Nomogram based on a novel nutritional immune-inflammatory status score to predict postoperative outcomes in esophageal squamous cell carcinoma

Table 1 Comparison of clinicopathological characteristics of patients in the training and validation sets

Variables	All patients (n = 829)	Training set (n = 568)	Validation set (n = 261)	P value
Age (year), median (IQR)	64 (44-84)	64 (44-84)	64 (47-77)	0.433
Gender, n (%)				0.866
Male	629 (75.9)	430 (74.7)	199 (76.2)
Female	200 (24.1)	138 (24.3)	62 (23.8)
Type of surgery, n (%)				0.824
Sweet Esophagectomy	334 (40.3)	232 (40.8)	102 (39.1)
Ivor-Lewis esophagectomy	49 (5.9)	31 (5.5)	18 (6.9)
Thoracoscopic esophagectomy	38 (4.6)	27 (4.8)	11 (4.2)
McKeown esophagectomy	408 (49.2)	278 (48.9)	130 (49.8)
Tumor size (cm), median (IQR)	4 (1-11)	4 (1-11)	4 (1-11)	0.233
Tumor centre location, n (%)				0.731
Upper thoracic segment	34 (4.1)	25 (4.4)	9 (3.4)
Middle thoracic segment	325 (39.2)	219 (38.6)	106 (40.6)
Lower thoracic segment	470 (56.7)	324 (57)	146 (55.9)
Histological grade, n (%)				0.138
G1	111 (13.4)	78 (13.7)	33 (12.6)
G2	534 (54.4)	375 (66)	159 (60.9)
G3	184 (22.2)	115 (20.2)	69 (26.4)
pT stage, n (%)				0.305
T1	243 (29.3)	174 (30.6)	69 (26.4)
T2	178 (21.5)	126 (22.2)	52 (19.9)
T3	246 (29.7)	158 (27.8)	88 (33.7)
T4	162 (19.5)	110 (19.4)	52 (19.9)
pN stage, n (%)				0.281
N0	527 (63.6)	369 (65)	158 (60.5)
N1	176 (21.2)	122 (21.5)	54 (20.7)
N2	101 (12.2)	62 (10.9)	39 (14.9)
N3	25 (3.0)	15 (2.6)	10 (3.8)
TNM stage, n (%)				0.355
I	234 (28.2)	170 (29.9)	64 (24.5)
II	231 (27.9)	155 (27.5)	75 (28.7)
III	303 (36.6)	204 (35.95)	99 (37.9)
IV	61 (7.4)	38 (6.7)	23 (8.8)
Vascular invasion				0.184
No	718 (86.6)	498 (87.7)	220 (84.3)
Yes	111 (13.4)	70 (12.3)	41 (15.7)
Nerve violations				0.462
No	725 (87.5)	500 (88.0)	225 (86.2)
Yes	104 (12.5)	68 (12)	36 (13.8)
Pathological types				0.749
Superficial type	257 (31)	182 (32)	75 (28.7)
Medullary type	321 (38.7)	214 (37.7)	107 (41)
Fungating type	21 (2.5)	14 (2.5)	7 (2.7)
Ulcerative type	221 (26.7)	153 (26.9)	68 (26.1)
Infiltrating type	9 (1.1)	5 (0.9)	4 (1.5)
Surgical margin				0.885
R0	809 (97.6)	554 (97.5)	255 (97.7)
R1-2	20 (2.4)	14 (2.5)	6 (2.3)
Weight (kg), median (IQR)	64.5 (34-102)	64 (34-102)	65 (41-92)	0.975
BMI (kg/m2), median (IQR)	23.03 (15.24-33.87)	23.03 (15.78-33.87)	23.03 (15.24-30.76)	0.645
HB (g/L), median (IQR)	131 (73-171)	131 (73-171)	132 (73-166)	0.856
NEUT (109/L), median (IQR)	3.62 (1.25-9.47)	3.62 (1.27-9.00)	3.62 (1.25-9.47)	0.310
PLT (109/L), median (IQR)	189 (51.0-527.0)	184.5 (61.0-527.0)	195 (51-481)	0.124
LYC (109/L), median (IQR)	1.51 (0.22-3.43)	1.49 (0.22-3.43)	1.53 (0.31-3.41)	0.983
MONO (109/L), median (IQR)	0.4 (0.12-4.8)	0.4 (0.12-4.8)	0.4 (0.16-2.56)	0.836
ALB (g/L), median (IQR)	45 (26-55.8)	45.25 (26-55.8)	44.3 (32.6-54.8)	0.044
NLR, median (IQR)	2.45 (0.44-21.8)	2.42 (0.72-21.8)	2.52 (0.44-18.51)	0.448
PLR, median (IQR)	125.9 (25.66-981.82)	124.81 (25.66-981.82)	126.94 (25.81-674.36)	0.195
LMR, median (IQR)	3.65 (0.19-17.46)	3.68 (0.19-17.46)	3.61 (0.36-13.94)	0.747
SII, median (IQR)	462.55 (92.33-4841.9)	454.03 (95.43-4575.27)	488.37 (92.33-4841.9)	0.099
PNI, median (IQR)	52.75 (35.75-67.15)	52.85 (35.75-67.15)	52.3 (38.45-64.2)	0.095
AGR, median (IQR)	1.59 (0.64-2.85)	1.60 (0.64-2.85)	1.56 (1.04-2.85)	0.051
HALP, median (IQR)	45.80 (6.6-231.87)	46.80 (6.6-231.87)	44.22 (9.36-203.11)	0.090
SIRI, median (IQR)	1.01 (0.15-14.35)	1.00 (0.16-14.35)	1.02 (0.15-12.33)	0.463

