Baseline Metabolic Risk Score and Postsurgical Esophageal Cancer-Specific Mortality: The Fujian Prospective Investigation of Cancer (FIESTA) Study

Hong Sha^1,*, Dan Hu^2,*, Sinan Wu^1,*, Feng Peng^3,*,✉, Guodong Xu¹, Guohui Fan¹, Xiandong Lin², Gang Chen², Binying Liang⁴, Ying Chen⁵, Chao Li², Hejun Zhang², Yan Xia², Jinxiu Lin³, Xiongwei Zheng^2,✉, Wenquan Niu^1,✉

1. Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China.
2. Department of Pathology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, Fujian, China.
3. Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
4. Department of Medical Record, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, Fujian, China.
5. Department of Core Research Laboratory, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, Fujian, China.
*Shared first authors.

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Citation:
Sha H, Hu D, Wu S, Peng F, Xu G, Fan G, Lin X, Chen G, Liang B, Chen Y, Li C, Zhang H, Xia Y, Lin J, Zheng X, Niu W. Baseline Metabolic Risk Score and Postsurgical Esophageal Cancer-Specific Mortality: The Fujian Prospective Investigation of Cancer (FIESTA) Study. J Cancer 2018; 9(7):1173-1181. doi:10.7150/jca.23631. Available from https://www.jcancer.org/v09p1173.htm

Abstract

Backgrounds: Compelling evidence has emerged to support a close relationship between metabolic syndrome and esophageal cancer (EC).

Aims: Using five baseline metabolism-related markers, we constructed a metabolic risk score (MRS), aiming to test whether MRS can improve the prediction of postsurgical EC-specific mortality over traditional demographic and clinicopathologic characteristics.

Methods: Total 2535 EC patients who received three-field lymphadenectomy were enrolled from January 2000 to December 2010, and they were followed up until December 2015.

Results: All EC patients were randomly split into derivation group (n=1512, 60%) and validation group (n=1014, 40%). MRS was generated in derivation group by adopting the Framingham 'points' system and shrinkage method, and it ranged from -9 to 17. EC-specific mortality risk increased with the increase of MRS, and adjusted estimates were more obvious in patients with upper tertile (MRS>6) than patients with lower MRS (≤2) in either derivation (hazard ratio [HR]=2.28, 95% confidence interval [CI]: 1.90-2.73, P<0.001) or validation group (HR=2.11, 95% CI: 1.66-2.67, P<0.001) or both groups (HR=2.37, 95% CI: 1.95-2.88, P<0.001). In Kaplan-Meier curve, cumulative survival rates differed significantly across tertiles of MRS. Further analysis indicated that MRS can improve classification accuracy and discriminatory ability over clinicopathologic parameters.

Conclusions: Our findings supported the usefulness of baseline MRS in predicting the prognosis of postsurgical EC-specific mortality.

Keywords: Esophageal cancer, The FIESTA study, Metabolic risk score, Prognosis.