The seven-day cumulative post-esophagectomy inflammatory response predicts cancer recurrence

Abstract

Background Therelationship between postoperative cumulative systemic inflammation and cancer survival needs to be investigated. We developed an approach for the prognostication of postoperative esophageal cancer by establishing low and high cut-off values for the C-reactive protein (CRP) area under the curve (AUC) at 7 and 14 days after esophagectomy. Methods This study included 125 consecutive patients with biopsy-proven invasive esophageal squamous cell carcinoma (SCC) who underwent esophagectomies. Postoperative CRP levels were analyzed for the first 14 days after surgery. The AUC on days 7 and 14 were calculated and compared with clinicopathological features and survival. Results The cut-off values for CRP at 7 days (CRP 7 d) and 14 days (CRP 14 d) were 599 mg/L and 1153 mg/L, respectively. The patients in the low CRP 7 d group had significantly better recurrence-free survival (RFS) and overall survival (OS) than those in the low CRP 14 d group(P=0.0117,0.0087, respectively). No difference in survival was observed between the low and high CRP 14d group. The OS rates in the high CRP group at post-operative days (PODs) 1, 3, 10, and 14 were significantly lower than those in the low CRP group. Postoperative complications were more common in the high CRP group on PODs 3, 10, and 14. Univariate analyses revealed that pTNM stage, depth of tumor invasion, tumor location, lymph node involvement, and CRP 7 d were significant prognostic factors for both OS and RFS. The Cox proportional hazards model identified pTNM, tumor location, and CRP 7 d as independent prognostic factors for RFS and OS. Conclusions Early prediction of patients with postoperative complications and adequate management will suppress the elevation of CRP 7 d and further suppress the CRP value in the late postoperative period, which may improve the prognosis of esophageal cancer patients after esophagectomy.