Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand.
Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand.
Asian Pac J Cancer Prev. 2021 Dec 1;22(12):3847-3855. doi: 10.31557/APJCP.2021.22.12.3847.
Malnutrition and weight loss are commonly observed in patient with esophageal and esophagogastric junction (EGJ) cancers. Chemoradiotherapy (CRT) is a mainstay of treatment for locally advanced esophageal and EGJ cancers. Impact of weight loss on patients with treated with CRT was not well studied.
Patients with locally advanced esophageal and EGJ cancer who received CRT were identified in our institutional database and allocated into low (LWL) and high (HWL) weight loss groups. HWL was defined as weight loss >5% of baseline during CRT.
A total of 167 patients were underwent definitive (n=89) or preoperative (n=78) CRT, respectively. HWL was observed in 46% and 55% of patients treated with definitive and preoperative CRT, respectively. Cisplatin/5FU regimen used during CRT was a significant predictive factor for weight loss in multivariate analysis (OR 2.07, 95% CI 1.09-3.94; p=0.026). In the definitive CRT group, patients in the HWL group experienced significantly worse overall survival than those in the LWL group (1.2 years vs 1.95 years; p=0.003). Multivariate analysis revealed that baseline albumin (>3.0 g/dL) was significantly associated with longer OS of definitive CRT patients (HR 2.15, 95% CI 1.1-4.19; p=0.024). Tolerability and toxicities during CRT were not statistically different between groups.
Significant weight loss during CRT was frequently observed in patients with locally advanced esophageal and EGJ cancers. Baseline hypoalbuminemia was an independent prognostic factor for OS in patients treated with definitive CRT. Nutritional support before and during treatment should be considered to potentially improve patients' outcomes.
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营养不良和体重减轻在食管和食管胃交界（EGJ）癌症患者中很常见。放化疗（CRT）是局部晚期食管和 EGJ 癌症的主要治疗方法。体重减轻对接受 CRT 治疗的患者的影响尚未得到很好的研究。
在我们的机构数据库中确定了接受 CRT 的局部晚期食管和 EGJ 癌症患者，并将其分为低（LWL）和高（HWL）体重减轻组。HWL 定义为 CRT 期间体重减轻超过基线的 5%。
共有 167 名患者分别接受了根治性（n=89）或术前（n=78）CRT。接受根治性和术前 CRT 的患者中，HWL 的发生率分别为 46%和 55%。多变量分析显示，CRT 期间使用顺铂/5FU 方案是体重减轻的显著预测因素（OR 2.07，95%CI 1.09-3.94；p=0.026）。在根治性 CRT 组中，HWL 组患者的总生存期明显短于 LWL 组（1.2 年 vs 1.95 年；p=0.003）。多变量分析显示，基线白蛋白（>3.0 g/dL）与根治性 CRT 患者的 OS 显著相关（HR 2.15，95%CI 1.1-4.19；p=0.024）。两组间 CRT 期间的耐受性和毒性无统计学差异。
在接受局部晚期食管和 EGJ 癌症治疗的患者中，CRT 期间体重明显减轻。基线低白蛋白血症是接受根治性 CRT 治疗的患者 OS 的独立预后因素。在治疗前和治疗期间应考虑进行营养支持，以潜在地改善患者的预后。
