Abstract: Objective To investigate the predictive value of prognostic nutritional index (PNI) in the long-term survival of elderly patients with esophageal cancer after radical radiotherapy or chemoradiotherapy. Methods Data of a total of 188 elderly patients with esophageal cancer who received radical radiotherapy or chemoradiotherapy and met the eligibility criteria were retrospectively analyzed. PNI values before radiotherapy were calculated for each patient [PNI=serum albumin level (g/L)+5×absolute lymphocyte count (×109/L)]. ROC curve was used to determine the optimal cutoff value for predicting long-term survival of the patients. The patients were divided into high PNI group and low PNI group，and the survival prognosis and acute adverse reactions were compared between the two groups of patients. Results The 1-，3- and 5-year overall survival rates were 74.5%，33.5% and 24.9%，respectively. According to the ROC curve，the optimal cutoff value of PNI before treatment was 48.65，the area under curve was 0.649，the sensitivity was 60.2% and the specificity was 70.1%. The 1-, 3- and 5-year overall survival rates were 83.7%, 43.0% and 32.5% for 86 patients in the high PNI group (≥ 48.65) and 66.7%, 24.5% and 15.7% for 102 patients in the low PNI group (< 48.65, χ2=11.719，P＜0.01). TNM stage Ⅲ and pretreatment PNI＜48.65 were independent risk factors that affect the overall survival rate of patients (P＜0.05). In addition, the incidence of grade≥3 acute radiation esophagitis was significantly lower in the high PNI group than that in the low PNI group (χ2=4.438, P＜0.05). Conclusion PNI has a good predictive value for the long-term survival of the elderly patients with esophageal cancer after radical radiotherapy. Patients with high level of PNI have relatively good prognosis.

Key words: esophageal neoplasms, carcinoma, squamous cell, aged, radiotherapy, intensity-modulated, nutrition assessment, prognosis, prognostic nutritional index