Clinical Impact of Platelet-to-albumin Ratio on Esophageal Cancer Patients Who Receive Curative Treatment

Abstract

Background/Aim: Perioperative nutrition and inflammation affect the oncological outcomes of various malignancies. We evaluated the clinical impact of the preoperative platelet-to-albumin ratio (PAR) in resectable esophageal cancer patients who received curative treatment. Patients and Methods: This study included 168 patients who underwent curative surgery followed by perioperative adjuvant chemotherapy for esophageal cancer between 2005 and 2018. The risk factors for overall survival (OS) and recurrence-free survival (RFS) were identified. Results: Based on the 3-and 5-year OS rates, we set the cut-off value for the PAR at 80×10 3 in the present study. Among 168 patients, 134 (79.8%) were defined as the as the PAR-high group. The 3-and 5-year OS rates were 60.2% and 51.7% in the PAR-low group and 30.2% and 18.9% in the PAR-high group, respectively. There were significant differences in OS (p=0.005). The PAR was therefore selected for the final multivariate analysis model [hazard ratio=1.997, 95% confidence interval (CI)=1. 230-3.241, p=0.037]. On comparing the perioperative clinical course between the PARhigh and PAR-low groups, there were marginally significant differences in the postoperative surgical complications and intraoperative blood loss between the groups. Conclusion:The PAR had clinical influence on the long-term oncological outcomes of esophageal cancer patients and might thus be a promising prognostic factor for esophageal cancer patients.Esophageal cancer is the eighth-most common cancer and the sixth leading cause of cancer-related mortality worldwide (1, 2). Standard treatment for resectable esophageal cancer is perioperative adjuvant treatment and esophagectomy (3,4). The survival rate after curative treatment has gradually improved thanks to improvements in perioperative management and perioperative adjuvant treatment and the introduction of minimally invasive surgery.However, more than half of patients experience recurrence, even after curative treatment. Once a patient's disease recurs, the prognosis is poor (5, 6). Therefore, it is necessary to identify prognostic factors in order to introduce more aggressive treatment. Recently, perioperative nutrition and inflammation have been shown to be associated with oncological outcomes in various malignancies (7,8). Previous studies demonstrated that perioperative malnutrition and systemic inflammation accelerated tumor growth and enhanced micrometastasis (9, 10). Therefore, assessing a patient's preoperative nutritional and inflammation status is important. If physicians can manage and control the perioperative nutrition and inflammation status using optimal screening tools, they may be able to improve a patient's survival. However, screening tools for evaluating both the perioperative nutrition status and inflammation status in esophageal cancer patients are limited at present.

Diagnostic Significance of Pre-Treatment Prognostic Nutritional Index, Platelet/Albumin Ratio and Red Cell Distribution Width in Patients with Differentiated Glioblastoma from Brain Metastasis

“…[40] A high pre-treatment PAR is an indicator of poor survival chances in large lung carcinomas, [41] advanced pancreatic cancer treated with chemoradiotherapy, [42] advanced nasopharyngeal cancers treated with chemoradiotherapy [43] and curative surgery followed by preoperative adjuvant chemotherapy for esophageal cancer. [44] Our study aims to use the preoperative PAR ratio in the differential diagnosis of GBM and BM. According to our study results, a PAR higher than 61.6 supports the possibility of metastasis.…”

“…Platelets protect circulating tumour cells (CTCs) from immune responses by producing adenine nucleotides and TGF-β that stimulate the epithelial-mesenchymal transition, cell proliferation and metastasis as part of the tumour microenvironment. [12,13] The prognostic effect of the PAR ratio has been shown in cancers such as diffuse large cell lymphoma, [14] nasopharyngeal carcinoma, [15] esophagus cancer [16] and pancreatic cancer. [17] The RDW reflects the value of variation in size (anisocytosis) of circulating red cells, closely related to chronic inflammation and chronic disease.…”

Development and validation of platelet-to-albumin ratio as a clinical predictor for diffuse large B-cell lymphoma

“…The Ann Arbor Staging System, treatment response, and disease progression were investigated by clinical and laboratory examinations, computed tomography (CT) scans and/or positron emission tomography-CT, and bone marrow biopsy. Response was defined according to the Revised Response Criteria for Malignant Lymphoma ( 19 ). Pretreatment clinical and laboratory information was retrospectively collected from the medical records as follows: age, sex, Eastern Cooperative Oncology Group (ECOG) performance status score, extranodal involvement, lactate dehydrogenase (LDH), platelet counts, serum albumin concentrations, Ann arbor stage, COO classification, double expressor lymphoma (DEL), and treatment response ( Table 1 ).…”

“…Recently, a combinational index of platelet counts and albumin concentrations had been proven as an independent prognostic predictor in several diseases such as nasopharyngeal carcinoma ( 17 ), pancreatic adenocarcinoma ( 18 ), esophageal cancer ( 19 ), and osteosarcoma ( 20 ). However, whether the platelet-to-albumin (PTA) ratio has somewhat prognostic indication in DLBCL is still not investigated.…”