Summary
Background and Aims
Methods
Results
Conclusion
KEYWORDS
Abbreviations:
HRQL (Health-related quality of life), NIS (Nutrition-impact symptoms), OC (Oesophageal Cancer)Introduction
- Lagergren P.
- Fayers P.
- Conroy T.
- Stein H.J.
- Sezer O.
- Hardwick R.
- et al.
- Markar S.R.
- Zaninotto G.
- Castoro C.
- Johar A.
- Lagergren P.
- Elliot J.A.
- et al.
Materials and methods
Data source and data collection
IDDSI Framework and Detailed Level Definitions.
Nutritional and quality of life outcomes
World Health Organisation. Body Mass Index - BMI. Available from: https://www.euro.who.int/en/health-topics/disease-prevention/nutrition/a-healthylifestyle/body-mass-index-bmi [Accessed 23/03/2021].
Statistical analysis
Results
Characteristics of the study cohort
Variable | Preoperative cohort (n=75) | 6-month cohort (n=66) | 12-month cohort (n=37) |
---|---|---|---|
Demographic Characteristics | |||
Sex | |||
Male (n, %) | 63, 84.0% | 55, 83.3% | 32, 86.5% |
Female (n, %) | 12, 16.0% | 11, 16.7% | 5, 13.5% |
Age at surgery (mean, SD) | 62.7, 10.3% | 63.3, 9.9 | 63.3, 9.9 |
Smoking status | |||
Current smoker (n, %) | 13, 17.3% | 10, 15.2% | 5, 13.5% |
Ex-smoker >1year (n, %) | 35, 46.7% | 31, 47.0% | 19, 51.4% |
Never smoked (n, %) | 24, 32.0% | 22, 33.3% | 13, 35.1% |
Unknown/not specified (n, %) | 3, 4.0% | 3, 4.5% | 0, 0.0% |
Alcohol intake | |||
Non-drinker (n, %) | 12, 16.0% | 8, 12.1% | 4, 10.8% |
Ex-drinker (n, %) | 9, 12.0% | 9, 13.6% | 5, 13.5% |
Heavy drinker (>14/21UPW) (n, %) | 17, 22.7% | 15, 22.7% | 7, 18.9% |
Social drinker (<14/21UPW) (n, %) | 35, 46.7% | 32, 48.5% | 21, 56.8% |
Unknown/not specified (n, %) | 2, 2.7% | 2, 3.0% | 0, 0.0% |
Clinicopathologic and Treatment Characteristics | |||
ASA grade at diagnosis | |||
1 (n, %) | 8, 10.7% | 8, 12.1% | 4, 10.8% |
2 (n, %) | 51, 68.0% | 44, 66.7% | 24, 64.9% |
3 (n, %) | 16, 21.3% | 14, 21.2% | 9, 24.3% |
Previous malignancy | |||
Yes (n, %) | 10, 13.3% | 10, 15.2% | 6, 16.2% |
No (n, %) | 62, 82.7% | 53, 80.3% | 31, 83.8% |
Unknown/not specified (n, %) | 3, 4.0% | 3, 4.5% | 0, 0.0% |
Barrett's oesophagus (n, %) | 29, 38.7% | 26, 39.4% | 17, 45.9% |
Tumour histology | |||
Adenocarcinoma (n, %) | 64, 85.3% | 56, 84.8% | 31, 83.8% |
Squamous cell carcinoma (n, %) | 11, 14.7% | 10, 15.2% | 6, 16.2% |
Main curative treatment | |||
Surgery (n, %) | 13, 17.3% | 13, 19.7% | 8, 21.6% |
Neoadjuvant therapy and surgery (n, %) | 57, 76.0% | 48, 72.7% | 26, 70.3% |
Surgery and endoscopic treatments (n, %) | 3, 4.0% | 3, 4.5% | 2, 5.4% |
Surgery and adjuvant therapy (n, %) | 1, 1.3% | 1, 1.5% | 1, 2.7% |
Surgery and radical CT/RT (n, %) | 1, 1.3% | 1, 1.5% | 0, 0.0% |
Neoadjuvant therapy type | |||
CROSS (n, %) | 25, 33.3% | 22, 33.3% | 8, 21.6% |
