Top

Published in:

Open Access 01-12-2023 | Nutrition | Research

Prognostic value of pre-therapeutic nutritional risk factors in elderly patients with locally advanced esophageal squamous cell carcinoma receiving definitive chemoradiotherapy or radiotherapy

Authors: Jianjian Qiu, Jun Yang, Yilin Yu, Zhiping Wang, Hancui Lin, Dongmei Ke, Hongying Zheng, Jiancheng Li, Qiwei Yao

Published in: BMC Cancer | Issue 1/2023

Abstract

Background

The nutritional status of cancer patients is a crucial factor in determining their prognosis. The objective of this study was to investigate and compare the prognostic value of pretreatment nutrition-related indicators in elderly esophageal squamous cell carcinoma (ESCC). Risk stratification was performed according to independent risk factors and a new nutritional prognostic index was constructed.

Methods

We retrospectively reviewed 460 older locally advanced ESCC patients receiving definitive chemoradiotherapy (dCRT) or radiotherapy (dRT). This study included five pre- therapeutic nutrition-related indicators. The optimal cut-off values for these indices were calculated from the Receiver Operating Curve (ROC). Univariate and multivariate COX analyses were employed to determine the association between each indicator and clinical outcomes. The predictive ability of each independently nutrition-related prognostic indicator was assessed using the time-dependent ROC (time-ROC) and C-index.

Results

Multivariate analyses indicated that the geriatric nutrition risk index (GNRI), body mass index (BMI), the controlling nutritional status (CONUT) score, and platelet-albumin ratio (PAR) could independently predict overall survival (OS) and progression-free survival (PFS) in elderly patients with ESCC (all p < 0.05), except for prognostic nutritional index (PNI). Based on four independently nutrition-related prognostic indicators, we developed pre-therapeutic nutritional prognostic score (PTNPS) and new nutritional prognostic index (NNPI). No-risk (PTNPS = 0–1 point), moderate-risk (PTNPS = 2 points), and high-risk (PTNPS = 3–4 points) groups had 5-year OS rates of 42.3%, 22.9%, and 8.8%, respectively (p < 0.001), and 5-year PFS rates of 44.4%, 26.5%, and 11.3%, respectively (p < 0.001). The Kaplan–Meier curves showed that the mortality of elderly ESCC patients in the high-risk group was higher than that in the low-risk group according to the NNPI.

Analysis of time-AUC and C-index revealed that the NNPI (C-index: 0.663) had the greatest predictive power on the prognosis in older ESCC patients.

Conclusions

In elderly ESCC patients, the GNRI, BMI, CONUT score, and PAR can be used as objective assessment measures for the risk of nutrition-related death. Compared to the other four indexes, the NNPI has the greatest prognostic value for prognosis, and elderly patients with a higher nutritional risk have a poor prognosis, which is helpful in guiding early clinical nutrition intervention.

Available only for authorised users

Sung H, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71:209–49. https://doi.org/10.3322/caac.21660.CrossRefPubMed

Pennathur A, Gibson MK, Jobe BA, Luketich JD. Oesophageal carcinoma. Lancet. 2013;381:400–12. https://doi.org/10.1016/S0140-6736(12)60643-6.CrossRefPubMed

Faiz Z, et al. Increased resection rates and survival among patients aged 75 years and older with esophageal cancer: a Dutch nationwide population-based study. World J Surg. 2012;36:2872–8. https://doi.org/10.1007/s00268-012-1762-2.CrossRefPubMed

van Blankenstein M, Looman CW, Siersema PD, Kuipers EJ, Coebergh JW. Trends in the incidence of adenocarcinoma of the oesophagus and cardia in the Netherlands 1989–2003. Br J Cancer. 2007;96:1767–71. https://doi.org/10.1038/sj.bjc.6603798.CrossRefPubMedPubMedCentral

Anandavadivelan P, Lagergren P. Cachexia in patients with oesophageal cancer. Nat Rev Clin Oncol. 2016;13:185–98. https://doi.org/10.1038/nrclinonc.2015.200.CrossRefPubMed

