Objective To explore the value of inflammation scoring system (ISS) for predicting prognosis in patients with esophageal squamous cell carcinoma (ESCC) treated with intensity-modulated radiation therapy (IMRT).

Methods Clinical data were collected from 60 patients with ESCC who were treated in the Oncology Department of the Second People′s Hospital of Rizhao City from May 2021 to April 2023 for a prospective study, including 40 males and 20 females with an age of (64.0±4.6) years. The last follow-up for patients was December 31, 2023. All patients with ESCC underwent IMRT and chemotherapy (cisplatin+5-fluorouracil). The patients were divided into survival and death groups based on their survival status within two years. Pre-treatment blood routine, liver function, kidney function, and other examination results were collected, and inflammatory markers were calculated, including systemic inflammation index (SII), systemic inflammatory response index (SIRI), neutrophil count to lymphocyte count ratio (NLR), monocyte count to lymphocyte count ratio (MLR), platelet count to lymphocyte count ratio (PLR), monocyte count to high density lipoprotein ratio (MHR), C-reactive protein to serum albumin ratio (CAR), C-reactive protein to serum pre-albumin ratio (CPR), and C-reactive protein to lymphocyte count ratio (CLR). T-test was used for the comparison of measurement data, chi square test and Fisher exact probability method were used for the comparison of counting data between two groups. Stepwise multivariate Logistic regression analyses were performed to select indicators related to the prognosis of patients with ESCC. ISS was constructed on the basis of the results of the stepwise multivariate Logistic regression. The ISS was visualized and transformed into an ISS risk nomogram model. The predictive performance of the ISS was assessed using receiver operating characteristic curve and calibration curves; the clinical benefit of the ISS was evaluated using decision curves.

Results During the two-year follow-up period, of the 60 patients with ESCC, 29 died and 31 survived. The results of stepwise multivariate Logistic regression analysis indicated that SIRI (OR (95%CI): 25.164 (2.597–243.864), P=0.005), PLR (OR (95%CI): 41.486 (4.202–409.600), P=0.001), MHR (OR (95%CI): 6.314 (1.923–43.185), P=0.045), and CLR (OR (95%CI): 8.027 (1.215–53.041), P=0.031) are independent risk factors for the two-year mortality of patients with ESCC. The constructed ISS is calculated as follows: ISS score=3.225×SIRI+3.725×PLR+1.843×MHR+2.083×CLR. The constructed ISS in this study has good predictive performance (AUC (95%CI): 0.915 (0.848–0.981), P<0.001) and stability. In addition, the ISS risk nomogram prediction model has good predictive ability (AUC (95%CI): 0.933 (0.874–0.991), P<0.001), calibration ability, and clinical benefits.

Conclusion ISS is an effective prognostic marker for patients with ESCC who were treated with IMRT. This marker can provide personalized assessment for such treatment modalities in patients with ESCC.