Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan.
Department of Surgery, Yokohama City University, Yokohama, Japan.
In Vivo. 2024 Mar-Apr;38(2):881-889. doi: 10.21873/invivo.13514.
BACKGROUND/AIM: Radical resection after preoperative adjuvant chemotherapy (NAC) is a standard treatment for patients with locally advanced esophageal squamous cell carcinoma (LAESCC), but its outcome remains unsatisfactory. In order to develop a personalized treatment program for LAES, we herein compared the survival prediction utility of five pre-NAC nutritional, inflammatory, and immune indexes in patients with LAESCC.
We evaluated the survival of 203 patients with LAESCC who underwent radical resection after NAC from January 2011 to September 2019 for the following representative pre-NAC nutritional, inflammatory, and immune indices: modified Glasgow Prognostic Score, Prognostic Nutritional Index, C-reactive protein/albumin ratio, serum neutrophil/lymphocyte ratio, and Geriatric Nutrition Risk Index (GNRI) were evaluated for their impact on survival.
Of the five indices, GNRI was the best predictor of survival as determined by the area under the curve (p<0.05). When patients were divided into three groups according to the nutritional risk assessment of Bouillanne et al. using the pre-NAC GNRI, the 5-year overall survival (OS) and recurrence-free survival (RFS) were significantly stratified (p<0.001). On multivariate analysis, the GNRI independently identified a poor OS group [group 1: hazard ratio (HR)=2.598, p=0.002; group 2: HR=6.257, p<0.001] and a high recurrence risk group (group 1: HR=1.967, p=0.016; group 2: HR=4.467, p<0.001).
In patients with LAESCC, GNRI may be the most accurate, reliable, and useful prognostic factor among the five major systemic inflammatory and nutritional indices.
背景/目的：术前辅助化疗（NAC）后行根治性切除术是局部晚期食管鳞癌（LAESCC）患者的标准治疗方法，但疗效仍不理想。为了为 LAES 制定个性化治疗方案，我们比较了 5 项 NAC 前营养、炎症和免疫指标在 LAESCC 患者中的生存预测价值。
我们评估了 203 例接受 NAC 后行根治性切除术的 LAESCC 患者的生存情况，这些患者于 2011 年 1 月至 2019 年 9 月接受治疗。评估了以下有代表性的 NAC 前营养、炎症和免疫指标：改良格拉斯哥预后评分、预后营养指数、C 反应蛋白/白蛋白比值、血清中性粒细胞/淋巴细胞比值和老年营养风险指数（GNRI），以评估其对生存的影响。
在这 5 个指标中，GNRI 的曲线下面积（AUC）最佳（p<0.05），可作为生存的最佳预测指标。当根据 NAC 前 GNRI 用 Bouillanne 等提出的营养风险评估将患者分为 3 组时，5 年总生存率（OS）和无复发生存率（RFS）明显分层（p<0.001）。多因素分析显示，GNRI 可独立识别出 OS 预后不良组[组 1：危险比（HR）=2.598，p=0.002；组 2：HR=6.257，p<0.001]和高复发风险组（组 1：HR=1.967，p=0.016；组 2：HR=4.467，p<0.001）。
在 LAESCC 患者中，GNRI 可能是 5 项主要全身炎症和营养指标中最准确、可靠和有用的预后因素。
