Impact of Weight Loss on Patients with Locally Advanced Esophageal and Esophagogastric Junction Cancers Treated with Chemoradiotherapy

Abstract

Introduction: Malnutrition and weight loss are commonly observed in patient with esophageal and esophagogastric junction (EGJ) cancers. Chemoradiotherapy (CRT) is a mainstay of treatment for locally advanced esophageal and EGJ cancers. Impact of weight loss on patients with treated with CRT was not well studied. Methods: Patients with locally advanced esophageal and EGJ cancer who received CRT were identified in our institutional database and allocated into low (LWL) and high (HWL) weight loss groups. HWL was defined as weight loss >5% of baseline during CRT. Results: A total of 167 patients were underwent definitive (n=89) or preoperative (n=78) CRT, respectively. HWL was observed in 46% and 55% of patients treated with definitive and preoperative CRT, respectively. Cisplatin/5FU regimen used during CRT was a significant predictive factor for weight loss in multivariate analysis (OR 2.07, 95% CI 1.09-3.94; p=0.026). In the definitive CRT group, patients in the HWL group experienced significantly worse overall survival than those in the LWL group (1.2 years vs 1.95 years; p=0.003). Multivariate analysis revealed that baseline albumin (>3.0 g/dL) was significantly associated with longer OS of definitive CRT patients (HR 2.15, 95% CI 1.1-4.19; p=0.024). Tolerability and toxicities during CRT were not statistically different between groups. Conclusion: Significant weight loss during CRT was frequently observed in patients with locally advanced esophageal and EGJ cancers. Baseline hypoalbuminemia was an independent prognostic factor for OS in patients treated with definitive CRT. Nutritional support before and during treatment should be considered to potentially improve patients' outcomes.

Clinical Impact of Preoperative Albumin-Bilirubin Status in Esophageal Cancer Patients Who Receive Curative Treatment

“…Esophagectomy with lymphadenectomy and perioperative adjuvant therapy is the standard treatment for resectable esophageal cancer (3,4). Several prognostic factors for resectable esophageal cancer have been reported, including the perioperative nutritional status, metabolic function, and immunological function (5)(6)(7)(8)(9)(10). Among them, the liver function is one of the key prognostic factors (11)(12).…”

Prognostic impact of sarcopenia in patients with locally advanced adenocarcinoma of the esophagogastric junction treated with neoadjuvant chemoradiotherapy

“…To further determine the nutritional status of patients, a comprehensive and detailed nutritional assessment is required. As for weight loss, it has been found that excessive weight loss during NAT or after surgery is associated with severe postoperative complications and worse survival in multiple cancers ( 10 , 11 , 31 ). Nevertheless, weight is affected by many factors.…”

“…Furthermore, malnutrition is considered a risk factor for adverse clinical outcomes in multiple tumors ( 7 – 9 ). In patients with gastric cancer and AEG, those who were at nutritional risk as assessed by the Nutritional Risk Screening 2002 (NRS 2002) and experienced weight loss, had more severe postoperative complications and poorer survival ( 7 , 10 , 11 ).…”

The Platelet-to-Lymphocyte Ratio Is an Independent Prognostic Factor for Patients With Esophageal Cancer Who Receive Curative Treatment

“…Therefore, it is necessary to determine prognostic factors and to establish which patients with prognostic factors require more aggressive treatment. Perioperative systemic inflammation is associated with both short-and long-term oncological outcomes (7,8). Previous studies demonstrated that perioperative systemic inflammation accelerated tumor invasion and enhanced micrometastasis in various malignancies (9,10).…”