Abstract
Background
Radical esophagectomy is the cornerstone of curative treatment for patients with resectable esophageal squamous cell carcinoma (ESCC). Patient survival after surgery for ESCC is mainly associated with pathological tumor progression. Recently, the impact of baseline immune-nutritional status of various types of patients with cancer on survival has been highlighted. The purpose of the present study was to investigate the association between the baseline prognostic nutritional index (PNI) and postoperative short- and long-term results after esophagectomy for patients with ESCC.
Methods
In total, 202 patients with ESCC who underwent radical esophagectomy at our institution between 2002 and 2010 were enrolled. PNI was calculated as 10× serum albumin (g/dL) + 0.005 × total lymphocyte counts (per mm3). Receiver operating characteristic (ROC) curves were generated for multiple logistic regression analysis using 5-year overall survival as the endpoint to determine an optimal PNI cutoff value, in which patients were classified into two groups: high PNI and low PNI. We evaluated the significance of PNI on postoperative morbidity and long-term survival using univariate and multivariate analyses.
Results
The mean PNI was 48.9 ± 4.6 (range 37.2–64.0). The area under the ROC curve in multiple logistic regression analysis was 0.5367. The projected 5-year survival rate was optimal at a PNI of 44.1. Hence, the PNI cutoff point was set at 44, with subjects classified by PNI level into the low (PNI <44) or high (PNI ≥44) PNI groups. Of 202 patients, 173 (85.7 %) and 29 (14.3 %) were classified as having high and low PNI, respectively. No significant differences were noted between the two groups regarding patient background, including age, sex, pT, pN, and pStage, or postoperative complications. However, overall survival (OS) and relapse-free survival (RFS) were significantly worse in the low PNI group than in the high PNI group. The 5-year OS and RFS rates in the high PNI vs. low PNI groups were 67.2 vs. 41.2 % (P = 0.007) and 61.5 vs. 38.8 % (P = 0.008), respectively. Multivariate analysis revealed that PNI was a significant prognostic factor for both OS (hazard ratio, 1.826; 95 % confidence interval, 1.015–3.285; P = 0.044) and RFS (hazard ratio, 1.862; 95 % confidence interval, 1.121–3.095; P = 0.016).
Conclusion
Preoperative PNI is an independent prognostic marker of both OS and RFS for patients with potentially curative ESCC. A careful follow-up for tumor recurrence after surgery is required for ESCC patients with low PNI.
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References
Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90.
Ando N, Kato H, Igaki H, et al. A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907). Ann Surg Oncol. 2012;19:68–74.
Enzinger PC, Mayer RJ. Esophageal cancer. N Engl J Med. 2003;349(23):2241–52.
Pennathur A, Gibson MK, Jobe BA, et al. Oesophageal carcinoma. Lancet. 2013;381(9864):400–12.
Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai Zasshi. 1984;85(9):1001–5 (in Japanese with English Abstract).
Kanda M, Fujii T, Kodera Y, et al. Nutritional predictors of postoperative outcome in pancreatic cancer. Br J Surg. 2011;98:268–74.
Pinato DJ, North BV, Sharma R. A novel, externally validated in inflammation –based prognostic algorithm in hepatocellular carcinoma: the prognostic nutrition index (PNI). Br J Cancer. 2012;106(8):1439–45.
Sakurai K, Ohira M, Tamura T, et al. Predictive potential of preoperative nutritional status in long-term outcome projections for patients with gastric cancer. Ann Surg Oncol. 2015;23(2):525–33.
Maeda K, Shibutani M, Ohtani H, et al. Low nutritional prognostic index correlates with poor survival in patients with stage IV colorectal cancer following palliative resection of the primary tumor. World J Surg. 2014;38:1217–22.
Sobin LH, Gaspodarowicz M, Wittekind C. TNM Classification of Malignant Tumors (UICC). 7th ed. New York: Wiley-Liss; 2009.
