Clinical Value of Pre-treatment Immunonutritional Indices in T4 Esophageal Cancer Treated With Radiotherapy

Background/Aim: T4 esophageal cancer that has invaded adjacent organs is often symptomatic and unresectable, and radiotherapy represents an important treatment option. Treatment strategies range from definitive to palliative approaches, making accurate prognostic assessment essential in clinical practice. Immunonutritional indices, such as the Glasgow Prognostic Score (GPS) and the Prognostic Nutritional Index (PNI), can be easily calculated from routine blood tests and have been reported as prognostic factors in various malignancies. However, their clinical significance in patients with T4 esophageal cancer treated with radiotherapy remains unclear. Patients and Methods: We retrospectively analyzed 79 patients with T4 esophageal cancer who were treated with radiotherapy. GPS was calculated based on serum C-reactive protein and albumin levels, and PNI was calculated using serum albumin levels and total lymphocyte counts. Overall survival (OS) was compared according to pretreatment GPS and PNI. Results: Pretreatment GPS scores were zero in 26 patients, one in 23 patients, and two in 30 patients, and the median pretreatment PNI was 40.7. The median OS for all 79 patients was 12 months. When patients were dichotomized into GPS 0/1 (N=49) and GPS 2 (N=30) groups, OS was significantly longer in the GPS 0/1 group than in the GPS 2 group (p=0.00224). Patients were also stratified according to a PNI cut-off value of 41 into a high-PNI group (PNI ≥41, N=38) and a low-PNI group (PNI <41, N=41); OS was significantly longer in the high-PNI group than in the low-PNI group (p=0.021). Conclusion: GPS and PNI, which are readily available from routine blood tests, are simple and useful prognostic indicators in patients with T4 esophageal cancer undergoing radiotherapy.