• Collaborative education
• Empowerment
• Esophageal cancer
• Psychological distress
• Quality of life

• 23YXYJ0188 Xi 'an Science and technology plan project

• Disease free survival
• Esophageal squamous cell carcinoma
• Overall survival
• Risk factors
• Survival analysis

• Esophageal cancer
• LSR
• PNI
• Radiotherapy

• Humans
• Male
• Female
• Retrospective Studies
• Prognosis
• Aged
• Esophageal Neoplasms/radiotherapy
• Esophageal Neoplasms/mortality
• Esophageal Neoplasms/pathology
• Esophageal Squamous Cell Carcinoma/radiotherapy
• Esophageal Squamous Cell Carcinoma/mortality
• Esophageal Squamous Cell Carcinoma/pathology
• Nutrition Assessment
• Middle Aged
• Aspartate Aminotransferases/blood
• Alanine Transaminase/blood
• Aged, 80 and over
• Radiotherapy, Intensity-Modulated/adverse effects
• Survival Rate

• KC2023-JX-0186-PM017 Beijing Science and Technology Innovation Medical Development Foundation

• Esophageal cancer
• Uganda
• districts
• ethnicity
• sub-regions

• Humans
• Esophageal Neoplasms/ethnology
• Esophageal Neoplasms/therapy
• Uganda/epidemiology
• Male
• Female
• Middle Aged
• Retrospective Studies
• Aged
• Ethnicity/statistics & numerical data
• Adult

No study has reported the risk stratification of BMI and PNI in patients with locally advanced esophageal squamous cell carcinoma (ESCC) undergoing definitive chemoradiotherapy (dCRT). This study aimed to construct a risk stratification to guide the treatment of ESCC following dCRT.

A total of 1,068 patients with locally advanced ESCC who received dCRT were retrospectively analyzed. The impacts of clinicopathological factors on overall survival (OS) and progression-free survival (PFS) were analyzed. Besides, the novel prognostic indices of pre-therapeutic nutritional index (PTNI) and prognostic index (PI) were developed.

The median follow-up period of OS and PFS were 22.9 and 17.4 months, respectively. The high body mass index (BMI) group had better 5-year OS and PFS (36.4 and 34.0%) than the low BMI group (18.8 and 17.2%). The high prognostic nutritional index (PNI) group also had better 5-year OS and PFS (33.4 and 30.9%) than the low PNI group (17.5 and 17.2%). Multivariate Cox regression analysis showed that BMI and PNI were independent prognostic factors for OS and PFS. Based on nutritional indices, patients were categorized into the low-risk (PTNI = 1), medium-risk (PTNI = 2), and high-risk (PTNI = 3) groups with 5-year OS rates of 38.5, 18.9, 17.5%, respectively (p < 0.001) and 5-year PFS rates of 35.8, 17.6, 16.8%, respectively (p < 0.001). Besides, we also constructed a prognostic index (PI) for OS and PFS which was calculated based on statistically significant factors for predicting OS and PFS. The results revealed that the high-risk group had worse OS and PFS than the low-risk group (p < 0.001). Finally, RCS analysis demonstrated a non-linear relationship between the PNI, BMI, and survival for patients with ESCC. The death hazard of PNI and BMI sharply decreased to 41.8 and 19.7.

The decreased pre-therapeutic BMI and PNI levels were associated with a worse survival outcome. BMI and PNI are readily available and can be used to stratify risk factors for locally advanced ESCC patients undergoing dCRT. The novel risk stratification may help to evaluate patients’ pre-therapeutic status and guide dCRT for locally advanced ESCC patients.

• body mass index
• definitive chemoradiotherapy
• esophageal squamous cell carcinoma
• nutritional indices
• prognostic nutritional index
• risk stratification

• alcohol drinking
• body mass index
• esophageal neoplasm
• prognosis
• squamous cell carcinoma

• The Medical Scientific Research Foundation of Guangdong Province of China

• esophageal cancer
• postoperative complications
• prognosis
• prognostic nutritional index

• Esophageal cancer
• Esophageal squamous cell carcinoma
• Neoadjuvant chemoradiotherapy
• Survival

This study aimed to investigate the potential determining epidemiological and clinical risk factors affecting the survival of esophageal cancer (EC) patients across multiple hospitals in China.

