Relationship and Prognostic Value of Circulating Tumor Cells with Clinical Characteristics and Systemic Inflammatory Markers in Esophageal Cancer Patients
Objective To develop a nomogram to estimate the probability of survival in patients with esophageal cancer(EC)after radical surgery(RS)and to evaluate the nonlinear relationship between circulating tumor cells(CTC),systemic inflammatory markers and prognosis by using combined restricted cubic splines(RCS).Methods CTC counts in blood samples from 500 patients with EC,which were collected after RS,were determined.The systemic immune-inflammation index(SII),neutrophil/(lymphocyte x platelet)ratio(NLPR),aggregate index of systemic inflammation(AISI)and systemic inflammation response index(SIRI)were calculated.The correlations between clinical data and these indices were analyzed.In addition,overall survival(OS)and progression-free survival(PFS)to assess the predictive value of CTC counts and systemic inflammatory markers were analyzed.Results CTC were strongly associated with clinical features(neoadjuvant therapy,preoperative comorbidities,pathological grade,vascular invasion,nerve invasion,tumor size)and inflammatory markers(SII,NLPR,SIRI,AISI).According to univariate and multivariate Cox regression analyses,the following factors were independent prognostic factors for survival:neoadjuvant therapy(P=0.031),preoperative comorbidities(P=0.028),treatment methods(P＜0.001),pathological grade(P=0.006),vascular invasion(P=0.012),nerve invasion(P=0.012),the SII(P＜0.001),the NLPR(P=0.008),the AISI(P＜0.001)and the CTC(P＜0.001).Four factors were significantly associated with PFS:neoadjuvant therapy,T stage(P=0.036),N stage(P=0.002)and vascular invasion(P＜0.001).The RCS plot showed that the CTC,SII,NLPR,SIRI and AISI had a nonlinear relationship with prognosis.Furthermore,Kaplan-Meier survival curves revealed that patients with lower CTCs,SII,NLPR,SIRI and AISI values had significantly longer OS and PFS.Conclusion The CTC,SII,NLPR and AISI may be powerful indicators of clinical prognosis in EC patients undergoing RS.The nomograms and RCS incorporating these factors facilitate individualized determination of patient prognosis in clinical practice.
万方数据
维普
