Objective: No study has reported the clinical outcomes of comprehensive nutritional index (CNI) in esophageal squamous cell carcinoma (ESCC) receiving neoadjuvant immunotherapy combined with chemotherapy (nICT).
Methods: This retrospective study involved 233 ESCC patients who underwent nICT. Principal component analysis was performed to establish the CNI based on 5 indexes including body mass index, usual body weight percentage, total lymphocyte count, albumin and hemoglobin. The relationships between the CNI and therapeutic response, postoperative complications and prognosis were analyzed.
Results: One hundred and forty-nine and 84 patients were assigned to the high and low CNI group, respectively. The incidences of respiratory complications (33.3% vs. 18.8%, P = 0.013) and vocal cord paralysis (17.9% vs. 8.1%, P = 0.025) in low CNI were significantly higher than those in high group, respectively. Seventy (30.0%) patients achieved pathological complete response (pCR). High CNI patients achieved a better pCR rate than those with low CNI (41.6% vs. 9.5%, P < 0.001). The CNI served as an independent pCR predictor [odds ratio (OR) = 0.167, 95% confidence interval (CI) = 0.074-0.377, P < 0.001)]. High CNI patients had better 3-year disease-free survival (DFS) (85.4% vs. 52.6%, P < 0.001) and overall survival (OS) (85.5% vs. 64.5%, P < 0.001) than those with low CNI, respectively. The CNI served as an independent prognostic score regarding DFS [hazard ratio (HR) = 3.878, 95% CI = 2.214-6.792, P < 0.001)] and OS (HR = 4.386, 95% CI = 2.006-9.590, P < 0.001).
Conclusion: Based on nutrition-related indicators, the pretreatment CNI serves as a sensitive and effective predictor of therapeutic response, postoperative complications and prognosis in ESCC receiving nICT.
Keywords: Complication; Comprehensive nutritional index; Esophageal squamous cell carcinoma; Immunochemotherapy; Neoadjuvant therapy; Prognosis.
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