Significant host- and tumor-related factors for predicting prognosis in patients with esophageal carcinoma

Abstract

Objective: To identify clinically useful parameters obtainable before treatment of predicting clinical outcomes in patients with esophageal carcinoma.

Summary background data: Various factors regarding the biologic state of tumors or the nutritional state of patients have been individually reported to correlate with prognosis. Reliable estimates of life expectancy before treatment are important, and consideration needs to be given not only to tumor-related but also to host-related factors in patients with esophageal carcinoma.

Methods: The following clinicopathological factors were retrospectively analyzed in 356 consecutive patients with surgical treatment: sex; age; serum C-reactive protein (CRP); proportion of lymphocytes; body weight changes; serum albumin; clinical TNM staging; tumor location; serum squamous cell-related antigen; serum carcinoembryonic antigen; and histology. Factors related to prognosis were evaluated by using univariate and multivariate analyses.

Results: According to univariate analysis, significant differences in survival were found for sex, serum CRP, proportion of lymphocytes, body weight change, serum albumin, serum squamous cell-related antigen, and clinical TNM staging. Multivariate analysis demonstrated that CRP levels (P = 0.0285), body weight change (P = 0.0165), and clinical TNM staging (P = 0.0008) displayed independent correlations to prognosis. When serum CRP elevation, body weight loss, and clinical TNM staging III and IV were scored as a combined index, the total score (prognostic index for esophageal cancer, PIEC) demonstrated a good stratification value for prognosis. Moreover, PIEC was superior to the conventional clinical TNM staging by the likelihood ratio test.

Conclusions: PIEC based on serum CRP, body weight change, and clinical TNM staging before treatment offers a very simple and informative method for predicting the prognosis of patients with esophageal carcinoma.

FIGURE 1. Five-year survival curves after univariate analysis using log-rank test. Significant differences were found in clinical TNM staging (a), serum CRP level (b), and proportion of body weight loss (c).

FIGURE 2. Five-year survival curves according to score 0-3. Significant difference was not found between score 2 and 3 (a). Five-year survival curves according to score 0, 1, and 2 or more. Significant differences were identified between each group (b).