Characteristics and influencing factors of postoperative weight change in patients with esophageal cancer: A prospective longitudinal study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Chengxiang ¹ , YANG Yang ² , ZHANG Tian ³ , XIE Ruonan ¹ , JIANG Xin ¹ , LENG Yingjie ¹ , NIE Zhuomiao ¹ ,  WANG Guorong ³

1. School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, P. R. China;
2. Institute of Integrated Traditional Chinese and Western Medicine/West China School of Nursing, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
3. Department of Nursing, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610042, P. R. China;

Corresponding?author：

WANG Guorong, Email: guorong_wang@uestc.edu.cn

Keywords：

Esophageal cancer; surgical patients; changes in body weight; longitudinal study; body composition; nutrition assessment; influencing factors

DOI：

10.7507/1007-4848.202401016

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Objective To longitudinally investigate the characteristics of postoperative weight changes in patients with esophageal cancer and analyze its influencing factors, which can provide certain guidance for nutritional intervention in patients with esophageal cancer. Methods Patients with esophageal cancer who underwent surgical treatment at the Sichuan Cancer Hospital from December 2020 to February 2022 were prospectively included. The general information questionnaire and body composition analyzer were used to longitudinally investigate the patients’ weight and body composition before surgery (T0), 1 month after surgery (T1), 3 months after surgery (T2) and 6 months after surgery (T3), and the change characteristics were analyzed. The generalized estimating equation was used to analyze the influencing factors for postoperative weight changes in patients with esophageal cancer. Results A total of 130 patients were enrolled, including 110 males and 20 females, aged 42-79 (63.33±8.16) years. The weight and body composition of patients with esophageal cancer showed a continuous slow downward trend within 6 months after surgery. The weight loss rate of patients at 1, 3, and 6 months after surgery was 5.10%, 7.76%, and 9.86%, respectively. The analysis results of the influencing factors for postoperative weight showed that patients with the following characteristics had more weight loss: female (β=?7.703, P=0.001), ≥60 years (β=?3.657, P=0.010), smoking (β=4.622, P=0.010), low tumor differentiation degree (β=4.314, P=0.039), and high frequency of eating (β=?3.400, P=0.008). Conclusion Weight loss is an important health problem for patients with esophageal cancer after surgery, and patients have a continuous downward trend in weight within 6 months after surgery. Medical staff should pay special attention to the patients who are female, ≥60 years, having smoking history and low tumor differentiation degree.

Citation： LI Chengxiang, YANG Yang, ZHANG Tian, XIE Ruonan, JIANG Xin, LENG Yingjie, NIE Zhuomiao, WANG Guorong. Characteristics and influencing factors of postoperative weight change in patients with esophageal cancer: A prospective longitudinal study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2026, 33(2): 267-274. doi: 10.7507/1007-4848.202401016 Copy

