Preoperative malnutrition and prognosis after neoadjuvant chemotherapy followed by subsequent esophagectomy
Preoperative malnutrition has been reported to correlate with unfavorable long-term outcomes in patients who undergo surgery for gastroenterological cancers, including esophageal (1-4), gastric (5), colorectal (6), and pancreatic (7) cancers and hepatocellular carcinoma (8). Appropriate methods are needed to preoperatively assess malnutrition likely to adversely affect long-term outcome. Although blood test data, such as serum albumin, transthyretin, transferrin, and cholesterol concentrations and total lymphocyte count (TLC) are candidate markers of nutritional status, suitable comprehensive indicators to estimate long-term postoperative outcomes have not been identified. Prognostic nutritional index (PNI), calculated as 10 × albumin (g/dL) + 0.005 × TLC (/μL), was the first nutrition-related indicator of the risk of complications after gastrointestinal cancers surgery (9) and is a useful predictor of long-term outcome after surgery for various gastrointestinal cancers (3,4,7,8,10). Predictive markers of prognosis after esophagectomy in patients with esophageal cancer include preoperative sarcopenia (11), body mass index (12), controlling nutritional status (CONUT) (1,2) and PNI (3,4).