13~2.79	0.012	2.05		1.25~3.36	0.004
N分期(N₀/N₁+N₂)	1.84	1.25~2.70	0.002	1.97		1.32~2.94	0.001
TNM分期(Ⅰ+Ⅱ/Ⅲ+Ⅳ)	1.89	1.28~2.78	0.001	2.09		1.39~3.13	0.001
NPS
0分组	1	-	-	1		-	-
1或2分组	3.35	1.58~7.11	0.002	3.42		1.45~8.06	0.005
3或4分组	6.15	2.89~13.11	0.001	6.76		2.88~15.87	0.001

因素	PFS		OS
性别	1.74	0.95~3.17	0.071	1.71	0.89~3.28	0.107
T分期	1.46	1.07~2.00	0.019	1.67	1.01~2.77	0.046
N分期	1.34	1.02~1.76	0.037	1.44	1.00~2.20	0.048
NPS
0分组	1	-	-	1	-	-
1或2分组	3.35	1.58~7.11	0.002	3.10	1.31~7.32	0.010
3或4分组	6.15	2.89~13.11	0.001	5.09	2.14~12.11	0.001

References18

[1]	Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020[J]. CA Cancer J Clin, 2020, 70(1): 7-30. DOI: 10.3322/caac.21590. doi:10.3322/caac.21590
[2]	Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019[J]. CA Cancer J Clin, 2019, 69(1): 7-34. DOI: 10.3322/caac.21551. doi:10.3322/caac.21551
[3]	Malhotra GK, Yanala U, Ravipati A, et al. Global trends in esophageal cancer[J]. J Surg Oncol, 2017, 115(5): 564-579. DOI: 10.1002/jso.24592. doi:10.1002/jso.24592pmid:28320055
[4]	Lin Y, Totsuka Y, He Y, et al. Epidemiology of esophageal cancer in Japan and China[J]. J Epidemiol, 2013, 23(4): 233-242. DOI: 10.2188/jea.je20120162. doi:10.2188/jea.je20120162
[5]	Liu J, Xie X, Zhou C, et al. Which factors are associated with actual 5-year survival of oesophageal squamous cell carcinoma?[J]. Eur J Cardiothorac Surg, 2012, 41(3): e7-e11. DOI: 10.1093/ejcts/ezr240. doi:10.1093/ejcts/ezr240
[6]	Liu Q, Cai XW, Wu B, et al. Patterns of failure after radical surgery among patients with thoracic esophageal squamous cell carcinoma: implications for the clinical target volume design of postoperative radiotherapy[J]. PLoS One, 2014, 9(5): e97225. DOI: 10.1371/journal.pone.0097225. doi:10.1371/journal.pone.0097225
[7]	Hu Y, Shen J, Liu R, et al. Prognostic value of pretreatment prognostic nutritional index in non-small cell lung cancer: a systematic review and meta-analysis[J]. Int J Biol Markers, 2018, 33(4): 372-378. DOI: 10.1177/1724600818799876. doi:10.1177/1724600818799876
[8]	Sun Y, Zhang L. The clinical use of pretreatment NLR, PLR, and LMR in patients with esophageal squamous cell carcinoma: evidence from a meta-analysis[J]. Cancer Manag Res, 2018, 10:6167-6179. DOI: 10.2147/CMAR.S171035. doi:10.2147/CMAR.S171035
[9]	Castillo-Martínez L, Castro-Eguiluz D, Copca-Mendoza ET, et al. Nutritional assessment tools for the identification of malnutrition and nutritional risk associated with cancer treatment[J]. Rev Invest Clin, 2018, 70(3): 121-125. DOI: 10.24875/RIC.18002524. doi:10.24875/RIC.18002524pmid:29943772
[10]	Yılmaz A, Tekin SB, Bilici M, et al. The significance of controlling nutritional status (CONUT) score as a novel prognostic parameter in small cell lung cancer[J]. Lung, 2020, 198(4): 695-704. DOI: 10.1007/s00408-020-00361-2. doi:10.1007/s00408-020-00361-2pmid:32424800
[11]	崔芳芳, 何贤英, 宇传华, 等. 1990—2016年中国人群食管癌疾病负担变化趋势及危险因素分析[J]. 中国卫生统计, 2021, 38(1): 87-91, 95. DOI: 10.3969/j.issn.1002-3674.2021.01.023. doi:10.3969/j.issn.1002-3674.2021.01.023
[12]	Galizia G, Lieto E, Auricchio A, et al. Naples prognostic score, based on nutritional and inflammatory status, is an independent predictor of long-term outcome in patients undergoing surgery for colo-rectal cancer[J]. Dis Colon Rectum, 2017, 60(12): 1273-1284. DOI: 10.1097/DCR.0000000000000961. doi:10.1097/DCR.0000000000000961
[13]	Yang Q, Chen T, Yao Z, et al. Prognostic value of pre-treatment Naples prognostic score (NPS) in patients with osteosarcoma[J]. World J Surg Oncol, 2020, 18(1): 24. DOI: 10.1186/s12957-020-1789-z. doi:10.1186/s12957-020-1789-z
[14]	Galizia G, Auricchio A, de Vita F, et al. Inflammatory and nutritional status is a predictor of long-term outcome in patients under-going surgery for gastric cancer. Validation of the Naples prognostic score[J]. Ann Ital Chir, 2019, 90:404-416.
[15]	Nakagawa N, Yamada S, Sonohara F, et al. Clinical implications of Naples prognostic score in patients with resected pancreatic cancer[J]. Ann Surg Oncol, 2020, 27(3): 887-895. DOI: 10.1245/s10434-019-08047-7. doi:10.1245/s10434-019-08047-7
[16]	Miyamoto Y, Hiyoshi Y, Daitoku N, et al. Naples prognostic score is a useful prognostic marker in patients with metastatic colorectal cancer[J]. Dis Colon Rectum, 2019, 62(12): 1485-1493. DOI: 10.1097/DCR.0000000000001484. doi:10.1097/DCR.0000000000001484pmid:31567920
[17]	Mantovani A, Allavena P, Sica A, et al. Cancer-related inflam-mation[J]. Nature, 2008, 454(7203): 436-444. DOI: 10.1038/nature07205. doi:10.1038/nature07205
[18]	Sun KY, Xu JB, Chen SL, et al. Novel immunological and nutritional-based prognostic index for gastric cancer[J]. World J Gastroenterol, 2015, 21(19): 5961-5971. DOI: 10.3748/wjg.v21.i19.5961. doi:10.3748/wjg.v21.i19.5961