Variation by stage in the effects of prediagnosis weight loss on mortality in a prospective cohort of esophageal cancer patients

Abstract

Cancer cachexia is increasingly recognized as a poor prognostic marker for various tumor types. Weight loss in esophageal cancer is multifactorial, as patients with bulky tumors also have reduced ability to eat. We aimed to investigate the relationship between prediagnosis weight loss and mortality in esophageal cancer and to determine whether these associations vary with tumor stage. We conducted a prospective cohort study of esophageal cancer patients at two tertiary centers. We recorded baseline patient characteristics including medications, smoking, body mass index, and weight loss in the year prior to diagnosis, and collected data on treatment and outcomes. We used Cox regression modeling to determine the associations between percent weight loss and outcomes. The main outcome of interest was all-cause mortality; secondary endpoints were esophageal cancer-specific mortality and development of metastases. We enrolled 134 subjects, the majority of whom had adenocarcinoma (82.1%); median percent weight loss was 4.7% (IQR: 0%-10.9%). Increasing percent weight loss was not associated with all-cause mortality (ptrend = 0.36). However, there was evidence of significant interaction by tumor stage (p = 0.02). There was a strong and significant association between prediagnosis weight loss and mortality in patients with T stages 1 or 2 (adjusted HR 8.26 for highest versus lowest tertile, 95%CI 1.11-61.5, ptrend = 0.03) but not for T stages 3 or 4 (ptrend = 0.32). Body mass index one year prior to diagnosis was not associated with mortality. Prediagnosis weight loss was associated with increased all-cause mortality only in patients with early stage esophageal cancer. This suggests that tumor-related cachexia can occur early in esophageal cancer and represents a poor prognostic marker.

Nutritional Status and Quality of Life in Hospitalised Cancer Patients Who Develop Intestinal Failure and Require Parenteral Nutrition: An Observational Study

“…Patients with upper gastrointestinal malignancies were identified to have lower weight and BMI on admission compared to patients with other types of malignancies. This finding is consistent with other studies and is attributed to the nature and location of oesophageal and gastric cancers, where the risk of malnutrition is highly prevalent by the time of diagnosis, mainly due to bowel obstruction and gastrointestinal symptoms [48][49][50][51]. A borderline difference in MUAMC was noted between different types of malignancy, indicating that severe weight loss due to muscle mass depletion defines this pattern of malnutrition [52,53].…”

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

“…Interestingly, some inflammatory markers and nutritional markers such as blood neutrophils and serum fibrinogen level have also been reported as prognostic risk factors for esophageal cancer which confirm our result further [18,19]. Therefore, preoperative weight loss in esophageal cancer may serve as a marker of more severe systemic inflammation, cachexia, malnutrition and worse prognosis [20]. Our study suggest that preoperative correction of nutritional status and reduction of inflammatory response in patients with esophageal cancer may be helpful to the prognosis of patients with esophageal cancer, but further studies are needed to prove this.…”

Dilated Thoracic Esophagus Presenting with Painful Progressive Persistent Dysphagia and Leukocytosis of Unknown Origin

“…Cancer cachexia from weight loss due to a loss of skeletal and fat tissue is associated with a high mortality and accounts for 20% of cancer-related deaths [ 7 ]. The incidence of weight loss in esophageal cancer is nearly as high as the weight loss associated with pancreatic and stomach cancers.…”