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3.	Martin-Richard M, Díaz Beveridge R, Arrazubi V, et al. SEOM clinical guideline for the diagnosis and treatment of esophageal cancer (2016). Clin Transl Oncol, 2016, 18(12): 1179-1186.
4.	Koterazawa Y, Oshikiri T, Takiguchi G, et al. Severe weight loss after minimally invasive oesophagectomy is associated with poor survival in patients with oesophageal cancer at 5 years. BMC Gastroenterol, 2020, 20(1): 407.
5.	Carr RA, Harrington C, Stella C, et al. Early implementation of a perioperative nutrition support pathway for patients undergoing esophagectomy for esophageal cancer. Cancer Med, 2022, 11(3): 592-601.
6.	Clavier JB, Antoni D, Atlani D, et al. Baseline nutritional status is prognostic factor after definitive radiochemotherapy for esophageal cancer. Dis Esophagus, 2014, 27(6): 560-567.
7.	Quyen TC, Angkatavanich J, Thuan TV, et al. Nutrition assessment and its relationship with performance and Glasgow prognostic scores in Vietnamese patients with esophageal cancer. Asia Pac J Clin Nutr, 2017, 26(1): 49-58.
8.	徐秀娟, 楊帆, 蔣淑年, 等. 營養風險對老年早期食管癌患者放療的預后的影響. 腫瘤學雜志, 2018, 24(9): 866-870.Xu XJ, Yang F, Jiang SN, et al. Prognostic significance of nutritional risk before radiotherapy in elderly patients with early stage esophageal cancer. J Chin Oncol, 2018, 24(9): 866-870.
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11.	Fukuda Y, Yamamoto K, Hirao M, et al. Prevalence of malnutrition among gastric cancer patients undergoing gastrectomy and optimal preoperative nutritional support for preventing surgical site infections. Ann Surg Oncol, 2015, 22 Suppl 3: S778-S785.
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13.	Zhang L, Lu Y, Fang Y. Nutritional status and related factors of patients with advanced gastrointestinal cancer. Br J Nutr, 2014, 111(7): 1239-1244.
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18.	Ericson J, Lundell L, Lindblad M, et al. Assessment of energy intake and total energy expenditure in a series of patients who have undergone oesophagectomy following neoadjuvant treatment. Clin Nutr ESPEN, 2020, 37: 121-128.
19.	Ludwig DJ, Thirlby RC, Low DE. A prospective evaluation of dietary status and symptoms after near-total esophagectomy without gastric emptying procedure. Am J Surg, 2001, 181(5): 454-458.
20.	Okabe H, Tsunoda S, Sunagawa H, et al. A long-term follow-up study of minimally invasive Ivor Lewis esophagectomy with linear stapled anastomosis. Surg Endosc, 2022, 36(3): 1979-1988.
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28.	Shim H, Cheong JH, Lee KY, et al. Perioperative nutritional status changes in gastrointestinal cancer patients. Yonsei Med J, 2013, 54(6): 1370-1376.
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31.	劉陽陽. 循環腫瘤細胞、中性粒細胞淋巴細胞比值及體重指數對局部晚期食管鱗癌患者預后評估中的臨床價值. 吉林醫學, 2022, 43(3): 796-799.Liu YY. Clinical value of circulating tumor cells, neutrophil-lymphocyte ratio and body mass index in prognosis evaluation of patients with locally advanced esophageal squamous cell carcinoma. Jilin Med J, 2022, 43(3): 796-799.
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1. 楊天碩, 李可心, 單保恩. 食管癌免疫治療研究進展. 中國腫瘤生物治療雜志, 2021, 28(12): 1207-1214.Yang TS, Li KX, Shan BE. Research progress on immunotherapy for esophageal cancer. Chin J Cancer Biother, 2021, 28(12): 1207-1214.
2. Kamangar F, Nasrollahzadeh D, Safiri S, et al. The global, regional, and national burden of oesophageal cancer and its attributable risk factors in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol, 2020, 5(6): 582-597.
3. Martin-Richard M, Díaz Beveridge R, Arrazubi V, et al. SEOM clinical guideline for the diagnosis and treatment of esophageal cancer (2016). Clin Transl Oncol, 2016, 18(12): 1179-1186.
4. Koterazawa Y, Oshikiri T, Takiguchi G, et al. Severe weight loss after minimally invasive oesophagectomy is associated with poor survival in patients with oesophageal cancer at 5 years. BMC Gastroenterol, 2020, 20(1): 407.
