P1.069. Distinct Postoperative CRP Trajectory Patterns and Their Association With Complication Severity Following Esophagectomy

Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer – early outcomes and complications Background Postoperative complications following esophagectomy are frequent and clinically heterogeneous. Serum C-reactive protein (CRP) is a widely available inflammatory marker, yet its longitudinal trajectory after esophagectomy and its relationship with complication severity have not been systematically characterized. This study aimed to identify distinct postoperative CRP trajectory patterns and evaluate their association with Clavien-Dindo graded complication outcomes. Methods Among 809 consecutive esophagectomy patients at a single center, 131 patients (16.2%) had complete serial CRP measurements on postoperative days (POD) 1, 3, 5, and 7. K-means clustering was applied to identify distinct CRP trajectory groups. Associations between trajectory groups and complications (Clavien-Dindo grading), anastomotic leak, and ICU length of stay were evaluated using chi-square tests, Kruskal-Wallis tests, and multivariable logistic regression. Receiver operating characteristic (ROC) analysis assessed the predictive utility of individual CRP timepoints and derived indicators. Results Three distinct CRP trajectories were identified: Low-Stable (n=86, 65.6%), Moderate-Declining (n=20, 15.3%), and High-Persistent (n=25, 19.1%). Complication rates increased significantly across trajectories: severe complications (CD≥III) occurred in 15.1%, 25.0%, and 56.0% of patients in each group, respectively (p<0.001). The High-Persistent group showed a 5.71-fold increased odds of severe complications on multivariable analysis (OR 5.71, 95%CI 1.99–16.40, p=0.001). CRP on day 7 demonstrated the highest individual discriminative value (AUC=0.671), while the CRP D3/D1 ratio (AUC=0.632) offered the earliest actionable prediction at POD 3. Conclusion Postoperative CRP trajectory patterns are significantly associated with complication severity after esophagectomy. The High-Persistent trajectory identifies a high-risk subgroup, and the D3/D1 ratio enables early risk stratification by POD 3. Prospective studies with larger cohorts are warranted to validate these findings.