Usefulness of Procalcitonin as a Predictor of Long-Term Prognosis in the Early Postoperative Period after Esophagectomy for Esophageal Cancer

Abstract

The aim of this study was to investigate the relationship between serum procalcitonin (PCT) levels after esophagectomy and infectious complications and long-term prognosis. A total of 105 patients who underwent esophagectomy between 2012 and 2019 were stratified into two groups: PCT-High group of ≥1 ng/mL and PCT-Low group of <1 ng/mL. The clinical outcomes and prognostic factors were compared between the two groups 2 postoperative days (POD), 4 POD, and 7 POD after esophagectomy. As the postoperative days passed, the association between PCT and infectious complications became stronger, and the positive predictive value was 100% at 7 POD. At 2 POD, there was no significant association between PCT elevation and infectious complications. Patients in the PCT-Low group had significantly worse overall survival (OS) and recurrence-free survival (RFS) than those in the PCT-High group at 2 POD (p = 0.026 and p = 0.011, respectively). In multivariate analysis, advanced pathological stage (hazard ratio (HR), 5.348; 95% confidence interval (CI), 2.299–12.500; p < 0.001) and PCT-Low group at 2 POD (HR, 3.673; 95% CI, 1.116–12.092; p = 0.032) were also independent predictors of worse OS. PCT in the early postoperative period after esophagectomy could be a good predictor of prognosis.

C-Reactive Protein as Predictor for Infectious Complications after Robotic and Open Esophagectomies

“…Regarding postoperative PCT-levels, Booka et al conducted a study, analyzing the association between postoperative PCT-levels, PIC and oncological outcome; they identified a prognostic value of 100% of PCT on POD 7 for development of PIC and overall outcome. However, similar to our analysis, they did not find a difference on POD 2 [ 57 ]. Hence, it may be concluded, that later PCT-values are of greater information compared to early PCT-values.…”

Prognostic value of post-operative serum procalcitonin in gastric adenocarcinoma patients undergoing radical gastrectomy: propensity score matching analysis of extended cohort from a prospective bi-center study

“…As a result, increased concentrations of serum PCT levels facilitated tumor metastasis and led to poor oncological outcomes [36]. In addition, bacterial toxins including endotoxins could directly stimulate the production of PCT in patients with developing infections, which might also weaken the immune system and facilitate tumor progression [13]. In the present study, a patient with a higher PCT concentration had a significantly worse prognosis no matter whether they developed an infection or not.…”

“…In another retrospective study consisting of 95 metastatic NSCLC patients who received immune-check point inhibitors, a baseline PCT concentration of > 0.1 mg/L was confirmed to result in significantly worse outcomes in terms of OS [33]. In contrast, Booka and colleagues [13] reported that in 105 esophageal cancer patients who underwent esophagestomy, a low PCT concentration (< 1 ng/mL) at POD 2 was an independent predictor of poorer OS. Possible explanations for the contradictory conclusions might be the inconsistency of patients inclusion criteria, varied PCT measurement times and the PCT cutoff concentration, relatively small sample sizes and the retrospective nature of the studies.…”

“…In recent years, many studies have highlighted the predictive role of PCT on the prognosis of several cancers, such as medullary thyroid cancer, NSCLC, colorectal cancer, neuroendocrine neoplasms, and so on [12][13][14][15]31]. In a prospective population-based study that enrolled 3322 patients [32], the baseline PCT was found to be significantly associated with all-cause mortality and cancer-related mortality in men after a median follow-up time of 16.2 years.…”

“…In recent years, more and more studies have reported that various types of cancers secret PCT and that PCT is a reliable predictor for long term survival, including for medullary thyroid cancer, colorectal cancer, non-small cell lung cancer (NSCLC), and others [12][13][14][15]. But whether the serum concentration of PCT was related to the oncological outcomes of GA patients has never been investigated.…”