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Platelet Indices and ApoA1 as Predictive Markers in Neoadjuvant Immunochemotherapy for Locally Advanced Esophageal Squamous Cell Carcinoma: A Retrospective Study

Year: 2025

Type: article

Abstract: Purpose: To evaluate the predictive value of baseline and preoperative blood parameters for treatment efficacy and prognosis in patients with locally advanced esophageal squamous cell carcinoma (LA-ESCC) undergoing neoadjuvant chemoimmunotherapy (nCIT) followed by radical surgery. Patients and Methods: This retrospective study analyzed clinical data from patients with LA-ESCC patients treated with nCIT followed by surgery (October 2019-November 2024). Patients were categorized based on pathological response (pathological complete response [pCR] and major pathological response [MPR]). Univariate and multivariate analyses identified factors associated with pCR and MPR. Cox regression and Kaplan-Meier methods were used to evaluate overall survival (OS) and disease-free survival (DFS). Nomograms and Receiver Operating Characteristic (ROC) curves were created for prognostic prediction. Results: Among 236 patients, the pCR rate was 31.8%, and the MPR rate was 51.7%. pCR was associated with improved DFS (Hazard Ratio [HR] = 0.27, 95% CI: 0.16-0.43, p < 0.0001) but not OS (p = 0.058). MPR was significantly correlated with both DFS (HR=0.27, 95% CI: 0.17-0.44, p < 0.0001) and OS (HR=0.38, 95% CI: 0.21-0.71, p = 0.0023). Identified predictors of treatment response included baseline and preoperative platelet indices (mean platelet volume [MPV], platelet distribution width [PDW], platelet-large cell ratio [P-LCR]) for both pCR and MPR, along with preoperative Apolipoprotein A1 (ApoA1) specifically for MPR (all identified as independent predictors on univariate and multivariate analysis, p < 0.05), reflecting their role in modulating the inflammatory response. A predictive model combining MPV (HR = 0.86, 95% CI: 0.61-1.22) and ApoA1 (HR = 0.24, 95% CI: 0.07-0.81) demonstrated good accuracy in forecasting DFS (30 months: AUC = 0.71, 95% CI: 0.60-0.81). Conclusion: Baseline and preoperative blood parameters (MPV, PDW, P-LCR) and preoperative ApoA1 are valuable predictors of treatment response and prognosis in LA-ESCC. Nomograms incorporating these markers offer reliable prognostic insights for DFS.

Source: Journal of Inflammation Research

DOI: 10.2147/jir.s567945