Neoadjuvant chemoradiotherapy (nCRT) is the standard treatment for patients with locally advanced esophageal squamous cell carcinoma (LA-ESCC), although perioperative immunotherapy has shown considerable promise. The integration of immunotherapy with nCRT (nICRT) is an innovative treatment paradigm and early-phase studies have reported enhanced pathological complete response (pCR) rates. However, comprehensive evaluations of safety, long-term prognosis, and recurrence patterns are lacking. In this multicenter real-world study, the clinical efficacy, recurrence patterns, and potential prognostic biomarkers were evaluated in patients with LA-ESCC receiving nICRT followed by esophagectomy. Clinical data from patients with LA-ESCC who underwent nICRT followed by esophagectomy between September 2020 and February 2023 were retrospectively analyzed across three tertiary cancer centers. Baseline inflammatory markers (platelet-to-lymphocyte ratio [PLR] and neutrophil-to-lymphocyte ratio [NLR]) were calculated from pretreatment complete blood counts. Treatment-related adverse events (AEs), survival outcomes, and recurrence patterns were rigorously assessed. Among the 71 enrolled patients, all achieved R0 resection (100

BACKGROUND:The current standard treatment for limited-stage small cell lung cancer (LS-SCLC) is concurrent chemoradiotherapy (cCRT) plus consolidation immunotherapy, with or without prophylactic cranial irradiation (PCI). However, it remains unknown whether administering immunotherapy concurrently with chemoradiotherapy confers additional benefit. This clinical trial is designed to investigate the efficacy and safety using durvalumab with chemoradiotherapy for LS-SCLC. METHODS:In this single-arm phase 2 study, patients with LS-SCLC received three (1-4) cycles of etoposide, cisplatin, or carboplatin, and durvalumab every 3 weeks, following by thoracic radiotherapy of 60.0 Gy to the gross tumor volume and 54.0 Gy to the planning target volume in 30 once-daily fractions and chemoimmunotherapy. After cCRT plus durvalumab, patients received durvalumab consolidation therapy every 3 weeks for a minimum of 1 year. PCI was recommended to patients with partial or complete response when chemoradiotherapy completed. Efficacy and adverse events were assessed. RESULTS:Overall, 51 patients were enrolled from March 1, 2021, to April 30, 2024, with a median follow-up of 32.0 months. The 1-, 2-, and 3-year progression-free survival (PFS) rates were 56.9%, 35.9%, and 28.2%, respectively, and the median PFS was 17.0 months. The 1-, 2-, and 3-year overall survival (OS) rates were 88.1%, 68.6%, and 49.6%, respectively, and the median OS was 32.0 months. There were 17 (33.4%) patients with grade 3 or 4 adverse events, 7 of which were immune‑related. CONCLUSIONS:These results suggest that the addition of durvalumab to chemoradiotherapy was well tolerated and showed encouraging efficacy, supporting further investigation in patients with LS-SCLC eligible for radical chemoradiotherapy.

Abstract Background Oesophageal squamous cell carcinoma is one of the most commonly diagnosed carcinomas in China, and postoperative radiotherapy plays an important role in improving the prognosis of patients. Carcinomas in different locations of the oesophagus could have different patterns of lymph node metastasis after surgery. Methods In this multicentric retrospective study, we enrolled patients with middle thoracic oesophageal squamous cell carcinomas from 3 cancer centres, and none of the patients underwent radiotherapy before or after surgery. We analysed the lymph node recurrence rates in different stations to explore the postoperative lymphatic recurrence pattern. Results From January 1st, 2014, to December 31st, 2019, 132 patients met the criteria, and were included in this study. The lymphatic recurrence rate was 62.1%. Pathological stage (P = 0.032) and lymphadenectomy method (P = 0.006) were significant predictive factors of lymph node recurrence. The recurrence rates in the supraclavicular, upper and lower paratracheal stations of lymph nodes were 32.6%, 28.8% and 16.7%, respectively, showing a high incidence. The recurrence rate of the subcarinal node station was 9.8%, while 8.3% (upper, middle and lower) thoracic para-oesophageal nodes had recurrences. Conclusions We recommend including the supraclavicular, upper and lower paratracheal stations of lymph nodes in the postoperative radiation field in middle thoracic oesophageal carcinomas. Subcarinal station is also potentially high-risk, while whether to include thoracic para-oesophageal or abdominal nodes needs careful consideration.

