Investigating the Prognostic Significance of Immune-Nutritional Indices in Esophageal Cancer Patients Following Esophagectomy

Main Article Content

Sajida Qureshi
Hira Jaleel
Waqas Ahmed Abbasi
Saeed Ahmed
Mohammad Saeed Quraishi

Abstract

Background: Esophageal cancer remains one of the most challenging malignancies to treat, with survival rates significantly influenced by various hematological and nutritional markers. Understanding these markers is critical in optimizing treatment approaches and improving patient outcomes.


Objective: This study aimed to investigate the prognostic significance of several markers, including Mean Corpuscular Volume (MCV), Red Cell Distribution Width (RDW), Mean Platelet Volume (MPV), C-Reactive Protein (CRP), Albumin, Total Lymphocyte Count (TLC), CRP Albumin ratio (CAR), and the Prognostic Nutritional Index (PNI), in patients with esophageal cancer undergoing esophagectomy.


Methods: A prospective observational study was conducted involving 43 patients diagnosed with esophageal carcinoma at Dr. Ruth K.M. Pfau Civil Hospital Karachi. Data collection included patient demographics, tumor characteristics, and laboratory results obtained from the Hospital Information and Management Security System (HIMSS). Statistical analysis was performed using SPSS version 25, with Kaplan–Meier survival curves and log-rank tests assessing the impact of hematological and nutritional markers on survival outcomes.


Results: The majority of patients presented with advanced disease (Stage III and IV) and tumor sizes ranging from 5 to 10 cm. Mean survival times and statistical comparisons were analyzed, but no significant differences in survival based on the markers were observed. For example, patients with low and high PNI values did not show significant differences in survival (Log-rank test p-value = 0.382).


Conclusion: The study did not demonstrate significant prognostic differences based on the evaluated hematological and nutritional markers. However, it highlights the importance of considering these factors in the overall management of esophageal cancer, suggesting further research with larger sample sizes and diverse populations is necessary.

Article Details

How to Cite
Sajida Qureshi, Hira Jaleel, Waqas Ahmed Abbasi, Saeed Ahmed, & Mohammad Saeed Quraishi. (2024). Investigating the Prognostic Significance of Immune-Nutritional Indices in Esophageal Cancer Patients Following Esophagectomy. Journal of Health and Rehabilitation Research, 4(2), 421–426. https://doi.org/10.61919/jhrr.v4i2.830
Section
Articles
Author Biographies

Sajida Qureshi, Dow University of Health Science Pakistan.

Dow University of Health Science, Pakistan.

Hira Jaleel, Dow University of Health Science Pakistan.

Dow University of Health Science, Pakistan.

Waqas Ahmed Abbasi, Dow University of Health Science Pakistan.

Dow University of Health Science, Pakistan.

Saeed Ahmed, Dow University of Health Science Pakistan.

Dow University of Health Science, Pakistan.

Mohammad Saeed Quraishi, Dow University of Health Science Pakistan.

Dow University of Health Science, Pakistan.

References

Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-49. Available from: http://dx.doi.org/10.3322/caac.21660.

Zhang H, Shang X, Ren P, Gong L, Ahmed A, Ma Z, et al. The Predictive Value of a Preoperative Systemic Immune-Inflammation Index and Prognostic Nutritional Index in Patients With Esophageal Squamous Cell Carcinoma. J Cell Physiol. 2019;234(2):1794-802. Available from: http://dx.doi.org/10.1002/jcp.27052.

Qian D, Wang Y, Zhao G, Cao F, Er P, Chen X, et al. Tumor Remission and Tumor-Infiltrating Lymphocytes During Chemoradiation Therapy: Predictive and Prognostic Markers in Locally Advanced Esophageal Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys. 2019;105(2):319-28. Available from: http://dx.doi.org/10.1016/j.ijrobp.2019.06.079.

Yousefi MS, Sharifi-Esfahani M, Pourgholam-Amiji N, Afshar M, Sadeghi-Gandomani H, Otroshi O, et al. Esophageal Cancer in the World: Incidence, Mortality and Risk Factors. Biomed Res Ther. 2018;5(7):2504-17. Available from: http://dx.doi.org/10.15419/bmrat.v5i7.460.

