O Hynes1, P Anandavadivelan2, J Gossage3, A M Johar4, J Lagergren5, P Lagergren6. 1. Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, United Kingdom; Division of Cancer Studies, King's College London, Room 2.20A, New Hunt's House, Guy's Campus, London, SE1 1UL, United Kingdom. Electronic address: Orla.Hynes@gstt.nhs.uk. 2. Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 17176 Stockholm, Sweden. Electronic address: poorna.anandavadivelan@ki.se. 3. Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, United Kingdom; Division of Cancer Studies, King's College London, Room 2.20A, New Hunt's House, Guy's Campus, London, SE1 1UL, United Kingdom. Electronic address: jgossage@doctors.org.uk. 4. Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 17176 Stockholm, Sweden. Electronic address: asif.johar@ki.se. 5. Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, United Kingdom; Division of Cancer Studies, King's College London, Room 2.20A, New Hunt's House, Guy's Campus, London, SE1 1UL, United Kingdom; Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 17176 Stockholm, Sweden. Electronic address: Jesper.Lagergren@ki.se. 6. Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 17176 Stockholm, Sweden. Electronic address: Pernilla.Lagergren@ki.se.
Abstract
BACKGROUND: Weight loss is a cardinal symptom of oesophageal cancer and is often continued after surgery. High body mass index (BMI) is a strong risk factor for oesophageal adenocarcinoma. This study aimed to assess the impact of pre- and post-operative weight loss and BMI on long-term mortality after resection for oesophageal cancer. METHODS: This prospective and nationwide cohort study included 390 patients, operated on for oesophageal cancer in Sweden in 2001-2005 with follow-up until 2016, who responded to a questionnaire on weight history 6 months after surgery. Multivariable Cox proportional hazard models provided hazard ratios (HRs) and 95% confidence intervals (95% CIs) of mortality while adjusting for several prognostic factors, including tumour stage. RESULTS: Compared to weight stable patients, pre-surgery weight loss indicated increased HRs of overall all-cause mortality (HR = 1.32, 95% CI 0.94-1.86) and disease-specific mortality (HR = 1.36, 95% CI 0.93-1.98). Patients with >20% weight loss post-surgery had worse overall all-cause mortality (HR = 1.71, 95% CI 1.01-2.88) and disease-specific mortality (HR = 2.20, 95% CI 1.24-3.89). Compared to patients with normal BMI, decreased HRs were indicated for patients who were obese at the time of surgery (overall all-cause mortality HR 0.87 95% CI, 0.58-1.31 and disease-specific mortality HR = 0.89, 95% CI 0.57-1.40), while patients with BMI ≤19.9 at 6 months post-surgery had increased all-cause mortality (HR = 1.41, 95% CI 1.03-1.95) and disease-specific mortality (HR = 1.55, 95% CI 1.09-2.21). CONCLUSION: 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.
BACKGROUND:Weight loss is a cardinal symptom of oesophageal cancer and is often continued after surgery. High body mass index (BMI) is a strong risk factor for oesophageal adenocarcinoma. This study aimed to assess the impact of pre- and post-operative weight loss and BMI on long-term mortality after resection for oesophageal cancer. METHODS: This prospective and nationwide cohort study included 390 patients, operated on for oesophageal cancer in Sweden in 2001-2005 with follow-up until 2016, who responded to a questionnaire on weight history 6 months after surgery. Multivariable Cox proportional hazard models provided hazard ratios (HRs) and 95% confidence intervals (95% CIs) of mortality while adjusting for several prognostic factors, including tumour stage. RESULTS: Compared to weight stable patients, pre-surgery weight loss indicated increased HRs of overall all-cause mortality (HR = 1.32, 95% CI 0.94-1.86) and disease-specific mortality (HR = 1.36, 95% CI 0.93-1.98). Patients with >20% weight loss post-surgery had worse overall all-cause mortality (HR = 1.71, 95% CI 1.01-2.88) and disease-specific mortality (HR = 2.20, 95% CI 1.24-3.89). Compared to patients with normal BMI, decreased HRs were indicated for patients who were obese at the time of surgery (overall all-cause mortality HR 0.87 95% CI, 0.58-1.31 and disease-specific mortality HR = 0.89, 95% CI 0.57-1.40), while patients with BMI ≤19.9 at 6 months post-surgery had increased all-cause mortality (HR = 1.41, 95% CI 1.03-1.95) and disease-specific mortality (HR = 1.55, 95% CI 1.09-2.21). CONCLUSION: 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.
Authors: Fausto Petrelli; Alessio Cortellini; Alice Indini; Gianluca Tomasello; Michele Ghidini; Olga Nigro; Massimiliano Salati; Lorenzo Dottorini; Alessandro Iaculli; Antonio Varricchio; Valentina Rampulla; Sandro Barni; Mary Cabiddu; Antonio Bossi; Antonio Ghidini; Alberto Zaniboni Journal: JAMA Netw Open Date: 2021-03-01
Authors: Rebecca A Carr; Caitlin Harrington; Christina Stella; Diana Glauner; Erin Kenny; Lianne M Russo; Meghan J Garrity; Manjit S Bains; Smita Sihag; David R Jones; Daniela Molena Journal: Cancer Med Date: 2021-12-21 Impact factor: 4.452