Objective:To analyze the local recurrence patterns after concurrent chemoradiotherapy (CCRT) for thoracic esophageal squamous cell carcinoma (ESCC) through image fusion, and to explore the risk factors of local recurrence and its relationships with dosimetric indices.Methods:A retrospective analysis was conducted for 209 thoracic ESCC patients who received radical CCRT in Fourth Hospital of Hebei Medical University during 2016-2019. For the patients diagnosed as the local recurrence of esophageal lesions, their CT images were fused with the original planning CT images using image registration software to identify the recurrence sites. Through 1∶1 propensity score matching (PSM) of the clinal data of patients with local recurrence (the recurrence group, nbefore = 81, nafter = 62) and those without local recurrence (the recurrence-free group, nbefore = 128, nafter=62), the dose and volume parameters of the treatment plans for the two groups were compared. Univariate and multivariate analyses were conducted using the Kaplan-Meier method and the Cox regression model to analyze the factors affecting the overall survival (OS), progression-free survival (PFS), and recurrence-free survival (RFS). Results:All patients had 1-, 3-, and 5-year OS rates of 80.9%, 42.6%, and 33.0%, respectively, 1-, 3-, and 5-year PFS rates of 67.9%, 34.0%, and 27.9%, respectively, and 1-, 3-, and 5-year RFS rates of 71.3%, 39.2%, and 30.5%, respectively. T stage, N stage, and radiation dose were independent prognostic factors for the OS, PFS, and RFS ( HR = 1.42-1.87, P < 0.05) of the patients, respectively. Among 68 patients with local recurrence, 62 cases (91.2%) suffered recurrence within the gross tumor volume (GTV). The dose and volume parameters of patients with local recurrence, such as GTV- D95%, clinical target volume (CTV)- D95%, GTV- D50%, CTV- D50%, and planning target volume (PTV)- D50%, GTV- V60, CTV- V60, and PTV- V60, were significantly lower than those of patients free from the local recurrence ( t=1.90-2.15, P < 0.05). Conclusions:Local recurrence of patients with thoracic ESCC after radical CCRT occurs mainly within the GTV. Increasing radiation doses may contribute to their survival benefits. The D50% for each target volume in the radiotherapy plan may be related to local recurrence, and it is necessary to conduct further research.

目的 探讨治疗前小野寺预后营养指数(PNI)对接受根治性放化疗颈胸上段食管鳞癌(CUTESCC)患者预后的影响和对≥2级放射性食管炎发生的预测价值.方法 回顾性分析河北医科大学第四医院2012年1月至2017年12月符合入组条件的163例CUTESCC患者的资料.应用受试者操作特征(ROC)曲线计算PNI预测患者预后的最佳截止值,对患者的预后进行单因素和Cox多因素分析.logistic二元回归模型用于单因素和多因素分析≥2级放射性食管炎(RE)的危险因素,将logistic多因素分析中具有统计学意义的因素用来构建预测≥2级RE的列线图.结果 PNI的最佳截止值为48.57[曲线下面积(AUC)=0.653,P＜0.001].全组患者中位总生存(OS)和无进展生存(PFS)期分别为26.1、19.4个月.PNI≥48.57组(47例)患者的 OS(x2=6.900,P=0.009)和 PFS(x2=9.902,P=0.003)均显著优于PNI＜48.57组(116例).Cox多因素分析显示,患者cTNM分期和PNI为影响患者OS(HR=1.513,95％CI为 1.193～1.920,P=0.001;HR=1.807,95％CI为 1.164～2.807,P=0.008)和PFS(HR=1.595,95％CI为 1.247～2.039,P＜0.001;HR=2.260,95％CI为 1.439～3.550,P＜0.001)的独立性预测指标,近期疗效为影响患者PFS的另一独立性指标(HR=2.072,95％CI为1.072～4.003,P=0.030).logistic多因素分析显示,病变最大横径(OR=3.026,95％CI 为 1.266～7.229,P=0.013)、大体肿瘤体积(GTV)(OR=3.456,95％CI为 1.373～8.699,P=0.008)、处方剂量(OR=3.124,95％CI为 1.346～7.246,P=0.009)和 PNI(OR=2.072,95％CI为1.072～4.003,P=0.030)是影响患者出现≥2级RE的独立性因素.将这4项指标纳入列线图模型:ROC曲线分析显示,该模型可以较好地预测患者≥2级RE的发生(AUC=0.686,95％CI为0.585～0.787);校正曲线显示,实际观测值与预测RE之间具有良好的一致性;决策曲线分析显示,在大多数阈值概率中列线图正净收益令人满意.结论 治疗前小野寺PNI为接受根治性放化疗颈胸上段食管鳞癌患者的独立性预后影响因素;病变最大横径、GTV、处方剂量和PNI这4项指标为本组患者出现≥2级放射性食管炎的危险因素,建立包含这些因素的预测模型,预测价值更大.

