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Comparative analysis of the prognostic utility of preoperative nutritional parameters in patients with resectable esophageal carcinoma

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Abstract

Objective

Although surgical resection is a mainstay in the management of esophageal carcinoma (EC), its postoperative outcomes remain unsatisfactory. To optimize surgical strategies for EC, a simple method of stratifying patients according to risk factors is desired. Controlling nutritional status (CONUT), the prognostic nutritional index (PNI), transthyretin and transferrin are nutritional parameters used to predict the long-term outcomes of EC patients. We aimed to comparatively evaluate the prognostic significance of these four markers, measured preoperatively, in patients with operable EC.

Methods

In total, 224 patients undergoing surgical resection for EC were retrospectively reviewed. Overall/cancer-specific survivals (OS/CSS) were estimated applying the Cox proportional hazard model to univariate and multivariate analyses. PNI, transthyretin and transferrin levels were treated as continuous variables in these analyses.

Results

Preoperative CONUT had significant associations with tumor location, depth and preoperative irradiation. The other three markers all showed significant relationships with age and tumor depth. On univariate Cox regression analysis, preoperative CONUT, PNI, transthyretin and transferrin all correlated significantly with OS and CSS. On multivariate Cox regression analysis, the preoperative transthyretin level was identified as an independent predictor of OS (HR 0.51 per 10 mg/dL increase, 95% CI 0.29–0.88, p = 0.017) and CSS (HR 0.50, 95% CI 0.27–0.91, p = 0.027) as well as tumor depth, nodal metastasis and preoperative irradiation, while the other three parameters were not.

Conclusions

Preoperative transthyretin, as a continuous variable, independently predicted both OS and CSS in resectable EC patients, appearing to be the best prognosticator among conventional nutrition-related parameters.

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Abbreviations

CI:

Confidence interval

CONUT:

Controlling nutritional status

CSS:

Cancer-specific survival

DCRT:

Definitive chemoradiotherapy

EC:

Esophageal carcinoma

HR:

Hazard ratio

OS:

Overall survival

PNI:

Prognostic nutritional index

TF:

Transferrin

TTR:

Transthyretin

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Acknowledgements

None declared.

Funding

This research received no specific grants from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan

    Masayuki Urabe, Masaki Ueno, Yusuke Ogawa, Akikazu Yago, Hayato Shimoyama, Aya Honda, Yu Ohkura, Shusuke Haruta & Harushi Udagawa

  2. Okinaka Memorial Institute for Medical Research, Tokyo, Japan

    Masaki Ueno, Yu Ohkura & Harushi Udagawa

Authors
  1. Masayuki Urabe
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  2. Masaki Ueno
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  3. Yusuke Ogawa
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  4. Akikazu Yago
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  5. Hayato Shimoyama
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  6. Aya Honda
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  7. Yu Ohkura
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  8. Shusuke Haruta
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Correspondence to Masayuki Urabe.

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Urabe, M., Ueno, M., Ogawa, Y. et al. Comparative analysis of the prognostic utility of preoperative nutritional parameters in patients with resectable esophageal carcinoma. Gen Thorac Cardiovasc Surg 69, 326–335 (2021). https://doi.org/10.1007/s11748-020-01555-4

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  • DOI: https://doi.org/10.1007/s11748-020-01555-4

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