This was a multicenter study comprising of newly diagnosed EC cases from Beijing, Hebei, Henan, Hubei, Zhejiang, and Guangdong Province of China. Their baseline characteristics and treatment methods data were collected from their medical records. The EpiData software was used for data quality control. The Kaplan‐Meier method was used to estimate their overall survival (OS), and the Cox's proportional hazard regression model was used to estimate hazard ratios (HR) and 95% confidence interval (CI).

The 3‐ and 5‐year OS rates of the 5283 investigated EC patients were 49.98% and 39.07%, respectively. Their median survival was 36.00 months. The median survival time of females was longer than that of males (females vs. males: 45.00 vs. 33.00, P < 0.001). The 5‐year OS rate of patients who never‐smoked was higher than that of smokers (never‐smokers vs smokers: 40.73% vs. 37.84%, P = 0.001). There was no significant difference in the 5‐year OS rate between drinkers and never‐drinkers (drinkers vs never‐drinkers: 34.22% vs. 29.65%, P = 0.330). In multivariate analysis, pathological stage (stage II: HR = 1.80, 95% CI = 1.40‐2.31; stage III: HR = 2.62, 95% CI = 2.06‐3.34; stage IV: HR = 3.90, 95% CI = 2.98‐5.09), poor differentiation/undifferentiated (HR = 1.34, 95% CI = 1.11‐1.63), not married status (HR = 2.45, 95% CI = 1.49‐4.04), production and service personnel (HR = 1.36, 95% CI = 1.01‐1.83) and farming/fishing (HR = 1.40, 95% CI = 1.12‐1.76) were independent prognostic risk factors for poor EC survival. Tumors in the thoracic or abdominal part of the esophagus, female and family history of any cancer were independent factors predictive of a good EC OS.

Gender, marital status, occupation, family history of any cancer, tumor topographical site, differentiation status, and pathological stage were associated with the survival rate of EC. This study reveals important clinical characteristics of esophageal cancer patients in China and provides helpful information for their clinical management and surveillance.

• clinical factors
• epidemiology
• esophageal cancer
• lifestyle
• multicenter study
• overall survival
• risk factors

The prognostic nutritional index (PNI), an immunity and nutrition based prognostic score, was correlated with clinical outcomes in different tumors. However, the prognostic significance of PNI has not been investigated in hormone sensitive prostate cancer (PCa). The objective of this study was to determine the prognostic significance of PNI in hormone sensitive PCa.

Two hundred eighty PCa patients undergoing androgen deprivation therapy (ADT) as first line therapy at three centers were enrolled. The serum albumin levels and peripheral lymphocyte count were measured at the time of diagnosis. PNI was calculated as 10 * serum albumin (g/dL) + 0.005 * total lymphocyte count (per mm3). Patients were categorized in two groups using a cut-off point of 50.2 as calculated by the receiver-operating curve analysis. Univariate and multivariate cox regression analyses were performed to evaluate PNI as a favorable prognostic factor for progression-free survival (PFS), cancer-specific survival (CSS) and overall survival (OS). Prognostic accuracy was evaluated with the Harrell concordance index.

Multivariate analyses identified PNI as an independent prognostic indicator with respect to PFS (hazard ratio (HR) = 0.521, p = 0.001), CSS (HR = 0.421, p = 0.002) and OS (HR = 0.429, p = 0.001). Patients with elevated PNI had better clinical outcomes. The addition of PNI to the final models improved predictive accuracy (c-index: 0.758, 0.830 and 0.782) for PFS, CSS and OS compared with the clinicopathological base models (c-index: 0.736, 0.801 and 0.752), which included Gleason score and incidence of metastasis.

Elevated pretreatment PNI was a favorable prognostic indicator for PCa patients treated with ADT.

• Prognostic factor
• Prognostic nutritional index
• Prostate cancer
• Survival

• Chemoradiotherapy
• chemotherapy
• esophageal cancer
• squamous cell carcinoma
• survival

Background: Esophageal squamous cell carcinoma (ESCC) is one of the most aggressive tumor types worldwide, and malnutrition prevails in these patients. However, there is no preoperative nutritional assessment tool specifically designed for patients with ESCC.

Methods: Patients who received esophagectomy from 2004 to 2016 were consecutively included. The preoperative nutritional risk factors for ESCC were screened by univariate and multivariate Cox regression analysis to construct a new nutritional scoring tool. A prognostic model of ESCC based on the new scoring tool was further proposed.