Background The improvement efficacy of consolidation chemotherapy after definitive concurrent chemotherapy and radio-therapy (CCRT) on the prognosis of patients with locally advanced esophageal squamous cell carcinoma (ESCC) remains controversial. In addition, there is a lack of nutritional risk screening tools which can consistently and accurately predict the survival of patients with esophageal cancer. Objective To investigate the effect of consolidation chemotherapy on the prognosis of patients with locally advanced ESCC receiving definitive CCRT. Methods A total of 223 patients with ESCC who received definitive CCRT in the department of radiotherapy, the Fourth Hospital of Hebei Medical University from January 2013 to December 2018 were selected as the research objects and divided into the simple CCRT group (n=87) and combined consolidation chemotherapy group (n=136) according to chemoradiotherapy regimen adopted by the patients. General data, ECOG score, tumor site, tumor length, TNM stage, radiotherapy dose, irradiation mode and chemotherapy regimen of the included patients were collected by electronic medical record system. Nutritional Risk Screening 2002 (NRS 2002) was used to score the nutritional status of the patients before chemoradiotherapy. Efficacy evaluation was performed within 1 month after CCRT, including complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD). Patients were followed up by telephone (completed by the follow-up center) and outpatient review until 2022-09-30, with overall survival (OS), local relapse-free survival (LRRFS) and distant metastasis-free survival (DMFS) collected. Survival curves of OS, LRRFS and DMFS were plotted by Kaplan-Meier method and compared by Log-rank test. Univariate and multivariate Cox risk regression models were used to explore the influencing factors of patient prognosis. Results There was no significant difference in baseline data between the simple CCRT group and combined consolidation chemotherapy group (P>0.05). There was no significant difference in the rates of OS, LRRFS and DMFS between the two groups (χ2=1.942, 0.743, 1.272; P=0.163, 0.389, 0.259). There were significant differences in the rates of OS, LRRFS and DMFS between patients with NRS 2002 score <3 (n=172) and patients with NRS 2002 score≥3 (n=51) before treatment (χ2=6.585, 4.858, 7.814; P=0.010, 0.028, 0.005). Multivariate Cox proportional hazard regression analysis showed that TNM stage and NRS 2002 score were influencing factors of OS and DMFS (P<0.05), irradiation mode was an influencing factor of LRRFS and DMFS (P<0.05), and clinical efficacy was an influencing factors of OS, LRRFS and DMFS (P<0.05). Stratified analysis showed that in patients with TNM stage Ⅱ and clinical efficacy of CR, the OS rates in the combined consolidation chemotherapy group (n=74, n=33) were significantly higher than those in the simple CCRT group (n=43, n=28), with statistically significant differences (χ2=4.811, 3.932; P=0.028, 0.047) . Conclusion Consolidation chemotherapy did not improve the prognosis of stageⅡ-Ⅲ ESCC patients after definitive CCRT, but may bring survival benefits for patients with early clinical stage, good response and nutritional status. As a nutritional risk screening tool, NRS 2002 has significant predictive value for the long-term survival of patients with locally advanced ESCC after chemoradiotherapy.

