The predictive role of PNI and NRS2002 for postoperative pulmonary complications in ESCC patients undergoing neoadjuvant chemoimmunotherapy followed by McKeown esophagectomy: a retrospective cohort study.

[BACKGROUND] Esophageal squamous cell carcinoma (ESCC) is a leading cause of cancer-related deaths, especially in East Asia. McKeown esophagectomy, the standard surgery for advanced ESCC, is often complicated by pulmonary issues like pneumonia and pleural effusion. Neoadjuvant chemoimmunotherapy, combining platinum-based chemotherapy with PD-1 inhibitors, enhances treatment outcomes but may also raise the risk of these complications. The Prognostic Nutritional Index (PNI) and Nutritional Risk Screening 2002 (NRS2002) are potential biomarkers for predicting postoperative complications, but their combined predictive value for pulmonary complications in ESCC patients has not been well studied. This research aims to assess the predictive role of PNI and NRS2002 for pulmonary complications following McKeown esophagectomy after neoadjuvant chemoimmunotherapy.

[METHODS] A retrospective cohort study was conducted with 230 ESCC patients who received neoadjuvant chemoimmunotherapy followed by McKeown esophagectomy between January 2019 and December 2023. Preoperative PNI and NRS2002 scores were calculated for each patient. Postoperative pulmonary complications, including pneumonia, respiratory failure, pleural effusion requiring intervention, atelectasis, and bronchospasm within 30 days post-surgery, were recorded. Univariate and multivariate logistic regression models identified independent predictors of these complications. The predictive performance of PNI, NRS2002, and their combination was assessed using ROC curve analysis, with area under the curve (AUC) as the primary metric.

[RESULTS] Of the 230 patients, 63 (27.4%) developed postoperative pulmonary complications. Univariate analysis showed significant associations between lower PNI (OR = 0.54, 95% CI: 0.46-0.64, p < 0.001) and higher NRS2002 scores (OR = 2.87, 95% CI: 1.14-7.24, p < 0.001) with increased risk of complications. Multivariate analysis indicated that each unit increase in PNI reduced the odds of complications by 68% (adjusted OR = 0.32, 95% CI: 0.15-0.71, p = 0.005), while each unit increase in NRS2002 score increased the odds by 2.75 times (adjusted OR = 2.75, 95% CI: 1.25-8.29, p = 0.002). The combined PNI-NRS2002 model achieved an AUC of 0.979, outperforming PNI (AUC = 0.945) and NRS2002 (AUC = 0.884) individually.

[CONCLUSIONS] PNI and NRS2002 are independent predictors of postoperative pulmonary complications in ESCC patients undergoing McKeown esophagectomy after neoadjuvant chemoimmunotherapy. The combined PNI-NRS2002 model offers superior predictive accuracy and can assist in preoperative risk stratification, improving perioperative management and patient outcomes.