BMI: Body mass index; HB: Hemoglobin; NEUT: Neutrophil count; PLT: Platelet count; LYC: Lymphocyte count; MONO: Monocyte count; ALB: Albumin; NLR: Neutrophil-to-lymphocyte ratio; PLR: Platelet-to-lymphocyte ratio; LMR: Lymphocyte-to-monocyte ratio; SII: Systemic immune-inflammation index; PNI: Prognostic nutritional index; AGR: Albumin-to-globulin ratio; HALP: Hemoglobin albumin lymphocyte platelet score; SIRI: Systemic inflammatory response index.

Table 2 Results of univariate and multivariate Cox regression analysis for overall survival in the training set

Variables	Univariate Cox regression analysis for OS		Multivariate Cox regression analysis for OS
	HR	P value	HR	P value
NIIS score, ≥ -6.58 vs < -6.58	2.497 (1.802, 3.458)	< 0.001	2.232 (1.599, 3.117)	< 0.001
Age	1.085 (1.058, 1.112)	< 0.001	1.073 (1.046, 1.101)	< 0.001
Size	1.264 (1.153, 1.385)	< 0.001	1.194 (1.082, 1.319)	< 0.001
Gender, female vs male	1.170 (0.805, 1.700)	0.412
Type of surgery
Sweet esophagectomy	1
Ivor-Lewis esophagectomy	1.079 (0.556, 2.097)	0.821
Thoracoscopic esophagectomy	1.413 (0.747, 2.672)	0.288
McKeown esophagectomy	0.886 (0.638, 1.232)	0.473
Site
Upper	1
Middle	2.735 (0.859, 8.714)	0.089
Lower	2.893 (0.917, 9.127)	0.07
Grade
G1	1
G2	1.457 (0.831, 2.554)	0.189	1.231 (0.697, 2.176)	0.474
G3	3.594 (1.998, 6.465)	< 0.001	2.124 (1.158, 3.899)	0.015
pT
T1	1
T2	0.960 (0.611, 1.507)	0.859
T3	1.338 (0.897, 1.998)	0.154
T4	1.267 (0.816, 1.967)	0.291
pN
N0	1
N1	1.579 (1.073, 2.324)	0.02	1.581 (0.890, 2.810)	0.118
N2	3.432 (2.306, 5.109)	< 0.001	2.950 (1.517, 5.740)	0.001
N3	6.749 (3.481, 13.084)	< 0.001	6.426 (2.312, 17.864)	< 0.001
TNM
I	1
II	1.290 (0.812, 2.049)	0.281	1.003 (0.626, 1.609)	0.989
III	1.941 (1.288, 2.924)	0.002	0.899 (0.481, 1.680)	0.738
IV	4.099 (2.377, 7.069)	< 0.001	0.842 (0.335, 2.115)	0.714
Venous invasion, No vs Yes	1.390 (0.908, 2.129)	0.129
Perineural invasion, No vs Yes	1.080 (0.683, 1.708)	0.742
Pathological type
Superficial type	1
Medullary type	1.072 (0.746, 1.541)	0.705
Fungating type	1.102 (0.399, 3.046)	0.851
Ulcerative type	0.879 (0.581, 1.329)	0.541
Infiltrating type	1.455 (0.354, 5.970)	0.603
Surgical margin, R0 vs R1-2	1.257 (0.516, 3.062)	0.614

OS: Overall survival; NIIS: Nutritional immune-inflammatory status.