Dindo D, Demartines N, Clavien PA. Classifications of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.
Buzby GP, Mullen JL, Matthews DC, et al. Prognostic nutritional index in gastrointestinal surgery. Am J Surg. 1980;139:160–7.
Feng JF, Chen QX. Significance of the prognostic nutritional index in patients with esophageal squamous cell carcinoma. Ther Clin Risk Manag. 2014;10:1–7.
Yokota T, Ando N, Igaki H, et al. Prognostic factors in patients receiving neoadjuvant 5-fluorouracil plus cisplatin for advanced esophageal cancer (JCOG9907). Oncology. 2015;89(3):143–51.
Jin Y, Zhao L, Peng F. Prognostic impact of serum albumin levels on the recurrence of stage I non-small cell lung cancer. Clinics. 2013;68:686–93.
Huang SH, Waldron JN, Milosevic M, et al. Prognostic value of pretreatment circulating neutrophils, monocytes, and lymphocytes in oropharyngeal cancer stratified by human papillomavirus status. Cancer. 2015;121:545–55.
Li X, Han Z, Cheng Z, et al. Prognostic value of preoperative absolute lymphocyte count in recurrent hepatocellular carcinoma following thermal ablation: a retrospective analysis. Onco Targets Ther. 2014;7:1829–35.
Vashist YK, Loos J, Dedow J, et al. Glasgow Prognostic Score is a predictor of perioperative and long-term outcome in patients with only surgically treated esophageal cancer. Ann Surg Oncol. 2011;18:1130–8.
Crumley AB, McMillan DC, McKernan M, et al. Evaluation of an inflammation-based prognostic score in patients with inoperable gastro-oesophageal cancer. Br J Cancer. 2006;94(5):637–41.
Sharaiha RZ, Halazun KJ, Mirza F, et al. Elevated preoperative neutrophil:lymphocyte ratio as a predictor of postoperative disease recurrence in esophageal cancer. Ann Surg Oncol. 2011;18(12):3362–9.
Balkwill F, Mantovani A. Inflammation and cancer: back to Virchow? Lancet. 2001;357:539–45.
Nozoe T, Kimura Y, Ishida M, et al. Correlation of pre-operative nutritional condition with post-operative complications in surgical treatment for oesophageal carcinoma. Eur J Surg Oncol. 2002;28(4):396–400.
Sun P, Zhang F, Chen C, et al. Comparison of the prognostic values of various nutritional parameters in patients with esophageal squamous cell carcinoma from Southern China. J Thorac Dis. 2013;5(4):484–91.
Law S, Wong KH, Kwok KF, et al. Predictive factors for postoperative pulmonary complications and mortality after esophagectomy for cancer. Ann Surg. 2004;240(5):791–800.
Biere SS, van Berge Henegouwen MI, Maas KW, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet. 2012;379(9829):1887–92.
Kassis ES, Kosinski AS, Ross P, et al. Predictors of anastomotic leak after esophagectomy: an analysis of the society of thoracic surgeons general thoracic database. Ann Thorac Surg. 2013;96(6):1919–26.
Ligthart-Melis GC, Weijs PJ, te Boveldt ND, Buskermolen S, et al. Dietician-delivered intensive nutritional support is associated with a decrease in severe postoperative complications after surgery in patients with esophageal cancer. Dis Esophagus. 2013;26(6):587–93.
Mudge L, Isenring E, Jamieson GG. Immunonutrition in patients undergoing esophageal cancer resection. Dis Esophagus. 2011;24(3):160–5.
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This was a retrospective study approved by the review board of Osaka City University Hospital.
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Kubo, N., Ohira, M., Tamura, T. et al. Prognostic significance of baseline nutritional index for patients with esophageal squamous cell carcinoma after radical esophagectomy. Esophagus 14, 84–90 (2017). https://doi.org/10.1007/s10388-016-0548-2
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DOI: https://doi.org/10.1007/s10388-016-0548-2