The impact of pre- and post-operative weight loss and body mass index on prognosis in patients with oesophageal cancer

Hynes, O.; Anandavadivelan, Poorna; Gossage, James; Johar, Asif; Lagergren, Jesper; Lagergren, Pernilla

doi:10.1016/j.ejso.2017.05.023

Cited by 52 publications

(38 citation statements)

References 40 publications

(38 reference statements)

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“…Patients with preoperative weight loss had a 19% higher risk of death (HR=1.19, 95%CI: 1.07-1.33, P=0.002) and a 13% higher risk of disease progression than those without weight loss. The previous studies also showed that preoperative weight loss was significantly associated with poor prognosis [11][12][13], which is consistent with our study.…”

Section: Discussionsupporting

confidence: 93%

“…Hynes' and Van' studys showed that preoperative weight loss of >10% was a potential risk factor for the prognosis of patients undergoing radical esophagectomy. And in Yu's cohort of patients receiving adjuvant chemotherapy after radical esophagectomy indicated that the greater the weight loss, the worse the prognosis [11][12][13]. On the contrary, other studies have suggested that weight loss is not a reliable independent prognostic factor [14].…”

Section: Ivyspringmentioning

confidence: 99%

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Preoperative weight loss is associated with poorer prognosis in operable esophageal cancer patients: A single-center retrospective analysis of a large cohort of Chinese patients

Zhang¹,

Tan²,

Cai³

et al. 2020

J. Cancer

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Background: Preoperative weight loss has been shown to be a prognostic factor for many cancers. However, whether preoperative weight loss has clinical significance in patients with esophageal cancer is still controversial. Methods: A total of 2,174 Chinese patients underwent radical resection of esophageal cancer from 2000 to 2008 were included in our study. Patients were divided into two group: no weight loss (-) and weight loss (+), according to whether they had weight loss compared with their usual weight at diagnosis. The influence of preoperative weight loss on disease-free survival (DFS) and overall survival (OS) was estimated using the Kaplan-Meier method and Cox proportional hazard models. Results: weight loss (+) was significantly associated with age (P=0.001), alcoholism (P<0.001), tumor location (P=0.003), pT category (P=0.003), pN category (P=0.001). Patients of group weight loss (+) had significantly poorer DFS (Mean: 63.3 months (m) vs 76.8 m, P<0.001) and OS (67.4 m vs 83.3 m, P<0.001) than the no weight loss (-) group. In the final multivariate survival analysis with adjustment for covariates, we found that the weight loss (+) group had a 19% higher risk of death (HR=1.19, 95%CI: 1.07-1.33, P=0.002) and had a 13% higher risk of disease progression (HR=1.13, 95%CI: 1.01-1.25, P=0.027), respectively, than the no weight loss (-) group. Subgroup analysis indicated that the association with preoperative weight loss and better DFS or OS was observed in patients with esophageal squamous cell carcinoma (ESCC) and early pathological stage (I-II). Conclusion: Preoperative weight loss is associated with shorter OS and DFS, which means poor postoperative prognosis in esophageal cancer patients.

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Section: Discussionsupporting

confidence: 93%

Section: Ivyspringmentioning

confidence: 99%

Preoperative weight loss is associated with poorer prognosis in operable esophageal cancer patients: A single-center retrospective analysis of a large cohort of Chinese patients

Zhang¹,

Tan²,

Cai³

et al. 2020

J. Cancer

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“…were associated with poor prognosis [29,30]. This phenomenon, well known in cardiovascular 13 literature, is called the obesity paradox [31].…”

Section: Post-diagnosis Statin Usementioning

confidence: 99%

Statin use after diagnosis is associated with an increased survival in esophageal cancer patients: a Belgian population-based study

Lacroix

Couttenier

Vaes³

et al. 2019

Cancer Causes Control

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“…Esophagectomy or neoadjuvant therapy followed by esophagectomy is the critical therapy for this malignant tumor . Postoperative weight loss is a common problem in patients with esophageal cancer, and severe weight loss (SWL) is closely related to poor prognosis . However, the degrees of postoperative body weight changes and the risk factors for SWL have not been identified .…”

Section: Introductionmentioning

confidence: 99%

“…2 Postoperative weight loss is a common problem in patients with esophageal cancer, and severe weight loss (SWL) is closely related to poor prognosis. 3,4 However, the degrees of postoperative body weight changes and the risk factors for SWL have not been identified. 5,6 The purpose of this study was to prospectively observe body weight changes in patients who underwent minimally invasive McKeown esophagectomy (McKeown-MIE) to explore the regularity of body weight changes and to analyze the risk factors leading to SWL.…”

Section: Introductionmentioning

confidence: 99%

Analysis of the associated factors for severe weight loss after minimally invasive McKeown esophagectomy

Wang

Sun

et al. 2018

Thoracic Cancer

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BackgroundThis study investigated the risk factors for severe weight loss (SWL) within one year after minimally invasive McKeown esophagectomy.MethodsEsophageal cancer patients who underwent McKeown esophagectomy between January and July 2017 were prospectively enrolled. Preoperative body weight (PBW) was chosen as the initial body weight.ResultsForty‐four patients were enrolled and successfully followed up for one year. Median weight loss was 7.4% (quartile: 5.3–8.1%) and 12.6% (quartile: 8.8–17.7%) four weeks and one year after surgery, respectively. Accelerated weight loss occurred during the first two weeks after discharge, with median weight loss of 5.6% (quartile: 4.2–7.1%). Multivariable analysis showed that age ≥ 70 years (odds ratio [OR] 7.65; P = 0.030), preoperative sarcopenia (OR 7.18; P = 0.030), the first surgery in the daily schedule (OR 6.87; P = 0.032) and vocal cord paralysis (OR 12.30; P = 0.046) were independent risk factors for short‐term (4 weeks) SWL (> 7.5% PBW), while an American Society of Anesthesiologists score of 3–4 (OR 6.58; P = 0.047), a high fat‐free mass (OR 21.91; P = 0.003), and vocal cord paralysis (OR 25.83; P = 0.017) were independent risk factors for long‐term (1 year) SWL (> 13.0% PBW) after esophagectomy. Postoperative symptoms of insomnia, appetite loss, dysphagia, eating difficulties, and taste issues were also related to SWL.ConclusionsIn esophageal cancer patients who have undergone esophagectomy, the first two weeks after hospital discharge is a key period for nutrition intervention. Patients with associated factors for SWL require postoperative nutrition support.

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The impact of pre- and post-operative weight loss and body mass index on prognosis in patients with oesophageal cancer

Abstract: Post-operative weight loss and low BMI at 6 months post-surgery are independent markers of poor prognosis in patients who undergo surgery for oesophageal cancer.

Cited by 52 publications

References 40 publications

Preoperative weight loss is associated with poorer prognosis in operable esophageal cancer patients: A single-center retrospective analysis of a large cohort of Chinese patients

Preoperative weight loss is associated with poorer prognosis in operable esophageal cancer patients: A single-center retrospective analysis of a large cohort of Chinese patients

Statin use after diagnosis is associated with an increased survival in esophageal cancer patients: a Belgian population-based study

Analysis of the associated factors for severe weight loss after minimally invasive McKeown esophagectomy

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