Nomogram-Integrated C-Reactive Protein/Albumin Ratio Predicts Efficacy And Prognosis In Patients With Thoracic Esophageal Squamous Cell Carcinoma Receiving Chemoradiotherapy

Figures & data

Table 1 Clinicopathological Characteristics Of 266 Patients With Thoracic Esophageal Squamous Cell Carcinoma

Characteristics	No. Of Patients	Proportion (%)
Sex
Male	172	64.7
Female	94	35.3
Age
<67	83	31.2
≥67	183	68.8
T classification
T1	19	7.1
T2	118	44.4
T3	94	35.3
T4	35	13.2
N classification
N0	100	37.6
N1	146	54.9
N2	20	7.5
Tumor location
Upper	85	32.0
Middle	134	50.4
Lower	47	17.6
TNM stage
I	35	13.2
II	145	54.5
III	86	32.3
Treatment modalities
RT alone	128	48.1
CRT	138	51.9
Tumor response
CR	75	28.2
PR	135	50.7
SD	50	18.8
PD	6	2.3

Abbreviations: T, tumor; N, lymph node; TNM, tumor-node-metastasis; RT, radiotherapy; CRT, chemoradiotherapy; CR, complete response; PR, partial response; SD, stable disease; PD, progressive disease.

Table 2 Univariate And Multivariate Logistic Regression Analysis Between Tumor Response And Inflammation-Based Markers And Clinicopathological Characteristics In Patients With Thoracic ESCC (n=266)

Factors			Univariate Analysis			Multivariate Analysis
Responder	Non-Responder	HR	95% CI	P-value	HR	95% CI	P-value
Age			0.946	0.503–1.781	0.864
<67	65	18
≥67	145	38
Sex			0.235	0.356–1.289	0.677
Male	132	40
Female	78	16
Location			2.000	1.009–3.964	0.047	1.664	0.765–3.621	0.199
Upper+middle	175	40
Lower	35	16
Clinical stage			0.364	0.198–0.667	0.001	0.397	0.201–0.785	0.008
I+II	154	28
III	56	28
Treatment			0.830	0.460–1.498	0.537
RT only	99	29
CRT	111	27
NLR			3.774	1.944–7.327	0.000	2.175	0.931–5.081	0.073
≥3.06	93	42
<3.06	117	14
PLR			2.312	1.249–4.283	0.008	1.160	0.521–2.583	0.715
≥145.26	96	37
<145.26	114	19
CRP/ALB			9.606	4.572–20.182	0.000	7.291	3.363–15.808	0.000
≥0.13	68	46
<0.13	142	10

Abbreviations: ESCC, esophageal squamous cell carcinoma; HR, hazard ratio; CI, confidence interval; NLR, neutrophil to lymphocyte ratio; PLR, platelet lymphocyte ratio; CRP/Alb, C-reactive protein/albumin; RT, radiotherapy; CRT, chemoradiotherapy.

Figure 1 Kaplan–Meier curves for OS stratified according to NLR, PLR, and CRP/ALB ratio median values.

Notes: (A) OS curves grouped by NLR median value (the 3-year OS for low NLR 48.1%, high NLR 20.8%, P=0.001). (B) OS curves stratified according to PLR median value (the 3-year OS for low PLR 44.4%, high PLR 24.5%, p=0.027). (C) OS curves stratified by CRP/ALB ratio median value (the 3-year OS for low CRP/ALB ratio 61.5%, high CRP/ALB ratio 9.1%, P=0.000).

Abbreviations: OS, overall survival; NLR, neutrophil to lymphocyte ratio; PLR, platelet lymphocyte ratio; CRP/Alb, C-reactive protein/albumin.

Table 3 Univariate And Multivariate Analysis Of Clinicopathological Parameters And Hematological Markers For The Prediction Of Overall Survival In Patients With Thoracic ESCC (N =266)

Factors	Univariate Analysis			Multivariate Analysis
HR	95% CI	P-value	HR	95% CI	P-value
Age (<67/≥67)	1.378	1.001–1.895	0.049	1.731	1.245–2.405	0.001
Sex (male/female)	1.003	0.743–1.353	0.978	–	–	–
TNM staging (I+II/III)	1.918	1.423–2.586	0.000	1.878	1.381–2.553	0.000
Tumor location (upper+middle/lower)	1.271	0.898–1.800	0.176	–	–	–
Treatment (RT only/CRT)	0.815	0.611–1.087	0.164	–	–	–
NLR (<3.06/≥3.06)	1.786	1.333–2.393	0.001	1.157	0.814–1.644	0.417
PLR (<145.26/≥145.26)	1.713	1.280–2.292	0.000	1.361	0.972–1.908	0.073
CRP/ALB (<0.13/≥0.13)	4.671	3.425–6.370	0.000	4.344	3.145–5.999	0.000

Figure 2 The ROC curves grouped by NLR, PLR and CRP/ALB ratio.

Notes: (A) ROC curves based on therapeutic effect. (B) ROC curves for OS.

Abbreviations: AUC, area under the curve; NLR, neutrophil lymphocyte ratio; PLR, platelet lymphocyte ratio; CRP/Alb, C-reactive protein/albumin; ROC, receiver operating characteristic.

Figure 3 Prediction Nomogram for therapeutic efficacy.

Notes: (A) Therapeutic evaluation of nomogram-integrated CRP/Alb ratio in the patients with esophageal squamous cell cancer receiving CRT RT only. (B) The calibration curve of the nomogram for the tumor response. (C) The decision curve analysis of the nomogram for the tumor response.

Figure 4 Prediction nomogram for overall survival.

Notes: (A) Survival evaluation of nomogram-integrated CRP/Alb ratio in the patients with esophageal squamous cell cancer receiving CRT RT only. (B) The calibration plot for the probability of survival at 3-year after treatment. (C) The decision curve analysis of the nomogram for the 3-year survival rate.