Effect of Weight Loss on Survival in Esophageal Cancer Patients undergoing Neoadjuvant Chemoradiotherapy and Surgery

Abstract

12], the impact of weight loss during neoadjuvant CRT on the long-term survival of patients with esophageal cancer remains unknown. Therefore, this retrospective study aimed to investigate the association of weight loss during neoadjuvant CRT with survival outcomes in patients with esophageal cancer. Materials & Methods Study design and participants A total of 102 patients with esophageal squamous cell cancer undergoing neoadjuvant CRT followed by surgery at Sichuan Cancer Hospital & Institute from March 2003 to August 2017 were retrospectively identified. Enrolled patients met the following inclusion criteria: ① newly diagnosed, histologically-confirmed primary esophageal squamous cell cancer; ② clinically stage II or III before treatment according to the 2002 American Joint Committee on Cancer Staging System (version 6.0); ③ Karnofsky performance score ≥ 80; and ④ patients underwent neoadjuvant chemoradiotherapy followed by radical esophagectomy. The exclusion criteria were as follows: ① missing weight records pre-or post-CRT; ② metastatic disease before or during preoperative treatment; ③ nonsquamous cell carcinoma; and ④ other active malignancy (except for basal cell carcinoma of the skin). The patient Abstract: Objective This study aimed to determine the impact of weight loss during neoadjuvant chemoradiotherapy on the survival of patients with esophageal carcinoma. Methods We retrospectively examined 102 consecutive patients with esophageal carcinoma who underwent neoadjuvant chemoradiotherapy followed by radical resection at Sichuan Cancer Hospital & Institute between 2003 and 2017. The patients were divided into three groups based on the amount of body weight lost during neoadjuvant chemoradiotherapy: severe weight loss (>10%), high weight loss (5%~10%), and low weight loss (< 5%). The correlations of weight loss with toxicity, progressionfree survival, and overall survival were investigated. Results The median overall survival was 49.7 months in the low weight loss group compared with 35.4 and 25.1 months in the high and severe weight loss groups (P = 0.041). The 1-year overall survival rates in the severe, high, and low weight loss groups were 62.5%, 85.0%, and 90.7%, respectively; the corresponding 3-year overall survival rates were 21.9%, 47.3%, and 68.8%, respectively, and the corresponding 5-year overall survival rates were 21.9%, 31.0%, and 44.4%, respectively. The multivariate analysis indicated that a pathological complete response and severe weight loss were independent prognostic factors for overall survival. Any leukopenia (P = 0.024), leukopenia of at least grade 3 (P = 0.021), and anemia (P = 0.042) occurred more frequently in the severe weight loss group. Conclusions Weight loss during neoadjuvant CRT is an independent and adverse prognostic factor in esophageal carcinoma patients, whereas a stable weight confers a better prognosis.

Analysis of the Risk Factors for Negative Emotions in Patients with Esophageal Cancer During the Peri-Radiotherapy Period and Their Effects on Malnutrition

“…6,7 However, radiotherapy has toxic side effects in patients and might also lead to malnutrition. 8 Long-term malnutrition reduces the quality of life of patients and their tolerance to radiotherapy and decreases treatment sensitivity, resulting in prolonged hospitalization or shortened survival time, or in severe cases, treatment failure due to lack of tolerance. 9,10 Some studies have shown that cancer patients always have negative emotions, and almost 50% of cancer patients suffer from anxiety and depression.…”