Comprehensive Nutritional Index (CNI) establishment and its correlation with clinical outcomes in patients with esophageal cancer before surgical treatment

Background: As a novel nutritional prognosis score, most of the current studies on the relationship between comprehensive nutritional index (CNI) and clinical outcomes of cancer patients focused on patients undergoing radiotherapy and chemotherapy. But no studies have reported the impact of CNI on clinical outcomes of esophageal cancer patients undergoing surgical treatment. Objectives: To construct a comprehensive nutritional index (CNI) for patients with esophageal cancer before surgical treatment and explore its correlation with clinical outcomes to provide a reference for improving the nutritional status of patients with esophageal cancer. Methods: We analyzed the clinical data of 81 patients diagnosed with esophageal cancer who underwent surgical treatment for the first time at the Department of Thoracic Surgery of Weifang People’s Hospital from May 2020 to September 2021. Principal component analysis was performed to establish the CNI based on 5 indices: body mass index, usual body weight percentage, total lymphocyte count, albumin, and hemoglobin. The relationships between CNI, other nutritional status parameters, and postoperative clinical outcomes were analyzed. Results: The differences in nutritional indices between patients with esophageal cancer before and after surgical treatment were statistically significant ( P <0.001). The largest area under the curve (AUC=0.656) in the CNI was found based on the receiver operator characteristic (ROC) curves. The CNI cutoff point for postoperative clinical outcomes was 0.292, with a sensitivity of 66.7% and specificity of 62.5%. Multivariate Logistic analysis showed that a low CNI (odds ratio [OR]=0.16, 95% CI: 0.04–0.64, P =0.009) was an independent risk factor for prolonged hospitalization, and tumor staging (III-IV, OR=2.94; 95% CI: 1.08–8.02, P =0.035) was an independent risk factor for postoperative complications. Conclusions: CNI reflects the comprehensive nutritional status of patients with esophageal cancer. CNI had a higher predictive ability for postoperative clinical outcomes than the other nutritional indexes. A low CNI is an independent risk factor for prolonged hospitalization.