Background:The systemic inflammation response index (SIRI) and prognostic nutritional index (PNI) have been shown to be correlated with the prognosis of various solid tumors. This study sought to investigate the prognostic value of the SIRI and the PNI individually and in combination in locally advanced elderly esophageal squamous cell carcinoma (ESCC) patients treated with radical radiotherapy.Methods:The data of 192 ESCC patients aged ≥65 years, who had been treated with definitive radiotherapy between 2013 and 2016, were retrospectively analyzed. The optimal cutoff values of SIRI and PNI were determined by receiver operating characteristic curves. Kaplan-Meier curves and Cox proportional hazards models were used to analyze the effect of the SIRI and PNI on overall survival (OS) and progression-free survival (PFS). The areas under the curve were measured to evaluate the predictive ability of the SIRI, PNI, and SIRI combined with PNI for OS.Results:The optimal cutoff values of the pretreatment SIRI and PNI were 1.03 and 49.60, respectively. The univariate and multivariate analyses demonstrated that T stage (P=0.021), TNM stage (P=0.022), synchronous chemotherapy (P=0.032), the SIRI (P=0.001), and the PNI (P=0.045) were independent prognostic factors for OS and N stage (P=0.004), synchronous chemotherapy (P=0.016) and the SIRI (P=0.004) were independent prognostic factors for PFS. The AUC of the combined SIRI and PNI (0.706; 0.612-0.801) was higher than those of the SIRI (0.648; 0.540-0.756) and the PNI (0.621; 0.523-0.720). Patients in the low-SIRI and high-PNI groups, especially those in clinical stage II or who received synchronous chemotherapy (P<0.001, P=0.002), had better OS and PFS than those in the other groups (P<0.001).Conclusions:The SIRI and PNI are simple and reliable biomarkers for predicting long-term survival in elderly patients with locally advanced ESCC after radical radiotherapy. A high SIRI and a low PNI indicated poor prognosis, and the combination of the SIRI and PNI improved the accuracy of prognosis prediction and could be used to guide individualized treatment of patients.

Background Radioresistance is a major cause of treatment failure in esophageal squamous cell carcinoma (ESCC) radiotherapy, and the underlying mechanisms of radioresistance are still unclear. Irradiation (IR) stimulates changes in tumor-derived exosome contents, which can be taken up by recipient cells, playing an important role in the proliferation, cell cycle and apoptosis of recipient cells. This study investigated the effect of IR-induced exosomal high mobility group box 1 (HMGB1) on radioresistance in ESCC cells. Methods Plasma exosomes were isolated from 21 ESCC patients and 24 healthy volunteers, and the expression of HMGB1 was examined. Then, the therapeutic effect of radiotherapy was analyzed according to the different expression levels of plasma exosomal HMGB1 in ESCC patients. The uptake of exosomes by recipient cells was verified by immunofluorescence staining, and the localization of exosomes and HMGB1 in cells before and after IR was evaluated. The effects of IR-induced exosomes on cell proliferation, invasion, apoptosis, cell cycle distribution and radioresistance after HMGB1 knockdown were verified. Moreover, western blotting was used to measure changes in the expression of cyclin B1, CDK1, Bax, Bcl2, phosphorylated histone H2AX and the PI3K/AKT/FOXO3A pathway in the HMGB1-knockdown exosome group and the negative control group. Results The expression of HMGB1 in ESCC plasma exosomes was significantly increased compared with that in healthy volunteers, and high expression of HMGB1 in plasma exosomes was associated with radioresistance (P = 0.016). IR-induced the release of exosomal HMGB1 and promoted proliferation and radioresistance in recipient cells, with a sensitization enhancement ratio (SER) of 0.906 and 0.919, respectively. In addition, IR-induced exosomal HMGB1 promotes G2/M phase arrest by regulating the proteins cyclin B1 and CDK1, cooperating with the proteins Bax and Bcl2 to reduce the apoptosis rate through the PI3K/AKT/FOXO3A signaling pathway, and participated in IR-induced DNA damage repair through γH2AX. Conclusion These findings indicate that high expression of plasma exosomal HMGB1 is associated with an adverse radiotherapy response. IR-induced exosomal HMGB1 enhances the radioresistance of ESCC cells.

