Higher pre-treatment skin sympathetic nerve activity and elevated resting heart rate after chemoradiotherapy predict worse esophageal cancer outcomes

• Published in: BMC cancer Vol. 22; no. 1; pp. 1086 - 11
• Main Authors: Tang, Chen-Ling, Tsai, Wei-Chung, Lee, Jui-Ying, Wang, Yao-Kuang, Chen, Yi-Hsun, Liu, Yu-Wei, Lin, Ming-Chieh, Fang, Pen-Tzu, Huang, Yu-Ling, Wu, I-Chen
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 22.10.2022; BioMed Central; BMC
• Subjects: Autonomic nerve system; Autonomic nervous system; Blood pressure; Cancer; Cancer therapies; Care and treatment; Chemoradiotherapy; Chemoradiotherapy - adverse effects; Chemoradiotherapy - methods; Chemotherapy; Electric stimulation; Electrocardiography; Esophageal cancer; Esophageal Neoplasms - pathology; Esophageal Neoplasms - therapy; Esophageal squamous cell carcinoma; Esophageal Squamous Cell Carcinoma - therapy; Health aspects; Heart beat; Heart Rate; Humans; Mortality; Patient outcomes; Patients; Prognosis; Questionnaires; Radiation therapy; Radiotherapy; Resting heart rate; Skin; Skin sympathetic nerve activity; Software; Squamous cell carcinoma; Survival; Survival analysis; Sympathetic nerves; Sympathetic nervous system; Treatment Outcome; Taiwan; Esophageal squamous cell carcinoma; Resting heart rate; Autonomic nerve system; Chemoradiotherapy; Survival; Skin sympathetic nerve activity
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-022-10180-8

Chemoradiotherapy (CRT), which might affect the autonomic system, is the mainstay therapy for advanced esophageal squamous cell carcinoma (ESCC). Autonomic dysfunction has been found to possibly lead to cancer mortality in those with elevated resting heart rates (RHR). Skin sympathetic nerve activity (SKNA) is a new method of stimulating electrical signals in skin to evaluate autonomic function from sympathetic tone. In this study, we investigated the association between changes in RHR and autonomic function and ESCC mortality. Thirty-nine stage II-IV ESCC patients receiving CRT between March 2019 and November 2020 were prospectively enrolled and carefully selected, followed up and received the same meticulous supportive care. Serial RHR was recorded every two weeks from before CRT to eight weeks after CRT and average SKNA were recorded before and four weeks after CRT. All-cause mortality was defined as primary outcome. We found the RHR of ESCC patients to be significantly elevated and peaking at four weeks after CRT (p < 0.001) and then to gradually decrease. Those with an elevated RHR above the cutoff level (18 beat-per-minute) at eight weeks after CRT had worse overall survival. In addition, those with higher baseline sympathetic tone (average SKNA ≥ 0.86 μV) also had poor outcome. Increased pre-treatment sympathetic tone and elevated RHR after CRT are alarm signs of poor ESCC outcome. Further exploration of the mechanisms underlying these associations could potentially lead to intervention strategies for reducing mortality. This study is registered with ClinicalTrials.gov, identifier: NCT03243448.