Results: A total of 510 ESCC patients were enrolled. A novel BLUT (BMI-lymphocyte-uric acid-triglyceride) scoring tool based on BMI, lymphocyte count, uric acid level, and triglyceride level was proposed, which could effectively predict the prognosis of ESCC patients (log rank P<0.001), and it was better than the traditional nutritional assessment tools. The C-index and 95% confidence interval (CI) of the nomogram based on the BLUT scoring tool was 0.735(0.698-0.772). It had good prognostic efficacy and was significantly better than the model based on T stage and N stage (P=0.038). The calibration curve of internal and external validation suggested a good fitting effect with the real situation in judging the 1-year, 3-year, and 5-year survival status.

Conclusions: The BULT scoring tool could distinguish the heterogeneity of preoperative nutritional status and the BLUT-based nomogram had good prognostic performance for ESCC patients.

• esophageal squamous cell carcinoma
• nutritional assessment tool
• prognostic model

Clinicopathological characteristics and prognosis of esophageal cancer (EC) patients with decreased prognostic nutritional index (PNI) have not been well investigated. So, we conducted this meta‐analysis. We performed comprehensive research in PubMed, Embase, and Cochrane databases. The effect size was hazard ratio (HR) with 95% confidence interval (CI) for overall survival (OS) and cancer‐specific survival (CSS). The pooled odds ratio (OR) with 95% CI were used to assess the association between PNI and clinicopathological features. A total of 3,425 EC patients were included in the present meta‐analysis. Male patients, advanced age, higher tumor stage, and lymph node metastases were associated with reduced PNI level (OR = 1.40, 95% CI: 1.10‐1.79; OR = 1.35, 95% CI: 1.10‐1.66; OR = 2.37, 95% CI: 1.91‐2.94; OR = 1.63, 95% CI: 1.04‐2.56). And, the EC patients with decreased PNI held a worse OS and CSS compared with those who carried a higher PNI (HR = 1.29, 95% CI: 1.10‐1.50; HR = 2.53, 95% CI: 1.15‐5.57). This meta‐analysis demonstrated PNI level was associated with tumor stage and lymph nodes metastases and was an independent prognostic factor in EC.

• esophageal cancer
• meta-analysis
• pretreatment
• prognosis
• prognostic nutritional index

The purpose of the present study is to investigate the utility of prognostic nutritional index (PNI) as a simple and readily available marker in esophageal squamous cell carcinoma (ESCC).

We retrospectively analyzed 169 patients who underwent potentially curative esophagectomy, for histologically verified ESCC. We decided to set the optimal cutoff value for preoperative PNI levels at 49.2, based on the cancer-specific survival (CSS) and the overall survival (OS) by receiver operating characteristic curve analysis.

Multivariate logistic regression analysis identified that TNM pStage III [hazard ratio (HR) 3.261, p < 0.0001] and PNI < 49.2 (HR 3.887, p < 0.0001) were confirmed as independent poor predictive factors for CSS, and age >70 (HR 2.024, p < 0.0042), TNM pStage III (HR 2.510, p = 0.0002), and PNI < 49.2 (HR 2.248, p = 0.0013) were confirmed as independent poor predictive factors for OS. In non-elderly patients, TNM pStage III (CSS; HR 3.488, p < 0.0001, OS; HR 2.615, p = 0.0007) and PNI < 49.2 (CSS; HR 3.849, p < 0.0001, OS; HR 2.275, p = 0.001) were confirmed as independent poor predictive factors for CSS, and OS when multivariate logistic regression analysis was applied. But in elderly patients, univariate analyses demonstrated that the TNM pStage III was the only significant risk factor for CSS (HR 3.701, p = 0.0057) and OS (HR 1.974, p = 0.0224).

The PNI was a significant and independent predictor of CSS and OS of ESCC patients after curative esophagectomy. The PNI was cost-effective and readily available, and it could act as a marker of survival.

• body mass index (bmi)
• esophagectomy
• meta-analysis
• prognosis

• Body Mass Index
• Carcinoma/complications
• Carcinoma/pathology
• Carcinoma/surgery
• Disease-Free Survival
• Esophageal Neoplasms/complications
• Esophageal Neoplasms/pathology
• Esophageal Neoplasms/surgery
• Esophagectomy/adverse effects
• Esophagectomy/methods
• Humans
• Overweight/complications
• Overweight/diagnosis
• Postoperative Complications/etiology
• Postoperative Complications/prevention & control
• Risk Adjustment/methods

Inflammation plays a critical role in cancer prognosis. In the current study, we proposed a novel inflammation-based prognostic score, named c-reactive protein/prognostic nutritional index ratio (CRP/PNI ratio), for predicting the prognosis for patients with resectable esophageal squamous cell carcinoma (ESCC).

