Fujiwara Yoshinori, Higashida Masaharu, Kubota Hisako, Okamoto Yuko, Mineta Shumei, Endo Shunji, Ueno Tomio
Department of Digestive Surgery, Kawasaki Medical School, Kurashiki, Japan.
Gastrointest Tumors. 2021 Apr;8(2):87-95. doi: 10.1159/000513961. Epub 2021 Mar 17.
We studied whether perioperative nutritional, immunological factors or postoperative inflammatory responses predicted esophageal cancer (EC) progression and prognosis in patients who received esophagectomies.
We evaluated preoperative prognostic nutritional index (PNI), BMI, neutrophil-to-lymphocyte ratio (NLR), intraoperative blood loss, postoperative C-reactive protein (CRP) max, recurrence-free survival (RFS), and overall survival (OS) in 111 patients with pStage I-IV squamous cell EC who received esophagectomies. Optimal cutoff values for each continuous parameter were determined by receiver operating characteristic curves and Youden indices. Univariate and multivariate Cox analyses were used to derive independent prognostic factors. Propensity score matching using inverse probability of treatment weighting was used in groups divided by Youden indices, as appropriate.
Cutoff values of continuous variables were NLR: 2.27, PNI: 44.2, blood loss: 159 mL, and CRPmax: 21.7 mg/dL. In multivariate analyses, PNI, CRPmax, and intraoperative blood loss were independent prognostic factors for OS and RFS. Among patients with stage II-IV disease, low PNI was associated with shorter RFS. Postoperative respiratory complications were associated with both higher CRP and shorter RFS.
DISCUSSION/CONCLUSIONS: Low preoperative PNI and high postoperative inflammatory response were associated with postoperative EC progression after esophagectomy. Preoperative nutritional interventions or suppression of postoperative inflammatory response, including respiratory complications, may improve patient prognosis.
我们研究了围手术期营养、免疫因素或术后炎症反应是否能预测接受食管切除术的食管癌（EC）患者的病情进展和预后。
我们评估了111例接受食管切除术的pStage I-IV期鳞状细胞EC患者的术前预后营养指数（PNI）、体重指数（BMI）、中性粒细胞与淋巴细胞比值（NLR）、术中失血量、术后C反应蛋白（CRP）最大值、无复发生存期（RFS）和总生存期（OS）。通过受试者工作特征曲线和尤登指数确定每个连续参数的最佳截断值。采用单因素和多因素Cox分析得出独立的预后因素。在根据尤登指数划分的组中，酌情使用倾向评分匹配法，采用治疗权重的逆概率。
连续变量的截断值为：NLR：2.27，PNI：44.2，失血量：159 mL，CRP最大值：21.7 mg/dL。在多因素分析中，PNI、CRP最大值和术中失血量是OS和RFS的独立预后因素。在II-IV期疾病患者中，低PNI与较短的RFS相关。术后呼吸并发症与较高的CRP和较短的RFS均相关。
讨论/结论：术前低PNI和术后高炎症反应与食管切除术后的EC病情进展相关。术前营养干预或抑制术后炎症反应，包括呼吸并发症，可能改善患者预后。
