Nutr Res Pract.  2020 Feb;14(1):20-24. 10.4162/nrp.2020.14.1.20.

Selection and optimization of nutritional risk screening tools for esophageal cancer patients in China

  • 1Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
  • 2Department of Respiratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
  • 3Department of Nutrition, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.


Malnutrition has multiple impacts on surgical success, postoperative complications, duration of hospital stay, and costs, particularly for cancer patients. There are various nutrition risk screening tools available for clinical use. Herein, we aim to determine the most appropriate nutritional risk screening system for esophageal cancer (EC) patients in China.
In total, 138 EC patients were enrolled in this study and evaluated by experienced nurses using three different nutritional screening tools, the Nutrition Risk Screening 2002 tool (NRS2002), the Patient-generated Subjective Globe Assessment (PG-SGA), and the Nutrition Risk Index (NRI).We compared sensitivity, specificity, positive and negative likelihood ratios, and Youden index generated by each of the three screening tools. Finally, cut-off points for all three tools were re-defined to optimize and validate the best nutritional risk screening tool for assessing EC patients.
Our data suggested that all three screening tools were 100% sensitive for EC patients, while the specificities were 44.4%, 2.96%, and 59.26% for NRS 2002, PG-SGA, and NRI, respectively. NRI had a higher positive likelihood ratio as well as a higher area under the receiver operating characteristic curve compared to those of NRS 2002 and PG-SGA; although, all three tools had null negative likelihood ratios. After adjusting the cut-off points, the specificity and accuracy for all tools were significantly improved, however, the NRI remained the most appropriate nutritional risk screening system for EC patients.
The NRI is the most suitable (highest sensitivity and accuracy) nutritional risk screening tool for EC patients. The performance of the NRI can be significantly improved if the cut-off point is modified according to the results obtained using MedCalc software.


Nutritional risk screening; esophageal cancer; NRI; Youden index

MeSH Terms

Esophageal Neoplasms*
Length of Stay
Mass Screening*
Postoperative Complications
ROC Curve
Sensitivity and Specificity


  • Fig. 1 Comparison of AUROC curves generated from PG-SGA, NRS 2002, and NRI.The AUROC values for PG-SGA, NRS 2002, and NRI were 0.515, 0.722, and 0.796, respectively. AUROC, area under receiver operating characteristic; PG-SGA, patient-generated subjective globe assessment; NRS 2002, nutrition risk screening 2002; NRI, nutrition risk index.


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