Objective To investigate the prognostic value of prognostic nutritional index in patients with esophageal adenocarcinoma. Methods 128 cases of esophageal adenocarcinoma treated in Fourth Hospital of Hebei Medical University between January 1st 2008 and December 31st 2010 were retrospectively analyzed. Demographic and clinicopathological data of patients were collected, including gender, age, degree of histological differentiation, tumour location and size, lymphatic metastasis,TNM classification, postoperative exhaust time, postoperative defecation time, diagnosis of stump invasion and tumour thrombus. The calculation of PNI was based on the count data of serum albumin and peripheral blood lymphocytes collected within one week before surgery. The date of surgery was set as starting point,and the date of death or the end date of follow-up ( December 31st 2015) as end point. The survival rate was calculated by Kaplan-Meier analysis;the differences between groups were compared using Log-rank test. Cox proportional hazard regression model was used to analyze the factors which may affect the prognosis of the patients. Results 120 out of 128 cases completed follow-up,so that the follow-up rate was 93. 8%. Patients were divided into high PNI group(n=41)and low PNI group(n=79)by the average value of PNI(40. 82). The tumour size,lymphatic metastasis, TNM classification and postoperative exhaust time of the patients were compared, and all the differences had statistical significance ( P﹤0. 001 ) . The results of single-factor analysis indicated that there were significant differences in the tumour size,lymphatic metastasis,TNM classification,postoperative exhaust time,postoperative defecation time and PNI(P﹤0. 05). The results of Cox proportional hazard regression model showed that TNM classification and PNI were the independent factors that affected the prognosis of the patients with esophageal adenocarcinoma(P﹤0. 05). The patients were divided into young &middle-aged group ( n=63 ) and senior group ( n =57 ) by the average age ( 61. 5 years old ) . The results of single -factor analysis indicated that in young & middle -aged group there were significant differences in gender, tumour size,lymphatic metastasis,TNM classification,postoperative exhaust time,postoperative defecation time and PNI( P﹤0. 05 );in senior group, there were significant differences in gender, tumour size, TNM classification, postoperative defecation time and PNI(P﹤0. 05). The results of Cox proportional hazard regression model showed that TNM classification, postoperative exhaust time and PNI were the independent factors that affected the prognosis of the young&middle-aged patients with esophageal adenocarcinoma(P﹤0. 05);PNI was the independent factor that affected the prognosis of the senior patients with esophageal adenocarcinoma(P﹤0. 05). Conclusion PNI is able to assess the surgical risk for patients with esophageal adenocarcinoma,and it is a valuable clinical marker of preoperative estimation as well as prognosis prediction.%目的：探讨预后营养指数（ PNI）在食管腺癌患者预后评估中的影响。方法选取2008—2010年就诊于河北医科大学第四医院的食管腺癌患者128例。收集患者人口学和临床病理资料，包括性别、年龄、组织学分化程度、肿瘤位置、肿瘤大小、淋巴结转移、TNM分期、术后排气时间、术后排便时间、有无残端受侵、有无脉管瘤栓。收集患者术前1周内血清蛋白和外周血淋巴细胞计数资料，计算PNI。以手术日期为观察起点，随访至2015-12-31，随访终点为死亡或截至随访日期。采用Kaplan-Meier法计算生存率，Log-rank检验比较生存率，Cox比例风险回归模型分析影响食管腺癌患者预后的因素。结果128例患者完成随访120例，随访率为93.8%。以患者平均 PNI （40.82）为界，分为高PNI组（n＝41）和低PNI组（n ＝79）。高 PNI 组和低 PNI 组患者肿瘤大小、淋巴结转移、TNM分期、术后排气时间比较，差异均有统计学意义（ P﹤0.001）。单因素分析结果显示，不同肿瘤大小、淋巴结转移、TNM分期、术后排气时间、术后排便时间、PNI水平者预后比较，差异均有统计学意义（ P﹤0.05）。Cox比例风险回归模型结果显示，TNM分期、PNI为影响食管腺癌患者预后的独立因素（ P﹤0.05）。以患者平均年龄（61.5岁）为界值，﹤61.5岁为中青年组（n＝63），≥61.5岁为老年组（n＝57）。单因素分析结果显示，中青年组中，不同性别、肿瘤大小、淋巴结转移、TNM分期、术后排气时间、术后排便时间、PNI水平者预后比较，差异均有统计学意义（P﹤0.05）。老年组中，不同性别、肿瘤大小、TNM分期、术后排便时间、PNI水平者预后比较，差异均有统计学意义（P﹤0.05）。Cox比例风险回归模型结果显示，TNM分期、术后排气时间、PNI为影响中青年食管腺癌患者预后的独立因素（P﹤0.05）；PNI为影响老年食管腺癌患者预后的独立因素（P﹤0.05）。结论 PNI能较好地评估食管腺癌患者的手术风险，是一项较有价值的术前评估和分析预后的指标。
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