title: Prognostic value of preoperative mean corpuscular volume in esophageal squamous cell carcinoma.
abstract: OBJECTIVE
  To evaluate whether preoperative mean corpuscular volume (MCV) is a prognostic indicator in patients with resectable esophageal squamous cell carcinoma (ESCC).
  
  
  METHODS
  A total of 298 consecutive, prospectively enrolled patients with histologically diagnosed ESCC who underwent surgery with curative intent from 2001 to 2011 were retrospectively evaluated. Patients were excluded if they had previous malignant disease, distant metastasis at the time of primary treatment, a history of neoadjuvant treatment, had undergone non-radical resection, or had died of a non-tumor-associated cause. Survival status was verified in September 2011. Pathological staging was performed based on the 2010 American Joint Committee on Cancer criteria. Preoperative MCV was obtained from blood counts performed routinely within 7 d prior to surgery. Receiver operating characteristic (ROC) curve analysis was used to determine a cutoff for preoperative MCV.
  
  
  RESULTS
  The 298 patients consisted of 230 males and 68 females, with a median follow-up of 30.1 mo. ROC analysis showed an optimal cutoff for preoperative MCV of 95.6 fl. Fifty-nine patients (19.8%) had high (> 95.6 fl) and 239 (80.2%) had low (≤ 95.6 fl) preoperative MCV. Preoperative MCV was significantly associated with gender (P = 0.003), body mass index (P = 0.017), and preoperative red blood cell count (P < 0.001). The predicted 1-, 3- and 5-year overall survival (OS) rates were 72%, 60% and 52%, respectively. Median OS was significantly longer in patients with low than with high preoperative MCV (27.5 mo vs 19.4 mo, P < 0.001). Multivariate analysis showed that advanced pT (P = 0.018) and pN (P < 0.001) stages, upper thoracic location (P = 0.010), lower preoperative albumin concentration (P = 0.002), and high preoperative MCV (P = 0.001) were negative prognostic factors in patients with ESCC. Preoperative MCV also stratified OS in patients with T3, N1-N3, G2-G3 and stage III tumors.
  
  
  CONCLUSIONS
  Preoperative MCV is a prognostic factor in patients with ESCC.
authors.affiliation: Department of Thoracic Oncology, Cancer Center, Sun Yat-Sen University, Guangzhou 510060, Guangdong Province, China.
authors.forename: Yu-Zhen
authors.initials: YZ
authors.lastname: Zheng
authors.forename: Shu-Qin
authors.initials: SQ
authors.lastname: Dai
authors.forename: Wei
authors.initials: W
authors.lastname: Li
authors.forename: Xun
authors.initials: X
authors.lastname: Cao
authors.forename: Yong
authors.initials: Y
authors.lastname: Li
authors.forename: Lan-Jun
authors.initials: LJ
authors.lastname: Zhang
authors.forename: Jian-Hua
authors.initials: JH
authors.lastname: Fu
authors.forename: Jun-Ye
authors.initials: JY
authors.lastname: Wang
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000097:blood* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D016009:Chi-Square Distribution; D004909:Erythrocyte Indices; D004938:Esophageal Neoplasms / Q000097:blood* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
keywords: Esophageal neoplasms; Mean corpuscular volume; Preoperative markers; Prognosis; Resectable