Abstract
Weight loss during chemotherapy has not been exclusively investigated. Macrophage inhibitory cytokine-1 (MIC-1) might play a role in its etiology. Here, we investigated the prognostic value of weight loss before chemotherapy and its relationship with MIC-1 concentration and its occurrence during chemotherapy in patients with advanced esophageal squamous cell carcinoma (ESCC). We analyzed 157 inoperable locally advanced or metastatic ESCC patients receiving first-line chemotherapy. Serum MIC-1 concentrations were assessed before chemotherapy. Patients were assigned into two groups according to their weight loss before or during chemotherapy: >5% weight loss group and≤5% weight loss group. Patients with weight loss>5% before chemotherapy had shorter progression-free survival period (5.8 months vs. 8.7 months; p=0.027) and overall survival (10.8 months vs. 20.0 months; p=0.010). Patients with weight loss>5% during chemotherapy tended to have shorter progression-free survival (6.0 months vs. 8.1 months; p=0.062) and overall survival (8.6 months vs. 18.0 months; p=0.022), and if weight loss was reversed during chemotherapy, survival rates improved. Furthermore, serum MIC-1 concentration was closely related to weight loss before chemotherapy (p=0.001) CONCLUSIONS: Weight loss both before and during chemotherapy predicted poor outcome in advanced ESCC patients, and MIC-1 might be involved in the development of weight loss in such patients.
Highlights
Esophageal cancer is the eighth most common cancer worldwide (Kamangar et al, 2006)
Weight loss before chemotherapy has been acknowledged to be a predictor for poor survival in cancer patients (Pedersen et al, 1982; Andreyev et al, 1998; Ross et al, 2004; Van Cutsem and Arends, 2005)
Its effects on survival in esophageal squamous cell carcinoma (ESCC) patients were controversial, which may be due to different cutoff values of weight loss (Pedersen et al, 1982; Andreyev et al, 1998)
Summary
Esophageal cancer is the eighth most common cancer worldwide (Kamangar et al, 2006). Because of its special anatomic structure and biological characteristics, the rate of malnutrition of esophageal cancer is among the highest reported malnutrition rates (Riccardi and Allen, 1999). A study concluded that esophageal cancer patients with>10% weight loss before chemotherapy had significantly shorter overall survival (OS) than those with≤10% weight loss (Pedersen et al, 1982). We investigated the prognostic value of weight loss before chemotherapy and its relationship with MIC-1 concentration and its occurrence during chemotherapy in patients with advanced esophageal squamous cell carcinoma (ESCC). Results: Patients with weight loss>5% before chemotherapy had shorter progression-free survival period (5.8 months vs 8.7 months; p=0.027) and overall survival (10.8 months vs 20.0 months; p=0.010). Serum MIC-1 concentration was closely related to weight loss before chemotherapy (p=0.001) Conclusions: Weight loss both before and during chemotherapy predicted poor outcome in advanced ESCC patients, and MIC-1 might be involved in the development of weight loss in such patients
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