Predictive value of preoperative weight loss on survival of elderly patients undergoing surgery for esophageal squamous cell carcinoma

Hanlu Zhang, Yushang Yang, Qixin Shang, Xiaoyang Li, Wenping Wang, Yang Hu, Yong Yuan, Yun Wang, Long-Qi Chen


Background: The role of preoperative weight loss (PWL) has rarely been studied in elderly patients undergoing surgery for esophageal squamous cell carcinoma (ESCC). The aim of this study is to evaluate whether PWL is an important determinant of survival in elderly patients following surgery for ESCC.
Methods: This retrospective study included a total of 974 elderly patients (≥65 years) who underwent esophagectomy for ESCC at the West China Hospital, Sichuan University from August 2005 to April 2013. PWL was determined as the percentage weight loss during the 3 months before admission. Patients were divided into three groups according to the PWL, defined as normal (PWL =0), slight PWL (0< PWL <10%) and severe PWL (PWL ≥10%). Prognostic factors were evaluated by using univariate and multivariate analyses.
Results: Patients were categorized as normal (n=605, 62.11%), slight PWL (n=284, n=29.17%) and severe PWL (n=85, 8.73%). Compared with patients without PWL, both the patients with slight and severe PWL suffered from higher risk of tumor depth invasion (P=0.002 and P<0.001, respectively), lymph node metastasis (P=0.009 and P=0.004, respectively) and advanced stage (P=0.006 and P<0.001, respectively). Both patients with slight and severe PWL were significantly associated with worse overall survival compared with patients without PWL (P=0.036 and P<0.001, respectively). Multivariate analysis revealed severe PWL was an independent prognostic factor of overall survival [hazard ratio (HR) =1.534, 95% CI: 1.163–2.024] after correcting for sex, body mass index (BMI), T stage, N stage, grade, and adjuvant therapy.
Conclusions: For elderly patients undergoing surgery for ESCC, PWL provided prognostic value for depth of tumor invasion, lymph node metastasis and advanced stage. PWL ≥10% was an independent predictor of worse overall survival.