Fu X, Li T, Dai Y, Li J. Preoperative Systemic Inflammation Score (SIS) Is Superior to Neutrophil to Lymphocyte Ratio (NLR) as a Predicting Indicator in Patients With Esophageal Squamous Cell Carcinoma. BMC Cancer. 2019;19(1):721. Available from: http://dx.doi.org/10.1186/s12885-019-5940-6.

Bindea G, Mlecnik B, Fridman WH, Galon J. The Prognostic Impact of Anti-Cancer Immune Response: A Novel Classification of Cancer Patients. Semin Immunopathol. 2011;33(4):335-40. Available from: http://dx.doi.org/10.1007/s00281-011-0264-x.

Jiang Y, Xu D, Song H, Qiu B, Tian D, Li Z, et al. Inflammation and Nutrition-Based Biomarkers in the Prognosis of Oesophageal Cancer: A Systematic Review and Meta-Analysis. BMJ Open. 2021;11(9):e048324. Available from: http://dx.doi.org/10.1136/bmjopen-2020-048324.

Li KJ, Gu WY, Xia XF, Zhang P, Zou CL, Fei ZH. High Mean Corpuscular Volume as a Predictor of Poor Overall Survival in Patients With Esophageal Cancer Receiving Concurrent Chemoradiotherapy. Cancer Manag Res. 2020;12:7467-74. Available from: http://dx.doi.org/10.2147/cmar.s230274.

Yoshida N, Horinouchi T, Toihata T, Harada K, Eto K, Sawayama H, et al. Clinical Significance of Pretreatment Red Blood Cell Distribution Width as a Predictive Marker for Postoperative Morbidity After Esophagectomy for Esophageal Cancer: A Retrospective Study. Ann Surg Oncol. 2021;28(Suppl 3):754-5. Available from: http://dx.doi.org/10.1245/s10434-021-10786-5.

Wang N, Li X, Luo H, Sun Y, Zheng X, Fan C, et al. Prognostic Value of Pretreatment Inflammatory Biomarkers in Primary Small Cell Carcinoma of the Esophagus. Thorac Cancer. 2019;10(10):1913-8. Available from: http://dx.doi.org/10.1111/1759-7714.13164.

Kunizaki M, Tominaga T, Wakata K, Miyazaki T, Matsumoto K, Sumida Y, et al. Clinical Significance of the C Reactive Protein to Albumin Ratio for the Prognosis of Patients With Esophageal Squamous Cell Carcinoma. Mol Clin Oncol. 2017. Available from: http://dx.doi.org/10.3892/mco.2017.1527.

Xue Y, Zhou X, Xue L, Zhou R, Luo J. The Role of Pretreatment Prognostic Nutritional Index in Esophageal Cancer: A Meta-Analysis. J Cell Physiol. 2019;234(11):19655-62. Available from: http://dx.doi.org/10.1002/jcp.28565.

Nagai H, Yuasa N, Takeuchi E, Miyake H, Yoshioka Y, Miyata K. The Mean Corpuscular Volume as a Prognostic Factor for Colorectal Cancer. Surg Today. 2018;48(2):186-94. Available from: http://dx.doi.org/10.1007/s00595-017-1575-x.

Yoon HJ, Kim K, Nam YS, Yun JM, Park M. Mean Corpuscular Volume Levels and All-Cause and Liver Cancer Mortality. Clin Chem Lab Med. 2016;54(7):1247-57. Available from: http://dx.doi.org/10.1515/cclm-2015-0786.

Zheng YZ, Dai SQ, Li W, Cao X, Li Y, Zhang LJ, et al. Prognostic Value of Preoperative Mean Corpuscular Volume in Esophageal Squamous Cell Carcinoma. World J Gastroenterol. 2013;19(18):2811-7. Available from: http://dx.doi.org/10.3748/wjg.v19.i18.2811.

