| Background and aims:Esophageal cancer is one of the cancer types with high morbidity and mortality worldwide,and the probability of malnutrition in patients with esophageal cancer is very high,which severely affects postoperative quality of life and long-term prognosis.Nutrition assessment and treatment play a very important role in the treatment of esophageal cancer.However,there is no nutritional assessment tool specifically designed for patients with esophageal squamous cell carcinoma before surgery.Therefore,we designed this retrospective study to compare the efficacy of traditional scoring tools in preoperative nutritional assessment of patients with esophageal squamous cell carcinoma.Besides,a new nutritional scoring tool for patients with esophageal squamous cell carcinoma was proposed based on preoperative general condition assessment and laboratory tests.Furthermore,a prognostic model of esophageal squamous cell carcinoma based on preoperative nutritional assessment tool was proposed.MethodsPatients who received surgical treatment of esophageal cancer at the Department of Thoracic Surgery,the First Affiliated Hospital,Zhejiang University School of Medicine from January 1,2004 to December 31,2016 were consecutively included.The clinical and pathological information of these patients were collected through the electronic medical record system.All patients were followed up and the cohort was divided into the training set and validation set.The efficacy of traditional nutrition scoring tools,such as nutritional prognostic index(PNI),controlling nutritional status(CONUT)and geriatric nutritional risk index(GNRI),was evaluated.The preoperative nutritional risk factors for esophageal squamous cell carcinoma were screened by univariate and multivariate cox regression analysis to construct a new BLUT(BMI-lyphocyte-uric acid-triglyceride)scoring tool,which was based on BMI,lymphocyte count,uric acid level,and triglyceride level.The efficacy of BLUT and conventional nutritional scoring tools was compared,and we further proposed a prognostic model of esophageal squamous cell carcinoma based on BLUT scores,which was shown in the form of a nomogram.The internal validation and external validation were conducted to demonstrate the validity of the model.ResultsA total of 510 patients with esophageal squamous cell carcinoma were enrolled in this study and there were 408 cases in the training set and 102 cases in the validation set.Middle esophageal cancer patients accounted for 69.61%,and male accounted for 87.06%.The mean age was 63.16 years and 86.47%of patients received Sweet or Ivor-Lewis resection of esophageal cancer.Traditional nutritional scoring tools such as PNI(log rank P=0.153),CONUT(log rank P=0.098)and GNRI(log rank P=0.174)could not effectively differentiate the prognosis of patients with esophageal squamous cell carcinoma.Univariate cox regression revealed that gender(P=0.008),smoking history(P=0.038),surgical approach(P=0.042),T-stage(P<0.001),N-stage(P<0.001),TNM stage(P<0.001),white blood cell count(P=0.022),lymphocyte count(P=0.036),triglyceride(P=0.004),uric acid(P=0.016)and BMI(P=0.016)were significantly associated with the prognosis of esophageal squamous cell carcinoma.Multivariate cox regression revealed that gender(P=0.003),T stage(P=0.005),N stage(P<0.001),lymphocyte count(P=0.030),white blood cell count(P=0.015),and uric acid level(P=0.007)were independent prognostic factors for esophageal squamous cell carcinoma.The BLUT scoring tool was constructed with BMI,lymphocyte counts,uric acid levels and triglyceride levels,and the model was simplified based on the number of the indicator in risk intervals.The new BLUT scoring tool could effectively distinguish the prognosis of patients with esophageal squamous cell carcinoma(log rank P<0.001),and it was an independent prognostic factor for esophageal squamous cell carcinoma(P=0.003).Compared with traditional scoring tools,BLUT had a more reasonable population interval distribution,a higher C-index and smaller AIC value.The C-index and 95%confidence interval of the nomogram based on the BLUT scoring tool was 0.735(0.698-0.772),and the AIC value was 1864.76.It had good prognostic efficacy and was significantly better than traditional model based on T stage and N stage(P=0.038).The calibration curve of internal validation suggested that the new prognostic model had a high degree of similarity with the real situation in judging the 1-year,3-year,and 5-year prognosis,and had a good fitting effect.The external validation results suggested that the consistency was good,indicating that the BLUT scoring-based esophageal cancer prognosis model could be applied to other population cohorts.ConclusionThe traditional nutritional scoring tools,such as PNI,CONUT and GNRI,have limited efficacy in preoperative nutritional assessment of esophageal squamous cell carcinoma.A new BLUT scoring tool was proposed.Compared with traditional scoring tools,the BULT scoring tool could distinguish the difference in preoperative nutritional risk more effectively.In addition,the BLUT-based prognostic model of esophageal squamous cell carcinoma had good prognostic effectiveness and can accurately determine the postoperative survival status of patients with esophageal squamous cell carcinoma. |
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