Preoperative maximal voluntary ventilation, hemoglobin, albumin, lymphocytes and platelets predict postoperative survival in esophageal squamous cell carcinoma

Table 1 Clinical characteristics of patients with esophageal squamous cell carcinoma

Variable	Cases
	n	%
Gender
Male	509	61.0
Female	325	39.0
Age at diagnosis in yr
Median (interquartile range)	60 (55-65)
Smoking history
No	434	52.0
Yes	400	48.0
Drinking history
No	574	68.8
Yes	260	31.2
Tumor length (cm)
Median (interquartile range)	4.0 (3.0-5.0)
Tumor location
Upper	140	16.8
Middle	549	65.8
Lower	145	17.4
Differentiation
Well	37	4.5
Moderate	459	55.0
Poor	338	40.5
Invasion depth
pT1	108	12.9
pT2	240	28.8
pT3	486	58.3
Lymph node metastasis
pN0	494	59.2
pN1	190	22.8
pN2	121	14.5
pN3	29	3.5
TNM stage
I	100	12.0
II	454	54.4
III	280	33.6
Surgical approach
Left	756	90.6
Right	78	9.4
Treatment type
Surgery	650	77.9
Surgery + adjuvant RT/CT	184	22.1
MVV
Median (interquartile range)	85.1 (68.5-96.6)
HALP score
Median (interquartile range)	43.2 (31.6-55.4)
Overall complications
No	683	81.9
Yes	151	18.1

CT: Chemotherapy; HALP: Hemoglobin, albumin, lymphocytes and platelets; MVV: Maximal voluntary ventilation; RT: Radiotherapy; TNM: Tumor-node-metastasis.

Table 2 Association of maximal voluntary ventilation and hemoglobin, albumin, lymphocytes and platelets score with basic clinical factors, n (%)

Variable	MVV			HALP score
	≥ 85.2	< 85.2	P value	≥ 38.8	< 38.8		P value
Gender			< 0.001				< 0.001
Male	404 (97.1)	105 (25.1)		319 (66.2)	190 (54.0)
Female	12 (2.9)	313 (74.9)		163 (33.8)	162 (46.0)
Age at diagnosis in yr			< 0.001				0.035
< 60	250 (60.1)	149 (35.6)		246 (51.0)	153 (43.5)
≥ 60	166 (39.9)	269 (64.4)		236 (49.0)	199 (56.5)
Smoking history			< 0.001				0.107
No	108 (26.0)	326 (78.0)		239 (49.6)	195 (55.4)
Yes	308 (74.0)	92 (22.0)		243 (50.4)	157 (44.6)
Drinking history			< 0.001				0.082
No	209 (50.2)	365 (87.3)		320 (66.4)	254 (72.2)
Yes	207 (49.8)	53 (12.7)		162 (33.6)	98 (27.8)
Tumor length in cm			0.013			< 0.001
< 4	175 (42.1)	212 (50.7)		249 (51.7)	138 (39.2)
≥ 4	241 (57.9)	206 (49.3)		233(48.3)	214 (60.8)
Tumor location			0.037			0.733
Upper	75 (18.0)	65 (15.5)		85 (17.6)	55 (15.6)
Middle	257 (61.8)	292(69.9)		315 (65.4)	234 (66.5)
Lower	84 (20.2)	61 (14.6)		82 (17.0)	63 (17.9)
Differentiation			0.490			0.183
Well	15 (3.6)	22 (5.3)		16 (3.3)	21 (6.0)
Moderate	229 (55.1)	230 (55.0)		267 (55.4)	192 (54.5)
Poor	172 (41.3)	166 (39.7)		199 (41.3)	139 (39.5)
Invasion depth			0.366			0.001
pT1	47 (11.3)	61 (14.6)		69 (14.3)	39 (11.1)
pT2	122 (29.3)	118 (28.2)		158 (32.8)	82 (23.3)
pT3	247 (59.4)	239 (57.2)		255 (52.9)	231 (65.6)
Lymph node metastasis			0.163			0.672
pN0	242 (58.2)	252 (60.3)		290 (60.2)	204 (57.9)
pN1	107 (25.7)	83 (19.8)		112 (23.2)	78 (22.2)
pN2	53 (12.7)	68 (16.3)		64 (13.3)	57 (16.2)
pN3	14 (3.4)	15 (3.6)		16 (3.3)	13 (3.7)
TNM stage			0.541			0.084
I	45 (10.8)	55 (13.2)		62 (12.9)	38 (10.8)
II	232 (55.8)	222 (53.1)		273 (56.6)	181 (51.4)
III	139 (33.4)	141 (33.7)		147 (30.5)	133 (37.8)
Surgical approach			0.478			0.718
Left	374 (89.9)	382 (91.4)		435 (90.2)	321 (91.2)
Right	42 (10.1)	36 (8.6)		47 (9.8)	31 (8.8)
Treatment type			0.001			0.353
Surgery	305 (73.3)	345 (82.5)		370 (76.8)	280 (79.5)
Surgery + adjuvant RT/CT	111 (26.7)	73 (17.5)		112 (23.2)	72 (20.5)
Overall complications			0.243			0.525
No	334 (80.3)	349 (83.5)		391 (81.1)	292 (83.0)
Yes	82 (19.7)	69 (16.5)		91 (18.9)	60 (17.0)

