Development and validation of a novel pre-operative comprehensive prognostic score in esophageal squamous cell carcinoma

Abstract

We herein propose a novel integrative score based on inflammatory and nutritional score, coagulation indicator and tumor marker, named comprehensive prognostic score (CPS), to predict post-operative survival in resectable esophageal squamous cell carcinoma (ESCC). We also aimed to establish and validate a nomogram based on CPS and other clinical features for individual survival prediction. A total of 490 resectable ESCC patients were randomly divided into either a training or validation cohort at a ratio of 7:3 for retrospective analysis. The CPS, based on squamous cell carcinoma antigen, C-reactive protein to albumin ratio, neutrophil to lymphocyte ratio, and fibrinogen, was divided into two models to verify its prognostic value. The predictive model of CPS-based nomogram was established and validated in two cohorts. The patients with CPS low group in Model 1 had better 5-year cancer-specific survival (CSS) than those in CPS high group (50.7% vs. 17.8%, p < 0.001). For Model 2, the 5-year CSS for CPS 0, 1 and 2 were 75.0%, 38.9% and 13.3%, respectively (p < 0.001). CPS was confirmed as an independent prognostic score in both models. The CPS-based nomogram can accurately and effectively predict survival in resected ESCC. The CPS is a novel, simple, and effective predictor in resectable ESCC. Moreover, CPS has a potential independent prognostic value in predicting post-operative survival, which can accurately and effectively predict individual survival in resectable ESCC.