Abstract
Background: This study aimed to compare the controlling nutritional status (CONUT) score, prognostic nutritional index (PNI), and geriatric nutritional risk index (GNRI) for predicting postoperative outcomes in patients with esophageal squamous cell carcinoma undergoing esophagectomy. Methods: We retrospectively reviewed the data of 1265 consecutive patients who underwent elective esophageal surgery. The patients were classified into no risk, low-risk, moderate-risk, and high-risk groups based on nutritional scores. Results: The moderate-risk (hazard ratio [HR]: 1.55, 95% confidence interval [CI]: 1.24–1.92, p < 0.001 in CONUT; HR: 1.61, 95% CI: 1.22–2.12, p = 0.001 in GNRI; HR: 1.65, 95% CI: 1.20–2.26, p = 0.002 in PNI) and high-risk groups (HR: 1.91, 95% CI: 1.47–2.48, p < 0.001 in CONUT; HR: 2.54, 95% CI: 1.64–3.93, p < 0.001 in GNRI; HR: 2.32, 95% CI: 1.77–3.06, p < 0.001 in PNI) exhibited significantly worse 5-year overall survival (OS) compared with the no-risk group. As the nutritional status worsened, the trend in the OS rates decreased (p for trend in all indexes < 0.05). Conclusions: Malnutrition, evaluated by any of three nutritional indexes, was an independent prognostic factor for postoperative survival.
Highlights
Esophageal cancer is the seventh most common type of malignancy and the sixth leading cause of cancer-related death worldwide, with esophageal squamous cell carcinoma (ESCC) being the main histological type in Asian countries [1]
Patients with esophageal cancer are often malnourished at diagnosis, and malnutrition is associated with poor prognosis [2]
A high controlling nutritional status (CONUT) score, low prognostic nutritional index (PNI), and low geriatric nutritional risk index (GNRI) were prognostic factors for postoperative survival in patients with esophageal cancer [9,10,11,12,13,14,15], discrepancies were observed in previous studies on postoperative morbidities [12,16,17,18]
Summary
Esophageal cancer is the seventh most common type of malignancy and the sixth leading cause of cancer-related death worldwide, with esophageal squamous cell carcinoma (ESCC) being the main histological type in Asian countries [1]. Nutritional assessment indexes, including the controlling nutritional status (CONUT) score [5], geriatric nutritional risk index (GNRI) [6], and prognostic nutritional index (PNI) [7,8] have been developed, and are used to assess the influence of nutritional status on the prognosis of esophageal cancer These indexes use different combinations of serum albumin level, peripheral total lymphocyte counts, total cholesterol levels, and anthropometric factors, such as body mass index, which are associated with nutrition and cancer progression. This study aimed to evaluate preoperative nutrition-related risks using the CONUT score, PNI, and GNRI, and compare the three indexes to identify prognostic values for postoperative outcomes after primary esophageal cancer surgery
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