Annals of Surgical Oncology

, Volume 26, Issue 13, pp 4744–4753 | Cite as

The Influence of the Perioperative Nutritional Status on the Survival Outcomes for Esophageal Cancer Patients with Neoadjuvant Chemotherapy

  • Makoto HikageEmail author
  • Yusuke Taniyama
  • Tadashi Sakurai
  • Chiaki Sato
  • Kai Takaya
  • Hiroshi Okamoto
  • Takuro Konno
  • Naoto Ujiie
  • Takeshi Naitoh
  • Michiaki Unno
  • Takashi Kamei
Thoracic Oncology



Studies have shown a variety of nutritional indices to be prognostic predictors for esophageal cancer patients. However, which nutritional index should be used and when it should be measured during the perioperative period remain unclear. This study attempted to clarify the details surrounding predictive nutritional evaluation by assessing the longitudinal data of serologic indices in perioperative esophageal cancer patients.


The study included 141 esophageal cancer patients who underwent neoadjuvant chemotherapy after radical esophagectomy at Tohoku University Hospital from April 2008 to December 2017. The nutritional status was retrospectively assessed during the perioperative period, and the prognostic factors related to survival were analyzed.


Use of the controlling nutritional status (CONUT) score showed that malnutrition occurred only from 14 days after surgery in most cases. Use of the prognostic nutritional index (PNI) showed that the ratio of malnutrition increased gradually from presurgery to 14 days after surgery. The timing of malnutrition that affected survival was 14 days after surgery with the CONUT score and presurgery and 4 months after surgery with the PNI. A multivariable analysis of independent prognostic factors predicting survival identified malnutrition 14 days after surgery with the CONUT score and a low PNI before surgery, invasion depth of the primary lesion, and node metastasis.


Malnutrition occurring during the perioperative state of esophageal cancer was shown to be a survival prognostic factor. Development of an optimal nutritional intervention is recommended for esophageal cancer patients to prevent malnutrition both before and after surgery.



This study did not receive any specific grant from any funding agencies in the public, commercial, or not-for-profit sectors. No preregistration was conducted for the study reported in this article.


There are no conflicts of interest.

Supplementary material

10434_2019_7742_MOESM1_ESM.doc (110 kb)
Supplementary material 1 (DOC 109 kb)
10434_2019_7742_MOESM2_ESM.tiff (14.9 mb)
Supplementary Fig. 1. Survival curves according to the nutrition score-based malnutrition groups derived using the Kaplan–Meier method. a The overall survival (OS) according to the prognostic nutritional index (PNI) pre-surgery (P = 0.066). b The OS according to the PNI four months after surgery (P = 0.069). (TIFF 15250 kb)


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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Makoto Hikage
    • 1
    Email author
  • Yusuke Taniyama
    • 1
  • Tadashi Sakurai
    • 1
  • Chiaki Sato
    • 1
  • Kai Takaya
    • 1
  • Hiroshi Okamoto
    • 1
  • Takuro Konno
    • 1
  • Naoto Ujiie
    • 1
  • Takeshi Naitoh
    • 1
  • Michiaki Unno
    • 1
  • Takashi Kamei
    • 1
  1. 1.Department of SurgeryTohoku University HospitalSendaiJapan

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