Effects Of S100 Protein And NLR On Prognosis Of Patients With Esophageal Squamous Cell Carcinoma And Construction Of Nomogram Model

Objective:To investigate the correlation of S100 protein and NLR with clinicopathological features of esophageal squamous cell carcinoma(ESCC)and their influence on prognosis of ESCC patients,and to establish a nomogram model based on S100 protein and NLR to predict the survival of patients with esophageal squamous cell carcinoma after radical resection.Methods:1、Patients with newly diagnosed esophageal cancer in the Department of Thoracic Surgery of Shaanxi Provincial People’s Hospital from January 1,2016 to December 31,2019 were retrospectively collected,and 156 patients were finally selected according to the inclusion and exclusion criteria.According to the ROC curve,the NLR was divided into high NLR group and low NLR group with 3.465 as the dividing point.Chi-square test was used to analyze the correlation of S100 protein expression and NLR with clinicopathological features.2、Patients who met the inclusion and exclusion criteria were followed up,and finally142 patients were included in the survival study,and 14 patients were lost to follow-up.Univariate and multivariate stepwise regression analysis were used to analyze the influence of S100 protein expression,NLR and clinicopathological characteristics on the overall survival rate of patients with esophageal squamous cell carcinoma.Based on the results of multivariate regression analysis,the independent influencing factors of prognosis of esophageal squamous cell carcinoma were found,and the Nomo gram for predicting the survival rate of patients with esophageal squamous cell carcinoma after operation was constructed and validated.Results:1、The positive expression of S100 protein was significantly correlated with smoking history(X~2=6.103,P =0.013),depth of tumor invasion(X~2=52.310,P<0.001),lymph node metastasis(X~2=27.318,P<0.001),pTNM stage(X~2=45.349,P<0.001),vascular invasion(X~2=29.701,P<0.001)and preoperative high NLR(X~2=24.638,P<0.001),but not with gender,age,tumor location and differentiation(P>0.05).2、The increase of preoperative NLR was significantly correlated with the depth of tumor invasion(X~2=22.584,P<0.001),lymph node metastasis(X~2=20.448,P<0.001),pTNM stage(X~2=33.797,P<0.001),vessel invasion(X~2=19.647,P<0.001)and S100positivity(X~2=24.638,P<0.001);There was no significant correlation with gender(P = 0.303),age(P = 0.670),smoking history(P = 0.108),tumor location(P = 0.679)and differentiation degree(P = 4.492).3、Univariate analysis showed that degree of differentiation(X~2=11.113,P =0.004),depth of invasion(X~2=43.905,P<0.001),lymph node metastasis(X~2=30.658,P<0.001),pTNM stage(X~2=53,898,P<0.001),vascular invasion(X~2=17.490,P<0.001),S100expression(X~2=34.948,P<0.001)and NLR(X~2=28.556,P<0.001)were significantly correlated with overall survival,which were included in the multivariate regression analysis,and the smallest AIC value was the optimal multivariate COX regression model.The analysis found that TNM stage(P<0.001 OR:5.122;95%CI 3.331-7.875),S100expression(P=0.028 OR:2.068;95%CI 1.083-3.948),and NLR grouping(P=0.036OR:1.713;95%CI 1.037-2.831)were significantly associated with overall survival.Advanced TNM,positive expression of S100 protein and high NLR are independent risk factors for poor prognosis in patients with esophageal squamous cell carcinoma.4、The Nomogram prediction model for predicting the survival of patients with esophageal squamous cell carcinoma after operation was established based on TNM staging,S100 protein expression and NLR grouping.AUC values for the 1-year,3-year,and 5-year survival rates of the model were 0.902(95% CI: 0.833-0.971),0.916(95% CI:0.872-0.961),and 0.966(95% Cl: 0.924-1.003),which were significantly better than those for the risk model alone,and the overall C index of the model was 0.882(95% CI: 0.843-0.920),indicating that the nomogram had good predictive ability.Conclusion:The positive expression of S100 protein and high NLR may be potential biomarkers for predicting the prognosis of patients with esophageal squamous cell carcinoma after operation.The Nomogram prediction model based on S100 protein,NLR and pTNM staging has a good predictive value for the survival rate of patients with esophageal squamous cell carcinoma after surgery.The inclusion of S100 protein and NLR as biomarkers for predicting the prognosis of esophageal cancer is helpful to assist clinicians in more accurate adjuvant treatment of esophageal cancer after surgery.