Preoperative Prognostic Nutritional Index is a Significant Predictor of Survival in Esophageal Squamous Cell Carcinoma Patients

Abstract

Background: Preoperative assessment of patients is meaningful to predict survival in patients with malignant tumors. The prognostic nutritional index (PNI) is one of the most significant factors related to the prognosis in various types of cancer; however, its role in esophageal cancer is still inconclusive. The aim of this study was to identify the prognostic value of PNI in predicting overall survival (OS) in esophageal squamous cell carcinoma (ESCC).

Methods: This retrospective study included 4146 ESCC patients, 3812 who underwent esophagectomy for ESCC. Other 334 had no surgery. The Preoperative PNI was measured before any therapies and calculated as 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per mm3). We classified the patients into three categories according to the PNI, >50, 45–50, and <45.

Results: Our study showed that PNI was associated with age (P<0.0001), gender(P<0.001),tumor length (P<0.0001), T grade (P = 0.001), N staging (P = 0.017),and M staging (P<0.0001). Multivariate analysis showed that PNI was a significant predictor of overall survival Lower PNI vs. Higher PNI group had significantly increased the hazard ratio of ESCC survival (OR = 1.2, 95% CI= 1.05-1.5, p = 0.01). The Kaplan-Meier curve suggested that high PNI group will significantly increase the OS in both surgical and non-surgical group.

Conclusion: PNI is a useful predictive factor for long-term survival in ESCC. The survival rate of ESCC can be discriminated between three groups, PNI, >50, 45–50, and <45. The prognostic value of PNI can be applied for both surgical and non-surgical ESCC patients.

Authors’ Contributions

All authors listed have contributed sufficiently to the project to be included as authors, and all those who are qualified to be authors are listed in the author byline. All authors (Fankai Xiao, Lin Wang, Wencai Zhang, Lidong Wang, Luosha Zhao) had a role in formulating the research question(s), initiated and directed the study, analyzing the data, and writing the article.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the National High-Tech Research and Development Program of China (SQ2015AA0202183), and the grants from the Health Commission of Henan Province and First Affiliated Hospital of Zhengzhou University.