Barker LA, Gout BS, Crowe TC. Hospital malnutrition: prevalence, identification and impact on patients and the healthcare system. Int J Environ Res Public Health. 2011;8:514–27. https://doi.org/10.3390/ijerph8020514.CrossRefPubMedPubMedCentral

McMillan DC. Systemic inflammation, nutritional status and survival in patients with cancer. Curr Opin Clin Nutr Metab Care. 2009;12:223–6. https://doi.org/10.1097/MCO.0b013e32832a7902.CrossRefPubMed

Rock CL, et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin. 2012;62:243–74. https://doi.org/10.3322/caac.21142.CrossRefPubMed

Liu X, et al. Prognostic significance of pretreatment serum levels of albumin, LDH and total bilirubin in patients with non-metastatic breast cancer. Carcinogenesis. 2015;36:243–8. https://doi.org/10.1093/carcin/bgu247.CrossRefPubMed

10.

Mayne ST, Playdon MC, Rock CL. Diet, nutrition, and cancer: past, present and future. Nat Rev Clin Oncol. 2016;13:504–15. https://doi.org/10.1038/nrclinonc.2016.24.CrossRefPubMed

11.

Lv GY, An L, Sun DW. Geriatric nutritional risk index predicts adverse outcomes in human malignancy: a meta-analysis. Dis Markers. 2019;2019:4796598. https://doi.org/10.1155/2019/4796598.CrossRefPubMedPubMedCentral

12.

Toyokawa T, et al. The pretreatment Controlling Nutritional Status (CONUT) score is an independent prognostic factor in patients with resectable thoracic esophageal squamous cell carcinoma: results from a retrospective study. BMC Cancer. 2016;16:722. https://doi.org/10.1186/s12885-016-2696-0.CrossRefPubMedPubMedCentral

13.

Feng J, Wang L, Yang X, Chen Q, Cheng X. The usefulness of pretreatment controlling nutritional status score for predicting recurrence in patients with esophageal squamous cell carcinoma undergoing neoadjuvant immunochemotherapy: A real-world study. Front Immunol. 2022;13:1015365. https://doi.org/10.3389/fimmu.2022.1015365.CrossRefPubMedPubMedCentral

14.

Okadome K, et al. Prognostic Nutritional Index, Tumor-infiltrating Lymphocytes, and Prognosis in Patients with Esophageal Cancer. Ann Surg. 2020;271:693–700. https://doi.org/10.1097/SLA.0000000000002985.CrossRefPubMed

15.

Zheng, Z., Zhu, H. & Cai, H. Preoperative Prognostic Nutritional Index Predict Survival in Patients With Resectable Esophageal Squamous Cell Carcinoma. Front Nutr (2022)9:824839https://doi.org/10.3389/fnut.2022.824839.

16.

Huang Z, et al. Prognostic significance of platelet-to-albumin ratio in patients with esophageal squamous cell carcinoma receiving definitive radiotherapy. Sci Rep. 2022;12:3535. https://doi.org/10.1038/s41598-022-07546-0.CrossRefPubMedPubMedCentral

17.

Dogan Akagunduz, D. & Turker, P. F. Nutritional Support in Older Patients with Esophageal Cancer Undergoing Chemoradiotherapy. Nutr Cancer (2022) 74:3634–3639, doi:https://doi.org/10.1080/01635581.2022.2096245.

18.

Short MW, Burgers KG, Fry VT. Esophageal Cancer. Am Fam Physician. 2017;95:22–8.PubMed

19.

Smyth EC, et al. Oesophageal cancer Nat Rev Dis Primers. 2017;3:17048. https://doi.org/10.1038/nrdp.2017.48.CrossRefPubMed

20.

Caccialanza R, et al. Unmet needs in clinical nutrition in oncology: a multinational analysis of real-world evidence. Ther Adv Med Oncol. 2020;12:1758835919899852. https://doi.org/10.1177/1758835919899852.CrossRefPubMedPubMedCentral

21.

