| Part 1:Effect of prognostic nutritional index on prognosis of patients with esophageal cancerObjective:The purpose of this study is to systematically evaluate the relationship between prognosis and clinicopathological features of prognostic nutritional index(PNI)and esophageal cancer(EC)patients.Methods:Literature search was done in PubMed,EMbase and Web of Science databases to collect the researches on the relationship between PNI before treatment and prognosis of EC patients.Risk ratio(HR)and 95%CI were used to evaluate the prognostic value of PNI for long-term survival,and odds ratio(OR)and 95%CI were used to evaluate the relationship between PNI and clinicopathological features.Meta-analysis was performed by Revman 5.3 software and Stata 15.0 software.Results:This meta-analysis included 20 studies,including 5174 EC patients.Meta-analysis showed that the overall survival(OS)of patients with low PNI was worse(HR=1.46,95%CI=1.24-1.72,P<0.00001),and the OS of patients with low PNI was worse in multivariate analysis(HR=1.38,95%CI=1.19-1.59,P<0.0001).Patients with low PNI had shorter cancer-specific survival time(CSS)(HR=1.76,95%CI=1.03-3.02,P=0.04).Patients with low PNI had shorter relapse-free survival(RFS)(HR=1.62,95%CI=1.24-2.12,P=0.0004).In addition,the results showed that PNI level is related to gender,TNM stage,lymph node metastasis and T stage.Conclusion:Low PNI is related to poor prognosis of EC patients,and may be a potential indicator of prognosis of EC patients.Part 2:The prognostic value of prognostic nutritional index in patients with esophageal squamous cell carcinomaObjective:To explore the correlation between prognostic nutritional index(PNI)and clinicopathological features and prognosis of esophageal cancer patients who received adjuvant radiotherapy after operation.Methods:The clinical data of 93 consecutive patients with esophageal squamous cell carcinoma diagnosed by postoperative pathology and assisted radiotherapy from June 1,2015 to June 1,2017 were analyzed retrospectively.According to the albumin level and lymphocyte count measured before radiotherapy,the PNI value was calculated,and the best cut-off value of PNI was determined according to receiver operating characteristic curve(ROC).All patients included in the study were divided into H-PNI group and L-PNI group.Aim to analyze the relationship between PNI and general clinicopathological features and total survival time;Univariate and multivariate Cox regression analysis were used to compare the effects of various factors on the prognosis of esophageal cancer patientsResults:According to the best cut-off value of PNI,93 patients were divided into L-PNI group(PNI≤47.275,n=43)and H-PNI group(PNI>47.275,n=50).The Chi-squared Test showed that there was no significant difference between two groups in age,sex,smoking history,drinking history,concurrent chemotherapy,tumor length and postoperative pathological N stage,but there were more patients with pathological T stage T1-T2 in H-PNI group than in L-PNI group(P=0.044),and more patients with postoperative pathological TNM stage Ⅰ-Ⅱ in H-PNI group than in L-PNI group(P=0.022).Kaplan-Meier survival analysis showed that the overall survival of patients in H-PNI group was better than that in L-PNI group(P<0.001).Univariate analysis showed that PNI level,smoking and drinking history,postoperative pathological T stage,postoperative pathological TNM stage and tumor length were related to prognosis.Multivariate analysis showed that PNI level,postoperative pathological T stage,postoperative pathological TNM stage and tumor length were independent prognostic factors of ESCC patients receiving postoperative adjuvant radiotherapy.Conclusion:PNI can be used as a prognostic indicator for patients with esophageal squamous cell carcinoma receiving postoperative adjuvant radiotherapy,which is convenient,cheap and worthy of clinical application. |
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