Baseline nutritional status is prognostic factor after definitive radiochemotherapy for esophageal cancer

Abstract

Identify prognostic factors for survival and patterns of treatment failure after definitive radiochemotherapy for esophageal cancer. Between 2003 and 2006, 143 patients with squamous cell carcinoma and adenocarcinoma of the esophagus were retrospectively reviewed. Median age was 65 years (42-81). Median radiation dose was 62.5 Gy (38-72) with 1.8-2 Gy fraction. Median follow-up was 20.8 months (2.8-92.4). Three and 5-year local recurrence-free survival rates were 58.3% and 50.9%. In univariate analysis, traversable esophageal stricture was a prognostic factor. Three, 5-year locoregional recurrence-free survival rates were 42.4% and 34.9%. In multivariate analysis, traversable esophageal stricture and stage < IIB were independent prognostic factors. Three and 5-year disease-free survival rates were 30.5% and 25.9%. In multivariate analysis, Nutritional Risk Index (NRI) ≥ 97.5 and performance status (PS) = 0 were independent prognostic factors. Median, 3, and 5-year overall survival rates were 22.1 months, 34.4%, and 19.8%. In multivariate analysis, independent prognostic factors were NRI ≥ 97.5 and PS = 0. Median survival times for the NRI classes (no denutrition, moderate and severe denutrition) were 29.5, 19.7, and 12 months (P = 0.0004), respectively. A major impact of baseline NRI was found in terms of survival; it should be included in future prospective trials.

Nutritional Management of Esophageal Cancer Patients

“…NRI is another tool used for the assessment of malnutrition based on serum albumin concentration and weight loss. Ιncreased nutritional risk, derived from NRI, is associated with reduced survival in esophageal cancer patients treated with definitive chemoradiotherapy [10,33], but is not associated with postoperative infectious complications in patients treated with esophagectomy [27]. The Geriatric Nutritional Risk Index (GNRI) is a new index recently introduced for the assessment of nutritional status of elderly patients.…”

Clinical implications of endoscopic ultrasonography non-traversability in patients with locoregional esophageal cancer receiving multimodality therapy

“…The median overall survival was reportedly 16.2 months when patients in whom the majority was in stage III underwent definitive CRT [15]. Another review of 143 EC patients reported 5-year overall survival of 19.8% with median overall survival of 22.1 months when patients received definitive CRT [10]. …”

“…Non-traversable esophageal stricture was reported to be a factor related to prognosis in EC patients receiving definitive CRT [10]. However, studies on the clinical implications of EUS non-traversability in patients with advanced locoregional squamous EC receiving preoperative CRT and esophagectomy has been limited, and we therefore sought to determine its significance in this specific group of patients.…”

The Prediction of Deterioration of Nutritional Status during Chemoradiation Therapy in Patients with Esophageal Cancer

“…Weight loss, related to tumor location and side effects of the treatment is frequently reported both before and during treatment (4,5). Before the start of the treatment 34-74% of patients report weight loss (6)(7)(8)(9)(10) and during treatment this is 40-57% (6,10,11). As preoperative weight loss is associated with postoperative morbidity (12)(13)(14)(15) and increased healthcare costs (4,5), it is important to recognize which patients are at risk for deterioration of nutritional status during treatment.…”

“…In the present era, almost half of the patients with esophageal cancer are overweight at diagnosis (9,10,16). Literature advises an assessment of nutritional status which, next to weight, body mass index (BMI) and weight loss, also comprises parameters of muscle mass or muscle strength (17,18) as overweight may mask a compromised nutritional status.…”