Prognostic Significance of Preoperative Prognostic Nutritional Index for Overall Survival and Postoperative Complications in Esophageal Cancer Patients

Figures & data

Figure 1 Flow chart showing patient recruitment.

Table 1 Patients’ Characteristic

	PNI-Low Group (≤48.33, n=128)	PNI-High Group (>48.33, n=279)	P value	NLR-Low Group (≤2.84, n=288)	NLR-High Group (>2.84, n=119)	P value	PLR-Low Group (≤170.61, n=305)	PLR-High Group (>170.61, n=102)	P value	SII-Low Group (≤433.25, n=163)	SII-High Group (>433.25, n=244)	P value
Gender			0.003			0.248			0.609			0.148
Female	15	68		63	20		64	19		39	44
Male	113	211		225	99		241	83		124	200
Age (mean±SD)	62.73±7.84	59.96±7.63	0.001	60.50±7.51	61.63±8.41	0.183	60.82±7.59	60.85±8.40	0.973	61.31±7.40	60.51±8.04	0.314
Alcohol use	74	155	0.670	161	68	0.891	177	52	0.214	83	146	0.076
Tobacco use	71	160	0.722	163	68	0.919	179	52	0.174	85	146	0.125
Past history
High blood pressure	27	54	0.683	54	27	0.345	60	21	0.841	28	53	0.261
Diabetes	8	11	0.306	14	5	0.774	14	5	0.897	6	13	0.440
Coronary heart disease	6	15	0.771	13	8	0.360	17	4	0.514	8	13	0.851
Comorbidity	30	54	0.345	59	25	0.906	62	22	0.789	36	48	0.555
Cancer thrombus	5	10	0.873	12	3	0.423	13	2	0.286	8	7	0.285
Tumor location			0.610			0.670			0.687			0.490
Cervical	4	4		5	3		7	1		2	6
Upper	6	13		15	4		15	4		5	14
Middle	88	186		190	84		207	67		112	162
Lower	30	76		78	28		76	30		44	62
T stage			0.092			0.023			0.028			0.049
Tis	1	10		11	0		10	1		6	5
T1	9	33		31	11		33	9		19	23
T2	34	77		87	24		93	18		55	56
T3	57	122		116	63		127	52		59	120
T4	27	37		43	21		42	22		24	40
N stage			0.972			0.835			0.706			0.432
N0	70	155		161	64		173	52		97	128
N1	35	71		74	32		77	29		37	69
N2	15	36		34	17		38	13		21	30
N3	8	17		19	6		17	8		8	17
M stage			0.139			0.119			0.083			0.413
M0	127	279		288	118		305	101		163	243
M1	1	0		0	1		0	1		0	1
TNM			0.076			0.089			0.100			0.540
0	1	9		10	0		9	1		5	5
I	8	34		31	11		33	9		20	22
II	58	126		133	51		144	40		76	108
III	60	110		114	56		119	51		62	108
IV	1	0		0	1		0	1		0	1
Hb (mean±SD)	135.66±13.99	143.26±13.20	<0.001	141.52±14.60	139.31±11.95	0.146	141.89±13.83	137.83±13.71	0.010	141.53±14.27	140.43±13.65	0.435
TP (mean±SD)	590.96±176.89	629.56 ±204.88	0.067	612.45±206.73	629.45 ±171.80	0.429	613.33±206.82	629.66 ±165.01	0.469	617.74±196.32	617.21 ±198.03	0.979
Alb (mean±SD)	38.53±2.93	43.63±3.05	<0.001	42.42±3.89	41.06±3.51	0.001	42.29±3.75	41.23±3.99	0.016	42.32±3.43	41.83±4.08	0.209
Lymphocyte (mean±SD)	130.55±45.93	196.61±83.16	<0.001	198.43±80.87	121.14±40.48	<0.001	195.33±79.94	117.52±40.75	<0.001	204.65±100.01	156.58±54.71	<0.001

Abbreviations: Hb, hemoglobin; Alb, albumin; TP, total protein; PNI, prognostic nutritional index; NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; SII, systemic immune-inflammation index.

Figure 2 Kaplan–Meier survival curves for OS according to PNI, NLR, PLR and SII in esophageal cancer patients. The number at risk was shown below. (A) The PNI-low group showed a significantly shorter OS compared with the PNI-high group (34.38% VS 49.46%, log rank P < 0.001). (B) The NLR-high group showed a significantly shorter OS compared with the NLR-low group (36.13% VS 48.26%, log rank P = 0.026). (C) The PLR-high group showed a significantly shorter OS compared with the PLR-low group (33.33% VS 48.52%, log rank P = 0.001). (D) No significantly difference were found between OS in SII groups (46.31% VS 42.33%, log rank P = 0.067).

