Body Weight Loss at Recurrence as an Independent Prognostic Factor in Patients With Recurrent Esophageal Cancer After Esophagectomy Who Receive First-line Treatment After Recurrence

Background/Aim: Body weight loss (BWL) is frequently observed after esophagectomy in patients with esophageal cancer (EC). We conducted a retrospective study to evaluate the clinical impact of BWL at recurrence on oncological outcomes in patients with recurrent EC who underwent esophagectomy and chemotherapy after recurrence.

Patients and Methods: We retrospectively reviewed the medical records and collected data from consecutive patients with recurrent EC who received systemic chemotherapy after recurrence at Yokohama City University from 2005 to 2022. Patients included in this study met the following criteria: histological diagnosis of esophageal adenocarcinoma, adenosquamous carcinoma, or squamous cell carcinoma based on a histological examination, and an imaging-based diagnosis of stage IV disease.

Results: Sixty-eight patients were included in this study. The median BWL was 12% (range=−26% to 41.1%). According to the 1- and 3-year OS rates, we set the cutoff value of BWL at 15% in the present study. Among the 68 patients, 49 were classified into the BWL-low group and 19 were classified into BWL-high group. The median OS was 22.2 months in the BWL-low group, while the median OS was 14.2 months in the BWL-high group (p=0.005). In addition, the 1- and 3-year OS rates were 69.6% and 43.9%, respectively in the BWL-low group and 51.7% and 0.0% in the BWL-high group. In the univariate and multivariate analyses for OS, BWL was selected as an independent prognostic factor (hazard ratio=2.111; 95% confidence interval=1.109-4.018, p=0.023). The best overall response rate was 52.6% in the BWL-low group and 34.7% in the BWL-high group (p=0.178).

Conclusion: BWL at recurrence was an independent prognostic factor in patients with recurrent EC who underwent esophagectomy. In addition, BWL at recurrence may affect first-line treatment after recurrence. Therefore, patients with EC after esophagectomy require careful attention for BWL, even when curative treatment and nutritional management or care are needed to maintain body weight.