Prognostic Importance of Controlling Nutritional Status in Patients Undergoing Curative Thoracoscopic Esophagectomy for Esophageal Cancer

Abstract

It is now clear that cancer survival is determined not only by tumor pathology but also by host-related factors, in particular, nutritional status and systemic inflammation. It is desirable that the essential properties of any scale designed or intended to be used for the prediction of survival are simple, convenient, and objective. In this study, we retrospectively reviewed the database of patients who underwent curative surgery for esophageal cancer in our department to evaluate controlling nutritional status (CONUT) and neutrophil–lymphocyte ratio (NLR) as predictors of cancer-specific survival (CSS) after esophagectomy. We retrospectively reviewed the database of 148 consecutive patients who underwent potentially curative surgery for histologically verified esophageal squamous cell carcinoma at our institute between January 2002 and December 2014. CONUT and NLR were calculated. On multivariate analysis, pTNM stage (P < 0.0001) and CONUT (P = 0.0291) were independently associated with worse prognosis. Multivariate analysis evaluated the prognostic factors in 2 different patient groups: patients younger than 70 years (nonelderly) and those aged 70 years or more (elderly). Multivariate analysis demonstrated that pTNM stage (P = 0.0083) and CONUT (P = 0.0138) were the independent risk factors for a worse prognosis among the nonelderly group, whereas univariate analysis demonstrated that pTNM stage (P = 0.0002) was the only independent risk factor for a worse prognosis among the elderly group. CONUT was a significant predictor of CSS in patients with esophageal cancer in this study. However, pTNM stage remained a significantly more powerful predictor of CSS. Therefore, the results of this study suggested that CONUT and pTNM stage are the significant and complementary factors predicting survival in patients with esophageal cancer. But, this study failed to confirm the NLR as a significant predictor of CSS after resection for esophageal cancer.

Nutritional Management of Esophageal Cancer Patients

“…Consequently, the duration of hospital stay in patients with moderate or severe malnutrition was significantly longer compared to well-nourished or slightly malnourished patients [30]. Similarly, Hirahara et al [31] and Toyokawa et al [32] demonstrated that CONUT was significantly associated with cancer death and poorer disease-free survival in patients with resectable esophageal squamous cell carcinoma. NRI is another tool used for the assessment of malnutrition based on serum albumin concentration and weight loss.…”

Preoperative Immune-Nutritional Abnormality Predicts Poor Outcome in Elderly Non-Small-Cell Lung Cancer Patients with Comorbidities

“…In addition, multivariate analysis showed that the CONUT score was an independent risk factor for CSS in surgically resected colorectal cancer patients. Hirahara et al 13) also presented that the CONUT score was a significant predictor of CSS in surgically resected esophageal cancer patients and the CONUT score was a significant predictor of CSS in patients with surgically resected esophageal cancer in the multivariate analysis. We also recently have shown that DFS, CS, and OS in patients with early-staged NSCLC with an abnormal CONUT score were significantly shorter than those in patients with a normal CONUT score and the CONUT score was an independent predictive factor of DFS, CSS, and OS.…”

A retrospective study on the prognostic value of preoperative neutrophil/lymphocyte ratio in patients with primary small-cell carcinoma of the esophagus

“…Several studies have shown NLR to be predictive of outcomes in ECs 25–29. However, the cutoff values for elevated NLR varied in these studies.…”

“…However, the cutoff values for elevated NLR varied in these studies. In these studies investigating NLR in EC, the cutoff value was mean/median value25,26 or was determined with ROC analysis27,28 or accepted as the cutoff value as in previous studies 29,30. The patients were classified according to a cutoff value (3.5) accepted as in a previous study by Feng et al,24 whereas in the present study, the cutoff value was determined by using the ROC analysis and it was calculated to be 2.97 by using a time-dependent ROC curve.…”