Long-term Impact Of Prognostic Nutritional Index In Cervical Esophageal Squamous Cell Carcinoma Received Definitive Radiotherapy

【Objective】According to global cancer statistics in 2018,the incidence of esophageal cancer in China ranks fifth in the world.Cervical esophageal cancer(CEC)accounts for only 2%-10% of all esophageal cancers,but 95% of CECs are squamous cell carcinoma.The 5-year survival rate after radical chemoradiotherapy(CRT)is only 30%,requiring more effective interventions to improve survival and more accurate indicators to guide prognosis.In recent years,the nutritional,inflammatory,and immune status of cancer patients has been attracted much attention to tumors.The prognostic nutritional index(PNI)is the sum of albumin plus 5-fold lymphocyte counts,which is a representative,simple,and effective indicator of systemic nutritional immune inflammatory response.It has been reported that PNI is significantly associated with prognosis in a variety of malignant tumors dominated by digestive tract tumors.This study investigated the prognostic impact of PNI on long-term survival after radiotherapy for cervical esophageal squamous cell carcinoma(CESCC).【Patients and methods】106 patients with CESCC who underwent radiotherapy(RT)+/-chemotherapy(CT)at the Cancer Hospital of Fujian Medical University from June 1,2000 to December 31,2015 were collected and analyzed.All patients received a total dose of 50-70 Gy of radiation therapy,5 times a week for 5-6 weeks,and some of them received synchronous platinum-based chemotherapy.Collect basic information of patients,history characteristics,laboratory and image-assisted examination data,survival information,calculate systemic nutrition,immunity and inflammation related indicators such as PNI according to serum indicators before and after chemotherapy,and calculate the optimal cutoff value with Cutoff Finder.Patients were divided into gender,age,radiotherapy,radiotherapy dose,synchronous chemotherapy,TN staging,and bone marrow suppression after treatment.The cutoff length,body mass index(BMI),LMR,NLR,PLR,CEI,SII,PNI,etc.were calculated by Cutoff Finder.Pearson chi-square test was used to assess the correlation between different categorical variables,and Spearman correlation analysis was used to evaluate the correlation between PNI and other clinicopathological factors.The Kaplan-Meier method was used to analyze the influence of various clinicopathological features and indicators on the long-term prognosis of CESCC.The Cox proportional hazard model was used to analyze the all clinical factors to determine the independent prognostic factors of CESCC.【Results】106 patients met the enrollment conditions,with a median follow-up time of 19.5 months(2-190 months),and 1 year,2 years,3 years,and 5 years of OS were 75.5%,46.2%,39.4%,and 28.3%,respectively.There were 79 males(74.53%)and 27 females(25.47%).The optimal cutoff value of PNI was 48.15,the area under the ROC curve was A.area 0.669,the sensitivity was 77.8%,the specificity was 55.7%,the 95% confidence interval was 0.550-0.789,and the P value was 0.009.It was divided into low PNI group(<48.15)and high PNI group(≥48.15).Univariate analysis showed low survival rate with male(P=0.004),tumor length ≥5.0CM(P=0.043),radiotherapy technics(P=0.016),synchronous chemotherapy(P=0.012),LMR(P=0.005),NLR(P=0.007),CEI(P=0.008),SII(P=0.043),PNI(P<0.001)were significantly correlated,the OS ratio of high PNI group higher than the low PNI group.In the multivariate analysis,gender(HR 2.315,95% CI 1.305-4.109;P = 0.004),radiotherapy technic(HR 0.609,95% CI 0.390-0.951;P = 0.029),and PNI(HR 0.537,95% CI 0.342-0.844;P = 0.007)were independent factors in the prognosis of CESCC receiving CRT.【Conclusions】The results of this study indicate that PNI values in patients with CESCC before CRT,age,tumor length,and radiotherapy methods are independent prognostic factors for CESCC.The PNI value is a simple,reliable,and reproducible effective indicator available for patient prognosis assessment and is worthy of being applied to clinical work.