The incidence of esophageal cancer is high in the world. Each year, there are about 580,000 new cases diagnosed worldwide, and about 510,000 people die of esophageal cancer every year. In China, nearly 300,000 patients with esophageal cancer die each year, accounting for more than 50% of the global deaths of esophageal cancer . Now it is generally recognized that inflammation plays an increasingly important role in the development of tumors, and its mechanism may be: inflammation releases cytokines and upregulates transcription factors, leading to the generation and accumulation of a large number of oxygen free radicals, which can cause DNA damage and breakage in parenchymal cells, including stem cells, overexpression of proto-oncogenes, loss of function of tumor suppressor genes and upregulation of genes that promote the cell cycle, leading to abnormal cell proliferation, thereby interfering with the stability of the body's microenvironment, thereby accelerating tumor growth, invasion, metastasis and other processes, affecting the prognosis of tumors  . Many reports have shown that LMR, NLR and NMR, PDW, RDW as inflammatory indicators, are closely related to the prognosis of a variety of diseases and can be used as prognostic factors in a variety of malignant tumors  .
In this study, we investigated the prognosis of inflammatory indicators in blood routine for esophageal squamous cell carcinoma. Survival curve analysis showed that age < 60 years and NLR < 3.52 patients had survival; univariate Cox regression analysis model showed that RDW (≥ 13.85%) and NLR (≥ 3.52) groups were risk factors for the prognosis of esophageal squamous cell carcinoma, which was the same as most studies; compared with NLR (≥ 3.52), HR was 1.340 (1.231–1.458; p < 0.001), which was consistent with Arigami T , Gao GD  studies, NLR > 3.0 and NLR > 2.83 were considered to be effective predictors of esophageal cancer; RDW (≥ 13.85%) had HR 1.099 (1.015–1.191; p = 0.020) compared with RDW (< 13.85), which was consistent with Chen GP  etal. It can effectively predict the prognosis of esophageal squamous cell carcinoma. Among other relevant blood routine test indicators, PDW has distinct conclusions. Kawakita Y  etal. believed that PDW < 12.5fl could predict the poor prognosis of esophageal cancer, consistent with this study. However, in contrast to Song Q  etal., he believed that high PDW could predict the poor prognosis of esophageal cancer. In predicting the prognosis of esophageal cancer, due to inconsistent results, the role of LMR in the prognosis of esophageal cancer was very different. Huang Y  et al. believed that preoperative LMR < 2.93 predicted the poor prognosis of patients with esophageal squamous cell carcinoma. Hu G  et al. also did a meta-analysis and concluded that low LMR could predict the poor prognosis of esophageal cancer. In this study, PDW and LMR were not considered to be related to the prognosis of esophageal cancer (P > 0.05), which may be different from the cut-off values of LMR and PDW in the included studies. The criteria and methods for determining cut-off values vary among institutions; a suitable cut-off value cannot be proposed by statistical analysis. This may affect the results and lead to an inevitable potential bias. This may limit the use of NLR, LMR, RDW, PDW in clinical practice and even lead to distinct conclusions, therefore, defining NLR, LMR, RDW, PDW requires a standard, uniform cutoff. In the present study, we attempted to establish a predictive nomogram based on prognostic factors of blood routine to predict survival prediction. We believe that our model is a simple and easy tool for both physicians and patients and can be used to estimate the survival rate of esophageal cancer patients in the case of initial diagnosis.
Several limitations should be acknowledged in the current study. First, the current study is a retrospective study, although it is a large sample, but other potential diseases affecting inflammatory cannot be completely ruled out; second, excessive uncontrollable factors of laboratory test results of blood cell count-related indicators and excessive variation of indicators lead to its limited role in the judgment of clinical prognosis. Therefore, this study aimed at the expression level of peripheral blood cells in patients with esophageal cancer and explored the relationship between a variety of inflammatory indicators and the prognosis of esophageal cancer, in order to provide new ideas for the prognosis of esophageal cancer. Similarly, we also expect to have a more scientific and rigorous prospective study to verify in the future.