Relationship between preoperative nutritional status, early postoperative systemic immunoinflammatory index, C-reactive protein/albumin ratio, NLR and anastomotic fistula after esophageal cancer surgery

doi:10.3877/cma.j.issn.2095-2015.2025.03.009

Abstract

Abstract:

Objective

To investigate the relationship between preoperative nutritional status,early postoperative systemic immunoinflammatory index, C-reactive protein/albumin ratio (CRP/Alb),neutrophil to lymphocyte ratio (NLR) and anastomotic fistula after esophageal cancer surgery.

Methods

The clinical records of 202 patients with esophageal cancer treated in Qingdao Municipal Hospital from February 2019 to February 2024 were retrospectively reviewed.According to whether anastomotic fistula occurred after surgery, these patients were divided into two groups, 19 patients with postoperative anastomotic fistula were considered as the observation group, and the remaining 183 patients without anastomotic fistula were considered as the control group.Preoperative nutritional status [prognostic nutritional index (PNI), serum albumin (ALB), prealbumin (PA)] and early postoperative systemic immunoinflammatory index (SII), CRP/Alb, NLR were detected in all patients.Pearson correlation was used to analyze the correlation between each index and postoperative anastomotic fistula.Receiver operating characteristic (ROC) curve was plotted, the area under the curve (AUC) value was calculated,and the predictive value of PNI, ALB, PA, SII, CRP/Alb and NLR for postoperative anastomotic fistula of esophageal cancer was analyzed.

Results

There were no statistically significant differences in gender,age, smoking history, drinking history, hypertension, diabetes, tumor location and TNM stage between the observation group and the control group (P<0.05).Compared with the control group, the PNI and CRP/Alb in the observation group was significantly reduced, while SII and NLR were significantly increased(P<0.05).The results of Pearson correlation analysis showed that PNI, CRP/Alb were negatively correlated with postoperative anastomotic fistula (r=-0.477, -0.655, P<0.05), and SII and NLR were positively correlated with postoperative anastomotic fistula (r=0.632, 0.518, P<0.05).Logistic multivariate regression analysis showed that PNI<45.45, SII≥556.54, CRP/Alb<0.44, NLR≥10.20 were all risk factors for predicting anastomotic fistula after esophageal cancer surgery (P<0.05).The ROC curve showed that the AUC for predicting anastomotic fistula after esophageal cancer surgery by combining preoperative PNI<45.45 and early postoperative SII≥556.54, CRP/Alb<0.44, and NLR≥10.20 was 0.824, and the sensitivity and specificity were 82.38% and 84.16%, respectively.

Conclusion

Preoperative PNI and early postoperative SII, CRP/Alb, NLR are closely related to anastomotic fistula after esophageal cancer surgery.These indicators play an important role in predicting the risk of anastomotic fistula after esophageal cancer surgery.

Key words: Esophageal cancer, Anastomotic fistula, Nutritional status, Systemic immune inflammatory index, C-reactive protein, Neutrophils

Shun Zhao, Xiaoyang Han, Tingting Zhao. Relationship between preoperative nutritional status, early postoperative systemic immunoinflammatory index, C-reactive protein/albumin ratio, NLR and anastomotic fistula after esophageal cancer surgery[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2025, 15(03): 235-239.

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URL: https://zhxhbyyxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-2015.2025.03.009

https://zhxhbyyxzz.cma-cmc.com.cn/EN/Y2025/V15/I03/235

Figures/Tables 7

组别	例数	性别[例(%)]		年龄(岁, $\overset{ˉ}{x}$ ± s )	吸烟史[例(%)]	饮酒史[例(%)]	高血压[例(%)]	糖尿病[例(%)]	肿瘤部位[例(%)]			TNM 分期[例(%)]
组别	例数	男	女	年龄(岁, $\overset{ˉ}{x}$ ± s )	吸烟史[例(%)]	饮酒史[例(%)]	高血压[例(%)]	糖尿病[例(%)]	食管上段	食管中段	食管下段	I	Ⅱ	Ⅲ
观察组	19	12(63.16)	7(36.84)	44.28±15.43	13(68.42)	10(52.63)	8(42.11)	6(31.58)	5(26.32)	8(42.11)	6(31.57)	7(36.84)	5(26.32)	7(36.84)
对照组	183	110(38.87)	73(39.89)	45.35±12.21	109(59.56)	103(56.28)	68(37.16)	54(29.51)	41(22.40)	110(60.11)	32(17.49)	61(33.34)	48(26.22)	74(40.44)
χ ²/t		0.066		0.354	0.564	0.093	0.179	0.035		0.487			0.511
P		0.795		0.723	0.452	0.760	0.671	0.850		0.247			0.229