Senesse P, et al. Nutritional support during oncologic treatment of patients with gastrointestinal cancer: who could benefit? Cancer Treat Rev. 2008;34:568–75. https://doi.org/10.1016/j.ctrv.2008.03.003.CrossRefPubMed

22.

Hebuterne X, et al. Prevalence of malnutrition and current use of nutrition support in patients with cancer. JPEN J Parenter Enteral Nutr. 2014;38:196–204. https://doi.org/10.1177/0148607113502674.CrossRefPubMed

23.

Tobert CM, Mott SL, Nepple KG. Malnutrition Diagnosis during Adult Inpatient Hospitalizations: Analysis of a Multi-Institutional Collaborative Database of Academic Medical Centers. J Acad Nutr Diet. 2018;118:125–31. https://doi.org/10.1016/j.jand.2016.12.019.CrossRefPubMed

24.

Pirlich M, et al. The German hospital malnutrition study. Clin Nutr. 2006;25:563–72. https://doi.org/10.1016/j.clnu.2006.03.005.CrossRefPubMed

25.

Bo, Y. et al. The Geriatric Nutritional Risk Index Predicts Survival in Elderly Esophageal Squamous Cell Carcinoma Patients with Radiotherapy. PLoS One (2016) 11:e0155903:https://doi.org/10.1371/journal.pone.0155903.

26.

Gu, Y. M. et al. The prognostic impact of preoperative body mass index changes for patients with esophageal squamous cell carcinoma who underwent esophagectomy: A large-scale long-term follow-up cohort study. Front Nutr (2022);9:947008. https://doi.org/10.3389/fnut.2022.947008.

27.

Martin L, et al. Diagnostic criteria for the classification of cancer-associated weight loss. J Clin Oncol. 2015;33:90–9. https://doi.org/10.1200/JCO.2014.56.1894.CrossRefPubMed

28.

Zhang SS, et al. The impact of body mass index on complication and survival in resected oesophageal cancer: a clinical-based cohort and meta-analysis. Br J Cancer. 2013;109:2894–903. https://doi.org/10.1038/bjc.2013.666.CrossRefPubMedPubMedCentral

29.

Deng, H. Y. et al. High BMI has no impact on the survival of Chinese patients with lower thoracic esophageal adenocarcinoma treated with curative esophagectomy: a propensity score-matched study. Dis Esophagus (2019);32. https://doi.org/10.1093/dote/doy059.

30.

Hasegawa T, et al. Impact of body mass index on surgical outcomes after esophagectomy for patients with esophageal squamous cell carcinoma. J Gastrointest Surg. 2015;19:226–33. https://doi.org/10.1007/s11605-014-2686-y.CrossRefPubMed

31.

Gupta R, Ihmaidat H. Nutritional effects of oesophageal, gastric and pancreatic carcinoma. Eur J Surg Oncol. 2003;29:634–43. https://doi.org/10.1016/s0748-7983(03)00124-0.CrossRefPubMed

32.

Takahashi, M. et al. Comparison of three nutritional scoring systems for outcomes after complete resection of non-small cell lung cancer. J Thorac Cardiovasc Surg (2021);162, 1257–1268 e1253. https://doi.org/10.1016/j.jtcvs.2020.06.030.

33.

Oh J, et al. Association between nutritional risk index and outcomes for head and neck cancer patients receiving concurrent chemo-radiotherapy. Head Neck. 2020;42:2560–70. https://doi.org/10.1002/hed.26315.CrossRefPubMed

34.

Tang S, et al. The Value of Geriatric Nutritional Risk Index in Evaluating Postoperative Complication Risk and Long-Term Prognosis in Elderly Colorectal Cancer Patients. Cancer Manag Res. 2020;12:165–75. https://doi.org/10.2147/CMAR.S234688.CrossRefPubMedPubMedCentral

35.

Li Y, et al. Prognostic significance of the controlling nutritional status (CONUT) score in epithelial ovarian cancer. Int J Gynecol Cancer. 2020;30:74–82. https://doi.org/10.1136/ijgc-2019-000865.CrossRefPubMed

36.