MAGIC (n, %) | 8, 10.7% | 6, 9.1% | 6, 16.2% |
FLOT (n, %) | 20, 26.7% | 15, 22.7 % | 7, 18.9% |
Not specified/Did not receive (n, %) | 22, 29.3% | 23, 34.8% | 16, 43.2% |
Surgery type | |||
Transhiatal oesophagectomy (n, %) | 20, 26.7% | 19, 28.8% | 12, 32.4% |
2-Stage oesophagectomy (n, %) | 42, 56.0% | 36, 54.5% | 20, 54.1% |
3-Stage oesophagectomy (n, %) | 13, 17.3% | 11, 16.7% | 5, 13.5% |
Postoperative complication | |||
Yes (n, %) | 44, 58.7% | 38, 57.6% | 20, 54.1% |
No (n, %) | 31, 41.3% | 28, 42.4% | 17, 45.9% |
CDC ≥3 (n, %) | 18, 24.3% | 15, 22.7% | 7, 18.9% |
Postoperative readmission | |||
Yes (n, %) | 11, 14.7% | 10, 15.2% | 7, 18.9% |
No (n, %) | 64, 85.3% | 56, 84.8% | 30, 81.1% |
Recurrence | |||
Yes (n, %) | 12, 16.0% | 10, 15.2% | 3, 8.1% |
No (n, %) | 63, 84.0% | 56, 84.8% | 34, 91.9% |
Variable | Preop (n=37) | 6 months (n=37) | 12 months (n=37) | P | P (preop vs 6m) | P (preop vs 12m) | P (6m vs 12m) |
---|---|---|---|---|---|---|---|
Weight, kg (mean, SD) | 80.3, 14.6 | 73.2, 12.0 | 72.9, 12.7 | <0.001 | <0.001 | <0.001 | 1.000 |
BMI, kg/m2 (mean, SD) | 27.4, 4.6 | 24.9, 3.4 | 24.8, 3.8 | <0.001 | <0.001 | <0.001 | 1.000 |
BMI >25 kg/m2 (n, %) | 26, 70.3% | 19, 51.4% | 17, 45.9% | 0.001 | 0.007 | <0.001 | 0.439 |
NRI (mean, SD) | 105.5, 7.1 | 102.5, 5.0 | 103.1, 4.9 | 0.039 | 0.040 | 0.164 | 0.737 |
Mild Malnutrition (n, %) | 4, 10.8% | 9, 24.3% | 7, 18.9% | 0.257 | |||
Moderate Malnutrition (n, %) | 2, 5.4% | 4, 10.8% | 4, 10.8% | 0.641 | |||
Severe Malnutrition (n, %) | 1, 2.7% | 0, 0% | 0, 0% | 0.368 | |||
Grip Strength (r), kg (mean, SD) | 33.0, 7.8 | 31.2, 7.3 | 32.6, 8.1 | 0.217 | |||
Grip Strength (l), kg (mean, SD) | 30.7, 8.3 | 31.2, 6.9 | 30.6, 8.4 | 0.897 | |||
MUAC, cm (mean, SD) | 26.9, 2.2 | 26.9, 2.5 | 0.852 | ||||
Waist Circumference, cm | 94.0, 64–106+ | 90.9, 11.9# | 0.704 | ||||
Hip Circumference, cm | 96.7, 65–108+ | 97.5, 6.6# | 0.992 | ||||
Waist: Hip ratio, (median, range) | 0.9, 0.8–1.0 | 0.9, 0.8–1.2 | 0.629 | ||||
% BWL (mean, SD) | 8.4, 5.8 | 8.8, 7.1 | 0.487 | ||||
>10% BWL (n, %) | 14, 37.8% | 16, 43.2% | 0.727 | ||||
Probable Sarcopenia (n, %) | 7, 35% | 12, 32.4% | 11, 29.7% | 0.472 |
Nutrition-impact symptoms (NIS) and dumping syndrome (DS)
Symptom | n, % of patients who scored 2 or 3 | Sig of the difference in scores from 6-12 months in 12-month cohort | |
---|---|---|---|
6 months (n=66) | 12 months (n=36) | P | |
Cramps | 9, 13.6% | (n=35) 4, 11.4% | 0.513 |
Bloating | 9, 13.6% | (n=35) 3, 8.6% | 0.090 |
Wind | 17, 25.7% | 8, 22.2% | 0.467 |
Belching | 12, 18.2% | 8, 22.3% | 0.132 |
Borborygmus | 10, 15.5% | 3, 8.4% | 0.808 |
Reflux | (n=65) 9, 13.8% | 2, 5.6% | 0.739 |
Anorexia | (n=65) 12, 18.4% | (n=35) 4, 11.5% | 0.109 |
