Comparative analysis of the prognostic utility of preoperative nutritional parameters in patients with resectable esopha
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ORIGINAL ARTICLE
Comparative analysis of the prognostic utility of preoperative nutritional parameters in patients with resectable esophageal carcinoma Masayuki Urabe1 · Masaki Ueno1,2 · Yusuke Ogawa1 · Akikazu Yago1 · Hayato Shimoyama1 · Aya Honda1 · Yu Ohkura1,2 · Shusuke Haruta1 · Harushi Udagawa1,2 Received: 16 October 2020 / Accepted: 16 November 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Objective Although surgical resection is a mainstay in the management of esophageal carcinoma (EC), its postoperative outcomes remain unsatisfactory. To optimize surgical strategies for EC, a simple method of stratifying patients according to risk factors is desired. Controlling nutritional status (CONUT), the prognostic nutritional index (PNI), transthyretin and transferrin are nutritional parameters used to predict the long-term outcomes of EC patients. We aimed to comparatively evaluate the prognostic significance of these four markers, measured preoperatively, in patients with operable EC. Methods In total, 224 patients undergoing surgical resection for EC were retrospectively reviewed. Overall/cancer-specific survivals (OS/CSS) were estimated applying the Cox proportional hazard model to univariate and multivariate analyses. PNI, transthyretin and transferrin levels were treated as continuous variables in these analyses. Results Preoperative CONUT had significant associations with tumor location, depth and preoperative irradiation. The other three markers all showed significant relationships with age and tumor depth. On univariate Cox regression analysis, preoperative CONUT, PNI, transthyretin and transferrin all correlated significantly with OS and CSS. On multivariate Cox regression analysis, the preoperative transthyretin level was identified as an independent predictor of OS (HR 0.51 per 10 mg/ dL increase, 95% CI 0.29–0.88, p = 0.017) and CSS (HR 0.50, 95% CI 0.27–0.91, p = 0.027) as well as tumor depth, nodal metastasis and preoperative irradiation, while the other three parameters were not. Conclusions Preoperative transthyretin, as a continuous variable, independently predicted both OS and CSS in resectable EC patients, appearing to be the best prognosticator among conventional nutrition-related parameters. Keywords Esophageal carcinoma · Esophagectomy · Outcome · Nutrition · Transthyretin Abbreviations CI Confidence interval CONUT Controlling nutritional status CSS Cancer-specific survival DCRT Definitive chemoradiotherapy EC Esophageal carcinoma HR Hazard ratio OS Overall survival * Masayuki Urabe urabe‑[email protected] 1
Department of Gastroenterological Surgery, Toranomon Hospital, 2‑2‑2 Toranomon, Minato‑ku, Tokyo 105‑8470, Japan
Okinaka Memorial Institute for Medical Research, Tokyo, Japan
2
PNI Prognostic nutritional index TF Transferrin TTR Transthyretin
Introduction Esophageal carcinoma (EC) is a malignant tumor aggressive in nature, with a poor prognosis. Despite advances in therapeutic modalities, this cancer is still ranked as the sixth leading cau
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