Analysis of risk factors for postoperative pneumonia following esophagectomy for esophageal cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Shan ¹ , LI Xiaoqing ¹ , YE Xinyi ¹ , WU Na ² , ZHOU Sicheng ² ,  HU Yang ²

1. Endoscopy Center, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
2. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding?author：

HU Yang, Email: huyangthoracic@126.com

Keywords：

Esophageal cancer; surgery; postoperative pneumonia; prediction; systemic immune-inflammation index; prognostic nutritional index; forced expiratory volume in 1 second percentage of predicted (FEV1%)

DOI：

10.7507/1007-4848.202512086

Video：

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Objective To explore the risk factors for postoperative pneumonia (POP) following esophagectomy for esophageal cancer, and to identify potential clinical indicators for predicting POP. Methods A retrospective analysis was conducted on the clinical data of patients with esophageal cancer who underwent esophagectomy at the Department of Thoracic Surgery, West China Hospital of Sichuan University from 2017 to 2021. Perioperative clinical indicators were collected to analyze the risk factors for the occurrence of POP. Patients were divided into a POP group and a non-POP group according to whether POP occurred. Results A total of 613 patients with esophageal cancer were included, comprising 472 males and 141 females, with a median age of 62.0 (53.0, 67.0) years. Among them, 51 patients were in the POP group, and 562 patients were in the non-POP group. Multivariate logistic regression analysis showed that the forced expiratory volume in 1 second percentage of predicted (FEV1%) [OR=0.958, 95%CI (0.943, 0.973), P<0.001], systemic immune-inflammation index (SII) [OR=1.001, 95%CI (1.000, 1.002), P=0.007], and prognostic nutritional index (PNI) [OR=0.869, 95% CI (0.813, 0.928), P<0.001] were independent risk factors for POP. Receiver operating characteristic (ROC) curve analysis combining FEV1%, SII, and PNI demonstrated that the area under the curve (AUC) for predicting POP was 0.826 [95%CI (0.793, 0.855), cut-off value: 0.08, sensitivity: 80.3%, specificity: 72.4%, Youden index: 0.528, P<0.001]. Cross-validation confirmed that the combined indicators had the highest predictive efficacy, which was significantly superior to that of any single indicator alone. Conclusion Preoperative levels of FEV1%, SII, and PNI are closely associated with the occurrence of POP following surgery for esophageal cancer. The combined application of FEV1%, SII, and PNI demonstrates good predictive efficacy for the occurrence of POP.