5. Carr RA, Harrington C, Stella C, et al. Early implementation of a perioperative nutrition support pathway for patients undergoing esophagectomy for esophageal cancer. Cancer Med, 2022, 11(3): 592-601.
6. Clavier JB, Antoni D, Atlani D, et al. Baseline nutritional status is prognostic factor after definitive radiochemotherapy for esophageal cancer. Dis Esophagus, 2014, 27(6): 560-567.
7. Quyen TC, Angkatavanich J, Thuan TV, et al. Nutrition assessment and its relationship with performance and Glasgow prognostic scores in Vietnamese patients with esophageal cancer. Asia Pac J Clin Nutr, 2017, 26(1): 49-58.
8. 徐秀娟, 楊帆, 蔣淑年, 等. 營養風險對老年早期食管癌患者放療的預后的影響. 腫瘤學雜志, 2018, 24(9): 866-870.Xu XJ, Yang F, Jiang SN, et al. Prognostic significance of nutritional risk before radiotherapy in elderly patients with early stage esophageal cancer. J Chin Oncol, 2018, 24(9): 866-870.
9. Gellrich NC, Handschel J, Holtmann H, et al. Oral cancer malnutrition impacts weight and quality of life. Nutrients, 2015, 7(4): 2145-2160.
10. Pressoir M, Desné S, Berchery D, et al. Prevalence, risk factors and clinical implications of malnutrition in French Comprehensive Cancer Centres. Br J Cancer, 2010, 102(6): 966-971.
11. Fukuda Y, Yamamoto K, Hirao M, et al. Prevalence of malnutrition among gastric cancer patients undergoing gastrectomy and optimal preoperative nutritional support for preventing surgical site infections. Ann Surg Oncol, 2015, 22 Suppl 3: S778-S785.
12. álvaro Sanz E, Garrido Siles M, Rey Fernández L, et al. Nutritional risk and malnutrition rates at diagnosis of cancer in patients treated in outpatient settings: early intervention protocol. Nutrition, 2019, 57: 148-153.
13. Zhang L, Lu Y, Fang Y. Nutritional status and related factors of patients with advanced gastrointestinal cancer. Br J Nutr, 2014, 111(7): 1239-1244.
14. Fujisawa K, Ohkura Y, Ueno M, et al. Nutritional outcomes of thoracic duct resection for radical esophagectomy by assessing body composition changes in one year: a single-center retrospective study. Ann Surg Oncol, 2021, 28(13): 8414-8425.
15. 王艷莉, 辛曉偉, 周秀耕, 等. 食管癌手術病人相位角與營養狀況的相關性研究. 腸外與腸內營養, 2019, 26(2): 65-69.Wang YL, Xin XW, Zhou XG, et al. A correlation study between phase angle of bioelectrical impedance analysis and nutritional status in patients with esophageal cancer undergoing surgery. Parenter Enter Nutr, 2019, 26(2): 65-69.
16. Movahed S, Varshoee Tabrizi F, Pahlavani N, et al. Comprehensive assessment of nutritional status and nutritional-related complications in newly diagnosed esophageal cancer patients: a cross-sectional study. Clin Nutr, 2021, 40(6): 4449-4455.
17. Kubo Y, Miyata H, Sugimura K, et al. Prognostic implication of postoperative weight loss after esophagectomy for esophageal squamous cell cancer. Ann Surg Oncol, 2021, 28(1): 184-193.
18. Ericson J, Lundell L, Lindblad M, et al. Assessment of energy intake and total energy expenditure in a series of patients who have undergone oesophagectomy following neoadjuvant treatment. Clin Nutr ESPEN, 2020, 37: 121-128.
19. Ludwig DJ, Thirlby RC, Low DE. A prospective evaluation of dietary status and symptoms after near-total esophagectomy without gastric emptying procedure. Am J Surg, 2001, 181(5): 454-458.
20. Okabe H, Tsunoda S, Sunagawa H, et al. A long-term follow-up study of minimally invasive Ivor Lewis esophagectomy with linear stapled anastomosis. Surg Endosc, 2022, 36(3): 1979-1988.
21. Miyazaki T, Tanaka N, Hirai H, et al. Ghrelin level and body weight loss after esophagectomy for esophageal cancer. J Surg Res, 2012, 176(1): 74-78.
22. Murphy CF, Fanning M, Raftery N, et al. Early experience with a nutrition and survivorship clinic in esophageal cancer. Dis Esophagus, 2021, 34(2): doaa061.