CT: Chemotherapy; HALP: Hemoglobin, albumin, lymphocytes and platelets; MVV: Maximal voluntary ventilation; RT: Radiotherapy; TNM: Tumor-node-metastasis.

Table 3 Univariate and multivariate analyses for patients' overall survival with esophageal squamous cell carcinoma

Variable	Univariate analysis		Multivariate analysis
	HR (95%CI)	P value	HR (95%CI)	P value
Gender		0.924
Female	1
Male	0.991 (0.831-1.183)
Age at diagnosis in yr		< 0.001		< 0.001
< 60	1		1
≥ 60	1.613 (1.355-1.920)		1.388 (1.155-1.668)
Smoking history		0.760
No	1
Yes	0.974 (0.821-1.155)
Drinking history		0.293
No	1
Yes	0.905 (0.752-1.090)
Tumor length in cm		< 0.001		0.018
< 4	1		1
≥ 4	1.691 (1.419-2.016)		1.259 (1.040-1.525)
Tumor location		0.064
Upper	1
Middle	0.782 (0.623-0.982)
Lower	0.733 (0.549-0.979)
Differentiation		< 0.001		0.308
Well	1		1
Moderate	1.308 (0.839-2.039)		1.189 (0.759-1.865)
Poor	1.829 (1.169-2.862)		1.334 (0.841-2.118)
Invasion depth		< 0.001		0.001
pT1	1		1
pT2	2.100 (1.491-2.958)		1.671 (1.173-2.379)
pT3	2.769 (2.007-3.819)		1.926 (1.371-2.706)
Lymph node metastasis		< 0.001		< 0.001
pN0	1		1
pN1	1.803 (1.463-2.222)		1.695 (1.362-2.109)
pN2	2.809 (2.224-3.549)		2.281 (1.780-2.922)
pN3	3.857 (2.571-5.787)		2.945 (1.926-4.504)
Surgical approach		0.130
Left	1
Right	1.250 (0.936-1.669)
Treatment type		0.512
Surgery	1
Surgery + adjuvant RT/CT	1.072 (0.871-1.319)
MVV		< 0.001		< 0.001
≥ 85.2	1		1
< 85.2	1.487 (1.252-1.767)		1.451 (1.208-1.743)
HALP score		< 0.001		< 0.001
≥ 38.8	1		1
< 38.8	1.617 (1.361-1.922)		1.537 (1.287-1.836)
Overall complications		< 0.001		< 0.001
No	1		1
Yes	1.456 (1.179-1.799)		1.515 (1.218-1.884)

CI: Confidence interval; CT: Chemotherapy; HALP: Hemoglobin, albumin, lymphocytes and platelets; HR: Hazard ratio; MVV: Maximal voluntary ventilation; RT: Radiotherapy.