Early postoperative weight loss is associated with poor prognosis in patients with esophageal cancer

• Published in: Esophagus : official journal of the Japan Esophageal Society Vol. 19; no. 4; pp. 596 - 603
• Main Authors: Yamamoto, Kei, Tanaka, Koji, Yamasaki, Makoto, Yamashita, Kotaro, Makino, Tomoki, Saito, Takuro, Yamamoto, Kazuyoshi, Takahashi, Tsuyoshi, Kurokawa, Yukinori, Nakajima, Kiyokazu, Eguchi, Hidetoshi, Doki, Yuichiro
• Format: Journal Article
• Language: English
• Published: Singapore Springer Nature Singapore 01.10.2022; Springer Nature B.V
• Subjects: Esophageal cancer; Gastroenterology; Health risks; Medical prognosis; Medicine; Medicine & Public Health; Multivariate analysis; Original Article; Ostomy; Postoperative period; Surgical Oncology; Thoracic Surgery; Weight; Early postoperative weight loss; Esophageal cancer; Prognosis
• ISSN: 1612-9059; 1612-9067
• DOI: 10.1007/s10388-022-00937-2

Background Surgery for esophageal cancer (EC) causes morphological and functional changes in the upper gastrointestinal tract, resulting in postoperative weight loss (PWL). PWL has been shown to lead to poor nutritional status and immunocompetence, which may worsen the prognosis for several types of cancer. However, few reports have examined the relationship between weight loss (WL) in the early postoperative period and cancer prognosis. Methods A total of 421 esophageal cancer patients underwent curative esophagectomy at Osaka University Hospital from 2010 to 2016. Based on the patients’ body weight 1.5 months after surgery, they were classified into severe WL ( n  = 50) and slight-moderate WL ( n  = 371) groups. Results The 5-year overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) were significantly lower in the severe WL group than the slight-moderate WL group ( p  = 0.0002, p  < 0.0001, and p  = 0.0004, respectively). In the multivariate analysis, tumor invasion depth (pT3, 4), lymph node metastasis (pN2, 3), preoperative Prognostic Nutrition Index (< 45), postoperative complications (≥ G3), and severe WL were independent prognostic factors for CSS (hazard ratio [HR] 2.5, 95% confidence interval [CI] 1.7–3.7; HR 1.6, 95% CI 1.1–2.4; HR 1.9, 95% CI 1.3–2.8; HR 1.6, 95% CI 1.1–2.4; and HR 2.7, 95% CI 1.7–4.2, respectively). In a multivariate analysis of risk factors leading to severe WL, thoracotomy (VATS) and postoperative MAX CRP (high) were independent risk factors (odds ratio [OR 0.48, 95% CI 0.24–0.97; OR 1.9, 95% CI 1.0–3.5). Conclusion Early PWL would be a useful marker of poor cancer prognosis in EC patients. Highly inflammatory conditions due to surgical invasion and postoperative complications may contribute to early PWL.