The optimal cut-off value was 0.10 for CRP/PNI ratio according to the ROC curve. Patients with CRP/PNI ratio ≤0.10 had a significantly better 5-year CSS compared to CRP/PNI ratio >0.10 (44.5% vs. 15.7%, P<0.001). On multivariate analyses, we revealed that CRP/PNI ratio was a significant predictive factor of CSS (P=0.009). A nomogram could be more accuracy for CSS. The Harrell's c-index for CSS prediction was 0.688.

A total of 308 patients with resectable ESCC were enrolled in this retrospective study. The optimal cuf-off value for CRP/PNI ratio was calculated by a receiver operating characteristic (ROC) curve. Kaplan-Meier methods were used to analyse the cancer-specific survival (CSS). Univariate and multivariate analyses were evaluated for CSS. A nomogram was also established to predict the prognosis for CSS.

The CRP/PNI ratio is a novel and useful prognostic score for CSS in patients with resectable ESCC.

• c-reactive protein (CRP)
• cancer-specific survival (CSS)
• esophageal squamous cell carcinoma (ESCC)
• prognostic nutritional index (PNI)

The present study was designed to investigate the prognostic significance of the preoperative sensitive-modified Glasgow prognostic score (S-mGPS) and its superiority in esophageal squamous cell carcinoma (ESCC). Clinicopathologic characteristics, preoperative albumin and C-reactive protein (CRP) levels were retrospectively collected in 442 patients who underwent transthoracic esophagectomy. The S-mGPS was calculated before surgery based on optimal cutoff values of 45.6 g/L for albumin and 10.0 mg/L for CRP. 360, 74 and 8 cases were assigned an mGPS of 0, 1 and 2, respectively. In contrast, the S-mGPS was 0 in 114, 1 in 258 and 2 in 70 patients. Of the 360 patients with an mGPS of 0, 246 migrated to the S-mGPS-1 group. Both mGPS and S-mGPS were significantly correlated with tumor length, depth of invasion, pathological tumor-node-metastasis (pTNM) stage and adjuvant treatment. In addition, they were significantly associated with disease free survival (DFS) and overall survival (OS) in univariate analysis. Furthermore, multivariate Cox regression analysis identified S-mGPS as an independent prognostic indicator for both DFS [hazard ratio (HR), 1.577; 95% confidence interval (CI), 1.149-2.163; P = 0.005] and OS (HR, 1.762; 95% CI, 1.250-2.484; P = 0.001), but not mGPS (HR, 0.957; 95% CI, 0.692-1.323; P = 0.790 for DFS and HR, 1.089; 95% CI, 0.781-1.517; P = 0.615 for OS, respectively). Moreover, subgroup analysis revealed that the prognostic impact of the S-mGPS was especially striking in pTNM stage II patients. The preoperative S-mGPS is superior to the mGPS as a prognostic predictor in patients with resectable ESCC.

• esophageal squamous cell carcinoma
• modified Glasgow prognostic score
• superiority
• survival

This study evaluated the prognostic effects of nutritional risk scores and performance status (PS) on unresectable locally advanced esophageal cancer (LAEC) patients who were treated with definitive concurrent chemoradiotherapy (dCRT). A total of 202 LAEC patients from four different cancer centers were retrospectively reviewed. Nutritional risk and PS were measured using the Nutritional Risk Screening 2002 (NRS-2002) scores and Eastern Cooperative Oncology Group (ECOG) scales. Outcomes were clinical response rate, overall survival (OS) and progression-free survival (PFS). Multivariate analysis of predictive factors of response to dCRT and survival were performed using a logistic regression and a Cox model, respectively. The majority of patients (71.8%) had an ECOG PS score of 0-1, and 52.5% (n=106) of patients were identified as having nutritional risk (NRS-2002 ≥3) upon treatment initiation. There was no correlation between NRS-2002 scores and ECOG PS (Spearman's ρ=0.046; P=0.516). In multivariate analysis, NRS-2002 scores (P=0.002, HR 2.805, 95%CI: 1.445-5.446) and ECOG PS (P=0.015, HR 2.719, 95%CI: 1.218-6.067) were independent prognostic factors for the response to dCRT. NRS-2002 scores (OS: HR 1.530, 95%CI 1.059-2.209; P=0.023; PFS: HR 1.517, 95%CI 1.105-2.082; P=0.010) and ECOG PS (OS: HR 1.729, 95%CI 1.185-2.522; P=0.005; PFS: HR 1.678, 95%CI 1.179-2.387; P=0.004) were both independent prognostic factors for OS and PFS. In conclusions, NRS-2002 scores and ECOG PS scales both have prognostic effects on clinical response and survival in LAEC, but a significant association of NRS-2002 scores and ECOG PS were not observed.

