He Xianneng, He Jinxian, Cen Haofeng, Sarkaria Inderpal S, Hirahara Noriyuki, Lin Chengbin, Zhu Keyun, Shen Weiyu
Department of Thoracic Surgery, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, China.
Health Science Center, Ningbo University, Ningbo, China.
J Thorac Dis. 2025 Mar 31;17(3):1673-1683. doi: 10.21037/jtd-2025-302. Epub 2025 Mar 27.
Across the world, esophageal cancer is one of the most common malignant tumors of the digestive system. Anastomotic leakage is a severe complication after minimally invasive esophagectomy (MIE) for esophageal cancer. Research indicates that inflammation and immune system and nutritional status are linked to anastomotic leakage. Neutrophil-to-lymphocyte ratio (NLR) and prognostic nutrition index (PNI) reflect the inflammatory and nutritional status of the human body. The aim of this study is to investigate the value of perioperative NLR combined with the PNI to predict anastomotic leakage after MIE.
A retrospective analysis was conducted on 232 patients who underwent MIE in The Affiliated Lihuili Hospital of Ningbo University from January 2019 to May 2023. Patients were divided into two groups based on the presence or absence of anastomotic leakage. Clinicopathological data and perioperative peripheral blood indices of the patients were collected, and the factors associated with postoperative anastomotic leakage were analyzed via univariate and multivariate logistic regression. Moreover, the value of NLR and PNI for predicting anastomotic leakage were evaluated using receiver operating characteristic (ROC) curves.
Anastomotic leakage occurred in 35 (15%) of 232 patients who underwent MIE. Multivariate logistic regression analysis identified a history of diabetes, higher NLR levels on postoperative days 3 and 5, and a lower PNI score on postoperative day 3 as independent risk factors of anastomotic leakage. ROC curve analysis indicated that NLR combined with PNI on postoperative day 3 had the best predictive value for anastomotic leakage, with an area under the curve (AUC) of 0.826, a sensitivity of 82.9%, and a specificity of 78.2%.
Persistently high NLR levels and persistently low PNI levels in the postoperative period correlated with the development of anastomotic leakage after MIE, and NLR combined with the PNI on postoperative day 3 had the best predictive value for anastomotic leakage after MIE.
在全球范围内，食管癌是消化系统最常见的恶性肿瘤之一。吻合口漏是食管癌微创食管切除术后的严重并发症。研究表明，炎症、免疫系统和营养状况与吻合口漏有关。中性粒细胞与淋巴细胞比值（NLR）和预后营养指数（PNI）反映了人体的炎症和营养状况。本研究旨在探讨围手术期NLR联合PNI对微创食管切除术后吻合口漏的预测价值。
对2019年1月至2023年5月在宁波大学附属李惠利医院接受微创食管切除术的232例患者进行回顾性分析。根据是否发生吻合口漏将患者分为两组。收集患者的临床病理资料和围手术期外周血指标，通过单因素和多因素logistic回归分析与术后吻合口漏相关的因素。此外，采用受试者工作特征（ROC）曲线评估NLR和PNI对吻合口漏的预测价值。
232例行微创食管切除术的患者中，35例（15%）发生吻合口漏。多因素logistic回归分析确定糖尿病史、术后第3天和第5天较高的NLR水平以及术后第3天较低的PNI评分是吻合口漏的独立危险因素。ROC曲线分析表明，术后第3天NLR联合PNI对吻合口漏的预测价值最佳，曲线下面积（AUC）为0.826，灵敏度为82.9%，特异度为78.2%。
术后持续高NLR水平和持续低PNI水平与微创食管切除术后吻合口漏的发生相关，术后第3天NLR联合PNI对微创食管切除术后吻合口漏的预测价值最佳。
