Novel preoperative nutritional assessment tool and prognostic model for ESCC patients

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.