Yoshida N, et al. Preoperative controlling nutritional status (CONUT) is useful to estimate the prognosis after esophagectomy for esophageal cancer. Langenbecks Arch Surg. 2017;402:333–41. https://doi.org/10.1007/s00423-017-1553-1.CrossRefPubMed

37.

Zhou P, Li B, Liu B, Chen T, Xiao J. Prognostic role of serum total cholesterol and high-density lipoprotein cholesterol in cancer survivors: A systematic review and meta-analysis. Clin Chim Acta. 2018;477:94–104. https://doi.org/10.1016/j.cca.2017.11.039.CrossRefPubMed

38.

Goh SL, De Silva RP, Dhital K, Gett RM. Is low serum albumin associated with postoperative complications in patients undergoing oesophagectomy for oesophageal malignancies? Interact Cardiovasc Thorac Surg. 2015;20:107–13. https://doi.org/10.1093/icvts/ivu324.CrossRefPubMed

39.

Damen PJJ, et al. The influence of severe radiation-induced lymphopenia on overall survival in solid tumors: a systematic review and meta-analysis. Int J Radiat Oncol Biol Phys. 2021;111:936–48. https://doi.org/10.1016/j.ijrobp.2021.07.1695.CrossRefPubMed

40.

Horsted, F., West, J. & Grainge, M. J. Risk of venous thromboembolism in patients with cancer: a systematic review and meta-analysis. PLoS Med (2012);9:e1001275. https://doi.org/10.1371/journal.pmed.1001275.

41.

Dong J, et al. Baseline nutritional status could be a predictor for radiation esophagitis in esophageal cancer patients undergoing radiotherapy. Ann Transl Med. 2020;8:1148. https://doi.org/10.21037/atm-20-4078.CrossRefPubMedPubMedCentral

42.

Yang Y, et al. Platelet to lymphocyte ratio is a predictive marker of prognosis and therapeutic effect of postoperative chemotherapy in non-metastatic esophageal squamous cell carcinoma. Clin Chim Acta. 2018;479:160–5. https://doi.org/10.1016/j.cca.2018.01.013.CrossRefPubMed

43.

Grivennikov SI, Greten FR, Karin M. Immunity, inflammation, and cancer. Cell. 2010;140:883–99. https://doi.org/10.1016/j.cell.2010.01.025.CrossRefPubMedPubMedCentral

44.

Lobo DN, et al. Perioperative nutrition: Recommendations from the ESPEN expert group. Clin Nutr. 2020;39:3211–27. https://doi.org/10.1016/j.clnu.2020.03.038.CrossRefPubMed

Title: Prognostic value of pre-therapeutic nutritional risk factors in elderly patients with locally advanced esophageal squamous cell carcinoma receiving definitive chemoradiotherapy or radiotherapy
Authors: Jianjian Qiu
Jun Yang
Yilin Yu
Zhiping Wang
Hancui Lin
Dongmei Ke
Hongying Zheng
Jiancheng Li
Qiwei Yao
Publication date: 01-12-2023
Publisher: BioMed Central
Keywords: Nutrition
Radiotherapy
Published in: BMC Cancer / Issue 1/2023
Electronic ISSN: 1471-2407
DOI: https://doi.org/10.1186/s12885-023-11044-5

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2023

Mean platelet volume/platelet count ratio in combination with tumor markers in colorectal cancer: a retrospective clinical study

Risk of seizures in a population of women with BRCA-positive metastatic breast cancer from an electronic health record database in the United States

Pan-cancer analysis identifies SPEN mutation as a predictive biomarker with the efficacy of immunotherapy

The impact of COVID-19 on national program of colorectal cancer screening in Tehran, Iran: a multicenter study

Acute and early-onset cardiotoxicity in children and adolescents with cancer: a systematic review

Whole-exome mutational landscape and molecular marker study in mucinous and clear cell ovarian cancer cell lines 3AO and ES2

Keynote webinar | Spotlight on antibody–drug conjugates in cancer