Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2021; 27(4): 321-335
Published online Jan 28, 2021. doi: 10.3748/wjg.v27.i4.321
Preoperative maximal voluntary ventilation, hemoglobin, albumin, lymphocytes and platelets predict postoperative survival in esophageal squamous cell carcinoma
Shou-Jia Hu, Xue-Ke Zhao, Xin Song, Ling-Ling Lei, Wen-Li Han, Rui-Hua Xu, Ran Wang, Fu-You Zhou, Liang Wang, Li-Dong Wang
Shou-Jia Hu, Xue-Ke Zhao, Xin Song, Ling-Ling Lei, Wen-Li Han, Rui-Hua Xu, Ran Wang, Li-Dong Wang, State Key Laboratory of Esophageal Cancer Prevention & Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, Henan Province, China
Fu-You Zhou, Department of Thoracic Surgery, Anyang Tumor Hospital, Anyang 455000, Henan Province, China
Liang Wang, Department of Tumor Biology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, United States
Author contributions: Wang LD and Hu SJ designed and wrote the paper; Lei LL, Han WL, Xu RH, Wang R and Zhou FY performed data collection, interpretation and follow-up; Hu SJ, Zhao XK and Song X contributed to data analysis; Zhou FY, Wang L and Wang LD revised the manuscript; Wang L edited the manuscript for English language.
Supported by National Natural Science Foundation of China, No. U1301227, No. 81872032 and No. U1804262; Doctoral Team Foundation of the First Affiliated Hospital of Zhengzhou University, No. 2016-BSTDJJ-03.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Zhengzhou University.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: We have no potential conflicts of interest to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li-Dong Wang, MD, PhD, Professor, State Key Laboratory of Esophageal Cancer Prevention & Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, No. 40 Daxue Road, Zhengzhou 450052, Henan Province, China. ldwang2007@126.com
Received: October 13, 2020
Peer-review started: October 13, 2020
First decision: December 3, 2020
Revised: December 17, 2020
Accepted: December 24, 2020
Article in press: December 24, 2020
Published online: January 28, 2021
Processing time: 103 Days and 11.8 Hours
Abstract
BACKGROUND

Preoperative pulmonary function plays an important role in selecting surgical candidates and assessing postoperative complications. Reduced pulmonary function is associated with poor survival in several cancers, but the prognostic value of preoperative pulmonary function in esophageal squamous cell carcinoma (ESCC) is unclear. Nutritional and systemic inflammation parameters are vital to cancer survival, and the combination of these parameters improves the prognostic value. The hemoglobin, albumin, lymphocytes and platelets (HALP) score is a novel prognostic indicator to reflect the nutritional and inflammation status, but the clinical effects of the HALP score combined with maximal voluntary ventilation (MVV), an important parameter of pulmonary function, have not been well studied in ESCC.

AIM

To investigate the prognostic value of MVV and HALP score for assessing postoperative survival of ESCC patients.

METHODS

Data from 834 ESCC patients who underwent radical esophagectomy with R0 resection were collected and retrospectively analyzed. Preoperative MVV and HALP data were retrieved from medical archives. The HALP score was calculated by the formula: Hemoglobin (g/L) × albumin (g/L) × lymphocytes (/L)/platelets (/L). The optimal cut-off values of MVV and HALP score were calculated by the receiver operating characteristic curve analysis. The Kaplan-Meier method with log-rank test was used to draw the survival curves for the variables tested. Multivariate Cox proportional hazard regression models were used to analyze the independent prognostic factors for overall survival.

RESULTS

MVV was significantly associated with gender (P < 0.001), age at diagnosis (P < 0.001), smoking history (P < 0.001), drinking history (P < 0.001), tumor length (P = 0.013), tumor location (P = 0.037) and treatment type (P = 0.001). The HALP score was notably associated with gender (P < 0.001), age at diagnosis (P = 0.035), tumor length (P < 0.001) and invasion depth (P = 0.001). Univariate Cox regression analysis showed that low MVV and low HALP score were associated with worse overall survival (all P < 0.001). Multivariate analysis showed that low MVV and the HALP score were both independent risk factors for overall survival (all P < 0.001). The combination of MVV and HALP score improved the prediction performance for overall survival than tumor-node-metastasis. Also, low combination of MVV and HALP score was an independent risk factor for poor overall survival (P < 0.001).

CONCLUSION

MVV, HALP score and their combination are simple and promising clinical markers to predict overall survival of ESCC patients.

Keywords: Maximal voluntary ventilation; Hemoglobin, albumin, lymphocytes and platelets score; Nutritional status; Inflammation status; Postoperative survival; Esophageal squamous cell carcinoma

Core Tip: Reduced pulmonary function is considered a risk factor for cancer survival. The combination score of hemoglobin, albumin, lymphocytes and platelets (HALP) is a novel prognostic indicator to reflect nutritional and inflammatory status. We demonstrated that preoperative maximal voluntary ventilation (MVV), an important parameter of pulmonary function, and HALP score were independent prognostic factors for patients with esophageal squamous cell carcinoma. The combination of MVV and HALP score has a better prognostic value than tumor-node-metastasis alone. The combination of MVV and HALP score reflects the status of inflammation, nutrition and pulmonary function simultaneously and may partly compensate for the limitation of the tumor-node-metastasis staging system.