组别	例数	性别[例(%)]		年龄(岁, $\overset{ˉ}{x}$ ± s )	吸烟史[例(%)]	饮酒史[例(%)]	高血压[例(%)]	糖尿病[例(%)]	肿瘤部位[例(%)]			TNM 分期[例(%)]
组别	例数	男	女	年龄(岁, $\overset{ˉ}{x}$ ± s )	吸烟史[例(%)]	饮酒史[例(%)]	高血压[例(%)]	糖尿病[例(%)]	食管上段	食管中段	食管下段	I	Ⅱ	Ⅲ
观察组	19	12(63.16)	7(36.84)	44.28±15.43	13(68.42)	10(52.63)	8(42.11)	6(31.58)	5(26.32)	8(42.11)	6(31.57)	7(36.84)	5(26.32)	7(36.84)
对照组	183	110(38.87)	73(39.89)	45.35±12.21	109(59.56)	103(56.28)	68(37.16)	54(29.51)	41(22.40)	110(60.11)	32(17.49)	61(33.34)	48(26.22)	74(40.44)
χ ²/t		0.066		0.354	0.564	0.093	0.179	0.035		0.487			0.511
P		0.795		0.723	0.452	0.760	0.671	0.850		0.247			0.229

组别	例数	PNI	SII	CRP/Alb	NLR
观察组	19	41.55±5.87	1197.25±412.26	0.35±0.53	11.16±1.25
对照组	183	51.35±5.24	411.07±182.06	0.95±0.13	9.76±1.65
F		7.671	15.298	12.345	3.589
P		＜0.001	＜0.001	＜0.001	＜0.001

与术后吻合口瘘相关性	PNI	SII	CRP/Alb	NLR
r	-0.477	0.632	-0.655	0.518
P	＜0.001	＜0.001	＜0.001	＜0.001

	变量	赋值
Y	术后吻合口瘘	否=0，是=1
X1	PNI	≥45.45=0，＜45.45=1
X2	SII	＜556.54=0，≥556.54=1
X3	CRP/Alb	≥0.44=0，＜0.44=1
X4	NLR	＜10.20=0，≥10.20=1

影响因素	β	SE(β)	Wald χ ²值	P值	OR	95% CI
PNI＜45.45	0.587	0.175	11.251	0.001	1.799	1.276～2.535
SII≥556.54	0.508	0.168	9.143	0.002	1.662	1.196～2.310
CRP/Alb＜0.44	0.541	0.187	8.370	0.004	1.718	1.191～2.478
NLR≥10.20	0.671	0.189	12.604	＜0.001	1.956	1.351～2.833

危险因素	截断值	AUC	敏感度(%)	特异度(%)
PNI	45.45	0.746	74.45	63.67
SII	556.54	0.722	72.66	66.48
CRP/Alb	0.44	0.617	74.45	66.55
NLR	10.20	0.589	72.77	65.36
联合	-	0.824	82.38	84.16

