Preoperative Inflammatory Response to Esophageal Cancer Is More Reliable Prognostic Factor in Patients Received Esophagectomy

Background: Inflammation and nutrition are closely related to the progression of gastrointestinal malignancies. We aimed to explore the potential of preoperative inflammation-based or nutrition-based biomarkers as predictors of survival in patients with resectable esophageal squamous cell carcinoma (ESCC) using multivariate Cox analysis. Methods: We included 122 patients with resectable ESCC (stages I–IV) in the study. We assessed the inflammation-based modified Glasgow prognostic score (mGPS), nutrition-based modified controlling nutritional status (mCONUT) score, CRP(C-reactive protein),serum albumin, lymphocyte counts, and total cholesterol. The relationships of these biomarkers with overall survival (OS) and recurrence-free survival (RFS) were evaluated. Three Cox model were performed for single parameters(CRP, albumin, lymphocyte, total cholesterol), for mCONUT and mGPS,and for clinicopathological factors. Results: The cut-off values for CRP, albumin, and mCONUT measured using receiver operating characteristic (ROC) curves were 0.3, 3.5, and 4, respectively. Patients with high mGPS and high mCONUT scores were significantly associated with shorter OS and RFS (p < 0.05).Multivariate Cox analysis showed that mGPS,pStage,tumor location were independent prognostic factors both FRS and OS. Also, Cox analysis for single parameters showed that preoperative CRP, lymphocyte counts were independent prognostic factors for RFS and albumin was prognostic factor for OS. Conclusions: Preoperative inflammation-based mGPS is most reliable independent prognostic factor in patients with resectable ESCC. Suppression of preoperative inflammation can be improved nutritional status and may improve the prognosis in these patients.