The Impact of Worsening Nutritional Status in Neoadjuvant Chemotherapy on Postoperative Outcomes in Esophageal Cancer

Esophageal squamous cell carcinoma (ESCC) significantly affects nutritional status. While neoadjuvant chemotherapy (NAC) is the standard treatment for clinical stage II/III ESCC, its impact on nutritional status and postoperative outcomes remains unclear. This study investigated the relationship between nutritional deterioration during NAC and outcomes following esophagectomy. This single-center retrospective study included 85 patients with thoracic ESCC who received NAC followed by esophagectomy between January 2019 and December 2023. The NAC regimens included cisplatin plus 5-fluorouracil (CF), administered with or without radiation, and docetaxel, cisplatin, and fluorouracil (DCF). Nutritional status and postoperative outcomes were evaluated. Of the 85 patients, 20 received DCF, 36 received CF alone, and 29 received CF with radiation. Nutritional deterioration was noted during NAC with significant decreases in Prognostic Nutritional Index (PNI), Geriatric Nutritional Risk Index (GNRI), and hemoglobin-albumin-lymphocyte-platelet (HALP) score. Grade 3-4 hematologic toxicities correlated with reductions in GNRI and increases in neutrophil-lymphocyte ratio (NLR) (p=0.004 and 0.020, respectively). An increase in NLR post-NAC and decrease in PNI post-NAC were associated with prolonged hospital stays (p=0.024 and 0.042, respectively). Post-NAC NLR of 2.3 or over and HALP score below 20 were significantly associated with poorer overall survival (p=0.012 and <0.001, respectively). Although NAC reduces tumor burden and eliminates micrometastases, it potentially worsens nutritional status. Chemotherapy-induced hematologic toxicities are a risk factor for this decline. Therefore, comprehensive nutritional assessment and timely intervention during NAC are essential to optimize patient outcomes.