Baseline nutritional status could be a predictor for radiation esophagitis in esophageal cancer patients undergoing radiotherapy

Esophageal cancer patients are at a high risk of malnutrition. Both the disease itself and chemoradiotherapy will lead to the deterioration of nutritional status. The development of nutritional oncology promotes the application of enteral nutrition in tumor patients. Through nutritional support, prognosis is improved and the incidence of adverse chemoradiotherapy reactions is reduced, especially in those with head and neck or esophageal cancer. This review summarizes enteral nutritional support in esophageal cancer patients undergoing chemoradiotherapy in recent years, including a selection of nutritional assessment tools, the causes and consequences of malnutrition in esophageal cancer patients, types of access and effects of enteral nutrition. More patients with esophageal cancer will benefit from the development of enteral nutrition technology in the future.

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PS01.170: IMPACT OF MUSCLE MASS, NUTRITIONAL STATUS AND MUSCLE STRENGTH ON OUTCOMES FOLLOWING SURGERY FOR ESOPHAGEAL CANCER

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.170 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 97-97

Author(s):

Eliza Hagens ◽

Minke Feenstra ◽

Mark I Van Berge Henegouwen ◽

Suzanne Gisbertz

Keyword(s):

Skeletal Muscle ◽

Overall Survival ◽

Esophageal Cancer ◽

Muscle Strength ◽

Nutritional Status ◽

Neoadjuvant Therapy ◽

Cancer Patients ◽

Surface Area ◽

Muscle Function ◽

Skeletal Muscle Index

Abstract Background Muscle function loss and loss of skeletal muscle have been associated with worse outcomes following surgery for malignancies of gastrointestinal origin. The influence on post-operative outcomes and survival after esophageal surgery remains unclear. Primary objectives of this study were to evaluate the incidence of sarcopenia and malnutrition and to evaluate the influence of skeletal muscle surface area and muscle strength on postoperative outcomes and overall survival in esophageal cancer patients. Methods A retrospective cohort study from a prospective database was conducted in patients with resectable esophageal cancer who underwent curative-intent treatment between January 2011 and January 2016. Skeletal muscle surface area was calculated with CT scans at L3 level and corrected for height and weight before start of treatment and in the interval between neoadjuvant treatment and surgery. Muscle strength was evaluated with various tests on muscle functions and lung function tests. Nutritional status was evaluated using BMI. Results 273 Patients were included. There were 4 patients with sarcopenia before neoadjuvant therapy and only one patient with sarcopenia after completion of neoadjuvant therapy. Median skeletal muscle surface area was 78cm2/m2 for men and 61cm2/m2 for woman. Table 1 shows skeletal muscle surface area, muscle strength and BMI in relation to no, minor or major complications. Muscle strength and nutritional status did not have a significant influence on postoperative complications and overall survival. Conclusion Sarcopenia did not occur frequently in this cohort with potentially curable esophageal cancer patients. Muscle function, skeletal muscle index and BMI did not statistically influence post-operative complications or survival. Disclosure All authors have declared no conflicts of interest.

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343 EFFECTS OF PREOPERATIVE PNI (PROGNOSTIC NUTRITIONAL INDEX) AND POSTOPERATIVE INFLAMMATORY RESPONSE ON PROGNOSIS IN PATIENTS WITH ESOPHAGEAL CANCER

Diseases of the Esophagus ◽

10.1093/dote/doab052.343 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Yoshinori Fujiwara ◽

Masaharu Higashida ◽

Hisako Kubota ◽

Yuko Okamoto ◽

Syumei Mineta ◽

...

Keyword(s):

Esophageal Cancer ◽

Blood Loss ◽

Inflammatory Response ◽

Nutritional Status ◽

Cancer Patients ◽

Inflammatory Responses ◽

Cox Model ◽

Prognostic Nutritional Index ◽

Nutritional Index ◽

Group 3

Abstract The effects of preoperative nutritional status and postoperative inflammatory response on esophageal cancer patients on prognosis were unclear. In the present study, we evaluated the preoperative nutritional parameters and postoperative inflammatory responses and analyzed relationship between these parameters and cancer prognosis. Methods One hundred and eleven esophageal squamous cell carcinoma patients were analyzed with pathological TNM StageI-IV. Preoperative nutritional parameters: PNI (Prognostic Nutritional Index) was calculated from following formula:10 x Albumin(g/dl) +0.005 x peripheral lymphocyte counts (/mm3). Preoperative NLR (Neutrophil/Lymphocyte ratio) was defined as absolute neutrophil counts divided by the absolute lymphocyte counts. The highest CRP level was evaluated as postoperative inflammatory responses. Cut-off values of these continuous parameters were calculated by ROC, and univariate and multivariate analysis using Cox model for overall survival (OS) were examined in the parameters. Results Overall three or five years survivals were 60.9%, 56.28%, respectively. Cut-off value of PNI, CRP, NLR, Intraoperative blood loss were 44.8, 21.7 mg/dl,2.27,159 mL, respectively. High PNI group was significantly better survival than low group (3 years OS, 65.94 vs 45.82%, p < 0.05). No association between PNI and prognosis was noted for patients with pStageI, but the low PNI patients of pStageII-IV were extremely poor prognosis (p < 0.01). High CRP group was tendency to be worse survival than low group (3 years OS, 65.97 vs 38.82%, p = 0.062). The patients of low blood loss group was significantly better survival than high group (p < 0.05).NLR was not associated with OS. Cox model showed that pTNM, tumor location, and PNI were independent prognostic factors. Conclusion Preoperative nutritional status affected the prognosis of esophageal cancer patients. But, postoperative inflammatory response was not affected the prognosis of these patients. Preoperative nutritional interventions may improve the prognosis of patients with esophageal cancer.

