Modified Systemic Inflammation Score is Useful for Risk Stratification After Radical Resection of Squamous Cell Carcinoma of the Esophagus

• Published in: Annals of surgical oncology Vol. 26; no. 13; pp. 4773 - 4781
• Main Authors: Kanda, Mitsuro, Koike, Masahiko, Tanaka, Chie, Kobayashi, Daisuke, Hattori, Norifumi, Hayashi, Masamichi, Yamada, Suguru, Omae, Kenji, Fujiwara, Michitaka, Kodera, Yasuhiro
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.12.2019; Springer Nature B.V
• Subjects: Aged; Body mass index; Esophageal cancer; Esophageal Neoplasms - pathology; Esophageal Neoplasms - surgery; Esophageal Squamous Cell Carcinoma - pathology; Esophageal Squamous Cell Carcinoma - surgery; Esophagectomy - adverse effects; Esophagectomy - mortality; Esophagus; Female; Follow-Up Studies; Humans; Inflammation; Inflammation - diagnosis; Inflammation - etiology; Male; Medicine; Medicine & Public Health; Monocytes; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - surgery; Oncology; Patients; Prognosis; Retrospective Studies; Risk assessment; Risk Assessment - methods; Squamous cell carcinoma; Surgery; Surgical Oncology; Survival Rate; Thoracic Oncology
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-019-07914-7

Background Inflammation plays a critical role in the development and progression of cancers. We evaluated the clinical significance of the preoperative modified systemic inflammation score (mSIS) to predict long-term outcomes of patients with esophageal squamous cell carcinoma (ESCC). Methods We included 443 patients who underwent curative resection of ESCC. The mSIS was formulated according to the serum albumin level (ALB) and lymphocyte-to-monocyte ratio (LMR) as follows: mSIS 0 (ALB ≥ 4.0 g/dL and LMR ≥ 3.4), mSIS 1 (ALB < 4.0 g/dL or LMR < 3.4), and mSIS 2 (ALB < 4.0 g/dL and LMR < 3.4). Results Patients were categorized into preoperative mSIS 0 ( n  = 165), mSIS 1 ( n  = 183), and mSIS 2 ( n  = 95) groups. Preoperative mSIS was significantly associated with age, preoperative body mass index, and pathological disease stage. The disease-specific survival times of patients in preoperative mSIS 0, 1, and 2 sequentially shortened ( P  = 0.009), and mSIS 2 was identified as an independent prognostic factor (hazard ratio 2.63, 95% confidence interval 1.33–5.27, P  = 0.0053). In most patient subgroups, the mSIS was associated with greater risk of disease-specific death. A stepwise increase in the prevalence of hematogenous recurrences was directly proportion to the mSIS. When patients were subdivided by mSIS before neoadjuvant treatment, there were no significant differences in disease-specific survival. Conclusions Our findings demonstrate that the preoperative mSIS may serve as a powerful prognosticator of ESCC that definitively stratifies clinical outcomes as well as a tool for selecting treatment strategies.