Combined Prognostic Value of Pre-Radiotherapy BMI and NRS-2002 for Overall Survival in Patients with Esophageal Cancer.
6 affiliations
- 1Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, People's Republic of China.
- 2School of Public Health, Chongqing Medical University, Chongqing, People's Republic of China.
- 3Key Laboratory of Nuclear Technology Medical Transformation, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, People's Republic of China.
- 4Sichuan Clinical Research Center for Radiation and Therapy,Mianyang Central Hospital, Mianyang, People's Republic of China.
- 5State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, Chongqing, People's Republic of China.
- 6Department of Nursing, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
Abstract
Nutritional status significantly affects the treatment efficacy and survival outcomes of esophageal cancer patients receiving radiotherapy. Although body mass index (BMI) and Nutritional Risk Screening 2002 (NRS-2002) are well-established independent assessment tools, there is a lack of strong evidence validating their combinedprognostic value. This study aims to compare theprognostic value of the combined BMI and NRS-2002 model with that of single-indexmodels (BMI or NRS-2002) for survival in esophageal cancer patients undergoing radiotherapy. A retrospective analysis was conducted on data from 676 esophageal cancer patients, with a median follow-up of 24 months. Cox regression analysis was used to evaluate the prognostic value of the combined model and single models, andthe Akaike Information Criterion (AIC) and C-index were used to compare model fit and discrimination. Meanwhile, the prognostic consistency of nutritional indicators was evaluated across key clinical subgroupssuch as TNM stage. Multivariate Cox regression analysis identified pre-radiotherapy BMI and NRS-2002 as independent prognostic factors for overall survival (OS). Compared to underweight patients, those with normal BMI (HR=0.599, 95% CI: 0.457-0.785, P<0.001) and overweight status (HR=0.689, 95% CI: 0.493-0.963, P=0.029) had significantly better survival. Conversely, nutritional risk (NRS-2002 ≥3) was associated with poorer survival (HR=1.279, 95% CI: 1.029-1.591, P=0.027). The combined model demonstrated superior model fit (lowest AIC: 5068.882) and discrimination (optimism-corrected C-index: 0.6597) compared to single-indicator models, although the incremental gain in discriminatory power was modest. Combining pre-radiotherapy BMI with the NRS-2002 provides a slight improvement in risk stratification for overall survival among esophageal cancer patients undergoing radiation therapy compared to a model based on a single indicator. Although this combined model offers complementary prognostic information, its incremental value in distinguishing patient risk is limited. In clinical practice, this combined assessment can serve as a practical adjunct to risk stratification, helping to identify high-risk patients who require comprehensive nutritional intervention. Further external validation in prospective cohorts is still needed.
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BibTeX
@article{wu2026combined,
title = {{Combined Prognostic Value of Pre-Radiotherapy BMI and NRS-2002 for Overall Survival in Patients with Esophageal Cancer.}},
author = {Danfeng Wu and Zhongli Liu and Chenxi He and Binwei Lin and Wen Zhou and Qiuling Shi and Xiaoyan Wang},
journal = {Cancer management and research},
year = {2026},
month = nov,
doi = {10.2147/cmar.s639380},
url = {https://europepmc.org/article/MED/42999794},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Combined Prognostic Value of Pre-Radiotherapy BMI and NRS-2002 for Overall Survival in Patients with Esophageal Cancer.
AU - Danfeng Wu
AU - Zhongli Liu
AU - Chenxi He
AU - Binwei Lin
AU - Wen Zhou
AU - Qiuling Shi
AU - Xiaoyan Wang
PY - 2026
DA - 2026/11/03
JO - Cancer management and research
DO - 10.2147/cmar.s639380
UR - https://europepmc.org/article/MED/42999794
AB - Nutritional status significantly affects the treatment efficacy and survival outcomes of esophageal cancer patients receiving radiotherapy. Although body mass index (BMI) and Nutritional Risk Screening 2002 (NRS-2002) are well-established independent assessment tools, there is a lack of strong evidence validating their combinedprognostic value. This study aims to compare theprognostic value of the combined BMI and NRS-2002 model with that of single-indexmodels (BMI or NRS-2002) for survival in esophageal cancer patients undergoing radiotherapy. A retrospective analysis was conducted on data from 676 esophageal cancer patients, with a median follow-up of 24 months. Cox regression analysis was used to evaluate the prognostic value of the combined model and single models, andthe Akaike Information Criterion (AIC) and C-index were used to compare model fit and discrimination. Meanwhile, the prognostic consistency of nutritional indicators was evaluated across key clinical subgroupssuch as TNM stage. Multivariate Cox regression analysis identified pre-radiotherapy BMI and NRS-2002 as independent prognostic factors for overall survival (OS). Compared to underweight patients, those with normal BMI (HR=0.599, 95% CI: 0.457-0.785, P<0.001) and overweight status (HR=0.689, 95% CI: 0.493-0.963, P=0.029) had significantly better survival. Conversely, nutritional risk (NRS-2002 ≥3) was associated with poorer survival (HR=1.279, 95% CI: 1.029-1.591, P=0.027). The combined model demonstrated superior model fit (lowest AIC: 5068.882) and discrimination (optimism-corrected C-index: 0.6597) compared to single-indicator models, although the incremental gain in discriminatory power was modest. Combining pre-radiotherapy BMI with the NRS-2002 provides a slight improvement in risk stratification for overall survival among esophageal cancer patients undergoing radiation therapy compared to a model based on a single indicator. Although this combined model offers complementary prognostic information, its incremental value in distinguishing patient risk is limited. In clinical practice, this combined assessment can serve as a practical adjunct to risk stratification, helping to identify high-risk patients who require comprehensive nutritional intervention. Further external validation in prospective cohorts is still needed.
SN - 1179-1322
ER -