Factors responsible for the decline in physical fitness during neoadjuvant chemotherapy in older patients with esophageal cancer: an exploratory prospective cohort study.

PURPOSE

The decline in physical fitness during neoadjuvant chemotherapy (NAC) impacts postoperative pneumonia and survival in older patients with locally advanced esophageal cancer (LAEC). However, information is lacking on the clinical mechanisms underlying the decline in physical fitness during NAC in older patients. This study investigated the factors responsible for the decline in physical fitness during NAC in older patients with LAEC.

METHODS

This was a single-center exploratory prospective cohort study. A total of 80 patients with LAEC aged ≥ 65 years who were scheduled for curative esophagectomy after NAC were consecutively enrolled between October 2021 and December 2023. The decline in the incremental shuttle walking test (ΔISWT; ΔISWT = pre-NAC (m) - post-NAC (m)) was calculated to assess physical fitness. Significant factors responsible for ΔISWT were detected using a multivariate regression model. Statistical significance was two-tailed at p < 0.05.

RESULTS

A total of 69 patients (mean age, 72.9 years) were analyzed. The mean ISWT distances before and after NAC were 418.7 m and 353.5 m, respectively; the mean ΔISWT was 65.2 m. Significant responding factors for the decline in physical fitness during NAC were changes in skeletal muscle mass index (SMI; adjusted coefficient - 14.239 cm/m, 95% confidence interval - 19.690 to - 8.788, p < 0.001) and decreased hemoglobin (Hb; vs. non-decreased Hb, adjusted coefficient 33.907, 95% confidence interval 9.913 to 64.288, p = 0.008) during NAC.

CONCLUSION

This prospective cohort study found that the significant factors for the decline in physical fitness during NAC were loss of skeletal muscle mass and decreased Hb during NAC in older patients with LAEC.