Preoperative Immunotherapy Combined with Chemotherapy: Evaluation of Nutritional and Immune-inflammatory Status in ESCC and Its Impact on Perioperative Period

Abstract

Objectives To investigate the effects of neoadjuvant therapy (NT) on the nutritional and immune-inflammatory status of patients with esophageal squamous cell carcinoma (ESCC), and to identify the relevant indicators that influence adverse perioperative outcomes. Methods From March 2021 to March 2024, a retrospective study was conducted on 78 patients clinically diagnosed ESCC who underwent surgery following immunotherapy and chemotherapy. The nutritional and immune-inflammatory status of pre-NT and pre-operation were compared, and logistic regression model and linear regression model were employed to investigate the indicators influencing postoperative complications and the duration of postoperative hospitalization. Results The malnutrition rates pre-NT and pre-operation were 37.2% and 44.9% respectively, p = 0.329. Preoperative indicators of nutritional status decreased compared with those pre-NT, but the differences were not statistically significant. The systemic immune-inflammation index (SII), white blood cell (WBC), neutrophil (NE) and platelet (PLT) counts showed significant decrease pre-operation compared to pre-NT (p < 0.05), while lymphocyte (LYC) and monocyte (MO) counts also decreased but not significantly (p > 0.05). Malnutrition under GLIM criteria was identified as an independent risk factor for postoperative complications (OR 11.366, 95% CI 1.079; 119.706, p = 0.043), and a reduction in intake by 50%-75% was an independent risk factor for prolonged postoperative hospital stay (OR 6.651, 95% CI 2.653; 10.648, p = 0.001). Conclusion The prevalence of malnutrition in patients with ESCC is high. Preoperative NT is not a primary factor exacerbating malnutrition but does suppress the body's immune-inflammatory status. In clinical practice, the predictive value of malnutrition under GLIM criteria and its indicators for adverse perioperative outcomes is significantly greater.