Cumulative scores based on plasma D-dimer and serum albumin levels predict survival in esophageal squamous cell carcinoma patients treated with transthoracic esophagectomy

Background:Recently,studies have shown that plasma D-dimer and serum albumin are prognostic markers for esophageal cancer.The purpose of this study was to evaluate a novel prognostic scoring system—DA score(combination of preoperative plasma D-dimer and serum albumin levels)—and analyze the association between survival of patients with esophageal squamous cell carcinoma(ESCC) and their Glasgow prognostic score.Methods:In this retrospective study,preoperative biochemical markers and clinicopathologic factors in 260 ESCC patients treated with transthoracic esophagectomy were reviewed.According to receiver operating characteristic analysis,the cutoff values of D-dimer and albumin were defined as 0.5 μg/mL and 43.8 g/L,respectively.Patients with high D-dimer levels(>0.5 μg/mL) and low albumin levels(<43.8 g/L) were assigned a score of 2,those with only one of the two abnormalities were assigned a score of 1,and those with neither of the two abnormalities were assigned a score of 0.Results:ESCC patients with a DA score of 0,l,and 2 numbered 55,116,and 89,respectively.Survival analysis showed that patients with a DA score of 2 had lower overall survival(OS) rates than those with DA scores of 1 and 0(37.1%vs.52.6%and 76.4%,P < 0.001);similar findings were observed for disease-free survival(DFS) rates(32.6%vs.44.8%and67.3%,P < 0.001).In addition,the predictive value of the DA score was also significant in patients with stages l-IIA and stages IIB-IV ESCC.Multivariate Cox regression analyses indicated that hazard ratios(HRs) for predicting OS of patients with DA scores 1 and 2 were 2.25 {P — 0.010) and 3.14(P< 0.001),respectively,compared with those with a DA score of 0,and HRs for predicting DFS of patients with DA scores of 1 and 2 were 1.86(P = 0.023) and 2.68(P < 0.001),respectively,compared with those with a DA scores of 0.Conclusions:Our study suggests that preoperative DA scores are notably associated with postoperative survival of ESCC patients.