Validation of a novel prognostic scoring system using inflammatory response biomarkers in patients undergoing curative thoracoscopic esophagectomy for esophageal squamous cell carcinoma

Figures & data

Table 1 Relationships between the LMR, NLR, and PLR, and clinicopathological features of 147 consecutive patients with esophageal SSC

Characteristics	Total patients	LMR			NLR			PLR
		<4 (n=64)	≥4 (n=83)	P-value	<1.6 (n=37)	≥1.6 (n=110)	P-value	<147 (n=79)	≥147 (n=68)	P-value
Age (years)		65.8±7.4	65.7±8.2	0.934	65.4±8.0	65.9±7.9	0.72	66.8±8.1	64.6±7.6	0.097
Gender				0.052			0.163			0.562
Male	132	61	71		31	101		72	60
Female	15	3	12		6	9		7	8
WBC		6,082.2±2,153.2	5,844.3±1,788.2	0.466	5,284.1±1,667.3	6,171.2±1,996.5	0.016	6,190.9±1,723.0	5,665.6±2,167.2	0.104
Neutrophil		3,944.7±1,804.6	3,412.8±1,470.4	0.051	2,491.0±948.3	4,032.3±1,643.7	<0.0001	3,509.3±1,300.5	3,801.3±1,960.9	0.283
Lymphocyte		1,322.0±546.4	1,942.5±584.5	<0.0001	2,187.6±658.6	1,499.0±541.8	<0.0001	2,029.2±586.3	1,257.7±426.2	<0.0001
Monocyte		546.8±211.3	328.7±111.1	<0.0001	379.0±161.3	438.7±203.3	0.1074	418.2±171.3	430.0±220.2	0.714
Platelet		236.6±79.2	226.9±66.2	0.42	231.0±76.9	231.2±70.7	0.987	203.5±49.2	263.2±80.9	<0.0001
Location of tumor				0.09			0.313			0.042
Ce	6	5	1		1	5		0	6
Ut	8	4	4		0	8		5	3
Mt	65	29	36		20	45		32	33
Lt	52	23	29		11	41		31	21
Ae	16	3	13		5	11		11	5
Tumor size (mm)		4.9±1.9	3.9±2.7	0.014	3.8±2.8	4.5±2.3	0.134	4.0±2.5	4.8±2.3	0.056
Depth of tumor invasion				0.0007			0.002			0.06
T1a–1b	66	20	46		18	48		40	26
T2	12	2	10		8	4		9	3
T3	56	33	23		8	48		26	30
T4a–4b	13	9	4		3	10		4	9
Lymph node metastasis				0.2732			0.1532			0.0639
N0	79	30	49		22	57		43	36
N1	42	19	23		12	30		25	17
N2	12	8	4		3	9		8	4
N3	14	7	7		0	14		3	11
Pathological stage				0.0002			0.1338			0.3497
1a–1b	59	14	45		20	39		36	23
2a–2b	33	21	12		6	27		16	17
3a–3c	55	29	26		11	44		27	28
Operation time (min)		644.8±162.2	663.5±159.2	0.4843	655.9±177.2	655.2±155.0	0.9798	676.5±149.0	630.8±170.2	0.0845
Intraoperative blood loss (mL)		751.8±622.8	581.6±633.4	0.1059	568.8±511.1	684.9±667.8	0.3359	598.5±633.1	722.2±629.7	0.2384
SCC antigen		1.19±1.06	1.12±1.12	0.7208	1.04±1.12	1.19±1.08	0.7643	1.05±0.91	1.27±1.26	0.8858

Note: Data presented as mean ± SD, number, or P-value.

Abbreviations: Ae, abdominal esophagus; Ce, cervical esophagus; LMR, lymphocyte-to-monocyte ratio; Lt, lower thoracic esophagus; Mt, middle thoracic esophagus; NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; SCC, squamous cell carcinoma; Ut, upper thoracic esophagus; WBC, white blood cell.

