Prognostic Significance of Low Body Mass Index and Betel-Quid Use in the 5-Year Survival Rates of Esophageal Squamous Cell Carcinoma Patients

Aim: This study aimed to examine the relationship between clinicopathological features, varied malnutrition criteria, and survival in esophageal squamous cell carcinoma (ESCC) patients. Methods: Six malnutrition criteria (body mass index (BMI) < 18.5 kg/m(2), serum albumin level < 3.5 g/dL, neutrophil-to-lymphocyte ratio (NLR) > 3.5, platelet-to-lymphocyte ratio (PLR) > 17, prognostic nutrition index (PNI) < 40, and blood total lymphocyte count (TLC) < 1,600 cells/mm(3)) were measured in 205 ESCC patients at the time of diagnosis. Malnutrition status and clinicopathological features were tested for prognostic effects on the 5-year survival rate. Results: Malnutrition rates vary according to nutrition assessment tools, ranging from 21.5% based on BMI < 18.5 kg/m(2) to 67.8% based on PNI < 40. These rates are associated with increased inflammation, but they showed no difference among various tumor stages. After adjustment of demographic variables and comorbid status, advanced tumor stage, low BMI at diagnosis, and betel quid use showed prognostic significance in the 5-year survival rate based on a multivariate logistic regression analysis. Conclusions: Different nutrition assessment criteria produced different malnutrition rates. Advanced tumor stage, low BMI at diagnosis, and betel quid use were independent prognostic factors for worse survival of ESCC patients.