• ECOG PS
• NRS-2002
• esophageal cancer
• survival
• treatment response

• cytokeratin 19 fragments
• esophageal squamous cell carcinoma
• neutrophil/lymphocyte ratio
• postoperative complication
• survival

As smoking affects the body mass index (BMI) and causes the risk of esophageal squamous cell carcinoma (ESCC), the prognostic impact of BMI in ESCC could be stratified by smoking status. We investigated the true prognostic effect of BMI and its potential modification by smoking status in ESCC.

We retrospectively analyzed 459 patients who underwent curative treatment at a single institution between January 2007 and December 2010. BMI was calculated using the measured height and weight before surgery. Chi-square test was used to evaluate the relationships between smoking status and other clinicopathological variables. The Cox proportional hazard models were used for univariate and multivariate analyses of variables related to overall survival.

BMI <18.5 kg/m² was a significantly independent predictor of poor survival in the overall population and never smokers after adjusting for covariates, but not in ever smokers. Among never smokers, underweight patients (BMI <18.5 kg/m²) had a 2.218 times greater risk of mortality than non-underweight (BMI ≥18.5 kg/m²) patients (P=0.015). Among ever smokers, BMI <18 kg/m² increased the risk of mortality to 1.656 (P=0.019), compared to those having BMI ≥18 kg/m².

Our study is likely the first to show that the prognostic effect of BMI was substantial in ESCC, even after stratifying by smoking status. Furthermore, the risk of death due to low BMI would be significantly increased in never smokers. We believe that the prognostic impact of BMI is modified but not eliminated by the smoking status in ESCC.

• BMI
• ESCC
• body mass index
• esophageal squamous cell carcinoma
• prognosis
• smoking
• survival

• Esophageal cancer
• Prognosis
• Prognostic nutritional index
• Squamous cell carcinoma
• Systemic inflammation score

• Adult
• Aged
• Aged, 80 and over
• Carcinoma, Squamous Cell/mortality
• Carcinoma, Squamous Cell/pathology
• Carcinoma, Squamous Cell/surgery
• Esophageal Neoplasms/mortality
• Esophageal Neoplasms/pathology
• Esophageal Neoplasms/surgery
• Esophageal Squamous Cell Carcinoma
• Esophagectomy
• Female
• Humans
• Inflammation/pathology
• Male
• Middle Aged
• Nutrition Assessment
• Prognosis
• ROC Curve
• Retrospective Studies
• Serum Albumin/analysis

The prognostic nutritional index (PNI) is related to the prognosis in many cancers; however, its role in esophageal cancer is still controversial. Further, controversy exists concerning the optimal cut-off points for PNI to predict survival. The aim of this study was to determine the prognostic value of PNI and propose the optimal cut-off points for PNI in predicting cancer-specific survival (CSS) in esophageal squamous cell carcinoma (ESCC).

This retrospective study included 375 patients who underwent esophagectomy for ESCC. The PNI was calculated as 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per mm³). With the help of the fit line on the scatter plot, we classified the patients into three categories according to the PNI, ie, >52, 42–52, and <42.

Our study showed that PNI was associated with tumor length (P=0.007), T grade (P=0.001), and N staging (P<0.001). The 5-year CSS in patients with PNI <42, 42–52, and >52 were 11.0%, 39.1%, and 55.2%, respectively (P<0.001). Multivariate analysis showed that PNI was a significant predictor of CSS (42–52 versus >52, P=0.011; <42 versus PNI >52, P<0.001).

PNI is a predictive factor for long-term survival in ESCC. The survival rate of ESCC can be discriminated between three groups, ie, PNI <42, 42–52, and >52.

• esophageal squamous cell carcinoma
• prognostic factor
• prognostic nutritional index
• survival