Preoperative chemoradiation therapy for esophageal cancer is a risk factor for the elevation of high mobility group box‐1, leading to an increase in postoperative severe pulmonary complications

• Published in: Diseases of the esophagus 2016-01, Vol.29 (1), p.70-78
• Main Authors: Takahata, R., Ono, S., Tsujimoto, H., Hiraki, S., Aosasa, S., Yamamoto, J., Hase, K.
• Format: Article
• Language: English
• Subjects: Aged; chemoradiation therapy; Chemoradiotherapy - adverse effects; Chemoradiotherapy - methods; Esophageal Neoplasms - metabolism; Esophageal Neoplasms - pathology; Esophageal Neoplasms - surgery; esophagectomy; Esophagectomy - adverse effects; Esophagectomy - methods; Female; HMGB1 Protein - metabolism; HMGB‐1; Humans; Lung Diseases - diagnosis; Lung Diseases - etiology; Lung Diseases - metabolism; Male; Middle Aged; Neoadjuvant Therapy - adverse effects; Neoadjuvant Therapy - methods; Neoplasm Staging; Postoperative Complications - diagnosis; Postoperative Complications - metabolism; Preoperative Care - adverse effects; Preoperative Care - methods; pulmonary complication; Severity of Illness Index; Treatment Outcome
• ISSN: 1120-8694; 1442-2050
• DOI: 10.1111/dote.12261

Summary We herein clarified the time course of changes in the serum high mobility group box chromosomal protein‐1 (HMGB‐1) concentrations in esophageal cancer patients after esophagectomy, and investigated whether the perioperative serum HMGB‐1 levels correlate with the administration of neoadjuvant chemoradiation therapy (NACRT) and the postoperative clinical course, especially the occurrence of pulmonary complications, in such patients. Sixty patients who underwent right transthoracic esophagectomy for esophageal cancer were enrolled in this study. The relationship between the perioperative serum HMGB‐1 levels and NACRT, and the postoperative severe pulmonary complications were evaluated. Patients with severe pulmonary complications (n = 44) tended to have undergone NACRT more often than those without severe pulmonary complications (n = 16). The preoperative and postoperative day 7 serum HMGB‐1 concentrations were significantly higher in patients with severe pulmonary complications than those in patients without severe pulmonary complications. In the univariate and multivariate analyses, the use of NACRT and the preoperative elevations in the serum HMGB‐1 levels (>4.2 ng/mL) were found to be significantly associated with pulmonary dysfunction. Furthermore, the response to NACRT was found to be significantly associated with the preoperative serum HMGB‐1 levels. The use of NACRT contributes to preoperative serum HMGB‐1 elevation, and these were risk factors for the occurrence of severe postoperative pulmonary complications in patients with esophageal cancer after thoracic esophagectomy.