Prognostic Nutritional Index, Tumor-infiltrating Lymphocytes, and Prognosis in Patients with Esophageal Cancer
Prognostic Nutritional Index, Tumor-infiltrating Lymphocytes, and Prognosis in Patients with Esophageal Cancer
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DOI：
10.1097/sla.0000000000002985
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发表时间：
2020-04-01
影响因子：
9
通讯作者：
Baba, Hideo
中科院分区：
文献类型：
--
作者：
Okadome, Kazuo;Baba, Yoshifumi;Baba, Hideo
目的：探讨食管癌预后营养指数（PNI）是否通过局部免疫影响临床预后。背景：PNI是营养状况和全身免疫能力的指标，并作为预后生物标志物而受到关注。肿瘤浸润性淋巴细胞（TIL）是人类癌症的一种特异性组织学特征，反映了个体的免疫肿瘤反应。研究方法：使用337例根治性切除食管癌的无偏倚数据库，我们评估了PNI、TILs状态、免疫组化染色CD 8表达与临床结局之间的关系。结果如下：与高PNI病例（n = 220）相比，低PNI病例（n = 117）的总生存率显著更差（log-rankP< 0.001;风险比：2.23; 95%可信区间：1.56-3.18;P< 0.001;多变量风险比：1.67; 95%可信区间：1.14-2.44;P= 0.008）。TILs状态与总生存期显著相关（P< 0.001）。此外，PNI与TIL状态（P< 0.001）和CD 8阳性细胞计数（P= 0.041）显著相关。外周血淋巴细胞计数与TIL状态之间也存在显著相关性（P< 0.001）。结论：PNI和TILs评分表达与食管癌的临床结局相关，支持其作为预后生物标志物的作用。考虑到PNI和TILs之间的关系，营养状况和全身免疫能力可能通过局部免疫反应影响患者的预后。
Objective: To determine whether prognostic nutritional index (PNI) affects clinical outcome through local immunity in esophageal cancers. Background: PNI is an indicator of nutritional status and systemic immune competence, and has attracted attention as a prognostic biomarker. Tumor-infiltrating lymphocytes (TILs) are a specific histological feature of human cancers, reflecting an individual's immunological tumor response. Methods: Using a nonbiased database of 337 curatively resected esophageal cancers, we evaluated the relationship between PNI, TILs status, CD8 expression by immunohistochemical staining, and clinical outcome. Results: Compared with PNI-high cases (n = 220), PNI-low cases (n = 117) showed significantly worse overall survival (log-rankP< 0.001; hazard ratio: 2.23; 95% confidence interval: 1.56-3.18;P< 0.001; multivariate hazard ratio: 1.67; 95% confidence interval: 1.14-2.44;P= 0.008). The TILs status was also significantly correlated with overall survival (P< 0.001). In addition, PNI was significantly associated with TILs status (P< 0.001) and the CD8-positive cell count (P= 0.041). A significant relationship between the peripheral blood lymphocyte count and TILs status was also observed (P< 0.001). Conclusions: PNI and TILs score expression were associated with clinical outcome in esophageal cancer, supporting their roles as prognostic biomarkers. Considering the relationship between PNI and TILs, nutritional status and systemic immune competence may influence patient prognosis through local immune response.