Analysis The Influencing Factors In Long-term Survival Of Esophageal Cancer And Its Predictive Value For Overall Survival

Objective: Analyzing the prognosis and diagnostic value of relevant hematological indexes on the survival status of patients with esophageal squamous cell carcinoma after radical surgery,and exploring the factors affecting the prognosis and diagnostic value of relevant hematological indexes on the survival status of patientsMethods: We enrolled 206 patients from the Department of Thoracic Surgery in the First Hospital of Jilin University in our research.All patients were diagnosed with thoracic esophageal squamous cell carcinoma and had surgical R0 resection from January 2013 to December 2020.Following the criterion,all patients were strictly included and excluded.They completed preoperative evaluation to determine the surgical indications,and then had drastic surgery after a sufficient amount of preoperative preparation.Afterward,they were closely monitored after undergoing postoperative rehabilitation and were successfully discharged from the hospital.According to the survival status of the patients at the end of the study,they were separated into survival group and death group.The data including the basic information,preoperative blood routine,albumin,fibrinogen,surgery-related information,and postoperative pathology and overall survival of the patients in the two groups were compared.All data were analyzed by SPSS 24.0 statistical software,the counting data was described in rate and constituent ratio.Continuous variables that conform to the normal distribution are expressed in terms of mean±SD,continuous variables that do not conform to the normal distribution are expressed by M（P25,P75）.The continuous variables that conform to the normal distribution between the two groups are t-tested,the continuous variables that do not conform to the normal distribution are analyzed by Z test,and the counting data are analyzed by X~2 test or Fisher’s exact probability method.The Kaplan-Meier method and the Proportional Risk Model（COX regression model）were used to analyze the risk factors affecting the survival of patients and plot the survival curve,and the log-rank test was used to compare whether the survival curves had statistical differences.Subject work characteristic curve（ROC curve）was applicated for indicator prediction analysis.A p-value less than 0.05 was determined as statistically significant.Results: A total of 206 patients were included in this study,with an average age of 60.21±8.19 years,including 196 males（95.1%）and 10 females（4.9%）.Patients with hypertension,cardiovascular disease and diabetes preoperatively were 14.6%,3.4% and 7.3% respectively.77.2% of the patients smoking and 84.4% drinking.43.2% of the patients received adjuvant therapy after operation.By the end of follow-up,the mortality was 65%,the survival rate was 35.0%,the 3-year OS was 51.0%,and the 5-year OS was 34.5%.The comparison of clinical data between survival group and death group showed that there was significant difference in OS between two groups（72.61 ± 22.15 months vs 27.07 ± 21.33 months,P < 0.001）.The degree of differentiation（P = 0.037）,depth of infiltration（P = 0.045）,pathological stage（P = 0.008）,vascular infiltration（P = 0.003）,nerve infiltration（P = 0.011）,fibrinogen（P = 0.009）,white blood cell（P = 0.015）,neutrophils（P = 0.002）,platelet（P = 0.007）and platelet hematocrit（P = 0.020）were statistically significant between the two groups.Kaplan Meier survival analysis showed the lower differentiation（X~2 = 11.234,P = 0.024）,tumor located in middle thorax（X~2 = 11.234,P = 0.024）,larger lesion length（X~2 = 6.219,P = 0.047）,deeper invasion（X~2 = 11.170,P = 0.011）,later pathological stage（X~2 = 13.80,P = 0.008）,vascular infiltration（X~2 = 22.154,P < 0.001）,nerve infiltration（X~2 = 5.605,P = 0.018）,lymph node metastasis（X~2 = 7.190,P = 0.007）,Cardiovascular disease（X~2 = 5.030,P = 0.025）and higher smoking grade（X~2 = 6.219,P = 0.045）were risk factors for poor prognosis of ESCC.COX multivariate analysis showed that cardiovascular disease（P = 0.006）,lower differentiation（P= 0.004）,tumor located in middle thorax（P = 0.015）and nerve infiltration（P = 0.002）were independent risk factors for the reduction of survival time of ESCC patients.As each increase of hematocrit（P = 0.037）and mean erythrocyte hemoglobin concentration（P = 0.040）before operation,the risk of postoperative death in ESCC patients will increase by 5.756 times and 1.475 times respectively.The results show that hemoglobin（P = 0.031）can be used as a protective factor for long-term survival of ESCC patients.ROC curve showed that the cut-off values of PLT,PCT,FIB,WBC and NE were 272.5×109/L、0.245%、3.175g/L、5.160×109/L、2.955×109/L respectively.Conclusions:（1）Patients with esophageal squamous cell carcinoma undergoing R0 resection have better 3-year and 5-year overall survival.The prognosis for R0 resection patients is better.（2）History of cardiovascular disease,tumor located in the middle chest,poorly differentiated esophageal squamous cell carcinoma,visible nerve cancer invasion,high HCT,high MCHC,and low HB are independent risk factors for long-term survival of ESCC patients.（3）PLT,PCT,FIB,WBC,and NE in preoperative blood routine have appreciable clinical diagnostic value for the survival status of ESCC patients.