Surgical Care Sciences, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Department of Surgery and Cancer, Imperial College London, London, UK.
Eur J Clin Nutr. 2022 Dec;76(12):1755-1761. doi: 10.1038/s41430-022-01183-6. Epub 2022 Aug 18.
Oesophageal cancer survivorship is afflicted by cancer cachexia related weight loss and nutrition impact symptoms. Identifying the factors which predict cancer cachexia specifically is warranted in order to identify those at risk and render the right kind of support. We aimed to assess if preoperative and postoperative body mass index (BMI) adjusted weight loss grading system (WLGS) is predictive of cancer cachexia at one year after surgery for oesophageal cancer.
Data were used from a prospective nationwide cohort study on patients operated on for oesophageal cancer in Sweden between 2013 and 2018 included at one year after surgery. The study exposure is BMI adjusted weight loss graded into one of five distinct weight loss grades (grades 0-4), defined in accordance with the WLGS by combining BMI and percentage weight loss, assessed at two clinical time points: preoperative and at 6 months post-surgery for oesophageal cancer. The study outcome is subjective measures of cancer cachexia one year after surgery, assessed using the cancer-cachexia specific questionnaire EORTC QLQ-CAX24. Multivariable linear regression models calculated mean score differences (MD) with 95% confidence intervals (CI) adjusted for predefined confounders. Statistical significance at p < 0.05 together with a clinically relevant difference of 10-points in mean scores was considered as a significant difference.
Among a total of 232 patients, the highest grade of preoperative WLGS 4 was associated with significantly worse physical decline than lower grades of WLGS 1 (MD -10, 95% CI: -20 to -1) and WLGS 2 (MD -11, 95% CI: -20 to -2). Those with preoperative WLGS 2, 3 and 4 reported lower scores on the adequacy of information on weight loss provided to them than those with preoperative WLGS 0. Those with the highest postoperative WLGS 4 had greater eating and weight loss worry than WLGS 2 (MD -17, 95% CI: -32 to -3) and WLGS 3 (MD -11, 95% CI: -21 to -2) and worse physical decline than WLGS 0 (MD -14, 95% CI: -25 to -2).
Higher grades of both preoperative and postoperative WLGS are predictive of cancer cachexia related physical decline one year after surgery for oesophageal cancer. Additionally, preoperative and postoperative WLGS were also predictive of inadequate information concerning weight loss and more worry regarding eating and weight loss, respectively. The WLGS may be an effective risk prediction tool for postoperative cachexia related physical decline in patients undergoing treatment for oesophageal cancer emphasizing its usability in the clinical setting.
食管癌的生存者受到癌症恶病质相关的体重减轻和营养影响症状的困扰。为了确定那些处于风险之中的人，并提供适当的支持，明确预测癌症恶病质的因素是有必要的。我们旨在评估在接受手术治疗食管癌的患者中，手术前后的体质指数（BMI）调整后的体重丢失分级系统（WLGS）是否能预测术后一年的癌症恶病质。
该研究数据来自于瑞典在 2013 年至 2018 年期间进行的一项针对接受食管癌手术的患者的前瞻性全国队列研究，包括术后一年的数据。该研究的暴露因素是 BMI 调整后的体重丢失，分为五个不同的体重丢失等级（等级 0-4），根据 WLGS 通过结合 BMI 和体重丢失百分比来定义，在两个临床时间点进行评估：术前和术后 6 个月用于食管癌。研究的结果是术后一年癌症恶病质的主观测量，使用特定于癌症恶病质的 EORTC QLQ-CAX24 问卷进行评估。多变量线性回归模型计算了经预定义混杂因素调整后的平均评分差异（MD）及其 95%置信区间（CI）。p 值<0.05 以及平均评分相差 10 分被认为具有统计学意义。
在总共 232 名患者中，术前 WLGS 4 最高等级与较差的身体下降明显相关，比 WLGS 1（MD-10，95%CI：-20 至-1）和 WLGS 2（MD-11，95%CI：-20 至-2）的等级更低。术前 WLGS 2、3 和 4 的患者报告称，他们获得的关于体重减轻的信息比术前 WLGS 0 的患者更不足。术后 WLGS 4 最高的患者比 WLGS 2（MD-17，95%CI：-32 至-3）和 WLGS 3（MD-11，95%CI：-21 至-2）的患者更担心进食和体重减轻，并且比 WLGS 0（MD-14，95%CI：-25 至-2）的患者的身体下降更严重。
术前和术后 WLGS 的较高等级都可预测食管癌术后一年与癌症恶病质相关的身体下降。此外，术前和术后 WLGS 也可预测与体重减轻相关的信息不足以及对进食和体重减轻的担忧增加。WLGS 可能是一种有效的术后恶病质相关身体下降的预测工具，适用于接受食管癌治疗的患者，强调了其在临床环境中的可用性。
