Clinical and Lifestyle-Related Prognostic Indicators among Esophageal Adenocarcinoma Patients Receiving Treatment at a Comprehensive Cancer Center

Abstract

Purpose: The incidence of esophageal adenocarcinoma (EAC) has risen substantially in recent decades, while the average 5-year survival remains only ~20%. Disease stage and treatment are the strongest prognostic factors. The role of lifestyle factors in relation to survival remains uncertain, with a handful of studies to date investigating associations with obesity, smoking, physical activity, diet, or medications. Methods: This study included patients diagnosed with primary adenocarcinoma of the esophagus, gastroesophageal junction, or cardia (N = 371) at Roswell Park Comprehensive Cancer Center between 2003 and 2019. Leveraging extensive data abstracted from electronic medical records, epidemiologic questionnaires, and a tumor registry, we analyzed clinical, behavioral, and environmental exposures and evaluated stage-specific associations with survival. Survival distributions were visualized using Kaplan–Meier curves. Cox proportional hazards regression models adjusted for age, sex, stage, treatment, and comorbidities were used to estimate the association between each exposure and all-cause or cancer-specific mortality. Results: Among patients presenting with localized/regional tumors (stages I–III), current smoking was associated with increased overall mortality risk (HR = 2.5 [1.42–4.53], p = 0.002), while current physical activity was linked to reduced risk (HR = 0.58 [0.35–0.96], p = 0.035). Among patients with stage IV disease, individuals reporting pre-diagnostic use of statins (HR = 0.62 [0.42–0.92], p = 0.018) or NSAIDs (HR = 0.61 [0.42–0.91], p = 0.016) had improved overall survival. Exploratory analyses suggested that high pre-diagnostic dietary consumption of broccoli, carrots, and fiber correlated with prolonged overall survival in patients with localized/regional disease. Conclusion: Our data suggest that lifestyle exposures may be differentially associated with EAC survival based on disease stage. Future investigation of larger, diverse patient cohorts is essential to validate these findings. Our results may help inform the development of lifestyle-based interventions to improve EAC prognosis and quality of life.

Exploring the Impact of the Obesity Paradox on Lung Cancer and Other Malignancies

“…Other studies showed improved outcomes in statin users when used after diagnosis [158,159]. Our group was able to show an overall and cancer-specific survival benefit of statins when they were used prior to esophageal adenocarcinoma diagnosis [157].…”

“…Statins have improved overall survival in stage four esophageal cancer patients [157]. Other studies showed improved outcomes in statin users when used after diagnosis [158,159].…”

“…The likely mechanism of this survival advantage is the pro-apoptotic and anti-proliferative effects caused by the statin medications [157]. Multiple mechanisms have been proposed, including endoplasmic reticulum stress, caspase induction, NF-kB blockade, and mTOR inhibition [157].…”

The Effect of Vinyasa Yoga Practice on the Well-Being of Breast-Cancer Patients during COVID-19 Pandemic

“…Physical activity evokes growing interest in cancer patient rehabilitation [ 1 ]. An increasing number of studies have shown that low to moderate-intensity exercises could help cancer patients to recover, deal with treatment, and also have an impact on extending survival time [ 2 , 3 , 4 , 5 ]. It is worth mentioning that physical activity leads to improved physiological and psychological functioning in oncological patients (a rehabilitation of patients with advanced cancer).…”

The association between statin use and prognosis in esophageal cancer patients: A meta-analysis

“…[17] To date, several studies have explored the association between statin use and survival in esophageal cancer. [18][19][20][21][22][23][24] However, their results are inconsistent and conflicting.…”