Impact of perioperative high mobility group box chromosomal protein 1 expression on long‐term outcomes in patients with esophageal squamous cell carcinoma

Abstract Background and Aim High mobility group box chromosomal protein‐1 (HMGB‐1) is a potential late mediator of sepsis and a possible risk factor for postoperative pulmonary complications after esophagectomy. This study aimed to determine the relationship between HMGB‐1 and clinicopathological factors and long‐term prognosis after esophagectomy for esophageal cancer. Methods We measured perioperative serum HMGB‐1 levels using ELISA and HMGB‐1 protein by immunohistochemistry expression in resected specimens. Results Postoperative serum HMGB‐1 levels were significantly higher than preoperative levels. Preoperative serum HMGB‐1 levels were significantly higher in patients with more intraoperative bleeding, longer intensive care unit stays, and postoperative pneumonia. Postoperative serum HMGB‐1 levels were significantly higher in older patients and those with longer operation time and more intraoperative bleeding. There were significant differences in long‐term outcomes according to postoperative but not preoperative serum HMGB‐1 levels. Multivariate analysis demonstrated that advanced pathological stage, postoperative pulmonary complications, and higher postoperative serum HMGB‐1 levels were independently associated with relapse‐free survival and overall survival. Preoperative serum HMGB‐1 levels were significantly higher in patients with high HMGB‐1 expression than those with low HMGB‐1 expression by immunohistochemistry, whereas such statistical differences were not observed in postoperative serum HMGB‐1. There were no differences in relapse‐free survival and overall survival according to HMGB‐1 expression by immunohistochemistry. Serum HMGB‐1 levels were significantly increased after esophagectomy for esophageal cancer. Conclusion Elevated postoperative serum HMGB‐1, which was associated not only with poor long‐term but also short‐term outcomes such as postoperative complications, might serve as a potential marker for prognosis in esophageal cancer.