Association of dental occlusal support with the Prognostic Nutritional Index in patients with esophageal cancer who underwent esophagectomy



The Prognostic Nutritional Index is useful for predicting surgical risk and overall survival based on preoperative immunological and nutritional status in patients undergoing digestive organ cancer surgery. The purpose of this study was to examine the association between the Prognostic Nutritional Index and dental status in patients with esophageal cancer who underwent esophagectomy.


This retrospective case–control study included 73 patients who underwent resection of esophageal cancer (69 males, 4 females; age 36–83). General and dental status were evaluated. The Prognostic Nutritional Index was calculated based on the serum albumin concentration and the total lymphocyte count, and subjects were divided into two groups based on index scores: a higher group, characterized by scores ≥ 45 (n = 54); and a lower group, characterized by scores < 45 (n = 19). Univariate analysis and multiple logistic regression analyses were used to compare between groups.


Total protein, C-reactive protein, the number of sound and total decayed, missing and filled teeth, and the rate of patients with poor dental occlusal support showed significant differences between the lower and higher Prognostic Nutritional Index groups (p < 0.05). Stepwise logistic regression analysis by backward selection approach showed that low total protein, few sound teeth, and poor status of dental occlusal support were significantly associated with the lower Prognostic Nutritional Index (p = 0.007, 0.042, and 0.009, respectively).


Dental status, especially dental occlusal support and the number of sound teeth, showed a positive relationship with the Prognostic Nutritional Index in esophageal cancer patients who underwent esophagectomy.

This is a preview of subscription content, log in to check access.


  1. 1.

    Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136:E359–E386386.

    CAS  Article  Google Scholar 

  2. 2.

    Malhotra GK, Yanala U, Ravipati A, et al. Global trends in esophageal cancer. J Surg Oncol. 2017;115:564–79.

    Article  Google Scholar 

  3. 3.

    Foundation for Promotion of Cancer Research. 5-year survival at the designated cancer care hospitals (diagnosed in 2008–2009). In: Cancer statictics in Japan-2018. Tokyo: Center for Cancer Control and Information Services, National Cancer Center; 2018. p. 92.

  4. 4.

    Low DE, Allum W, De Manzoni G, et al. Guidelines for perioperative care in esophagectomy: enhanced recovery after surgery (ERAS®) society recommendations. World J Surg. 2019;43:299–330.

    Article  Google Scholar 

  5. 5.

    Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai Zasshi. 1984;85:1001–5.

    CAS  PubMed  Google Scholar 

  6. 6.

    Hirahara N, Tajima Y, Fujii Y, et al. Preoperative prognostic nutritional index predicts long-term outcome in gastric cancer: a propensity score-matched analysis. Anticancer Res. 2018;38:4735–46.

    Article  Google Scholar 

  7. 7.

    Okugawa Y, Toiyama Y, Oki S, et al. Feasibility of assessing prognostic nutrition index in patients with rectal cancer who receive preoperative chemoradiotherapy. JPEN J Parenter Enteral Nutr. 2018;42:998–1007.

    CAS  Article  Google Scholar 

  8. 8.

    Yoshida M, Kikutani T, Yoshikawa M, et al. Correlation between dental and nutritional status in community-dwelling elderly Japanese. Geriatr Gerontol Int. 2011;11:315–9.

    Article  Google Scholar 

  9. 9.

    Kikutani T, Yoshida M, Enoki H, et al. Relationship between nutrition status and dental occlusion in community-dwelling frail elderly people. Geriatr Gerontol Int. 2013;13:50–4.

    Article  Google Scholar 

  10. 10.

    Wakabayashi H, Matsushima M, Ichikawa H, et al. Occlusal support, dysphagia, malnutrition, and activities of daily living in aged individuals needing long-term care: a path analysis. J Nutr Health Aging. 2018;22:53–8.

    CAS  Article  Google Scholar 

  11. 11.

    World Health Organization. Oral health survey: basic methods. 4th ed. Geneva: World Health Organization; 1997.

    Google Scholar 

  12. 12.

    Ueno M, Yanagisawa T, Shinada K, et al. Masticatory ability and functional tooth units in Japanese adults. J Oral Rehabil. 2008;35:337–44.

    CAS  Article  Google Scholar 

  13. 13.

    Samnieng P, Ueno M, Shinada K, et al. Oral health status and chewing ability is related to mini-nutritional assessment results in an older adult population in Thailand. J Nutr Gerontol Geriatr. 2011;30:291–304.

    Article  Google Scholar 

  14. 14.

    Ueno M, Yanagisawa T, Shinada K, et al. Category of functional tooth units in relation to the number of teeth and masticatory ability in Japanese adults. Clin Oral Investig. 2010;14:113–9.

    Article  Google Scholar 

  15. 15.

    Jian-Hui C, Iskandar EA, Cai SI, et al. Significance of Onodera's prognostic nutritional index in patients with Acolorectal cancer: a large cohort study in a single Chinese institution. Tumour Biol. 2015;37:3277–83.

    Article  Google Scholar 

  16. 16.

    Wen J, Bedford M, Begum R, et al. The value of inflammation based prognostic scores in patients undergoing surgical resection for oesophageal and gastric carcinoma. J Surg Oncol. 2018;117:1697–707.

    Article  Google Scholar 

  17. 17.

