The Role of Nutritional Status in Oesophageal and Gastro-Oesophageal Junction Adenocarcinoma

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Introduction

The incidence of oesophageal cancer is rising. Despite improvement in treatment, the five year survival rate is 12%. Patients present with dysphagia and weight loss which affects their nutritional status and their ability to tolerate treatment.

Aims

We aim to assess how patients’ nutritional status can affect their survival.

Methods

Retrospective review of clinical notes of patients diagnosed with early stage oesophageal (OAC) and gastro-oesophageal adenocarcinoma (GOJ) in the Northern Ireland Cancer Centre between 2013 and 2017. Patients’ demographics and survival data were collected. The body mass index (BMI), Lorentz ideal body weight and the nutritional risk index (NRI) were calculated. Being underweight is defined as having a BMI of less than 18.5. Normal NRI is defined as a score of more than 100.

Results

164 patients were diagnosed with early stage OAC/GOJ between 2013 and 2017 of whom 134 (81.7%) were male and the median age was 63.9 (31-82). Seven patients (4.4%) were underweight and their recurrence free (RFS) and overall survival (OS) were significantly worse [HR 0.36 (CI 0.13-1); p=0.04 and HR 0.33 (CI 0.12-0.94); p=0.028) respectively). Twelve (7.6%) have NRI of less than 100. NRI<100 strongly predicted for poorer RFS [HR 2.6 (CI 1.1-6.2); p= 0.023] and OS [HR 3.4 (CI 1.5-7.7); p=0.002].

Conclusion

Poor nutritional status is a poor prognostic factor in patients undergoing neo-adjuvant chemotherapy and surgery for oesophageal adenocarcinoma.