The purpose of this study was to evaluate several preradiotherapy serum inflammatory indicators, including the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and systemic inflammation score (SIS), and compare which of these indicators had the highest value in predicting survival. Inflammatory markers were combined with traditional prognostic factors, and novel nomogram models were developed to predict overall survival (OS) and progression-free survival (PFS) for patients with esophageal squamous cell carcinoma. A total of 245 patients were enrolled. The Kaplan-Meier method and univariate and multivariate analyses were used to compare survival differences. A total of 239 patients met the eligibility criteria. The survival numbers at 1, 3, and 5 years were 176, 83, and 62, respectively. The OS and PFS rates estimated at 1, 3, and 5 years were 74.6%, 36.8%, and 26.5% and 58.4%, 31.3%, and 20.5%, respectively. The differences in patients' OS and PFS were significant when univariate analysis was applied based on inflammation-based measures. Multivariate analysis showed that tumor length, tumor stage, tumor/node/metastasis stage, chemotherapy, and SIS value were predictive variables for OS and PFS. The nomogram model established based on the multivariate models of the training data set had good predictive ability. The unadjusted C-index was 0.701 (95% CI, 0.662-0.740) and 0.695 (95% CI, 0.656-0.734) for OS and PFS, respectively. This study showed that the SIS-based nomogram could accurately predict the OS and PFS of patients with esophageal squamous cell carcinoma.

目的 探讨那不勒斯预后评分(NPS)对临床Ⅲ期食管癌患者生存预后的预测价值.方法 回顾性分析行根治性放疗的163例临床Ⅲ期食管癌患者.根据放疗前血常规及生化结果计算每例患者NPS,然后依据NPS分值分为低危组(0分)、中危组(1～2分)以及高危组(3～4分)并比较3组生存预后差异.应用Kaplan-Meier法及Cox比例风险模型进行单因素和多因素预后分析,绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC),比较NPS与预后营养指数(PNI)、中性粒细胞/淋巴细胞比值(NLR)、淋巴细胞/单核细胞比值(LMR)等其他营养及炎症指标对生存预后的预测价值.结果 依据放疗前NPS结果,将163例患者分为低危组38例、中危组71例及高危组54例.对低、中、高危组生存状况的分析显示,1年总生存率分别为89.7％、78.3％、66.9％,3年总生存率分别为60.1％、40.7％、26.6％,5年总生存率分别为48.1％、25.2％、17.1％(Log-rankχ2=16.398,P<0.01);1年无进展生存率分别为76.7％、52.7％、50.8％;3年无进展生存率分别为50.1％、25.3％、19.4％,5年无进展生存率分别为42.0％、21.1％、12.9％(Log-rankχ2=16.852,P<0.01).多因素分析显示,NPS中、高危组和同期未化疗为影响患者总生存及无进展生存的独立危险因素.NPS预测生存的AUC值(0.658)优于PNI(0.581)、NLR(0.561)、LMR(0.578),差异有统计学意义(Z分别为1.938、2.016、1.950,P<0.05).结论 放疗前NPS是接受根治性放疗的临床Ⅲ期食管癌患者预后的独立影响因素,其对生存预后的预测价值优于其他营养及炎症指标,NPS较高的患者预后相对较差.