1.	GBD 2021 Causes of Death Collaborators. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet, 2024, 403(10440): 2100-2132.
2.	Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
3.	Ajani JA, D'Amico TA, Bentrem DJ, et al. Esophageal and esophagogastric junction cancers, version 2. 2023, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2023, 21(4): 393-422.
4.	Ando N, Ozawa S, Kitagawa Y, et al. Improvement in the results of surgical treatment of advanced squamous esophageal carcinoma during 15 consecutive years. Ann Surg, 2000, 232(2): 225-232.
5.	Luketich JD, Alvelo-Rivera M, Buenaventura PO, et al. Minimally invasive esophagectomy: outcomes in 222 patients. Ann Surg, 2003, 238(4): 486-494.
6.	Santillan AA, Farma JM, Meredith KL, et al. Minimally invasive surgery for esophageal cancer. J Natl Compr Canc Netw, 2008, 6(9): 879-884.
7.	Biere SS, van Berge Henegouwen MI, Maas KW, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet, 2012, 379(9829): 1887-1892.
8.	Raftery NB, Murphy CF, Donohoe CL, et al. The complexity of defining postoperative pneumonia after esophageal cancer surgery: a spectrum of lung injury rather than a simple infective complication? Ann Surg, 2022, 276(5): e400-e406.
9.	Wang W, Yu Y, Sun H, et al. Predictive model of postoperative pneumonia after neoadjuvant immunochemotherapy for esophageal cancer. J Gastrointest Oncol, 2022, 13(2): 488-498.
10.	Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control, 2008, 36(5): 309-332.
11.	李蓮玉, 譚小欣, 李玉霞, 等. 食管癌術后肺部感染患者肺功能指標觀察. 中華醫院感染學雜志, 2016, 26(16): 3755-3757.Li LY, Tan XQ, Li YX, et al. Observation on pulmonary function indexes in patients with pulmonary infection after esophageal cancer surgery. Chin J Nosocomiol, 2016, 26(16): 3755-3757.
12.	Tao B, Xiao LZ, Bi L, et al. Effect of pleural adhesions on short- and long-term outcomes after minimally invasive esophagectomy: a propensity score matching analysis. Surg Endosc, 2023, 37(3): 1727-1734.
13.	呂明闖, 曹睿, 丁旭青, 等. 食管癌術后并發肺部感染危險因素和預測模型構建. 中華醫院感染學雜志, 2024, 34(10): 1507-1511.Lyu MC, Cao R, Ding XQ, et al. Risk factors for pulmonary infection in patients with esophageal cancer and establishment of prediction model. Chin J Nosocomiol, 2024, 34(10): 1507-1511.
14.	王乃馨, 單單單, 張繼露. 食管癌根治術患者術后肺部感染的相關危險因素分析. 實用癌癥雜志, 2024, 39(2): 233-236.Wang NX, Shan DD, Zhang JL. Analysis of related risk factors of postoperative pulmonary infection in patients underwent radical esophageal cancer. Pract J Cancer, 2024, 39(2): 233-236.
15.	Shuang L, Jingwen S, Qiyu S, et al. A nomogram for predicting postoperative pulmonary infection in esophageal cancer patients. BMC Pulm Med, 2021, 21(1): 283.
16.	Nakamura K, Yoshida N, Baba Y, et al. Elevated preoperative neutrophil-to-lymphocyte ratio predicts poor prognosis after esophagectomy in T1 esophageal cancer. Int J Clin Oncol, 2017, 22(3): 469-475.
17.	Yutong H, Xiaoli X, Shumei L, et al. Increased neutrophil-lymphocyte ratio is a poor prognostic factor in patients with esophageal cancer in a high incidence area in China. Arch Med Res, 2015, 46(7): 557-563.
18.	Fan L, Wang R, Chi C, et al. Systemic immune-inflammation index predicts the combined clinical outcome after sequential therapy with abiraterone and docetaxel for metastatic castration-resistant prostate cancer patients. Prostate, 2018, 78(4): 250-256.
19.	Lolli C, Basso U, Derosa L, et al. Systemic immune-inflammation index predicts the clinical outcome in patients with metastatic renal cell cancer treated with sunitinib. Oncotarget, 2016, 7(34): 54564-54571.
20.	Jiang R, Li P, Shen W, et al. The predictive value of the preoperative systemic immune-inflammation index in the occurrence of postoperative pneumonia in non-small cell lung cancer: a retrospective study based on 1486 cases. Thorac Cancer, 2023, 14(1): 30-35.
21.	Sun K, Chen S, Xu J, et al. The prognostic significance of the prognostic nutritional index in cancer: a systematic review and meta-analysis. J Cancer Res Clin Oncol, 2014, 140(9): 1537-1549.
22.	Mohri Y, Inoue Y, Tanaka K, et al. Prognostic nutritional index predicts postoperative outcome in colorectal cancer. World J Surg, 2013, 37(11): 2688-2692.
23.	Chen C, Li C. Preoperative prognostic nutritional index as a predictive factor for postoperative pneumonia in esophageal cancer patients undergoing esophagectomy. Front Nutr, 2025, 12: 1674518.

