The Value of Preoperative Nutritional Status, the Systemic Inflammation Index and A Nomogram for the Prognosis of Patients with Esophageal Cancer After Radical Resection

Abstract

Background Controlling nutritional status (CONUT), prognostic nutritional index (PNI), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) are new parameters that reflect the immune-nutritional status in some cancers. Purpose To investigate the relationship between preoperative nutritional status and systemic inflammatory indexes on the clinicopathological prognosis of patients with stage I-IV esophageal cancer and to clarify the predictive value of nutritional status and inflammatory indexes on tumor recurrence, metastasis and long-term survival after radical resection. Methods The clinical data of 381 patients who underwent radical esophagectomy at the First Affiliated Hospital of Zhengzhou University from August 5, 2013, to August 1, 2021, were analyzed retrospectively. The preoperative clinical characteristics and hematological examination results were collected, the data on nutritional and immune status were analyzed, tumor recurrence and survival were evaluated by telephone follow-up, and overall survival (OS) and progression-free survival (PFS) were calculated. Nutritional data and the immune status, clinical data and survival information were also analyzed. Results Analysis of the clinical data of 381 patients with esophageal cancer undergoing radical esophagectomy revealed that preoperative nutritional status was related to preoperative complications, neoadjuvant therapy, TNM stage, tumor location, pathological type, vascular invasion, nerve invasion and regional lymph node metastasis, and the indexes of systemic inflammation were related to neoadjuvant therapy, TNM stage, tumor location, pathological type and nerve invasion. In univariate analysis, vascular invasion, preoperative CONUT, PNI and SII were identified as important factors affecting prognosis. In multivariate analysis, vascular invasion, preoperative CONUT, PNI, and SII were identified as important factors showing an independent correlation with survival time. A nomogram was developed, and the statistically significant influencing factors from the multivariate Cox regression model were included to predict the 2-, 3- and 5-year overall survival rates of patients with lung metastasis from gastric cancer. Conclusion CONUT, PNI and SII are independent risk factors for predicting overall survival and recurrence-free survival after radical resection of esophageal cancer. The proposed nomogram prediction model can aid in individualized analysis of the prognosis of these patients.