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. 2025 Jul 31;17(7):5133-5145.
doi: 10.21037/jtd-2025-1229. Epub 2025 Jul 29.

Patient-reported outcomes of the prognostic nutritional index for resectable esophageal squamous cell carcinoma

Xinming Nie #  1 , Xin Nie #  2 , Qin Xie #  1 , Changding Li  1 , Wenwu He  1 , Kunhan Ni  1 , Simiao Lu  1 , Chenghao Wang  1 , Yan Miao  1 , Longlin Jiang  1 , Kangning Wang  1 , Guangyuan Liu  1 , Qiang Fang  1 , Lin Peng  1 , Qiuling Shi  3 , Jun Kanamori  4 , Alberto Aiolfi  5 , Cristian Deana  6 , Yongtao Han #  1 , Xuefeng Leng #  1
Affiliations

Patient-reported outcomes of the prognostic nutritional index for resectable esophageal squamous cell carcinoma

Xinming Nie et al. J Thorac Dis. .

Abstract

Background: The prognostic nutritional index (PNI) involves both the nutritional status and immune function as crucial factors linked to the prognosis of various gastrointestinal cancers. The relationship between the PNI and postoperative quality of life (QOL) in patients with esophageal cancer (EC) has not been examined. This study sought to examine the effects of the PNI on the postoperative patient-reported outcomes (PROs) of patients with esophageal squamous cell carcinoma (ESCC).

Methods: Consecutive ESCC patients undergoing minimally invasive McKeown esophagectomy at a single center from April 2019 to December 2020 were enrolled in this study. The patients were allocated to the PNI-high group (PNI ≥45) and PNI-low group (PNI <45). The longitudinal PROs were handled to compare the functions and symptoms using a linear mixed-effect models. The M.D. Anderson Symptom Inventory (MDASI) and the European Organization for Research and Treatment of Cancer (EORTC) questionnaires were used to assess patients' symptoms and QOL.

Results: A total of 274 patients were included in the study. Patients with esophageal cancer experienced a decline in functional status and significant esophageal cancer-related symptoms shortly after surgery. When PNI was less than 45, a higher PNI might be associated with improved functional status and more obvious symptoms such as pain, problems with taste, sadness, shortness of breath, and drowsiness (P<0.05).

Conclusions: There might be a non-linear association between PNI and the postoperative health-related QOL of ESCC patients. It was emphasized that individualized nutritional intervention should be provided for patients with PNI lower than 45.

Keywords: Prognostic nutritional index (PNI); esophageal squamous cell carcinoma (ESCC); esophagectomy; patient-reported outcomes (PROs).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-2025-1229/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
The flow chart of enrollment. PNI, prognostic nutritional index.
Figure 2
Figure 2
The quality-of-life scales of PNI-high group and PNI-low group. Each graph shows the mean symptom or function scores for the groups from pre-surgery to 6 months post-surgery. Higher scores reflect better function or worse symptom. *, P<0.05. MDASI-Eso, M.D. Anderson Symptom Inventory; PNI, prognostic nutritional index.
See this image and copyright information in PMC

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