Nutritional Status During Concurrent Chemoradiotherapy (CCRT) Is Critical for Survival in Patients with Locally Advanced Unresectable Esophageal Cancer

Abstract

Weight loss is commonly presented in patients with locally advanced esophageal cancer (EC) during their treatment course. However, an optimal goal of nutrition support for patients with locally advanced EC remains unclear. This study was conducted to evaluate the association between nutritional status change during CCRT and survival outcome for patients with cT4b EC without baseline underweight (body mass index (BMI) ≥ 18.5 kg/m2). A retrospective review of 1120 newly diagnosed EC patients at our institution between 2009 and 2017 was conducted. One hundred and twenty-three T4b thoracic EC patients without distant metastasis who underwent curative CCRT were identified. Within this population, 101 patients without baseline underweight were included in this study. Clinical factors, body weight, and BMI were recorded before CCRT started. Nutritional statuses based on weight change during CCRT course were also measured and recorded for analysis. Survival analysis was calculated using Kaplan-Meier method with log-rank test, and prognostic factors were examined by Cox proportional hazards model. The mean pretreatment BMI of this cohort was 22.64 ± 3.11 kg/m2. The median percentage of weight loss during CCRT was 4.85% (Interquartile range (IQR) = 2.32%-8.76%) and the median time to reach the lowest weight after CCRT was 34 days (IQR = 23-41 days). The median overall survival (OS) of the entire cohort was 15.5 months. Univariate analysis revealed that better nutritional status, defined as weight loss ≤ 4%, during CCRT was a significant prognostic factor for OS. The median OS time for patients with weight loss ≤ 4% and weight loss > 4% were 24.9 months and 12.3 months, respectively (p = 0.007). Multivariate analysis further confirmed that weight loss ≤ 4% during CCRT was an independent prognostic factor for OS with a hazard ratio of 1.950 (95% Confidence Interval : 1.198-3.174, p = 0.007). Our study revealed that better nutritional status during CCRT course is associated with better survival for patients with unresectable locally advanced EC. This index, weight loss ≤ 4%, could be served as a goal for nutrition support in this group of patients during their CCRT course in the future. Further prospective studies are warranted to validate our findings.Abstract 2423; Table 1CharacteristicsMedian Survival (month)Univariable AnalysisMultivariable AnalysisHR95% CIp ValueHR95% CIp ValueWeight Loss≤ 4%24.91.9551.206-3.1690.007*1.9981.229-3.2490.005*> 4%12.3Salvage SurgeryYes38.22.0661.244-3.4320.005*1.9001.125-3.2080.016*No10.4Age≤ 6516.62.3211.373-3.9230.002*1.8631.087-3.1910.024*> 659.6Clinical N stage≤ 153.41.9081.148-3.1690013*1.8321.092-3.0740.022*> 113.2HR, Hazard Ratio; CI, Confidence Interval. Open table in a new tab