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

Authors Zhang H, Guo XW, Yin XX, Liu YC, Ji SJ

Received 21 August 2019

Accepted for publication 22 October 2019

Published 6 November 2019 Volume 2019:11 Pages 9459—9468


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Professor Nakshatri

Han Zhang,1,* Xin-Wei Guo,2,* Xiao-Xiang Yin,2,* Yang-Chen Liu,2 Sheng-Jun Ji3

1School of Mathematics, Nanjing Normal University, Taizhou College, Taizhou 225300, People’s Republic of China; 2Department of Radiation Oncology, Affiliated Taixing People’s Hospital of Yangzhou University, Taixing 225400, People’s Republic of China; 3Department of Radiotherapy and Oncology, Nanjing Medical University Affiliated Suzhou Hospital, Suzhou 215002, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Sheng-Jun Ji
Department of Radiotherapy and Oncology, Nanjing Medical University Affiliated Suzhou Hospital, Suzhou 215002, People’s Republic of China
Tel +86 18914087033

Objective: To investigate the therapeutic effect and survival outcome using nomogram by incorporating significant inflammatory markers in patients with thoracic esophageal squamous cell carcinoma (ESCC) who received chemoradiotherapy (CRT) or single radiotherapy (RT).
Method: A total of 266 patients diagnosed with thoracic ESCC receiving standard curative RT only or concurrent CRT were retrospectively analysed. The patients were grouped for statistical analysis depending on the median values of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and C-reactive protein/albumin (CRP/Alb) ratio. The therapeutic effect was analysed by univariate and multivariate logistic analyses. The survival prognosis was estimated by univariate and multivariate Cox analyses. At last, the nomogram was developed by incorporating the significant inflammatory markers and clinicopathological parameters, and the predictive value was verified by calibration curve, concordance index (C-index) and decision curve.
Results: The treatment responses were highly associated with clinical stage, tumor location, NLR, PLR and CRP/Alb ratio (all P<0.05) by univariate logistic analysis. However, in the multivariate logistic analysis, the results showed that only CRP/Alb ratio (P=0.000) and TNM stage (P=0.008) were independent risk parameters for tumour response. In addition, NLR, PLR, CRP/Alb ratio, age and TNM stage were significantly associated with OS by the univariate Cox analysis (all P<0.05). Furthermore, the multivariate Cox analysis showed that only CRP/Alb ratio (P=0.000), TNM stage (P=0.000) and age (P=0.001) were considered independent prognostic factors for OS. Finally, the calibration curves of nomogram were highly consistent with actual observation for the therapeutic effect and prognosis, and the decision curve analysis showed more potential of clinical benefit of the nomogram compared with TNM staging system.
Conclusion: This research found that nomogram-integrated CRP/Alb ratio was promising as a predictive model for the therapeutic effect and survival outcome in patients with thoracic ESCC receiving CRT or single RT.

Keywords: esophageal squamous cell carcinoma, haematological markers, efficacy, prognosis, nomogram

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