References 23

[1]	Sun D, Liu C, Zhu Y, et al.Long-Term Exposure to Fine Particulate Matter and Incidence of Esophageal Cancer: A Prospective Study of 0.5 Million Chinese Adults[J].Gastroenterology, 2023, 165(1):61-70.e5.
[2]	王佳燕, 鲜雪梅, 贺晓映, 等.老年食管癌病人吞咽困难干预策略研究进展[J].护理研究, 2024, 38(8): 1384-1388.
[3]	Morino K, Kitano T, Kadokawa Y, et al.Esophagogastrostomy Versus Double Tract Reconstruction for Laparoscopic Proximal Gastrectomy: Short-term Outcomes Based on Nutritional Parameters and Skeletal Muscle Index[J].In Vivo, 2024, 38(3): 1325-1331.
[4]	Lu Y, Ren Z.Clinical application of gastrointestinal decompression in anastomotic fistula after McKeown esophagectomy for esophageal cancer[J].Medicine(Baltimore), 2022, 101(29): e29831.
[5]	Takegawa N, Hirabayashi T, Tanaka S, et al.The impact of nutritional status in nivolumab-treated patients with advanced esophageal cancer[J].PLoS One, 2023, 18(5): e0285365.
[6]	Feng T, Ma Z, Pan C, et al.Pentoxifylline decreases the activity of the nucleotide-binding oligomerization domain-like receptor protein 3 pathway: potential role for preventing arteriovenous fistula stenosis[J].J Vasc Access, 2024, 25(2): 566-575.
[7]	Nishimura S, Noma K, Kawasaki K, et al.Gastro-tracheal fistula following esophageal cancer surgery through the retrosternal route: a case report[J].Surg Case Rep, 2024, 10(1): 252.
[8]	Chen X, Dang Y, Zhang Q, et al.MFI-11 in Chinese elderly esophageal cancer patients with postoperative adverse outcomes[J].BMC Geriatr, 2024, 24(1): 677.
[9]	陈海南, 冷雪峰.食管癌术后吻合口瘘预测因子及相关预测模型的研究进展[J].临床外科杂志, 2024, 32(8): 892-895.
[10]	时祥音, 白璟, 吕丛, 等.围术期食管癌术后吻合口瘘的危险因素及风险预测模型构建与验证[J].海南医学, 2024, 35(7):1026-1030.
[11]	郭峰杰, 孙爱英, 于丹丹.预后营养指数指导下的营养管理干预在食管癌根治术患者中的应用[J].齐鲁护理杂志, 2023, 29(4):29-33.
[12]	Aoyama T, Nagasawa S, Nakazono M, et al.The clinical impacts of lymphocyte-to-C-reactive protein ratio for esophageal cancer patients who receive curative treatment[J].J Cancer Res Ther, 2023, 19(3):556-561.
[13]	Wu M, Zhu Y, Chen X, et al.Prognostic nutritional index predicts the prognosis of patients with advanced esophageal cancer treated with immune checkpoint inhibitors: a retrospective cohort study[J].J Gastrointest Oncol, 2023, 14(1): 54-63.
[14]	Asaka S, Shimakawa T, Nishiguchi R, et al.Preoperative and Postoperative C-Reactive Protein to Albumin Ratio(CAR) as a Prognostic Marker for Survival of Esophageal Squamous Cell Carcinoma Patients After Surgery[J].Anticancer Res, 2023, 43(11):5139-5147.
[15]	Esashi R, Aoyama T, Maezawa Y, et al.The Clinical Impact of the Systemic Immune-inflammation Index in Esophageal Cancer Patients Receiving Curative Treatment[J].Anticancer Res, 2024, 44(11):5035-5041.
[16]	江美南, 李添翼, 任粤, 等.治疗前泛免疫炎症值预测食管癌术后辅助放疗患者预后的价值[J].实用临床医药杂志, 2024, 28(17):1-8.
[17]	Ren J, Ma Y, Wei M, et al.Effects of intravenous anesthesia and inhalation anesthesia on postoperative inflammatory markers in patients with esophageal cancer: a retrospective study[J].BMC Anesthesiol, 2024, 24(1): 462.
[18]	李德冰, 张克, 梁少杰.食管癌患者术前PLT、白细胞数、NLR及PLR 水平对预后的预测价值[J].实用癌症杂志, 2024, 39(9):1544-1547.
[19]	Xiao H, Lv X, Zhou S, et al.Association of systemic inflammatory markers with postoperative arrhythmias in esophageal cancer: a propensity score matching[J].J Cardiothorac Surg, 2024, 19(1): 142.
[20]	Aoyama T, Kazama K, Maezawa Y, et al.Usefulness of Nutrition and Inflammation Assessment Tools in Esophageal Cancer Treatment[J].In Vivo, 2023, 37(1): 22-35.
[21]	Lu J, Du L, Lei X, et al.Prognostic value of esophageal cancer immune prognostic index in advanced esophageal squamous cell carcinoma patients with anti-programmed cell death-1 therapy[J].Cancer Med, 2023, 12(10): 11334-11343.
[22]	Kato A, Aoyama T, Maezawa Y, et al.Geriatric Nutritional Risk Index Is an Independent Prognostic Factor for Patients With Esophageal Cancer Who Receive Curative Treatment[J].Anticancer Res, 2024, 44(1): 331-337.
[23]	Luo W, Dong J, Deng J, et al.Radiomics and prognostic nutritional index for predicting postoperative survival in esophageal carcinoma[J].Eur J Med Res, 2025, 30(1): 178.

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