• Takaaki Arigami, Hiroshi Okumura, Masataka Matsumoto, Yasuto Uchikado, Yoshikazu Uenosono, Yoshiaki Kita, Tetsuhiro Owaki, Shinichiro Mori, Hiroshi Kurahara, Yuko Kijima, Sumiya Ishigami, and Shoji Natsugoe.
• From the Department of Digestive Surgery, Breast and Thyroid Surgery, Field of Oncology, Kagoshima, Japan (TA, HO, MM, YU, YK, SM, HK, YK, SI, SN); Molecular Frontier Surgery, Kagoshima, Japan (TA, YU, SN); and Education Center for Doctors in Remote Islands and Rural Areas, Course of Advanced Therapeutics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan (TO).
• Medicine (Baltimore). 2015 Oct 1; 94 (42): e1702e1702.

AbstractEsophageal squamous cell carcinoma (ESCC) is one of the most aggressive malignancies in gastrointestinal tract cancers and even patients with early ESCC have a high metastatic potential. Difficulties are associated with clinically predicting tumor progression and prognosis based on conventional tumor markers determined from preoperative blood examinations. The aim of the present study was to measure plasma fibrinogen levels and the neutrophil-lymphocyte ratio (NLR) in blood and compare the clinical impacts of their combined values (fibrinogen and neutrophil-lymphocyte ratio score-F-NLR score) and the modified Glasgow Prognostic Score (mGPS) in patients with ESCC.We classified 238 patients with ESCC based on cut-off values for hyperfibrinogenemia (>400 mg/dL) and high NLR (>3.0) as F-NLR scores of 2 (both of these hematological abnormalities), 1 (one of these abnormalities), or 0 (neither abnormality). We also categorized patients based on cut-off values for high C-reactive protein (CRP) (>0.5 mg/dL) and hypoalbuminemia (<3.8 g/dL) as mGPS of 2 (elevated CRP and hypoalbuminemia), 1 (either elevated CRP or hypoalbuminemia), or 0 (neither elevated CRP nor hypoalbuminemia).The F-NLR score correlated with the depth of tumor invasion, lymph node metastasis, lymphovascular invasion, tumor size, and stage (all P < 0.05). Prognoses among the groups based on the F-NLR score and mGPS significantly differed (all P < 0.001). A multivariate analysis identified the depth of tumor invasion, lymph node metastasis, and F-NLR score as independent prognostic factors (P = 0.002, P = 0.007, and P = 0.037, respectively).The results of the present study showed that the F-NLR score is a promising blood predictor for tumor progression and outcomes in patients with ESCC.

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