Abstract
BACKGROUND: The current study was aimed at comparing the prognostic value of the combination of plasma fibrinogen and tumor marker index (TMI) [F-TMI] system with TMI alone in patients with esophageal squamous cell carcinoma (ESCC) after surgical resection. METHODS: A total of 317 patients with ESCC who underwent surgical resection were retrospectively analyzed. The TMI was calculated as the square root of (CYFRA 21-1 concentration/3.3 µg/L) × (SCC concentration/1.5 µg/L). The patients were divided into F-TMI scores according to the following criteria: score 2, both elevated fibrinogen and high TMI; score 1, either elevated fibrinogen or high TMI; and score 0, neither abnormality. Univariate and multivariate survival analyses were performed to evaluate the prognostic value of F-TMI or TMI alone. RESULTS: The five-year overall survival rate of patients with high TMI was significantly lower than that of patients with low TMI (30.8% vs 50.4%, p <0.001). There was a significant correlation between the F-TMI score with age, tumor size, NLR, PLR, pT status, and pN status. The five-year overall survival rates for patients with F-TMI scores of 2, 1, and 0 were 27.6%, 38.7%, and 63.3%. Multivariate analysis revealed that the F-TMI score (HR 1.297; 95% CI 1.046-1.609, p = 0.018) was an independent prognostic factor. The F-TMI's prediction ability was larger than that of fibrinogen, TMI, and the conventional TNM stage. CONCLUSION: F-TMI was an independent prognostic factor for patients with ESCC and a more useful prognostic indicator than either of the parameters alone.