Hasegawa Makoto, Saze Zenichiro, Yago Hiroki, Suzuki Hiroya, Mitsui Dai, Matsuishi Akira, Maruyama Yuya, Matsuida Hajime, Kikuchi Tomohiro, Nirei Azuma, Hanayama Hiroyuki, Kono Koji
Department of Gastrointestinal Tract Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
Department of Gastrointestinal Tract Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan.
In Vivo. 2025 Sep-Oct;39(5):2842-2853. doi: 10.21873/invivo.14084.
BACKGROUND/AIM: Esophageal squamous cell carcinoma (ESCC) significantly affects nutritional status. While neoadjuvant chemotherapy (NAC) is the standard treatment for clinical stage II/III ESCC, its impact on nutritional status and postoperative outcomes remains unclear. This study investigated the relationship between nutritional deterioration during NAC and outcomes following esophagectomy.
This single-center retrospective study included 85 patients with thoracic ESCC who received NAC followed by esophagectomy between January 2019 and December 2023. The NAC regimens included cisplatin plus 5-fluorouracil (CF), administered with or without radiation, and docetaxel, cisplatin, and fluorouracil (DCF). Nutritional status and postoperative outcomes were evaluated.
Of the 85 patients, 20 received DCF, 36 received CF alone, and 29 received CF with radiation. Nutritional deterioration was noted during NAC with significant decreases in Prognostic Nutritional Index (PNI), Geriatric Nutritional Risk Index (GNRI), and hemoglobin-albumin-lymphocyte-platelet (HALP) score. Grade 3-4 hematologic toxicities correlated with reductions in GNRI and increases in neutrophil-lymphocyte ratio (NLR) (=0.004 and 0.020, respectively). An increase in NLR post-NAC and decrease in PNI post-NAC were associated with prolonged hospital stays (=0.024 and 0.042, respectively). Post-NAC NLR of 2.3 or over and HALP score below 20 were significantly associated with poorer overall survival (=0.012 and <0.001, respectively).
Although NAC reduces tumor burden and eliminates micrometastases, it potentially worsens nutritional status. Chemotherapy-induced hematologic toxicities are a risk factor for this decline. Therefore, comprehensive nutritional assessment and timely intervention during NAC are essential to optimize patient outcomes.
背景/目的：食管鳞状细胞癌（ESCC）显著影响营养状况。虽然新辅助化疗（NAC）是临床II/III期ESCC的标准治疗方法，但其对营养状况和术后结局的影响仍不明确。本研究调查了NAC期间营养恶化与食管切除术后结局之间的关系。
这项单中心回顾性研究纳入了85例胸段ESCC患者，他们在2019年1月至2023年12月期间接受了NAC，随后进行了食管切除术。NAC方案包括顺铂加5-氟尿嘧啶（CF），联合或不联合放疗，以及多西他赛、顺铂和氟尿嘧啶（DCF）。评估了营养状况和术后结局。
85例患者中，20例接受DCF，36例仅接受CF，29例接受CF联合放疗。在NAC期间观察到营养恶化，预后营养指数（PNI）、老年营养风险指数（GNRI）和血红蛋白-白蛋白-淋巴细胞-血小板（HALP）评分显著下降。3-4级血液学毒性与GNRI降低和中性粒细胞-淋巴细胞比值（NLR）升高相关（分别为=0.004和0.020）。NAC后NLR升高和NAC后PNI降低与住院时间延长相关（分别为=0.024和0.042）。NAC后NLR≥2.3和HALP评分<20与较差的总生存期显著相关（分别为=0.012和<0.001）。
虽然NAC可减轻肿瘤负荷并消除微转移，但它可能会使营养状况恶化。化疗引起的血液学毒性是这种下降的危险因素。因此，在NAC期间进行全面的营养评估和及时干预对于优化患者结局至关重要。