    Okabe Y, Takeuchi K, Izumi M, et al. Posterior teeth occlusion and dysphagia risk in older nursing home residents: a cross-sectional observational study. J Oral Rehabil. 2017;44:89–95.

    CAS  Article  Google Scholar 

  18. 18.

    Sakai M, Sohda M, Miyazaki T, et al. Association of preoperative nutritional status with prognosis in patients with esophageal cancer undergoing salvage esophagectomy. Anticancer Res. 2018;38:933–8.

    PubMed  Google Scholar 

  19. 19.

    Matsumoto Y, Zhou Q, Kamimura K, et al. The prognostic nutrition index predicts the development of hematological toxicities in and the prognosis of esophageal cancer patients treated with cisplatin plus 5-fluorouracil chemotherapy. Nutr Cancer. 2018;70:447–52.

    Article  Google Scholar 

  20. 20.

    Hildebrandt GH, Dominguez BL, Schork MA, et al. Functional units, chewing, swallowing, and food avoidance among the elderly. J Prosthet Dent. 1997;77:588–95.

    CAS  Article  Google Scholar 

  21. 21.

    Leake JL, Hawkins R, Locker D. Social and functional impact of reduced posterior dental units in older adults. J Oral Rehabil. 1994;21:1–10.

    CAS  Article  Google Scholar 

  22. 22.

    Iwasaki M, Yoshihara A, Ogawa H, et al. Longitudinal association of dentition status with dietary intake in Japanese adults aged 75–80 years. J Oral Rehabil. 2016;43:737–44.

    CAS  Article  Google Scholar 

  23. 23.

    Toniazzo MP, Amorim PS, Muniz F, et al. Relationship of nutritional status and oral health in elderly: systematic review with meta-analysis. Clin Nutr. 2018;37:824–30.

    Article  Google Scholar 

  24. 24.

    Tang J, Humes DJ, Gemmil E, et al. Reduction in length of stay for patients undergoing oesophageal and gastric resections with implementation of enhanced recovery packages. Ann R Coll Surg Engl. 2013;95:323–8.

    CAS  Article  Google Scholar 

  25. 25.

    Yamanaka R, Soga Y, Minakuchi M, et al. Occlusion and weight change in a patient after esophagectomy: success derived from restoration of occlusal support. Int J Prosthodont. 2013;26:574–6.

    Article  Google Scholar 

  26. 26.

    Soutome S, Yanamoto S, Funahara M, et al. Effect of perioperative oral care on prevention of postoperative pneumonia associated with esophageal cancer surgery: a multicenter case-control study with propensity score matching analysis. Medicine (Baltimore). 2017;96:e7436.

    Article  Google Scholar 

  27. 27.

    Akutsu Y, Matsubara H, Shuto K, et al. Pre-operative dental brushing can reduce the risk of postoperative pneumonia in esophageal cancer patients. Surgery. 2010;147:497–502.

    Article  Google Scholar 

  28. 28.

    Chen QL, Zeng XT, Luo ZX, et al. Tooth loss is associated with increased risk of esophageal cancer: evidence from a meta-analysis with dose-response analysis. Sci Rep. 2016;6:18900.

    CAS  Article  Google Scholar 

  29. 29.

    Iwasaki T, Hirose A, Azuma T, et al. Associations between caries experience, dietary habits, and metabolic syndrome in Japanese adults. J Oral Sci. 2019;61:300–6.

    Article  Google Scholar 

  30. 30.

    Amano K, Maeda I, Morita T, et al. Clinical implications of c-reactive protein as a prognostic marker in advanced cancer patients in palliative care settings. J Pain Symptom Manage. 2016;51:860–7.

    Article  Google Scholar 

Download references


The authors are deeply grateful to the team members in Okayama University Hospital. The authors give a special thanks to Daisuke Ekuni DDS, Ph.D. (Department of Preventive Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences) for his advice about statistical analysis. This work was supported in part by the Japan Society for the Promotion of Science (JSPS) through KAKENHI Grant-in-Aid for Scientific Research (C) (Nos. 16K11858 and 19K10444) from JSPS.

Author information




RY-K designed the study, obtained research funds, performed data collection, analysis and interpretation of data, and wrote the initial draft of the manuscript. YS, ST, and TF contributed to the analysis and interpretation of data from the perspective of esophageal surgeons and assisted in the preparation of the manuscript. MI-M and AY contributed to data collection, analysis and interpretation of data, and assisted in the preparation of the manuscript. MM and HK contributed to data collection. MM contributed to analysis and interpretation of the data from the perspective of a dentist, epidemiologist, and statistician, and assisted in the preparation of the manuscript. All authors contributed to interpretation and critically reviewed the manuscript. All authors approved the final version of the manuscript, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Yasuhiro Shirakawa.

Ethics declarations

Ethical Statement

All procedures were in accordance with the ethical standards of the responsible committees on human experimentation and with the Helsinki Declaration of 1964 and later versions.

Conflict of interest

The authors declare that they have no conflict of interest to report.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Yamanaka-Kohno, R., Shirakawa, Y., Inoue-Minakuchi, M. et al. Association of dental occlusal support with the Prognostic Nutritional Index in patients with esophageal cancer who underwent esophagectomy. Esophagus (2020).

Download citation


  • Esophageal cancer surgery
  • Prognostic factor
  • Nutrition