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The Impact of Weight Loss during Chemoradiotherapy for Unresectable Esophageal Cancer: Real-World Results. Life (Basel) 2022; 12:life12050706. [PMID: 35629373 PMCID: PMC9146706 DOI: 10.3390/life12050706] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 11/22/2022] Open
Abstract
Weight loss is a common phenomenon presented in unresectable esophageal cancer (EC) patients during their definitive chemoradiotherapy (dCRT) treatment course. This study explored the prognostic value of weight changes during dCRT in unresectable EC patients. From 2009 to 2017, 69 cT4b thoracic EC patients undergoing complete curative dCRT without baseline malnutrition were included. Clinical factors were analyzed via the Cox proportional hazards model and survival was analyzed by the Kaplan−Meier method. During dCRT, the median weight loss percentage was 5.51% (IQR = 2.77−8.85%), and the lowest body weight was reached at 35 days (IQR = 23−43 days). Median OS of these patients was 13.5 months. Both univariate and multivariate analysis demonstrated that weight loss ≤ 4% during dCRT was significantly associated with superior OS with a hazard ratio of 2.61 (95% CI: 1.40−4.85, p = 0.002). The median OS for patients with weight loss ≤ 4% and >4% during dCRT was 59.6 months and 9.7 months, respectively (p = 0.001). Our study demonstrated that weight loss ≤ 4% during dCRT course is a favorable prognostic factor for cT4b EC patients. This index could serve as a nutrition support reference for unresectable EC patients receiving dCRT in the future.
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Zouhry Y, Taibi A, Durand-Fontanier S, Darbas T, Forestier G, Monteil J, Lebrun-Ly V, Fayemendy P, Leobon S, Jesus P, Deluche E. Degradation of skeletal mass in locally advanced oesophageal cancer between initial diagnosis and recurrence. BMC Cancer 2021; 21:1313. [PMID: 34876055 PMCID: PMC8653570 DOI: 10.1186/s12885-021-09037-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/19/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The prognostic value of a low skeletal mass index (SMI) has been investigated in locally advanced oesophageal (LAE) cancer at diagnosis. However, nothing is known about its evolution and clinical impact between initial diagnosis and recurrence. METHODS A total of 89 patients treated for LAE cancer between January 2009 and December 2019 were included in this study. Computed tomography (CT) scans before treatment and at recurrence were evaluated. SMI and other body composition parameters were analysed by the L3 scan method. RESULTS Participants were aged 66.0 (36.0-86) years. The incidence of low SMI increased by 12.3% between diagnosis and recurrence (70.7% vs. 83.0%, respectively) over a median follow-up of 16.9 (1.7-101.6) months. Patients with high SMI at diagnosis showed loss of muscle mass (58.0 vs. 55.2 cm2/m2, respectively; P < 0.001) and decreased body mass index (BMI) (27.9 vs. 26.3 kg/m2, respectively; P = 0.05), but fat mass was increased (68.9 vs. 72.0 cm2/m2, respectively; P = 0.01). Patients with low SMI at diagnosis showed no significant changes in body composition parameters and no improvement of SMI, even with nutritional support. Low SMI (hazard ratio [HR]: 1.8; 95% confidence interval [CI]: 1.02-3.16) was an independent predictor (P = 0.041) of high nutritional risk index (HR: 1.79; 95% CI: 1.03-3.11; P = 0.039) at diagnosis. CONCLUSIONS The percentage of patients with a low SMI increased during follow-up. Our data suggest that an assessment of skeletal muscle parameters and nutrition support may be more useful in patients with a high SMI.
