Nakatani M, Migita K, Matsumoto S, Wakatsuki K, Ito M, Nakade H, Kunishige T, Kitano M, Kanehiro H
Department of Surgery, Nara Medical University, Nara, Japan.
Dis Esophagus. 2017 Aug 1;30(8):1-7. doi: 10.1093/dote/dox020.
Nutritional status is one of the most important issues faced by cancer patients. Several studies have shown that a low preoperative nutritional status is associated with a worse prognosis in patients with various types of cancer, including esophageal cancer (EC). Recently, neoadjuvant chemotherapy (NAC) and/or radiotherapy have been accepted as the standard treatment for resectable advanced EC. However, NAC has the potential to deteriorate the nutritional status of a patient. This study aimed to evaluate the prognostic significance of the nutritional status for EC patients who underwent NAC. We retrospectively reviewed 66 squamous cell EC patients who underwent NAC consisting of docetaxel, cisplatin, and 5-fluorouracil followed by subtotal esophagectomy at Nara Medical University Hospital between January 2009 and August 2015. To assess the patients' nutritional status, the prognostic nutritional index (PNI) before commencing NAC and prior to the operation was calculated as 10 × serum albumin (g/dl) + 0.005 × total lymphocyte count in the peripheral blood (per mm3). The cutoff value of the PNI was set at 45. A multivariable analysis was performed to identify prognostic factors for overall survival (OS) and relapse-free survival (RFS). The mean pre-NAC and preoperative PNI were 50.2 ± 5.7 and 48.1 ± 4.7, respectively (P = 0.005). The PNI decreased following NAC in 44 (66.7%) patients. Before initiating NAC, 9 (13.6%) patients had a low PNI, and 12 (18.2%) patients had a low PNI prior to the operation. The pre-NAC PNI and preoperative PNI were significantly associated with the OS (P = 0.013 and P = 0.004, respectively) and RFS (P = 0.036 and P = 0.005, respectively) rates. The multivariable analysis identified the preoperative PNI as an independent prognostic factor for poor OS and RFS, although the pre-NAC PNI was not an independent predictor. Our results suggest that the preoperative PNI is a useful marker for predicting the long-term outcomes of EC patients undergoing NAC and subsequent subtotal esophagectomy. Therefore, patients with a low preoperative nutritional status may be at a higher risk of EC recurrence.
营养状况是癌症患者面临的最重要问题之一。多项研究表明，术前营养状况不佳与包括食管癌（EC）在内的各类癌症患者的预后较差相关。最近，新辅助化疗（NAC）和/或放疗已被公认为可切除的晚期EC的标准治疗方法。然而，NAC有可能使患者的营养状况恶化。本研究旨在评估营养状况对接受NAC的EC患者的预后意义。我们回顾性分析了2009年1月至2015年8月在奈良医科大学医院接受由多西他赛、顺铂和5-氟尿嘧啶组成的NAC并随后行食管次全切除术的66例鳞状细胞EC患者。为评估患者的营养状况，在开始NAC前及手术前计算预后营养指数（PNI），其计算公式为10×血清白蛋白（g/dl）+0.005×外周血总淋巴细胞计数（每立方毫米）。PNI的临界值设定为45。进行多变量分析以确定总生存期（OS）和无复发生存期（RFS）的预后因素。NAC前和术前PNI的平均值分别为50.2±5.7和48.1±4.7（P=0.005）。44例（66.7%）患者在NAC后PNI下降。在开始NAC前，9例（13.6%）患者PNI较低，12例（18.2%）患者在手术前PNI较低。NAC前PNI和术前PNI分别与OS率（分别为P=0.013和P=0.004）和RFS率（分别为P=0.036和P=0.005）显著相关。多变量分析确定术前PNI是OS和RFS不良的独立预后因素，尽管NAC前PNI不是独立预测因素。我们的结果表明，术前PNI是预测接受NAC及随后食管次全切除术的EC患者长期预后的有用标志物。因此，术前营养状况不佳的患者EC复发风险可能更高。
