Risk factors for weight loss among patients surviving 5 years after esophageal cancer surgery

Abstract

Background: This study aimed to identify factors influencing postoperative weight loss ≥15 % in long-term survivors after esophageal cancer surgery.

Methods: A population-based study was conducted in Sweden between 2001 and 2005, with regular follow-up for 5 years. Current weight, weight at operation, and average weight were assessed and dichotomized as weight loss of ≥15 %. Logistic regression estimated relative risks of weight loss between pre- and 5 years postoperatively, expressed as odds ratios (ORs) with 95 % confidence intervals (CIs). Statistically significant differences in nutritional symptoms between weight loss groups were analyzed using linear regression models to likewise test as risk factors. Body mass index (BMI) at operation (< or ≥25), sex, and preoperative weight loss (< or ≥10 %) were tested as risk factors. Nutritional symptoms were selected from the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-OES18, including fatigue, nausea and vomiting, dyspnoea, appetite loss, diarrhea, and dysphagia, eating difficulties, reflux and pain.

Results: A total of 117 patients were included. Patients with preoperative BMI ≥25 were at a threefold increased risk (OR 3.2; 95 % CI 1.4-7.3) for postoperative weight loss of ≥15 % 5 years after operation. Moreover, eating difficulties, pain, fatigue, nausea and vomiting, and appetite loss were clinically relevant and statistically significantly worse symptoms experienced among those with a weight loss of ≥15 % (all at p < 0.05).

Conclusions: Overweight at the time of operation is associated with postoperative weight loss from a long-term perspective. Several nutritional symptoms are associated with weight loss of >15 % 5 years postoperatively.