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Affiliation(s)
- Yacine Zouhry
- Medical Oncology Department, Limoges University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France
| | - Abdelkader Taibi
- Digestive Surgery Department, Limoges University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France
| | - Sylvaine Durand-Fontanier
- Digestive Surgery Department, Limoges University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France
| | - Tiffany Darbas
- Medical Oncology Department, Limoges University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France
| | - Geraud Forestier
- Neuroradiology Department, Limoges University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France
| | - Jacques Monteil
- Nuclear Medicine Department, Limoges University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France
| | - Valérie Lebrun-Ly
- Medical Oncology Department, Limoges University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France
| | - Philippe Fayemendy
- Nutrition Unit, Limoges University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France.,Tropical Neuroepidemiology Institute GEIST, INSERM, U1094, 33 rue François Mitterrand, 87032, Limoges, France
| | - Sophie Leobon
- Medical Oncology Department, Limoges University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France
| | - Pierre Jesus
- Medical Oncology Department, Limoges University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France
| | - Elise Deluche
- Medical Oncology Department, Limoges University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France.
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Wang B, Jiang XW, Tian DL, Zhou N, Geng W. Combination of Haemoglobin and Prognostic Nutritional Index Predicts the Prognosis of Postoperative Radiotherapy for Esophageal Squamous Cell Carcinoma. Cancer Manag Res 2020; 12:8589-8597. [PMID: 32982451 PMCID: PMC7509334 DOI: 10.2147/cmar.s266821] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/21/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose To investigate the predictive effect of the combined markers of haemoglobin and prognostic nutritional index (PNI) on the long-term survival of patients undergoing postoperative radiotherapy for esophageal squamous cell carcinoma (ESCC). Patients and Methods A total of 238 patients were included in this retrospective analysis. PNI was calculated as the serum albumin level (g/L) + 5 × absolute lymphocyte count, and the cut-off values of PNI and haemoglobin were calculated by receiver operating characteristic (ROC) curve analysis. Then, we combined haemoglobin and PNI, named the H-PNI score, as a predictor of tumour prognosis. The patients were divided into three groups: H-PNI score of 2 (having both hyper-haemoglobin and high PNI), H-PNI score of 1 (having one of these haematological abnormalities), and H-PNI score of 0 (having neither hyper-haemoglobin nor high PNI). The overall survival (OS) rate was calculated using the Kaplan–Meier method, and survival differences between groups were evaluated using the Log rank test. Cox proportional hazards models were used for univariate and multivariate analyses. P values <0.05 indicated statistical significance. Results The cut-off values of haemoglobin and PNI were 132.5 (g/L) and 46.55, respectively. Kaplan–Meier analysis showed that patients with high haemoglobin and PNI levels had a significantly better prognosis than those with low haemoglobin and PNI levels (P = 0.015 and P = 0.002, respectively). Similarly, the survival rate was significantly lower in patients with an H-PNI score of 0 than in those with an H-PNI score of 1–2 (P=0.000). Univariate analysis indicated that differentiation, T and N classification, and H-PNI score were significantly associated with OS. Finally, differentiation (P=0.002), T and N classification (P=0.000), and H-PNI score (P=0.01) were independent prognostic factors for ESCC patients undergoing postoperative radiotherapy. Conclusion The H-PNI score was an independent prognostic factor for ESCC patients undergoing postoperative radiotherapy.
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Affiliation(s)
- Bei Wang
- Department of Radiotherapy Oncology, The Affiliated Yancheng First Hospital of Nanjing University Medical School, The First People's Hospital of Yancheng, Yancheng 224000, Jiangsu Province, People's Republic of China
| | - Xiao-Wen Jiang
- Department of Radiotherapy Oncology, The Affiliated Yancheng First Hospital of Nanjing University Medical School, The First People's Hospital of Yancheng, Yancheng 224000, Jiangsu Province, People's Republic of China
| | - Da-Long Tian
- Department of Radiotherapy Oncology, The Affiliated Yancheng First Hospital of Nanjing University Medical School, The First People's Hospital of Yancheng, Yancheng 224000, Jiangsu Province, People's Republic of China
| | - Ning Zhou
- Department of Radiotherapy Oncology, The Affiliated Yancheng First Hospital of Nanjing University Medical School, The First People's Hospital of Yancheng, Yancheng 224000, Jiangsu Province, People's Republic of China
| | - Wei Geng
- Department of Radiotherapy Oncology, The Affiliated Yancheng First Hospital of Nanjing University Medical School, The First People's Hospital of Yancheng, Yancheng 224000, Jiangsu Province, People's Republic of China
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