Prognostic Significance of Prognostic Nutritional Index in Esophageal Squamous Cell Carcinoma Patients Undergoing Radical Radiotherapy: A Propensity Score Matching Analysis

Figures & data

Table 1. Relationships between PNI and clinicopathological features in ESCC patients before and after propensity score matching.

Characteristics	Total patients	Before propensity score matching (n = 354)			Total patients	After propensity score matching (n = 224)
		PNI ≤ 50.5 (n = 224)	PNI > 50.5 (n = 130)	P value		PNI ≤ 50.5 (n = 112)	PNI > 50.5 (n = 112)	P value
Sex				0.232				0.241
Male	206	125	81		158	83	75
Female	148	99	49		66	29	37
Age				0.019				0.141
≤65	159	90	69		107	48	59
>65	195	134	61		117	64	53
Tumor location				0.144				0.862
Cervical + Upper	117	66	51		79	38	41
Middle	159	104	55		96	48	48
Lower	78	54	24		49	26	23
T stage				0.014				0.535
T1 + T2	100	52	48		63	28	35
T3	113	73	40		78	42	36
T4	141	99	42		83	42	41
N stage				0.756				0.656
N0	107	69	38		63	30	33
N+	247	155	92		161	82	79
TNM stage				0.017				0.563
I	36	17	19		24	11	13
II	134	79	55		88	41	47
III	184	128	56		112	60	52
BMI				0.045				0.734
<18.5	33	24	9		12	7	5
18.5–24.9	237	156	81		150	76	74
≥25	84	44	40		62	29	33
Irradiation method				<0.001				0.422
IFI	211	157	54		108	57	51
ENI	143	67	76		116	55	61
RT dose				0.110				0.584
≤60 Gy	153	104	49		88	42	46
>60 Gy	201	120	81		136	70	66
Adjuvant chemotherapy				0.058				0.272
No	165	113	52		84	47	39
Yes	189	111	78		140	65	73
HGB(g/L)				<0.001				0.006
≤120	74	63	11		30	22	8
>120	280	161	119		194	90	104
PAB(g/L)				<0.001				0.026
≤200	152	111	41		63	39	24
>200	202	98	104		161	73	88

PNI, prognostic nutritional index; BMI, body mass index; IFI, involved-field irradiation; ENI, elective node irradiation; RT, radiotherapy; HGB, hemoglobin; PAB, prealbumin.

Figure 1. ROC curve for the PNI for predicting the overall survival of ESCC patients undergoing radiotherapy.

Figure 2. Correlations between PNI and (A) HGB and (B) PAB were assessed using Pearson’s correlation analysis in all ESCC patients.

Figure 3. Kaplan-Meier curves of survival based on PNI in 354 ESCC patients undergoing definitive radiotherapy. A: overall survival; B: progression free survival.

Figure 4. Kaplan-Meier curves of survival based on PNI in ESCC patients with different TNM stage undergoing definitive radiotherapy. A: stage I-II; B: stage III.

Table 2. Univariate and multivariate analyses of prognostic factors for OS in 354 ESCC patients.

Variables	Univariate analysis		Multivariate analysis
	HR(95%CI)	P value	HR(95%CI)	P value
Sex (male/female)	0.974(0.765–1.239)	0.830
Age (≤65/>65)	1.300(1.021–1.656)	0.033	1.004(0.760–1.326)	0.978
Tumor location (cervical,upper /middle,lower)	1.597(1.226–2.081)	0.001	1.202(0.904–1.596)	0.205
TNM stage (I,II/III)	1.763(1.386–2.243)	<0.001	1.649(1.282–2.121)	<0.001
irradiation method (IFI/ENI)	0.550(0.428–0.707)	<0.001	0.800(0.602–1.063)	0.123
RT dose (≤60 Gy/>60 Gy)	0.633(0.499–0.804)	<0.001	0.830(0.641–1.075)	0.159
Adjuvant chemotherapy (no/yes)	0.609(0.479–0.772)	<0.001	0.651(0.494–0.857)	0.002
PNI (≤50.5/>50.5)	0.609(0.472–0.786)	<0.001	0.754(0.577–0.984)	0.038

Table 3. Univariate and multivariate analyses of prognostic factors for PFS in 354 ESCC patients.

