Nutritional status impacts treatment response, survival in esophageal cancer

November 23, 2007

NEW YORK (Reuters Health) - In patients with locally advanced esophageal cancer, poor baseline nutritional status is associated with nonresponse to definitive chemoradiotherapy and shorter survival, independent of clinical and tumor characteristics, according to a retrospective study.

In a report in the November issue of the American Journal of Gastroenterology, Dr. Frederic Di Fiore, from Rouen University Hospital, France, and associates say these "striking findings underline the key role of nutritional parameters in these patients' outcomes."

In their review of 105 patients with nonmetastatic esophageal cancer who were treated with external radiotherapy and concomitant cisplatin-based chemotherapy with curative intent, the mean value of baseline nutritional parameters was significantly different between the 42 nonresponders and the 63 complete responders to treatment.

In multivariate analysis, Dr. Di Fiore's team found that a baseline serum albumin level greater than 35 g/L was strongly and independently associated with response to chemoradiotherapy (hazard ratio, 5.26).

The median overall survival for the entire cohort was 16.2 months. In multivariate analysis, BMI greater than 18, dysphagia Atkinson score less than 2, and dose of radiotherapy greater than 50 Grays delivered to the tumor bed, as well as having a complete response to therapy, were predictive of longer survival.

"Undernutrition is a very common status in patients with esophageal cancer and is a well-known predictive factor of morbidity after surgery," the investigators note. "Our results may provide the concept basis for performing a prospective nutritional intervention study in patients treated by definitive chemoradiotherapy for an esophageal cancer."