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The Influence of the Perioperative Nutritional Status on the Survival Outcomes for Esophageal Cancer Patients with Neoadjuvant Chemotherapy

Annals of Surgical Oncology ◽

10.1245/s10434-019-07742-9 ◽

2019 ◽

Vol 26 (13) ◽

pp. 4744-4753 ◽

Cited By ~ 3

Author(s):

Makoto Hikage ◽

Yusuke Taniyama ◽

Tadashi Sakurai ◽

Chiaki Sato ◽

Kai Takaya ◽

...

Keyword(s):

Esophageal Cancer ◽

Neoadjuvant Chemotherapy ◽

Nutritional Status ◽

Cancer Patients ◽

Survival Outcomes

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Comprehensive assessment of nutritional status and nutritional-related complications in newly diagnosed esophageal cancer patients: a cross-sectional study

Clinical Nutrition ESPEN ◽

10.1016/j.clnesp.2021.09.663 ◽

2021 ◽

Vol 46 ◽

pp. S777-S778

Author(s):

S. Movahed ◽

V. Mozafari ◽

A. Norouzy ◽

F. Bozzetti

Keyword(s):

Esophageal Cancer ◽

Nutritional Status ◽

Cancer Patients ◽

Cross Sectional Study ◽

Comprehensive Assessment ◽

Newly Diagnosed ◽

Sectional Study ◽

Cross Sectional

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Feasibility study of preoperative chemotherapy for patients with advanced esophageal cancer with or without naso-gastric ED tube for enteral feeding.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.184 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 184-184

Author(s):

Takashi Ogata ◽

Hiroaki Osakabe ◽

Shinsuke Nagasawa ◽

Masato Nakazono ◽

Kentaro Hara ◽

...

Keyword(s):

Esophageal Cancer ◽

Nutritional Status ◽

Cancer Patients ◽

Preoperative Chemotherapy ◽

Oral Intake ◽

Hematologic Toxicity ◽

Advanced Esophageal Cancer ◽

Group A ◽

Grade 3 ◽

Group B

184 Background: Advanced esophageal cancer patients sometimes have a difficulty to swallow food. On the other hand, standard treatment for resectable advanced esophageal cancer patients is surgery after 2 course preoperative chemotherapy of CDDP-5-FU (JCOG 9907). So we usually use naso-gastric ED tube for patients with difficulty of oral intake during preoperative chemotherapy to administrate adequate nutrition. But there is no report of the safety of this trial. Methods: The aim of this study is to clarify the safety of using ED tube during preoperative chemotherapy and compare the nutritional status between using ED tube or not. From Jan 2012 to June 2017, 122 patients were undergone esophagectomy with 2 course of preoperative chemotherapy, and 14 patients were treated with ED tube for nutrition(Group A) and 108 patients without ED tube(Group B). We evaluated the changes of nutritional status and postoperative complication as an indicator of safety. Results: Changes before and after preoperative chemotherapy(GroupA/B): average of body weight: 53.1→50.8/58.1→57.0, BMI: 20.0→19.2/22.0→21.6, TP: 6.7→6.9/7.3→6.9, alb: 3.5→3.8/4.3→4.2, pre-alb: 20.1→21.7/24.8→23.4, RBP: 2.77→3.33/3.15→3.23. Adverse events during chemotherapy: 1 case of Grade 3 hematologic toxicity and 1 case of Grade 2 non-hematologic toxicity were found at Group A(14.2%), and 11 cases of Grade 3 hematologic toxicity and 8 cases of Grade 2 non-hematologic toxicity were found at Group B(17.61%)(p = 0.758). Postoperative complications (clavien-dindo classification, Grade3 or more): 2 cases were observed at Group A(14.2%), and 21 cases were observed at Group B(19.4%)(p = 0.62). Conclusions: Preoperative chemotherapy with ED tube for nutrition was safe and effective to maintain the preoperative nutritional status.