Variables	Univariate analysis		Multivariate analysis
	HR(95%CI)	P value	HR(95%CI)	P value
Sex (male/female)	1.000(0.792–1.264)	0.999
Age (≤65/>65)	1.241(0.982–1.569)	0.070
Tumor location (cervical,upper/middle,lower)	1.469(1.141–1.893)	0.003	1.085(0.824–1.428)	0.562
TNM stage (I,II/III)	1.732(1.370–2.189)	<0.001	1.582(1.238–2.021)	<0.001
irradiation method (IFI/ENI)	0.544(0.426–0.694)	<0.001	0.749(0.566–0.992)	0.044
RT dose (≤60 Gy/>60 Gy)	0.648(0.514–0.818)	<0.001	0.837(0.650–1.077)	0.166
Adjuvant chemotherapy (no/yes)	0.635(0.504–0.800)	<0.001	0.696(0.545–0.889)	0.004
PNI (≤50.5/>50.5)	0.667(0.521–0.854)	0.001	0.842(0.649–1.092)	0.196

Table 4. Univariate and multivariate analyses of prognostic factors for OS in propensity score matched 224 ESCC patients.

Variables	Univariate analysis		Multivariate analysis
	HR(95%CI)	P value	HR(95%CI)	P value
Sex (male/female)	0.957(0.683–1.342)	0.800
Age(≤65/>65)	1.357(0.997–1.846)	0.052
Tumor location (cervical,upper /middle,lower)	1.894(1.346–2.665)	0.000	1.532(0.974–2.410)	0.065
TNM stage (I,II/III)	1.707(1.255–2.321)	0.001	1.570(1.139–2.165)	0.006
irradiation method (IFI/ENI)	0.600(0.441–0.815)	0.001	0.802(0.571–1.128)	0.205
RT dose (≤60 Gy/>60 Gy)	0.605(0.445–0.822)	0.001	0.754(0.542–1.047)	0.092
Adjuvant chemotherapy (no/yes)	0.709(0.521–0.965)	0.029	0.748(0.541–1.034)	0.079
PNI (≤50.5/>50.5)	0.633(0.466–0.861)	0.004	0.680(0.498–0.928)	0.015

Table 5. Univariate and multivariate analyses of prognostic factors for PFS in propensity score matched 224 ESCC patients.

Variables	Univariate analysis		Multivariate analysis
	HR(95%CI)	P value	HR(95%CI)	P value
Sex (male/female)	1.119(0.811–1.543)	0.495
Age (≤65/>65)	1.271(0.945–1.709)	0.113
Tumor location (cervical,upper /middle,lower)	1.720(1.247–2.374)	0.001	1.324(0.933–1.878)	0.116
TNM stage (I,II/III)	1.738(1.290–2.341)	<0.001	1.584(1.163–2.156)	0.003
irradiation method (IFI/ENI)	0.579(0.430–0.778)	<0.001	0.749(0.542–1.033)	0.078
RT dose (≤60 Gy/>60 Gy)	0.594(0.441–0.800)	0.001	0.724(0.524–0.998)	0.059
Adjuvant chemotherapy (no/yes)	0.738(0.547–0.995)	0.047	0.799(0.584–1.094)	0.161
PNI (≤50.5/>50.5)	0.721(0.537–0.969)	0.030	0.777(0.576–1.047)	0.097

Table 6. Comparison between PNI and acute adverse reactions.

Variables	N	PNI ≤ 50.5	PNI > 50.5	P value
≥ grade two radiation esophagitis	110	74	36	0.295
≥ grade two radiation pneumonitis	51	36	15	0.242
≥ grade two hematological toxicity	94	70	24	0.009

Table

Fund institution	Approval number	Principal investigator
Health Commission of Hebei Province	20190725	Zhao Yan