Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Department of Perioperative Functioning Care and Support, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan.
Esophagus. 2022 Apr;19(2):250-259. doi: 10.1007/s10388-021-00883-5. Epub 2021 Sep 21.
The correlation between perioperative changes in nutritional status during esophagectomy and prognosis remains unclear. This study aimed to evaluate the impact of changes in prognostic nutritional index levels during the perioperative period on esophageal cancer patient survivals.
From January 2009 to May 2019, 158 patients with esophageal squamous cell carcinoma were enrolled. From the time-dependent ROC analysis, the cutoff values of preoperative and postoperative prognostic nutritional index levels were 46.9 and 40.9. Patients were divided into preoperative-high group (Group H) and preoperative-low group (Group L). Then, patients in Group L were divided into preoperative-low and postoperative-high group (Group L-H) and preoperative-low and postoperative-low group (Group L-L). Long-term outcomes and prognostic factors were evaluated.
Patients in Group L had significantly worse overall survival than those in Group H (p = 0.001). Patients in Group L-L had significantly worse overall survival than those in Group L-H (p = 0.023). However, there was no significant difference in overall survival between Groups H and L-H (p = 0.224). In multivariable analysis, advanced pathological stage (hazard ratio 10.947, 95% confidence interval 2.590-46.268, p = 0.001) and Group L-L (hazard ratio 2.171, 95% confidence interval 1.249-3.775, p = 0.006) were independent predictors of poor overall survival.
Patients in Group L-H had a good prognosis, similar to those in Group H. This result indicated that increasing the postoperative prognostic nutritional index level sufficiently using various intensive perioperative support methods could improve prognosis after esophagectomy in patients with poor preoperative nutritional status.
食管癌手术期间营养状态的变化与预后之间的相关性尚不清楚。本研究旨在评估围手术期预后营养指数水平变化对食管癌患者生存的影响。
2009 年 1 月至 2019 年 5 月，共纳入 158 例食管鳞状细胞癌患者。从时间依赖的 ROC 分析中，术前和术后预后营养指数水平的临界值分别为 46.9 和 40.9。患者被分为术前高组（Group H）和术前低组（Group L）。然后，将 Group L 中的患者分为术前低和术后高组（Group L-H）和术前低和术后低组（Group L-L）。评估长期结果和预后因素。
Group L 患者的总生存明显差于 Group H 患者（p=0.001）。Group L-L 患者的总生存明显差于 Group L-H 患者（p=0.023）。然而，Group H 和 Group L-H 患者的总生存无显著差异（p=0.224）。多变量分析显示，晚期病理分期（风险比 10.947，95%置信区间 2.590-46.268，p=0.001）和 Group L-L（风险比 2.171，95%置信区间 1.249-3.775，p=0.006）是总生存不良的独立预测因素。
Group L-H 患者的预后良好，与 Group H 患者相似。这一结果表明，通过各种强化围手术期支持方法充分提高术后预后营养指数水平，可以改善术前营养状况较差的食管癌患者手术后的预后。