Table 2 Univariate and Multivariate Analyses of Prognostic Factors for OS

	Univariate		Multivariate
	HR (95% CI)	P value	HR (95% CI)	P value
Gender		0.337		0.285
Female	1
Male	1.180(0.841–1.656)		_
Age		0.268		0.067
>65	1
≤65	0.857(0.652–1.126)		_
Alcohol use		0.895
Absence	1
Presence	1.018(0.782–1.325)
Tobacco use		0.696
Absence	1
Presence	1.054(0.809–1.375)
High blood pressure		0.256
Absence	1
Presence	1.201(0.875–1.649)
Diabetes		0.574
Absence	1
Presence	0.834(0.442–1.572)
Coronary heart disease		0.864
Absence	1
Presence	0.948(0.517–1.738)
T stage		<0.0001		<0.0001
T0+T1+T2	1		1
T3+T4	2.706(2.007–3.648)		1.989(1.400–2.826)
N stage		<0.0001
N0+N1	1		1	0.014
N2+N3	2.293(1.699–3.094)		1.557(1.094–2.217)
M stage		0.861
M0	1
M1	1.191(0.167–8.502)
TNM		<0.0001		0.034
0+I+II	1		1
III+IV	2.595(1.987–3.390)		1.475(1.029–2.114)
Cancer thrombus		0.165
Absence	1
Presence	1.569(0.831–2.961)
Hb	0.997(0.988–1.006)	0.539
TP	1.000(0.999–1.001)	0.749
Alb	0.947(0.915–0.986)	0.002	_	0.684
PNI		0.001		0.002
>48.33	1		1
≤48.33	1.604(1.224–2.103)		1.529(1.163–2.011)
NLR		0.028		0.672
≤2.84	1
>2.84	1.363(1.033–1.797)		_
PLR		0.001		0.186
≤170.61	1
>170.61	1.605(1.207–2.134)		_
SII		0.673
≤433.25	1
>433.25	0.945(0.724–1.232)
Postoperative complications		0.001		0.028
0+1+2	1		1
3+4	2.084(1.328–3.269)		1.666(1.057–2.627)

Abbreviations: Hb, hemoglobin; Alb, albumin; TP, total protein; PNI, prognostic nutritional index; NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; SII, systemic immune-inflammation index.

Table 3 Correlation of PNI NLR PLR SII with Postoperative Complications

Clavien-Dindo Classification	PNI			NLR			PLR			SII
	Low (128)	High (278)	P	Low (288)	High (119)	P	Low (305)	High (102)	P	Low (163)	High (244)	P
1	1	19		17	3		16	4		7	13
2	19	3		14	8		16	6		6	16
3	11	9		10	10		13	7		5	15
4	5	4		4	5		7	2		4	5
5	2	2		3	1		3	1		3	1
Total (%)	38 (29.69)	37 (13.26)	<0.001	48 (16.67)	27 (22.69)	0.124	55 (8.03)	20 (19.61)	0.867	25 (15.34)	50 (20.49)	0.326

Note: Clavien-Dindo classification was used to evaluate the postoperative complications.

Abbreviations: PNI, prognostic nutritional index; NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; SII, systemic immune-inflammation index.

Table 4 Univariate and Multivariate Logistic Analyses on the Occurrence of Complications

	Univariate		Multivariate
	HR (95% CI)	P value	HR (95% CI)	P value
Gender		0.050		0.957
Female	1
Male	2.103(1.001–4.421)		_
Age		0.012		0.025
>65	1		1
≤65	0.520(0.312–0.867)		0.426(0.202–0.898)
Operation duration		0.616
>3 hours	1
≤3 hours	0.880(0.533–1.452)
Type of surgery		0.018		0.688
Transthoracic	1
Thoracoscopic	2.310(1.157–4.613)		_
Blood loss		0.008		0.009
<100	1		1
100–200	1.914(0.931–3.934)		2.050(0.760–5.531)
>200	6.739(1.663–24.474)		9.209(2.051–41.342)
ASA score		0.861
1+2	1
3+4	1.046(0.630–1.737)
Alb	0.900(0.841–0.962)	0.002	_	0.627
TP	0.997(0.996–0.998)	<0.0001	0.998(0.997–1.000)	0.038
PNI		<0.0001		0.008
>48.33	1		1
≤48.33	2.762(1.653–4.614)		2.784(1.312–5.909)
NLR		0.156		0.101
≤2.84	1
>2.84	1.467(0.864–2.491)		_
PLR		0.723
≤170.61	1
>170.61	1.109(0.627–1.959)
SII		0.190		0.883
≤433.25	1
>433.25	1.423(0.840–2.411)		_

Abbreviations: Alb, albumin; TP, total protein; PNI, prognostic nutritional index; NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; SII, systemic immune-inflammation index; ASA, American Society of Anesthesiologists.