Yeşil A, Senateş E, Bayoğlu IV, Erdem ED, Demirtunç R, Kurdaş Övünç AO. Red Cell Distribution Width: A Novel Marker of Activity in Inflammatory Bowel Disease. Gut Liver. 2011;5(4):460-7. Available from: http://dx.doi.org/10.5009/gnl.2011.5.4.460.

Gunebakmaz O, Kaya MG, Duran M, Akpek M, Elcik D, Eryol NK. Red Blood Cell Distribution Width in ‘Non-Dippers’ Versus ‘Dippers’. Cardiology. 2012;123(3):154-9. Available from: http://dx.doi.org/10.1159/000342667.

Karabulut A, Uzunlar B. Correlation Between Red Cell Distribution Width and Coronary Ectasia in the Acute Myocardial Infarction. Clin Appl Thromb Hemost. 2012;18(5):551-2. Available from: http://dx.doi.org/10.1177/1076029611436198.

Albayrak S, Zengin K, Tanik S, Bakirtas H, Imamoglu A, Gurdal M. Red Cell Distribution Width as a Predictor of Prostate Cancer Progression. Asian Pac J Cancer Prev. 2014;15(18):7781-4. Available from: http://dx.doi.org/10.7314/apjcp.2014.15.18.7781.

Agarwal S. Red Cell Distribution Width, Inflammatory Markers and Cardiorespiratory Fitness: Results From the National Health and Nutrition Examination Survey. Indian Heart J. 2012;64(4):380-7. Available from: http://dx.doi.org/10.1016/j.ihj.2012.06.006.

McMillan DC. Systemic Inflammation, Nutritional Status and Survival in Patients With Cancer. Curr Opin Clin Nutr Metab Care. 2009;12(3):223-6. Available from: http://dx.doi.org/10.1097/MCO.0b013e32832a7902.

Hébuterne X, Lemarié E, Michallet M, de Montreuil CB, Schneider SM, Goldwasser F. Prevalence of Malnutrition and Current Use of Nutrition Support in Patients With Cancer. JPEN J Parenter Enteral Nutr. 2014;38(2):196-204. Available from: http://dx.doi.org/10.1177/0148607113502674.

Shen W, Cui MM, Wang X, Wang RT. Reduced Mean Platelet Volume Is Associated With Poor Prognosis in Esophageal Cancer. Cancer Biomark. 2018;22(3):559-63. Available from: http://dx.doi.org/10.3233/CBM-181231.

Feng JF, Sheng C, Zhao Q, Chen P. Prognostic Value of Mean Platelet Volume/Platelet Count Ratio in Patients With Resectable Esophageal Squamous Cell Carcinoma: A Retrospective Study. PeerJ. 2019;7:e7246. Available from: http://dx.doi.org/10.7717/peerj.7246.

Kinoshita A, Onoda H, Imai N, Iwaku A, Oishi M, Tanaka K, et al. The C-Reactive Protein/Albumin Ratio, a Novel Inflammation-Based Prognostic Score, Predicts Outcomes in Patients With Hepatocellular Carcinoma. Ann Surg Oncol. 2015;22(3):803-10. Available from: http://dx.doi.org/10.1245/s10434-014-4048-0.

Zhou T, Zhan J, Hong S, Hu Z, Fang W, Qin T, et al. Ratio of C-Reactive Protein/Albumin Is an Inflammatory Prognostic Score for Predicting Overall Survival of Patients With Small-Cell Lung Cancer. Sci Rep. 2015;5(1):10481. Available from: http://dx.doi.org/10.1038/srep10481.

Ishibashi Y, Tsujimoto H, Yaguchi Y, Kishi Y, Ueno H. Prognostic Significance of Systemic Inflammatory Markers in Esophageal Cancer: Systematic Review and Meta-Analysis. Ann Gastroenterol Surg. 2020;4(1):56-63. Available from: http://dx.doi.org/10.1002/ags3.12294.

