BACKGROUND

The prognostic nutritional index (PNI) has garnered increasing attention for its role in predicting the nutritional status and prognosis of cancer patients. However, its influencing factors are still unclear, which limits its precise clinical application. This study aims to investigate the correlation between nutrition-related indicators and PNI and their impact on PNI, with the expectation of providing a more reliable basis for clinical nutritional assessment and intervention, filling the current gap in the research of influencing factors of PNI, and promoting the implementation of individualized nutritional therapy in the comprehensive management of esophageal cancer.

METHODS

The clinical baseline data of 1,894 patients who underwent esophageal cancer surgery between January 2016 and December 2020 were retrospectively analyzed. Univariate and multivariate analyses were employed to investigate the association between PNI and age, weight status, hepatic and renal function, glucose metabolism, inflammation, as well as other indicators.

RESULTS

Among the 1,894 patients diagnosed with esophageal cancer, 1,599 (84.4%) were male and 295 (15.6%) were female. The age of onset was comparatively higher in females than in males. The univariate analysis of PNI revealed that the low PNI group had a higher average age compared to the high PNI group, and there was a significantly higher proportion of individuals aged ≥65 years in the low PNI group (55%) than in the high PNI group (46.6%) (P<0.05). The high PNI group exhibited significantly higher body weight and body mass index (BMI) compared to the low PNI group, along with a higher prevalence of overweight. Conversely, the low PNI group demonstrated a significantly higher incidence of wasting and neoadjuvant therapy (NT) treatment (P<0.05). In the multivariate logistic regression analysis, by constructing the multivariate logistic regression equation, the results showed that: age [odds ratio (OR) =0.574, 95% confidence interval (CI): 0.399-0.824, P=0.003] and NT (OR =0.186, 95% CI: 0.118-0.295, P<0.001) were identified as significant risk factors for high PNI group. Conversely, total protein (TP) (OR =17.194, 95% CI: 10.555-28.009, P<0.001), albumin/globulin ratio (A/G) (OR =5.128, 95% CI: 3.159-8.324, P<0.001), prealbumin (PA) (OR =3.195, 95% CI: 1.942-5.256, P<0.001), white blood cell (WBC) (OR =3.627, 95% CI: 1.729-7.608, P=0.001), platelet count (PLT) (OR =1.905, 95% CI: 1.047-3.465, P=0.035) and hemoglobin (Hb) (OR =2.499, 95% CI: 1.653-3.778, P=0.035) were protective factors in the high PNI group.

CONCLUSIONS

PNI is an indicator that comprehensively reflects nutritional, immune and metabolic status. Patients with low PNI need to focus on the elderly, emaciated, and NT treatment groups, which also provides a basis for the timing of nutritional intervention. Meanwhile, increasing protein intake (improving TP and PA), correcting anemia (Hb), and maintaining PLT and WBC levels may help improve PNI and clinical prognosis.