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10-12-2022 | Esophageal Cancer | Original Article

The impact of weight loss during neoadjuvant chemotherapy on postoperative infectious complications and prognosis in patients with esophageal cancer: exploratory analysis of OGSG1003

Authors: Shu Aoyama, Masaaki Motoori, Makoto Yamasaki, Osamu Shiraishi, Hiroshi Miyata, Motohiro Hirao, Atsushi Takeno, Keijiro Sugimura, Tomoki Makino, Koji Tanaka, Takuya Hamakawa, Kotaro Yamashita, Yutaka Kimura, Kazumasa Fujitani, Takushi Yasuda, Masahiko Yano, Yuichiro Doki

Published in: Esophagus | Issue 2/2023

Abstract

Background

Neoadjuvant therapy followed by surgery is the standard treatment for locally advanced esophageal cancers. During neoadjuvant therapy, tumor-induced esophageal stenosis or adverse events often cause weight loss. However, little is known about the effects of weight loss during neoadjuvant therapy on postoperative complications or prognosis. We investigated the association between weight loss during neoadjuvant chemotherapy, postoperative infectious complications, and prognosis.

Methods

Data from OGSG1003, a randomized phase-II trial comparing two regimens of neoadjuvant chemotherapy, cisplatin and fluorouracil plus Adriamycin and cisplatin and fluorouracil plus docetaxel, for locally advanced esophageal squamous cell carcinoma were used. Body weight was measured before neoadjuvant chemotherapy and esophagectomy. Multivariate analysis for infectious complications and prognosis was performed.

Results

The study included 134 patients. The median weight loss during neoadjuvant chemotherapy was 2.83% (−2.07% to 6.29%). Postoperative infectious complications were observed in 37 patients who had a significantly higher weight loss during neoadjuvant chemotherapy (5.18% vs. 1.90%, P = 0.002). Multivariate analysis revealed that > 5% of weight loss during neoadjuvant chemotherapy was the only independent factor associated with postoperative infectious complications (odds ratio 2.69, 95% confidence interval 1.12–6.46, P = 0.027). Weight loss during neoadjuvant chemotherapy was significantly associated with worse recurrence-free survival in the univariate analysis (log-rank test, P = 0.002), but this association was marginal in the multivariate analysis (hazard ratio 1.73, 95% confidence interval 0.98–3.08, P = 0.058).

Conclusions

Severe weight loss during neoadjuvant chemotherapy was an independent risk factor for postoperative infectious complications. Weight maintenance during neoadjuvant chemotherapy may reduce the incidence of postoperative infectious complications.

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Title: The impact of weight loss during neoadjuvant chemotherapy on postoperative infectious complications and prognosis in patients with esophageal cancer: exploratory analysis of OGSG1003
Authors: Shu Aoyama
Masaaki Motoori
Makoto Yamasaki
Osamu Shiraishi
Hiroshi Miyata
Motohiro Hirao
Atsushi Takeno
Keijiro Sugimura
Tomoki Makino
Koji Tanaka
Takuya Hamakawa
Kotaro Yamashita
Yutaka Kimura
Kazumasa Fujitani
Takushi Yasuda
Masahiko Yano
Yuichiro Doki
Publication date: 10-12-2022
Publisher: Springer Nature Singapore
Keywords: Esophageal Cancer
Esophagus Resection
Neutropenia
Esophageal Cancer
Esophagus Resection
Cytostatic Therapy
Published in: Esophagus / Issue 2/2023
Print ISSN: 1612-9059
Electronic ISSN: 1612-9067
DOI: https://doi.org/10.1007/s10388-022-00975-w

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Abstract

Background

Methods

Results

Conclusions

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