Background To study lymphatic recurrence distribution after radical surgery in the real world and guide clinical tumor volume delineation for regional lymph nodes during postoperative radiotherapy for lower thoracic squamous cell esophageal carcinomas. Methods We enrolled patients who underwent radical esophagectomy, without radiation before or after surgery, at 3 cancer hospitals. Patients were classified into groups according to tumor locations. We included patients with tumors in the lower thoracic segment and analyzed the postoperative lymph node recurrence mode. A cutoff value of 10% was used to differentiate high-risk lymph node drainage areas from others. Results We enrolled 1905 patients in the whole study series, including 652 thoracic esophageal carcinomas that met our inclusion criteria; there were 241 cases of lower thoracic esophageal carcinomas. 1st, 2nd, 4th, 7th, 8th groups of lymph nodes, according to the 8th edition of the AJCC classification, displayed as high-risk recurrence areas, representing 17.8%, 23.9%, 11.7%, 10.9% and 12.2% of lymph node recurrence. Stage III-IV tumors located in the lower segment of the thoracic esophagus showed a tendency to recur in the left gastric nodes (7.9%) and celiac nodes (10.6%). Conclusions According to our results, we recommended including the 4th, 7th and 8th groups of lymph nodes in the radiation field, and for patients with stage III-IV disease, the 17th and 20th groups of nodes should be irradiated during postoperative treatment. Whether including 1st/2nd groups in preventive irradiation needed more proofs.

Objective:To investigate the relationship between systemic immune-inflammation index (SII) and the prognosis of esophageal cancer patients treated with radical radiotherapy and to predict the prognosis of the patients using the SII combined with clinical staging.Methods:A retrospective analysis was conducted for 248 patients with esophageal cancer who were admitted to the Department of Radiotherapy in the Fourth Hospital of Hebei Medical University between 2014 and 2016. These patients included 146 males and 102 females, with a median age of 67 years. Among them, 134 patients received concurrent chemotherapy and 114 patients received radiotherapy alone. The SII before radiotherapy was defined as platelet count × neutrophil count/lymphocyte count. The patients were divided into a low-SII group and a high-SII group according to the optimal cutoff value of pretreatment SII determined by the receiver operating characteristics (ROC) curve. Survival analysis was calculated using the Kaplan-Meier method, and the Cox proportional hazards model was used for multivariate analysis. For these patients, the prognosis effects and the predictive value for survival of different SII levels combined with TNM staging were compared.Results:According to the ROC curves, the optimal cutoff value of SII before radiotherapy was 740.80. Based on this number, the patients were divided into a low-SII group (< 740.80, 150 cases) and a high-SII group (≥ 740.80, 98 cases). The objective response rate of the low-SII group was significantly higher than that of the high-SII group (86.0% vs 75.5%, χ2=4.39, P=0.036). The 1-, 3-, and 5-year overall survival (OS) rates of the low-SII group were 78.6%, 45.6%, and 32.3%, respectively. These rates were significantly higher than the corresponding rates of the high-SII group, which were 71.0%, 28.3%, and 16.4% ( χ2=11.22, P=0.001), respectively. Moreover, the 1-, 3- and 5-year progression-free survival (PFS) rates of the low-SII group were 67.0%, 36.9%, and 32.0%, respectively. Again, these rates were significantly higher than those of the high-SII group, which were 45.5%, 17.5%, and 12.5% ( χ2=15.38, P < 0.001), respectively. Multivariate analysis showed that TNM staging, treatment method, and SII were independent prognostic factors for OS and PFS ( HR=1.39-1.60, P<0.05). Patients with low SII and early clinical staging had a better prognosis than other subgroups ( χ2=13.68, 13.43, P=0.001). The area under curve (AUC) of SII combined with TNM staging (0.70) was higher than that of SII (0.63) and TNM staging (0.62) ( Z=2.48, 2.57, P < 0.05). Conclusions:Pretreatment SII has a high predictive value for the prognosis of esophageal cancer after radiotherapy, and higher SII indicates a worse prognosis. Thus, combining SII with TNM staging can improve the prediction accuracy of the prognosis of esophageal cancer patients.