Yoshida N, Harada K, Baba Y, Kosumi K, Iwatsuki M, Kinoshita K, et al. Preoperative Controlling Nutritional Status (CONUT) Is Useful to Estimate the Prognosis After Esophagectomy for Esophageal Cancer. Langenbecks Arch Surg. 2017;402(2):333-41. Available from: http://dx.doi.org/10.1007/s00423-017-1553-1.

Sierzega M, Lenart M, Rutkowska M, Surman M, Mytar B, Matyja A, et al. Preoperative Neutrophil-Lymphocyte and Lymphocyte-Monocyte Ratios Reflect Immune Cell Population Rearrangement in Resectable Pancreatic Cancer. Ann Surg Oncol. 2017;24(3):808-15. Available from: http://dx.doi.org/10.1245/s10434-016-5634-0.

Sharaiha RZ, Halazun KJ, Mirza F, Port JL, Lee PC, Neugut AI, et al. Elevated Preoperative Neutrophil:Lymphocyte Ratio as a Predictor of Postoperative Disease Recurrence in Esophageal Cancer. Ann Surg Oncol. 2011;18(12):3362-9. Available from: http://dx.doi.org/10.1245/s10434-011-1754-8.

Tokunaga R, Sakamoto Y, Nakagawa S, Miyamoto Y, Yoshida N, Oki E, et al. Prognostic Nutritional Index Predicts Severe Complications, Recurrence, and Poor Prognosis in Patients With Colorectal Cancer Undergoing Primary Tumor Resection. Dis Colon Rectum. 2015;58(11):1048-57. Available from: http://dx.doi.org/10.1097/DCR.0000000000000458.

Pinato DJ, North BV, Sharma R. A Novel, Externally Validated Inflammation-Based Prognostic Algorithm in Hepatocellular Carcinoma: The Prognostic Nutritional Index (PNI). Br J Cancer. 2012;106(8):1439-45. Available from: http://dx.doi.org/10.1038/bjc.2012.92.

Kanda M, Fujii T, Kodera Y, Nagai S, Takeda S, Nakao A. Nutritional Predictors of Postoperative Outcome in Pancreatic Cancer. Br J Surg. 2011;98(2):268-74. Available from: http://dx.doi.org/10.1002/bjs.7305.

Jeon HG, Choi DK, Sung HH, Jeong BC, Seo SI, Jeon SS, et al. Preoperative Prognostic Nutritional Index Is a Significant Predictor of Survival in Renal Cell Carcinoma Patients Undergoing Nephrectomy. Ann Surg Oncol. 2016;23(1):321-7. Available from: http://dx.doi.org/10.1245/s10434-015-4614-0.

Watanabe M, Iwatsuki M, Iwagami S, Ishimoto T, Baba Y, Baba H. Prognostic Nutritional Index Predicts Outcomes of Gastrectomy in the Elderly. World J Surg. 2012;36(7):1632-9. Available from: http://dx.doi.org/10.1007/s00268-012-1526-z.

Nozoe T, Kimura Y, Ishida M, Saeki H, Korenaga D, Sugimachi K. Correlation of Pre-Operative Nutritional Condition With Post-Operative Complications in Surgical Treatment for Oesophageal Carcinoma. Eur J Surg Oncol. 2002;28(4):396-400. Available from: http://dx.doi.org/10.1053/ejso.2002.1257.

Nakatani M, Migita K, Matsumoto S, Wakatsuki K, Ito M, Nakade H, et al. Prognostic Significance of the Prognostic Nutritional Index in Esophageal Cancer Patients Undergoing Neoadjuvant Chemotherapy. Dis Esophagus. 2017;30(8):1-7. Available from: http://dx.doi.org/10.1093/dote/dox020.

Hirahara N, Tajima Y, Fujii Y, Kaji S, Yamamoto T, Hyakudomi R, et al. Preoperative Prognostic Nutritional Index Predicts Long-Term Surgical Outcomes in Patients With Esophageal Squamous Cell Carcinoma. World J Surg. 2018;42(7):2199-208. Available from: http://dx.doi.org/10.1007/s00268-017-4437-1.