1. GBD 2021 Causes of Death Collaborators. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet, 2024, 403(10440): 2100-2132.
2. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
3. Ajani JA, D'Amico TA, Bentrem DJ, et al. Esophageal and esophagogastric junction cancers, version 2. 2023, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2023, 21(4): 393-422.
4. Ando N, Ozawa S, Kitagawa Y, et al. Improvement in the results of surgical treatment of advanced squamous esophageal carcinoma during 15 consecutive years. Ann Surg, 2000, 232(2): 225-232.
5. Luketich JD, Alvelo-Rivera M, Buenaventura PO, et al. Minimally invasive esophagectomy: outcomes in 222 patients. Ann Surg, 2003, 238(4): 486-494.
6. Santillan AA, Farma JM, Meredith KL, et al. Minimally invasive surgery for esophageal cancer. J Natl Compr Canc Netw, 2008, 6(9): 879-884.
7. Biere SS, van Berge Henegouwen MI, Maas KW, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet, 2012, 379(9829): 1887-1892.
8. Raftery NB, Murphy CF, Donohoe CL, et al. The complexity of defining postoperative pneumonia after esophageal cancer surgery: a spectrum of lung injury rather than a simple infective complication? Ann Surg, 2022, 276(5): e400-e406.
9. Wang W, Yu Y, Sun H, et al. Predictive model of postoperative pneumonia after neoadjuvant immunochemotherapy for esophageal cancer. J Gastrointest Oncol, 2022, 13(2): 488-498.
10. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control, 2008, 36(5): 309-332.
11. 李蓮玉, 譚小欣, 李玉霞, 等. 食管癌術后肺部感染患者肺功能指標觀察. 中華醫院感染學雜志, 2016, 26(16): 3755-3757.Li LY, Tan XQ, Li YX, et al. Observation on pulmonary function indexes in patients with pulmonary infection after esophageal cancer surgery. Chin J Nosocomiol, 2016, 26(16): 3755-3757.
12. Tao B, Xiao LZ, Bi L, et al. Effect of pleural adhesions on short- and long-term outcomes after minimally invasive esophagectomy: a propensity score matching analysis. Surg Endosc, 2023, 37(3): 1727-1734.
13. 呂明闖, 曹睿, 丁旭青, 等. 食管癌術后并發肺部感染危險因素和預測模型構建. 中華醫院感染學雜志, 2024, 34(10): 1507-1511.Lyu MC, Cao R, Ding XQ, et al. Risk factors for pulmonary infection in patients with esophageal cancer and establishment of prediction model. Chin J Nosocomiol, 2024, 34(10): 1507-1511.
14. 王乃馨, 單單單, 張繼露. 食管癌根治術患者術后肺部感染的相關危險因素分析. 實用癌癥雜志, 2024, 39(2): 233-236.Wang NX, Shan DD, Zhang JL. Analysis of related risk factors of postoperative pulmonary infection in patients underwent radical esophageal cancer. Pract J Cancer, 2024, 39(2): 233-236.
15. Shuang L, Jingwen S, Qiyu S, et al. A nomogram for predicting postoperative pulmonary infection in esophageal cancer patients. BMC Pulm Med, 2021, 21(1): 283.
16. Nakamura K, Yoshida N, Baba Y, et al. Elevated preoperative neutrophil-to-lymphocyte ratio predicts poor prognosis after esophagectomy in T1 esophageal cancer. Int J Clin Oncol, 2017, 22(3): 469-475.
17. Yutong H, Xiaoli X, Shumei L, et al. Increased neutrophil-lymphocyte ratio is a poor prognostic factor in patients with esophageal cancer in a high incidence area in China. Arch Med Res, 2015, 46(7): 557-563.
18. Fan L, Wang R, Chi C, et al. Systemic immune-inflammation index predicts the combined clinical outcome after sequential therapy with abiraterone and docetaxel for metastatic castration-resistant prostate cancer patients. Prostate, 2018, 78(4): 250-256.
19. Lolli C, Basso U, Derosa L, et al. Systemic immune-inflammation index predicts the clinical outcome in patients with metastatic renal cell cancer treated with sunitinib. Oncotarget, 2016, 7(34): 54564-54571.
20. Jiang R, Li P, Shen W, et al. The predictive value of the preoperative systemic immune-inflammation index in the occurrence of postoperative pneumonia in non-small cell lung cancer: a retrospective study based on 1486 cases. Thorac Cancer, 2023, 14(1): 30-35.
21. Sun K, Chen S, Xu J, et al. The prognostic significance of the prognostic nutritional index in cancer: a systematic review and meta-analysis. J Cancer Res Clin Oncol, 2014, 140(9): 1537-1549.
22. Mohri Y, Inoue Y, Tanaka K, et al. Prognostic nutritional index predicts postoperative outcome in colorectal cancer. World J Surg, 2013, 37(11): 2688-2692.
23. Chen C, Li C. Preoperative prognostic nutritional index as a predictive factor for postoperative pneumonia in esophageal cancer patients undergoing esophagectomy. Front Nutr, 2025, 12: 1674518.

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