Table 2 Relationships between the IRB score and clinicopathological features of 147 consecutive patients with esophageal SCC

Characteristics	Total patients	IRB score			P-value
		0–1 (0: n=3 and 1: n=49)	2 (n=62)	3 (n=33)
Age (years)		65.6±7.4	64.2±7.9	68.9±8.0	0.0202
Gender					0.9305
Male	132	47	55	30
Female	15	5	7	3
WBC		5,611.5±2,218.8	6,067.7±1,788.6	6,252.7±1,770.0	0.2767
Neutrophil		3,650.2±1,958.8	3,532.1±1,542.5	3,846.1±1,246.5	0.6765
Lymphocyte		1,241.3±539.1	1,901.2±619.1	1,921.6±486.5	<0.0001
Monocyte		488.9±236.3	417.9±169.4	331.8±117.5	0.0011
Platelet		256.8±80.5	223.2±70.4	205.7±45.5	0.0028
Location of tumor					0.0059
Ce	6	6	0	0
Ut	8	2	3	3
Mt	65	27	27	11
Lt	52	16	21	15
Ae	16	1	11	4
Tumor size (mm)		4.9±2.1	4.0±2.6	4.0±2.5	0.0824
Depth of tumor invasion					0.0488
T1a–1b	66	16	31	19
2	12	3	7	2
3	56	26	18	12
4a–4b	13	7	6	0
Lymph node metastasis					0.5705
N0	79	27	33	19
N1	42	15	17	10
N2	12	3	8	1
N3	14	7	4	3
Pathological stage					0.2646
1a–1b	59	15	27	17
2a–2b	33	15	13	5
3a–3c	55	22	22	11
Operation time (min)		632.8±178.5	653.3±150.4	694.8±144.1	0.2201
Intraoperative blood loss (mL)		752.3±582.9	616.7±642.4	576.7±687.0	0.3768
SCC antigen		1.21±1.10	1.17±1.27	1.03±0.61	0.7438
LMR					<0.0001
<4	64	45	19	0
≥4	83	7	43	33
NLR					0.0002
<1.6	37	13	24	0
≥1.6	110	39	38	33
PLR					<0.0001
<147	79	3	43	33
≥147	68	49	19	0

Note: Data presented as mean ± SD, number, or P-value.

Abbreviations: Ae, abdominal esophagus; Ce, cervical esophagus; IRB, inflammatory response biomarker; LMR, lymphocyte-to-monocyte ratio; Lt, lower thoracic esophagus; Mt, middle thoracic esophagus; NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; SCC, squamous cell carcinoma; Ut, upper thoracic esophagus; WBC, white blood cell.

Table 3 Prognostic factors for cancer-specific survival in 147 consecutive patients with esophageal SCC

Variables	Patients (n=147)	Category or characteristics	Univariate			Multivariate
			HR	95% CI	P-value	HR	95% CI	P-value
Gender	15/132	Female/male	0.942	0.406–2.740	0.9007
Age	46/101	<70/≥70	1.427	0.742–2.639	0.2771
Pathological stage	92/55	1, 2/3	4.876	2.625–9.420	<0.0001	4.449	2.289–9.044	<0.0001
Tumor size	45/102	<3/≥3	3.405	1.548–8.981	0.0014	1.579	0.638–4.487	0.3356
Operation time	99/48	<600/≥600	2.041	1.116–3.741	0.0209	1.312	0.695–2.477	0.4004
Intraoperative blood loss	72/75	<500/≥500	1.321	0.723–2.463	0.3663
LMR	83/64	≥4.0/<4.0	2.829	1.537–5.378	0.0008	1.072	0.392–3.066	0.8945
NLR	37/110	≥1.6/<1.6	1.469	0.753–2.734	0.2494
PLR	79/68	<147/≥147	2.013	1.100–3.783	0.0232	2.126	0.804–5.499	0.1286
SCC	109/38	<1.5/≥1.5	1.3	0.603–2.564	0.4842
IRB score	95/52	2, 3/0, 1	3.711	2.024–6.984	<0.0001	6.023	1.675–13.078	0.0055

Abbreviations: CI, confidence interval; HR, hazard ratio; IRB, inflammatory response biomarker; LMR, lymphocyte-to-monocyte ratio; NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; SCC, squamous cell carcinoma.

Figure 1 Kaplan–Meier survival curves of postoperative CSS according to inflammatory response biomarkers: (A) LMR, (B) PLR, and (C) NLR in 147 consecutive patients with esophageal squamous cell carcinoma.

Abbreviations: CSS, cancer-specific survival; LMR, lymphocyte-to-monocyte ratio; NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio.

Figure 2 Kaplan–Meier survival curves of postoperative CSS according to the IRB score in patients with esophageal squamous carcinoma.

Abbreviations: CSS, cancer-specific survival; IRB, inflammatory response biomarker.