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Development and Validation of a Practical Prognostic Coagulation Index for Patients with Esophageal Squamous Cell Cancer

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

This study aimed to establish an effective and practical prognostic index for esophageal squamous cell cancer (ESCC) based on the coagulation factors.

Methods

The training cohort of 965 patients with ESCC was retrospectively collected at Sichuan Cancer Hospital from 2012 to 2014, along with clinical characteristics and follow-up information. Risk factors of coagulation status, including 11 blood parameters (platelet [PLT], mean platelet volume [MPV], platelet distribution width [PDW], plateletocrit [PCT], thrombin time [TT], prothrombin time [PT], international normalized ratio [INR], activated partial thromboplastin time [APTT], fibrinogen, D-dimer, and fibrinogen degradation product [FDP]), were studied by least absolute shrinkage and selection operator (LASSO) Cox regression and the Coagulation Index was established. The index was validated in a cohort of 848 patients with ESCC at the same institution, from 2015 to 2016.

Results

Three variables of PLT, MPV, and fibrinogen were identified by selecting features with coefficients in the LASSO algorithm, and a Coagulation Index was established as follows: Coagulation Index = 0.0005 × PLT (109/L) − 0.0384 × MPV (fL) + 0.1148 × fibrinogen (g/L). A higher Coagulation Index score was significantly associated with higher pT stage and pN stage (p < 0.05). With this prognostic index, patients could be stratified into three risk groups. The 3-year overall survival (OS) rates of the low-, middle- and high-risk groups in the training cohort were 63.5%, 55.5% and 43.1%, respectively (log-rank p < 0.001). Similarly, in the validation set, the respective 3-year OS for each risk group was significantly different across the three risk groups. Multivariate analysis indicated that the Coagulation Index remained a significant factor for predicting OS, independently of pathological TNM stage.

Conclusions

The Coagulation Index is an independent predictor of survival for patients with ESCC.

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Acknowledgment

This work was supported by the National Natural Science Foundation of China (Grant No. 81872402), Grants from Sichuan Science and Technology Department Key Research and Development Project Fund (2019YFS0378, 2018JY0277), Wu Jieping Medical Foundation, Grant/Award Number 320.6750.17237, and new service model of tumor radiotherapy based on ‘Internet+’: the systemic development and application research of ‘Precision cloud radiotherapy’ (Project Number 2017YFC0113100).

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Author notes

  1. Qifeng Wang and Bangrong Cao contributed equally to this work.

Authors and Affiliations

  1. Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China

    Qifeng Wang MD, Bangrong Cao MD, Jinyi Lang PhD & Kun Mi PhD

  2. Department of Radiation Oncology, Sichuan Cancer Hospital and Institution, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China

    Qifeng Wang MD, Yi Wang MD, Lei Wu MD & Jinyi Lang PhD

  3. Department of Thoracic Surgery, Sichuan Cancer Hospital and Institution, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China

    Lin Peng MD, Wei Dai MD, Yinchun Jiang MD, Tianpeng Xie MD, Qiang Fang MD & Yongtao Han MD

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  1. Qifeng Wang MD
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Correspondence to Kun Mi PhD.

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Qifeng Wang, Bangrong Cao, Lin Peng, Wei Dai, Yinchun Jiang, Tianpeng Xie, Qiang Fang, Yi Wang, Lei Wu, Yongtao Han, Jinyi Lang, and Kun Mi declare no actual or potential financial conflicts of interest.

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Wang, Q., Cao, B., Peng, L. et al. Development and Validation of a Practical Prognostic Coagulation Index for Patients with Esophageal Squamous Cell Cancer. Ann Surg Oncol 28, 8450–8461 (2021). https://doi.org/10.1245/s10434-021-10239-z

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