Nausea | 11, 13.6% | 3, 8.4% | 0.475 |
Vomiting | 0, 0% | 0, 0% | 0.655 |
Urgency to open bowels | 5, 7.6% | 4, 11.1% | 0.467 |
Incomplete passing of stool | 5, 7.5% | (n=35) 4, 11.5% | 0.660 |
Oily stool | (n=65) 6, 9.2% | (n=35) 4, 11.4% | 0.564 |
Floating stool | 7, 10.6% | 2, 5.6% | 0.480 |
Foul-smelling stool | 9, 13.7% | 6, 16.6% | 0.218 |
Sleep disturbance due to bowels | 0, 0% | (n=35) 1, 2.9% | 0.739 |
Health-related quality of life
Nutritional status and HRQL
Dumping syndrome and HRQL
HRQL item | 6 months (n=65) | 12 months (n=35) | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Dumping syndrome (median) | Non-dumping syndrome (median) | P | Median score difference | Clinically relevant (EBIG) | Dumping syndrome (median) | Non-dumping syndrome (median) | P | Median score difference | Clinically relevant (EBIG) | |
Physical function | 83.33 | 100 | 0.005 | 16.67 | Yes | 83.33 | 100 | 0.046 | 16.67 | No |
Social function | 66.67 | 100 | 0.001 | 33.33 | Yes | 83.33 | 100 | 0.011 | 16.67 | Yes |
Fatigue | 33.33 | 11.11 | <0.001 | 22.22 | Yes | 33.33 | 11.11 | 0.004 | 22.22 | Yes |
Dyspnoea | 33.33 | 0 | 0.001 | 33.33 | Yes | 33.33 | 0 | 0.016 | 33.33 | Yes |
Eating restrictions | 25.00 | 8.33 | 0.011 | 16.67 | Yes | 25 | 8.33 | 0.038 | 16.67 | Yes |
Trouble enjoying meals | 33.33 | 0 | 0.007 | 33.33 | Yes | 33.33 | 0 | 0.028 | 33.33 | Yes |
Pain and discomfort | 33.33 | 16.67 | 0.001 | 16.66 | Yes | 33.33 | 16.67 | 0.038 | 16.66 | Yes |
Nutrition-impact symptoms and HRQL




Predictors of HRQL
Predictor Variable | 6 months | 12 months | |||||||
---|---|---|---|---|---|---|---|---|---|
Beta | CI | P | [Part]2 x100 | Beta | CI | P | [Part] [ [2] ] x100 | ||
Nutritional risk index | 0.033 | -0.588–0.821 | 0.741 | 0.10 | 0.199 | -0.336–1.592 | 0.192 | 3.31 | |
Sigstad score | -0.127 | -1.195–0.335 | 0.265 | 1.17 | -0.401 | -2.251–-0.301 | 0.012 | 13.40 | |
Steatorrhoea-specific score | 0.079 | -1.573–2.557 | 0.635 | 0.21 | -0.342 | -4.515–0.990 | 0.200 | 3.20 | |
mGSRS score | -0.572 | -3.163–-0.628 | 0.004 | 8.24 | -0.095 | -1.697–1.225 | 0.743 | 0.20 | |
CDC≥3 | 0.189 | -0.889–17.785 | 0.075 | 3.03 | -0.026 | -11.117–13.196 | 0.862 | 0.06 | |
ASA grade of 3 | -0.285 | -22.228–-3.898 | 0.006 | 7.51 | -0.136 | -15.482–5.731 | 0.354 | 1.66 | |
Model Summary | Adjusted R square: 0.411 (P<0.001) | Adjusted R square: 0.387 (P=0.003) |
Discussion
- Tyner B.C.B.
- O’Neill M.
- Philips M.
- Marshall L.
- Smith S.M.
- Ryan M.
- Lagergren P.
- Fayers P.
- Conroy T.
- Stein H.J.
- Sezer O.
- Hardwick R.
- et al.
Conclusion
Funding statement
Author contributions
Not relevant
Conflicts of interest
Appendix A. Supplementary data
- Multimedia component 1
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