| Background and objective:Esophageal cancer is a common malignant tumor of the digestive tract.According to statistics,the number of new cases of esophageal cancer worldwide in 2012 was 455,800,and the death toll was about 400,200.The incidence ratio of male and female of esophageal cancer was about 3-4:1.China is a high incidence of esophageal cancer,the latest epidemiological data show that the incidence of esophageal cancer in China ranks the 3rd among all types of malignant tumors,and the annual mortality ranks the 4th.Among esophageal cancer patients in China,squamous cell carcinoma is the most common,accounting for about 90%.At present,the main treatment methods for esophageal cancer include surgery,radiotherapy,chemotherapy,etc.,and surgery is still the preferred treatment for esophageal cancer.With the improvement of clinical medical level,the disease control rate,survival period and the life quality of esophageal cancer patients have been significantly improved,but the five-year survival rate is still about 15%-20%.Therefore,the study of various factors affecting the prognosis of esophageal cancer patients is still very important.Studies have shown that preoperative peripheral blood platelet(PLT)level and platelet lymphocyte ratio(PLR)are important factors affecting the prognosis of esophageal cancer.A higher preoperative platelet(PLT)level is associated with a higher platelet lymphocyte ratio(PLR)and a poorer prognosis for esophageal cancer,so a combined score of the two may be more effective in predicting prognosis in patients with esophageal cancer.Oncologists and patients alike want reliable prognostic information for individual patients.In recent years,statistical prediction models have been developed for most cancer types.The nomogram is one of the prediction tool,it creates a simple statistical prediction model of graphics,the model generation numerical probability of clinical events.Nomogram for many cancers compared with the traditional TNM staging system has the advantage,therefore have been proposed as an alternative or even a new standard.There are many indicators for the prognosis evaluation of esophageal cancer,but there is a lack of a unified evaluation system.Therefore,in this study,we can construct a nomogram to predict the prognosis of patients with esophageal cancer better.The purpose of this study was to evaluate the prognostic value of combined PLT-PLR score based on preoperative peripheral blood platelet(PLT)level and platelet lymphocyte ratio(PLR)in patients with esophageal cancer and to construct a nomogram by analyzing various indicators that can predict the prognosis of patients with esophageal cancer.Methods:A total of 300 patients with esophageal cancer who underwent esophagectomy in QiLu hospital of Shandong university on December 31,2012 were included in this study.The follow-up date was January 31,2016.Patients were followed every 3 months for 2 years after surgery and every 6 months for 2 years until death or follow-up.Clinicopathological data of the patients were collected,including:gender,age.smoking,drinking,chronic disease,histological type,tumor size,infiltration depth,number of lymph node metastases,distant metastasis,tumor site,degree of differentiation,and hematological indexes of the week before surgery.In the study,we used the subject operating curve(ROC)curve to determine the boundary value of various hematological indicators.The continuous variables in the study were analyzed by independent sample t test and mean value analysis,while the categorical variables were analyzed by Fisher's exact test or Pearson's test.Kaplan-Meier survival analysis was used to analyze patients' PFS and OS,and COX proportional risk regression model was used for univariate and multivariate survival analysis.SPSS 20.0 software was used to analyze the above data.The alignment diagram and test curve were drawn by software R3.5.1.Double-tailed p values were used in the study,and p<0.05 was considered statistically significant.Results:In this study,the median overall survival(OS)was 37 months and the median progression-free survival(PFS)was 34 months.PLT-PLR score was closely related to T stage(p=0.036),N stage(p=0.002),TNM stage(p=0.005).tumor area(p<0.001),neutrophil count(NEUT,p=0.001),globulin(GLB,p=0.02),clearance ratio of albumin to globulin(A/G,p=0.002)and fibrinogen(FIB,p<0.001).K-M analysis showed that higher PLT-PLR scores were significantly associated with lower progression-free survival(PFS,p<0.001)and overall survival(OS,p<0.001).Multi-factor analysis showed that PLT-PLR,T stage,N stage,neutrophil count(NEUT),low density lipoprotein cholesterol(LDL),alkaline phosphatase(AKP)were associated with a significant overall survival of patients with esophageal cancer,and PLT-PLR,T stage,N stage,neutrophil count(NEUT),the alkaline phosphatase(AKP)were progression-free survival of patients with esophageal cancer stage significantly correlated,and confirmed that PLT-PLR is an independent predictor of esophageal cancer.Median survival and progression-free survival nomogram were plotted and tested using these independent predictors.Conclusions:The prognostic value of PLT-PLR score in patients with esophageal cancer is better than that of PLT and PLR alone,and PLT-PLR is an independent predictor of progression-free survival and total survival of esophageal cancer.The 1-year total survival period,3-year total survival period and 1-year progression-free survival period and 3-year progression-free survival period of esophageal cancer established based on these predictors have good predictive value.PLT-PLR indicators and nomograms can be applied in clinical practice to better predict the prognosis of patients,so as to identify high-risk patients for active intervention to improve patient survival. |
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