Objective:To investigate the relationship between Onodera′s prognostic nutritional index (PNI) and prognosis of patients with esophageal squamous cell carcinoma (ESCC) after definitive chemoradiotherapy or radiotherapy, aiming to provide a convenient, effective and accurate predictive indicator for evaluating the long-term survival of patients after treatment.Methods:Clinical data of 231 ESCC patients treated with definitive chemoradiotherapy or radiotherapy at the Fourth Hospital of Hebei Medical University from 2013 to 2015 were retrospectively analyzed. The PNI values of each patient at different radiotherapy periods were calculated and the ROC curve was used to determine the optimal cutoff value of PNI before radiotherapy, 231 patients were divided into the better-nourishment group ( n=86) and worse-nourishment group ( n=145). Kaplan- Meier method was used for survival analysis. Cox proportional hazards model was utilized to analyze the relationship between different nutritional status and prognosis. The short-term clinical efficacy and incidence of acute toxicities were statistically compared between two groups. Results:The mean values of PNI before, at week 3, week 6 and 1 month after radiotherapy were48.68±5.08, 39.68±4.87, 43.74±4.89 and48.31±4.92, respectively. The optimal cutoff value of pretreatment PNI was 49.25, the area under the curve (AUC) was 0.655, the sensitivity and specificity were 68.6% and 60.9%, respectively. The 5-year overall survival (OS) and progression-free survival (PFS) rates in the better-nourishment group (PNI≥49.25) were 36.0% and 31.3%, significantly better than 19.3% and 18.6% in the worse-nourishment group (PNI<49.25)( P=0.001, P=0.039). Multivariate analysis showed PNI before the therapy was an independent prognostic factor for OS ( P=0.021). Stratified analysis demonstrated that Stage Ⅰ/Ⅱ and concurrent chemotherapy patients in the better-nourishment group all obtained significantly better OS than their counterparts in the worse-nourishment group ( P=0.007, P=0.004). In addition, the objective response rate in the better-nourishment group was significantly higher than that in the worse-nourishment group ( P=0.047), whereas the incidence of ≥3 grade radiation esophagitis was lower than that in the worse-nourishment group ( P=0.060). Conclusions:Pretreatment PNI is a convenient and reliable indicator for predicting the long-term survival of ESCC patients after definitive chemoradiotherapy or radiotherapy. Patients with higher PNI have relatively better prognosis and radiotherapy tolerance, especially in those with early stage or concurrent chemotherapy.

Background: Several inflammatory markers have been reported to be associated with clinical outcomes in patients with esophageal squamous cell carcinoma (ESCC). This study was to evaluate several pre-radiotherapy serum inflammatory indicators, including the neutrophil / lymphocytes ratio (NLR), platelet / lymphocyte (PLR), systemic immune-inflammatory index (SII), systemic inflammation score(SIS), and compare which one has the highest predicted survival value. Finally, combining inflammatory markers with traditional prognostic factors, a new Nomogram model was developed to predict overall survival (OS) and progression-free survival (PFS) for ESCC patients receiving radiotherapy (RT) or chemoradiotherapy (CRT). Methods: This study retrospectively reviewed the data of 245 patients with thoracic esophageal squamous cell carcinoma (ESCC) underwent RT or CRT in the Fourth Hospital of Hebei Medical University from January 2013 to December 2015. The survival differences of these indexes were compared by the Kaplan-Meier method, and the univariate and the multivariate analyses were performed to determine these prognostic factors of overall survival (OS) and progression-free survival (PFS). Multivariate Cox proportional hazards regression models were used to create nomogram for OS and PFS. Results: 239 patients met the eligibility criteria. The estimated 1-, 3-, and 5-year OS and PFS rates were 74.6%, 36.8%, 26.5% and 58.4%, 31.3%, 20.5%, respectively, for the whole group. The difference in survival between OS and PFS was significant when univariate analysis were applied based on these inflammation-based measures. Multivariate analysis showed that tumor length, T stage, TNM stage, chemotherapy, SIS were predictive variables for OS and PFS in the multivariate model. The nomogram model established based on multivariate models of training data set had good predictive ability, the unadjusted C-index was 0.701 (95% CI, 0.662– 0.740) and 0.695 (95% CI, 0.656 - 0.734) for OS and PFS. Conclusions: This study show that SIS, as a comprehensive indicator of inflammation and nutrition, had the strongest predictive power for evaluating prognosis. Moreover, our nomogram can accurately predict OS and PFS after treatment and may provide guidance regarding adjuvant therapy and surveillance.