Pre-treatment serum bicarbonate predicts survival in patients with locally advanced esophageal squamous cell carcinoma undergoing definitive radiotherapy: a retrospective propensity score matching study.
- 1Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, NO.12, Jiankang Road, Shijiazhuang, China.
- 2Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, NO.12, Jiankang Road, Shijiazhuang, China. [email protected].
Abstract
Background
This study aimed to evaluate the prognostic value of pre-treatment serum bicarbonate (HCO₃⁻) for overall survival (OS) and progression-free survival (PFS) in locally advanced esophageal squamous cell carcinoma (LA-ESCC) patients undergoing definitive radiotherapy.Methods
Patients with stage Ⅱ-Ⅳa ESCC treated with definitive radiotherapy between 2015 and 2022 were screened and then divided into Group A (high HCO₃⁻) and Group B (low HCO₃⁻). Propensity score matching (PSM) was performed using sex, age, ECOG score, body mass index, tumor length, tumor location, clinical T category, clinical N category, clinical TNM stage, combined chemotherapy, and radiation dose as covariates at a 1:2 ratio (Group A: Group B). OS and PFS were compared between different groups using Kaplan-Meier analysis and Cox regression analysis.Results
A total of 301 patients were included in the study. The median follow-up time was 54.1 months. The median OS and PFS were 17.3 months and 11.0 months. The median HCO₃⁻ was 24.9 mmol/L. Before PSM, the median OS was 27.0 months in Group A (HCO₃⁻ ≥26 mmol/L, n = 103) and 14.8 months in Group B (HCO₃⁻ <26 mmol/L, n = 198), p < 0.0001. The median PFS was 16.3 months in Group A and 9.6 months in Group B, p = 0.0002. After 1:2 PSM, the median OS was 25.7 months in Group A (n = 97) and 15.3 months in Group B (n = 169), p = 0.0011. The median PFS was 13.0 months in Group A and 9.6 months in Group B, p = 0.0059. Multivariate Cox analysis suggested that age ≥ 66 (HR 0.739, p = 0.036), T category < 3 (HR 0.484, p < 0.001), clinical N category < 2 (HR 0.713, p = 0.022), combined chemotherapy (HR 0.625, p = 0.003), and HCO₃⁻ ≥26 mmol/L (HR 0.656, p = 0.004) were independent favorable prognostic factors for OS. Clinical T category < 3 (HR 0.565, p < 0.001), clinical stage Ⅱ-Ⅲ (HR 0.685, p = 0.019), and pre-treatment HCO₃⁻ ≥26 mmol/L (HR 0.717, p = 0.019) were independent favorable prognostic factors for PFS.Conclusions
A high pre-treatment serum bicarbonate level is associated with an increased OS and PFS in LA-ESCC patients undergoing definitive radiotherapy. Therefore, pre-treatment serum bicarbonate may serve as a readily available prognostic biomarker to inform risk stratification and treatment planning in LA-ESCC patients undergoing definitive radiotherapy.
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BibTeX
@article{ji2026pretreatment,
title = {{Pre-treatment serum bicarbonate predicts survival in patients with locally advanced esophageal squamous cell carcinoma undergoing definitive radiotherapy: a retrospective propensity score matching study.}},
author = {Hongshan Ji and Ping Zhang and Yajing Wang and Yuhao Su and Hanyu Si and Yage Jia and Xueying Qiao and Zhiguo Zhou},
journal = {BMC cancer},
year = {2026},
month = aug,
doi = {10.1186/s12885-026-16723-7},
url = {https://europepmc.org/article/MED/43009855},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Pre-treatment serum bicarbonate predicts survival in patients with locally advanced esophageal squamous cell carcinoma undergoing definitive radiotherapy: a retrospective propensity score matching study.
AU - Hongshan Ji
AU - Ping Zhang
AU - Yajing Wang
AU - Yuhao Su
AU - Hanyu Si
AU - Yage Jia
AU - Xueying Qiao
AU - Zhiguo Zhou
PY - 2026
DA - 2026/08/14
JO - BMC cancer
DO - 10.1186/s12885-026-16723-7
UR - https://europepmc.org/article/MED/43009855
AB - Background This study aimed to evaluate the prognostic value of pre-treatment serum bicarbonate (HCO₃⁻) for overall survival (OS) and progression-free survival (PFS) in locally advanced esophageal squamous cell carcinoma (LA-ESCC) patients undergoing definitive radiotherapy.Methods Patients with stage Ⅱ-Ⅳa ESCC treated with definitive radiotherapy between 2015 and 2022 were screened and then divided into Group A (high HCO₃⁻) and Group B (low HCO₃⁻). Propensity score matching (PSM) was performed using sex, age, ECOG score, body mass index, tumor length, tumor location, clinical T category, clinical N category, clinical TNM stage, combined chemotherapy, and radiation dose as covariates at a 1:2 ratio (Group A: Group B). OS and PFS were compared between different groups using Kaplan-Meier analysis and Cox regression analysis.Results A total of 301 patients were included in the study. The median follow-up time was 54.1 months. The median OS and PFS were 17.3 months and 11.0 months. The median HCO₃⁻ was 24.9 mmol/L. Before PSM, the median OS was 27.0 months in Group A (HCO₃⁻ ≥26 mmol/L, n = 103) and 14.8 months in Group B (HCO₃⁻ <26 mmol/L, n = 198), p < 0.0001. The median PFS was 16.3 months in Group A and 9.6 months in Group B, p = 0.0002. After 1:2 PSM, the median OS was 25.7 months in Group A (n = 97) and 15.3 months in Group B (n = 169), p = 0.0011. The median PFS was 13.0 months in Group A and 9.6 months in Group B, p = 0.0059. Multivariate Cox analysis suggested that age ≥ 66 (HR 0.739, p = 0.036), T category < 3 (HR 0.484, p < 0.001), clinical N category < 2 (HR 0.713, p = 0.022), combined chemotherapy (HR 0.625, p = 0.003), and HCO₃⁻ ≥26 mmol/L (HR 0.656, p = 0.004) were independent favorable prognostic factors for OS. Clinical T category < 3 (HR 0.565, p < 0.001), clinical stage Ⅱ-Ⅲ (HR 0.685, p = 0.019), and pre-treatment HCO₃⁻ ≥26 mmol/L (HR 0.717, p = 0.019) were independent favorable prognostic factors for PFS.Conclusions A high pre-treatment serum bicarbonate level is associated with an increased OS and PFS in LA-ESCC patients undergoing definitive radiotherapy. Therefore, pre-treatment serum bicarbonate may serve as a readily available prognostic biomarker to inform risk stratification and treatment planning in LA-ESCC patients undergoing definitive radiotherapy.
SN - 1471-2407
ER -