Prognostic Nutritional Index Predicts Early Recurrence After Esophagectomy for Esophageal Cancer Following Neoadjuvant Chemotherapy

Background/Aim: Although neoadjuvant chemotherapy (NAC) has improved oncologic outcomes in esophageal cancer, early postoperative recurrence remains a major cause of a poor prognosis. Immune-, inflammation-, and nutrition-based prognostic scores (IINBPS), such as the prognostic nutritional index (PNI), are reported prognostic markers in various malignancies; however, their ability to predict early recurrence after NAC remains unclear. This study aimed to identify the most reliable IINBPS for predicting early recurrence after esophagectomy following NAC. Patients and Methods: We retrospectively analyzed 61 patients with esophageal cancer who underwent curative esophagectomy following NAC between January 2012 and December 2024. Early recurrence was defined as recurrence within six months after surgery. Clinicopathological factors and IINBPS before and after NAC were evaluated. Receiver operating characteristic curve analysis was used to assess predictive performance, and risk factors for early recurrence were analyzed using univariate and multivariate logistic regression analyses. Results: without early recurrence had significantly lower pre-NAC PNI values. Multivariate analysis identified low pre-NAC PNI as an independent predictor of early recurrence. Conclusion: Pre-NAC PNI was the most useful IINBPS predictor of early recurrence after esophagectomy for esophageal cancer.