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Nutritional Status and Feeding Regimen of Patients with Esophagus Cancer—A Study from Vietnam

Healthcare ◽

10.3390/healthcare9030289 ◽

2021 ◽

Vol 9 (3) ◽

pp. 289

Author(s):

Binh Pham Van ◽

Hoa Nguyen Thi Thanh ◽

Huong Le Thi ◽

Anh Nguyen Le Tuan ◽

Hang Dang Thi Thu ◽

...

Keyword(s):

Weight Loss ◽

Esophageal Cancer ◽

Nutritional Status ◽

Dietary Intake ◽

Total Energy ◽

Cancer Patients ◽

Energy Intake ◽

Strongly Correlated ◽

Esophagus Cancer ◽

Day By Day

Background: Esophagus cancer patients are at high risk of malnutrition. This study was performed to assess the nutritional status and dietary intake of newly diagnosed esophageal cancer patients in Vietnam National Cancer Hospital (NCH). Methods: A cross-sectional study was conducted on 206 early esophageal cancer inpatients after gastrostomy from September 2017 to June 2018. The chi-squared test, Fisher exact test, and Mann–Whitney test were performed. The software of the Vietnam National Institute of Nutrition was used to evaluate the dietary intake of patients. Results: All the participants were male with a mean age of 57.1 ± 8.5 years. Overall, 87.4% of patients had dysphagia. Furthermore, 82.5% and 90.8% of patients reported weight loss one and six months pre-diagnosis, respectively. Moreover, 52.9% of patients suffered from mild/moderate malnutrition and 29.6% of patients had severe malnutrition according to the Patient-Generated Subjective Global Assessment (PG-SGA). The body mass index (BMI) and mid upper arm circumference (MUAC) measurement revealed 47.6% and 50% of undernourished patients, respectively. The proportions of patients having malnutrition were 10.7%, 55.8%, and 27.2% according to albumin, prealbumin, and total lymphocyte counts, respectively. The means of energy, protein, lipid, and carbohydrate in the patients’ 24 h preoperative diets were 973.6 ± 443.0 kcal/day, 42.4 ± 21.6 g/day, 31.0 ± 15.5 g/day, and 130.0 ± 64.5 g/day. The total energy, total protein, animal protein, total lipid, and plant lipid in the dietary intake of patients were strongly correlated with age, economic classification, and PG-SGA (each p < 0.05). The total energy intake increased day by day, with the average energy intake of 1343.9 ± 521.3 kcal on the seventh day. Energy and protein response rates increased day by day and were highest at 7 days post-operation at 18.0% and 19.4%. Conclusion: Malnutrition and insufficient intake are noteworthy in esophageal cancer patients. The PG-SGA is strongly correlated with the dietary intake of patients. The results from this study will help medical staff to prevent malnutrition and improve the nutritional status of esophageal cancer inpatients. Furthermore, public awareness should be raised on recognizing weight loss as an early symptom of esophageal cancer and the utilization of preoperative assessment tools for nutritional assessment and malnutrition management.

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The Influence of Pretherapeutic and Preoperative Sarcopenia on Short-Term Outcome after Esophagectomy

Cancers ◽

10.3390/cancers12113409 ◽

2020 ◽

Vol 12 (11) ◽

pp. 3409

Author(s):

Johanna Grün ◽

Lea Elfinger ◽

Han Le ◽

Christel Weiß ◽

Mirko Otto ◽

...

Keyword(s):

Esophageal Cancer ◽

Nutritional Status ◽

Cancer Patients ◽

Postoperative Morbidity ◽

Neoadjuvant Treatment ◽

Postoperative Outcome ◽

Morbidity And Mortality ◽

Short Term ◽

Term Outcome ◽

Skeletal Muscle Index

By introducing minimally invasive surgery the rate of postoperative morbidity in esophageal cancer patients could be reduced. But esophagectomy is still associated with a relevant risk of postoperative morbidity and mortality. Patients often present with nutritional deficiency and sarcopenia even at time of diagnosis. This study focuses on the influence of skeletal muscle index (SMI) on postoperative morbidity and mortality. Fifty-two patients were included in this study. SMI was measured using computer tomographic images at the time of diagnosis and before surgery. Then, SMI and different clinicopathological and demographic features were correlated with postoperative morbidity. There was no correlation between SMI before neoadjuvant therapy (p = 0.5365) nor before surgery (p = 0.3530) with the short-term postoperative outcome. Regarding cholesterol level before surgery there was a trend for a higher risk of complications with lower cholesterol levels (p = 0.0846). Our findings suggest that a low preoperative SMI does not necessarily predict a poor postoperative outcome in esophageal cancer patients after esophagectomy but that there are many factors that influence the nutritional status of cancer patients. To improve nutritional status, cancer patients at our clinic receive specialized nutritional counselling during neoadjuvant treatment as well as after surgery.

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