Post-radiation Prognostic Nutritional Index Predicts Survival and Guides Consolidation Chemotherapy in Esophageal Cancer Patients

Purpose: Nutritional status is associated with the prognosis of esophageal cancer (EC) patients, which can influence treatment efficacy. Additionally, the efficacy of consolidation chemotherapy (CCT) after definitive chemoradiotherapy (DCRT) is unclear. This study aimed to explore the prognostic value of the prognostic nutritional index (PNI) at different treatment periods, as well as its influence on CCT efficacy. Methods: We reviewed the data of 106 patients with cT2-4N0-3M0 EC who received DCRT between December 2016 and October 2020. Survival analyses were performed to investigate the prognostic effect of PNI and CCT. Results: The 3-year Progression-Free Survival (PFS) and Overall Survival (OS) rates were 41.58% and 49.31%, respectively. In the univariate analysis, tumor location, T stage, N stage, clinical stage, and post-radiation PNI were significantly associated with PFS, whereas tumor location, N stage, clinical stage, CCT, and post-radiation PNI were associated with OS. Furthermore, post-radiation PNI was identified as an independent risk indicator for PFS and OS, and CCT was identified as an independent risk indicator for OS by multivariate analysis. Additionally, we found that PNI detected 60–120 days after radiotherapy may be an ideal prognostic predictor. CCT improved PFS and OS in patients with post-radiation PNI ≥ 41.98, but not in patients with post-radiation PNI < 41.98. Conclusion: Our results revealed that post-radiation PNI and CCT were independently associated with survival in EC patients receiving DCRT. However, patients with low post-radiation PNI could not benefit from CCT, indicating that it is unnecessary to add CCT after concurrent chemoradiotherapy in these patients.