Impact of nutritional status on pathological response and recurrence-free survival in locally advanced oesophagogastric adenocarcinoma treated with perioperative FLOT therapy

Background: Malnutrition, prevalent in locally advanced oesophagogastric adenocarcinoma (LA-OGA), has an undetermined impact on survival. This study aimed to elucidate the association between survival and nutritional status in patients with LA-OGA undergoing perioperative 5-fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) treatment. Materials and methods: We screened patients with LA-OGA (cT2-4 and/or N1-3) treated with FLOT from 423 patients who underwent radical resection at The Royal Marsden Hospital between 2017 and 2023. Nutritional status was assessed using body weight and prognostic nutritional index (PNI). The primary outcome was 3-year recurrence-free survival (RFS) rate. Survival time was estimated using Kaplan–Meier curves and restricted mean survival time at 36 months. Multivariate analyses were carried out. Pathological response was defined as a tumour regression grade of 1-2 using the Mandard criteria. Results: A total of 210 patients met the inclusion criteria [median follow-up time, 26.5 months; 3-year RFS rate, 53% (95% confidence interval 45% to 60%)]. Weight loss and PNI at diagnosis and after neoadjuvant chemotherapy were not significant predictors of RFS. A decrease in PNI during neoadjuvant chemotherapy was associated with a significantly shorter 3-year RFS rate than a maintained or increased PNI (46% versus 69%, P < 0.01). The restricted mean survival time difference was 5.46 months (95% confidence interval 1.73-9.19 months, P < 0.001). A decreased PNI (P = 0.03) independently and negatively predicted RFS. The pathological response was not associated with PNI changes (28.2% versus 30.4%, P = 0.75). Conclusions: Our findings suggest that changes in PNI during neoadjuvant therapy may be associated with survival outcomes.