23. 雷海科, 廖忠莉, 李小升, 等. 重慶市食管癌患者生存隨訪調查及預后影響因素研究. 中國癌癥雜志, 2020, 30(2): 98-105.Lei HK, Liao ZL, Li XS, et al. Survival of esophageal cancer patients and its related risk factors in Chongqing. Chin J Cancer, 2020, 30(2): 98-105.
24. Finley FJ, Lamy A, Clifton J, et al. Gastrointestinal function following esophagectomy for malignancy. Am J Surg, 1995, 169(5): 471-475.
25. McLarty AJ, Deschamps C, Trastek VF, et al. Esophageal resection for cancer of the esophagus: long-term function and quality of life. Ann Thorac Surg, 1997, 63(6): 1568-1572.
26. Cao J, Xu H, Li W, et al. Nutritional assessment and risk factors associated to malnutrition in patients with esophageal cancer. Curr Probl Cancer, 2021, 45(1): 100638.
27. Martin L, Jia C, Rouvelas I, et al. Risk factors for malnutrition after oesophageal and cardia cancer surgery. Br J Surg, 2008, 95(11): 1362-1368.
28. Shim H, Cheong JH, Lee KY, et al. Perioperative nutritional status changes in gastrointestinal cancer patients. Yonsei Med J, 2013, 54(6): 1370-1376.
29. 張芳. 貧血、吸煙、飲酒、體重指數與食管鱗癌預后關系的臨床研究. 山東大學, 2014.Zhang F. The prognostic value of anemia, smoking, drinking and body mass index in esophageal squamous cell carcinoma with primary treatment. Shandong University, 2014.
30. He Y, Liang D, Du L, et al. Clinical characteristics and survival of 5283 esophageal cancer patients: a multicenter study from eighteen hospitals across six regions in China. Cancer Commun (Lond), 2020, 40(10): 531-544.
31. 劉陽陽. 循環腫瘤細胞、中性粒細胞淋巴細胞比值及體重指數對局部晚期食管鱗癌患者預后評估中的臨床價值. 吉林醫學, 2022, 43(3): 796-799.Liu YY. Clinical value of circulating tumor cells, neutrophil-lymphocyte ratio and body mass index in prognosis evaluation of patients with locally advanced esophageal squamous cell carcinoma. Jilin Med J, 2022, 43(3): 796-799.
32. 羅越魁, 王成, 孟于琪, 等. 體重指數與食管鱗狀細胞癌切除術后轉歸及總生存率關系的研究. 中國胸心血管外科臨床雜志, 2016, 23(5): 467-471.Luo YK, Wang C, Meng YQ, et al. Impact of body mass index on the outcome and overall survival of patients with esophageal squamous cell cancer after surgery. Chin J Clin Thorac Cardiovasc Surg, 2016, 23(5): 467-471.
33. Garcidue?as-Fimbres TE, Paz-Graniel I, Nishi SK, et al. Eating speed, eating frequency, and their relationships with diet quality, adiposity, and metabolic syndrome, or its components. Nutrients, 2021, 13(5): 1687.Garcidue?as-Fimbres TE, Paz-Graniel I, Nishi SK, et al. Eating speed, eating frequency, and their relationships with diet quality, adiposity, and metabolic syndrome, or its components. Nutrients, 2021, 13(5): 1687.
34. Zhu Y, Hollis JH. Associations between eating frequency and energy intake, energy density, diet quality and body weight status in adults from the USA. Br J Nutr, 2016, 115(12): 2138-2144.Zhu Y, Hollis JH. Associations between eating frequency and energy intake, energy density, diet quality and body weight status in adults from the USA. Br J Nutr, 2016, 115(12): 2138-2144.
35. Lochs H, Allison SP, Meier R, et al. Introductory to the ESPEN guidelines on enteral nutrition: terminology, definitions and general topics. Clin Nutr, 2006, 25(2): 180-186.
36. Parsons EL, Stratton RJ, Cawood AL, et al. Oral nutritional supplements in a randomised trial are more effective than dietary advice at improving quality of life in malnourished care home residents. Clin Nutr, 2017, 36(1): 134-142.
37. 石海燕, 陳宏林, 吳超, 等. 口服營養補充對食管癌根治術后出院患者營養狀況影響的研究. 中國現代醫生, 2021, 59(11): 176-179.Shi HY, Chen HL, Wu C, et al. The effect of oral nutritional supplementation on the nutritional status of discharged patients after radical resection of esophageal cancer. Chin Mod Dr, 2021, 59(11): 176-179.
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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Characteristics and influencing factors of postoperative weight change in patients with esophageal cancer: A prospective longitudinal study

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