Patient-reported outcomes of the prognostic nutritional index for resectable esophageal squamous cell carcinoma

The prognostic nutritional index (PNI) involves both the nutritional status and immune function as crucial factors linked to the prognosis of various gastrointestinal cancers. The relationship between the PNI and postoperative quality of life (QOL) in patients with esophageal cancer (EC) has not been examined. This study sought to examine the effects of the PNI on the postoperative patient-reported outcomes (PROs) of patients with esophageal squamous cell carcinoma (ESCC).

Consecutive ESCC patients undergoing minimally invasive McKeown esophagectomy at a single center from April 2019 to December 2020 were enrolled in this study. The patients were allocated to the PNI-high group (PNI ≥45) and PNI-low group (PNI <45). The longitudinal PROs were handled to compare the functions and symptoms using a linear mixed-effect models. The M.D. Anderson Symptom Inventory (MDASI) and the European Organization for Research and Treatment of Cancer (EORTC) questionnaires were used to assess patients' symptoms and QOL.

A total of 274 patients were included in the study. Patients with esophageal cancer experienced a decline in functional status and significant esophageal cancer-related symptoms shortly after surgery. When PNI was less than 45, a higher PNI might be associated with improved functional status and more obvious symptoms such as pain, problems with taste, sadness, shortness of breath, and drowsiness (P<0.05).

There might be a non-linear association between PNI and the postoperative health-related QOL of ESCC patients. It was emphasized that individualized nutritional intervention should be provided for patients with PNI lower than 45.