Preoperative Prognostic Nutritional Index Predicts Long-Term Surgical Outcomes in Patients with Esophageal Squamous Cell Carcinoma

BACKGROUND: The purpose of the present study is to investigate the utility of prognostic nutritional index (PNI) as a simple and readily available marker in esophageal squamous cell carcinoma (ESCC). METHODS: We retrospectively analyzed 169 patients who underwent potentially curative esophagectomy, for histologically verified ESCC. We decided to set the optimal cutoff value for preoperative PNI levels at 49.2, based on the cancer-specific survival (CSS) and the overall survival (OS) by receiver operating characteristic curve analysis. RESULTS: Multivariate logistic regression analysis identified that TNM pStage III [hazard ratio (HR) 3.261, p < 0.0001] and PNI < 49.2 (HR 3.887, p < 0.0001) were confirmed as independent poor predictive factors for CSS, and age >70 (HR 2.024, p < 0.0042), TNM pStage III (HR 2.510, p = 0.0002), and PNI < 49.2 (HR 2.248, p = 0.0013) were confirmed as independent poor predictive factors for OS. In non-elderly patients, TNM pStage III (CSS; HR 3.488, p < 0.0001, OS; HR 2.615, p = 0.0007) and PNI < 49.2 (CSS; HR 3.849, p < 0.0001, OS; HR 2.275, p = 0.001) were confirmed as independent poor predictive factors for CSS, and OS when multivariate logistic regression analysis was applied. But in elderly patients, univariate analyses demonstrated that the TNM pStage III was the only significant risk factor for CSS (HR 3.701, p = 0.0057) and OS (HR 1.974, p = 0.0224). CONCLUSIONS: The PNI was a significant and independent predictor of CSS and OS of ESCC patients after curative esophagectomy. The PNI was cost-effective and readily available, and it could act as a marker of survival.