Abstract
BACKGROUND: Existing literature on serum cholinesterase (ChE) in cancer prognosis have predominantly evaluated preoperative levels, ignoring serial ChE measurements during postoperative follow-up. METHODS: 5925 patients undergoing curative resection for stage I-III non-small cell lung cancer (NSCLC), colorectal cancer (CRC), and gastric cancer (GC) were retrospectively included. Patients were divided into persistently normal, normalized, lowered and persistently low perioperative ChE patterns, as well as longitudinal ChE trajectories identified by the latent class growth mixed model (LCGMM). The associations of ChE dynamic changes with overall survival (OS) and recurrence-free survival (RFS) were evaluated. RESULTS: Postoperative ChE emerged as an independent prognostic factor, event after accounting for preoperative levels. Perioperative ChE stratification revealed divergent survival outcomes: the persistently normal group (82.5%) demonstrated 8.6% higher 5-year OS rate than the lowered group (73.9%), while the normalized group (73.3%) had 13.9% higher 5-year OS rate than the persistently low group (59.4%). LCGMM identified three distinct longitudinal trajectories: slow-rising (5-year OS rate: 79.7%; reference group), rising-decreasing (5-year OS rate: 64.8%; adjusted HR: 1.50, 95% CI: 1.14 to 1.99) and decreasing-rising (5-year OS rate: 58.1%; adjusted HR: 2.33, 95% CI: 1.69 to 3.22). Consistent results were observed for RFS as well. Furthermore, stratified analyses confirmed statistically significant associations of ChE dynamic changes with prognosis across all histological subtypes. CONCLUSIONS: A routine follow-up measurement of postoperative ChE was recommended to improve individualized management of cancer patients.