Prognostic value of nutritional status for esophageal cancer patients undergoing neoadjuvant therapy and resection.

Abstract

133 Background: Malnutrition, linked to decreased patient tolerance to chemotherapy and increased rates of therapy-related toxicity, negatively affects cancer prognosis. Esophageal carcinomas (EC) frequently present with dysphagia and significant weight loss which may be exacerbated by neoadjuvant chemoradiation, placing EC patients at an increased risk of malnutrition. We therefore aim to assess the prognostic value of pre-operative malnutrition for esophageal cancer patients undergoing neoadjuvant therapy (NAT). Methods: Query of our institution’s IRB approved database of 1113 EC patients (pts) identified 725 individuals who underwent NAT followed by resection from 1994-2018. Seventy-six pts were considered to be at higher nutritional risk during NAT, as indicated by significant weight loss and enteral feeding tube requirement (ETF+), while 644 did not receive pre-operative feeding tube placement (ETF–). Clinicopathologic characteristics, post-operative outcomes, and survival were compared between ETF+ and ETF– using various statistical methods. Results: Of the included pts, 83% were male with a median age of 64.5 (28-86) years. Between ETF+ (n = 76) and ETF– (n = 644), pt characteristics were balanced in terms of initial stage, age, histology and tumor location. A higher percentage of ETF+ pts had > 5% weight loss before NAT (32 vs. 6%; p < .01). ETF+ was associated with a significantly worse median survival (27 vs. 77 m; p < .01), but not with increased post-operative length of hospital stay (p = .69), complications (p = .20) or tumor recurrence (p = .89). Although completion of chemotherapy (p = .46) and radiation (p = .49) were comparable between ETF+ and ETF–, tumor response was worse in the ETF+ group (71 vs. 60% non-complete response; p = .02). Conclusions: Our results suggest that baseline malnutrition is a risk factor for poor survival and negatively impacts the efficacy of neoadjuvant therapy in EC patients. Poor response to NAT in malnourished patients may stem from impaired immune function. Future prospective studies should evaluate other parameters for nutritional assessment to further assess the impact of malnutrition on tumor regression and survival after NAT.

Translating Evidence-Based Guidelines into Practice—Are We Getting It Right? A Multi-Centre Prospective International Audit of Nutrition Care in Patients with Foregut Tumors (INFORM)

“…Martin et al [ 36 ] have highlighted the need for standardized nutrition care pathways with clearly defined roles and responsibilities. Further, the prognostic significance of cancer-related malnutrition and sarcopenia [ 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 ] in these patients warrants specific attention. The Clinical Oncology Society of Australia (COSA) have recently articulated a Position Statement to support the implementation of a co-ordinated, multidisciplinary pathway for screening, assessment and treatment of these conditions [ 61 ].…”

Phase I trial of hypofractionated chemoradiotherapy in the palliative management of esophageal and gastro-esophageal cancer

“…Dysphagia management is a critical goal of any therapy and allows improved nutritional status and quality of life. This may have a resultant positive impact on overall patient outcomes [ 7 ]. There are a number of approaches to dysphagia management including esophageal dilatation, placement of intraluminal stents, systemic chemotherapy, external beam radiotherapy (EBRT), brachytherapy and concurrent chemoradiotherapy (CTRT) [ 6 , 8 ].…”

Phase I trial of hypofractionated chemoradiotherapy in the palliative management of esophageal and gastro-esophageal cancer

“…Dysphagia management is a critical goal of any therapy and allows improved nutritional status and quality of life. This may have a resultant positive impact on overall patient outcomes (7). There are a number of approaches to dysphagia management including esophageal dilatation, placement of intraluminal stents, systemic chemotherapy, external beam radiotherapy (EBRT), brachytherapy and concurrent chemoradiotherapy (CTRT) (6, 8).…”