Impact of Clinical Markers of Nutritional Status and Feeding Jejunostomy Use on Outcomes in Esophageal Cancer Patients Undergoing Neoadjuvant Chemoradiotherapy
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patient Selection and Data Collection
2.2. Statistical Analysis
3. Results
3.1. Baseline Characteristics and Markers of Nutritional Status
3.2. Markers of Malnutrition and Toxicity during nCRT
3.3. Association between Albumin, Weight Loss, and Toxicity during CRT
3.4. RFS and OS by Albumin, Weight Loss, and FJT Status
4. Discussion
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Hospitalizations | Any Unexpected Hospitalization during nCRT |
---|---|
Nonhematologic toxicity 1 | Any-grade mucositis, nausea, vomiting, diarrhea, constipation, anorexia, dehydration, fatigue, esophagitis, dysphagia, neurotoxicity |
Hematologic toxicity 2 | Neutropenia, thrombocytopenia, anemia |
Grade ≥3 toxicity 3 | Onset of any grade ≥3 toxicity during nCRT Hgb < 8 g/dL, ANC < 1000/mm3, Plts < 50,000/mm3, Cr < 3× baseline or >3.0 mg/dL |
Dose reduction or interruption 4 | Unplanned chemotherapy dose reduction or interruption |
Characteristic | Total N = 125 (%) |
---|---|
Median Age | 63, range 35–80 |
Gender | |
Male | 105 (84) |
Female | 20 (16) |
Pathologic subtype | |
Adenocarcinoma | 108 (86) |
Squamous | 17 (14) |
Location | |
Lower tumor | 110 (88) |
Other | 15 (12) |
Smoking status | |
Past | 71 (57) |
Current | 21 (17) |
Former | 33 (26) |
Charlson comorbidity index | |
CCI = 0 | 87 (70) |
CCI = 1 | 25 (20) |
CCI >1 | 13 (11) |
Performance status | |
0 | 70 (56) |
≥1 or greater | 55 (44) |
Clinical stage | |
I | 1 (0) |
II | 48 (38) |
III | 63 (50) |
IV 1 | 13 (10) |
Pathologic stage | |
0 2 | 32 (26) |
I | 15 (12) |
II | 47 (38) |
III | 24 (19) |
IV 3 | 7 (6) |
Chemotherapy regimen | |
Carboplatin/Paclitaxel | 45 (36) |
Cisplatin/5-FU | 65 (52) |
Other 4 | 15 (12) |
Radiation dose | |
<5000 cGy | 33 (26) |
≥5000 cGy | 92 (74) |
Characteristic | Total N = 125 (%) |
---|---|
Mean weight pre-nCRT (lbs) | 188 |
Mean weight post-nCRT | 178 |
Mean weight change | 10 |
Weight change category | |
Weight gain | 20 (16) |
Weight loss <5% | 40 (32) |
Weight loss ≥5–10% | 45 (36) |
Weight loss ≥10% | 20 (16) |
Mean albumin 1 (pre-nCRT) (g/dL) | 3.8 |
Mean albumin (post-nCRT) (g/dL) | 3.4 |
Mean albumin (g/dL) loss | 0.4 |
Albumin change | |
<0.5 g/dL | 59 (47) |
≥0.5 g/dL | 61 (49) |
Pre-CRT feeding jejunostomy tube placement | |
Yes | 62 (50) |
No | 63 (50) |
Mean weight loss with FJT (lbs) | 8 |
Mean weight loss without FJT (lbs) | 13 |
Mean albumin loss with FJT (g/dL) | 0.38 |
Mean albumin loss without FJT (g/dL) | 0.52 |
Chemotherapy dose reductions | 12 (10) |
Chemotherapy dose interruptions | 27 (22) |
Dose reductions/interruptions | 33 (26) |
Hospitalizations | 23 (18) |
Albumin Change (<0.5 vs. ≥0.5) | Weight Loss (Gain or <5%, 5–10%, >10%) | J-Tube (Yes vs. No) | ||||
---|---|---|---|---|---|---|
Toxicity | UVA (p-value) | MVA (p > z or p > t) | UVA (p-value) | MVA (p > z or p > t) | UVA (p-value) | MVA (p > z or p > t) |
Dose reductions/ interruptions | NS | 0.043 | NS | NS | NS | NS |
Hospitalizations | NS | NS | NS | NS | NS | NS |
Nonhematologic toxicity | 0.011 | 0.004 | 0.019 | <5% = NS 5–10% = 0.035 >10% = 0.002 | NS | NS |
Hematologic toxicity | 0.004 | 0.002 | NS | NS | NS | NS |
Grade ≥3 toxicity | 0.006 | 0.004 | NS | <5% = NS 5–10% = NS >10% = 0.032 | NS | NS |
Albumin Change (<0.5 vs. ≥0.5) | Weight Loss (<5% vs. ≥5%) | J-Tube (Yes vs. No) | |
---|---|---|---|
MVA HR [95% CI], p-Value | MVA HR [95% CI], p-Value | MVA HR [95% CI], p-Value | |
Relapse-free survival | 1.13 [0.64–2.01], p = 0.67 | 1.29 [0.71–2.32], p = 0.40 | 1.36 [0.69–2.69], p = 0.37 |
Overall survival | 0.98 [0.57–1.70], p = 0.95 | 1.27 [0.73–2.24], p = 0.40 | 0.86 [0.47–1.59], p = 0.63 |
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Jain, R.; Shaikh, T.; Yee, J.-L.; Au, C.; Denlinger, C.S.; Handorf, E.; Meyer, J.E.; Dotan, E. Impact of Clinical Markers of Nutritional Status and Feeding Jejunostomy Use on Outcomes in Esophageal Cancer Patients Undergoing Neoadjuvant Chemoradiotherapy. Nutrients 2020, 12, 3177. https://doi.org/10.3390/nu12103177
Jain R, Shaikh T, Yee J-L, Au C, Denlinger CS, Handorf E, Meyer JE, Dotan E. Impact of Clinical Markers of Nutritional Status and Feeding Jejunostomy Use on Outcomes in Esophageal Cancer Patients Undergoing Neoadjuvant Chemoradiotherapy. Nutrients. 2020; 12(10):3177. https://doi.org/10.3390/nu12103177
Chicago/Turabian StyleJain, Rishi, Talha Shaikh, Jia-Llon Yee, Cherry Au, Crystal S. Denlinger, Elizabeth Handorf, Joshua E. Meyer, and Efrat Dotan. 2020. "Impact of Clinical Markers of Nutritional Status and Feeding Jejunostomy Use on Outcomes in Esophageal Cancer Patients Undergoing Neoadjuvant Chemoradiotherapy" Nutrients 12, no. 10: 3177. https://doi.org/10.3390/nu12103177