The prediction of preoperative decline in nutritional status during chemo-radiation therapy in patients with esophageal cancer

Rationale: Patients with esophageal cancer are at high risk for developing malnutrition during neo-adjuvant chemo-radiation therapy (NA-CRTh), which in turn is associated with postoperative morbidity. The aim of this study was to identify which pre-treatment parameters were predictive for a decline in nutritional status during NA-CRTh. Methods: In this prospective study, 87 patients with esophageal cancer treated with NA-CRTh were included. Age, gender, % weight change, body mass index (kg/m2), fat (free) mass index (kg/m2), phase angle (°), handgrip strength (kg), energy (%EI)- and protein intake (%PI) as % of requirements, tumor classification and performance score were measured. A prediction model was constructed to analyze which of these parameters predicted a decline in nutritional status (defined as weight loss of >5% and/or decline in fat free mass of ≥1,4 kg) during NA-CRTh. Results: Nutritional status declined in 36% of the patients during NA-CRTh. Main predictors were a higher phase angle (OR 1.76 (95% CI 1.05-2.94)) and a lower %PI (OR 0.97 (95% CI 0.94- 0.99)). The prediction formula was defined as: -1.486 + 0.566∗PA-0.035∗%PI. This indicates for example a 55% chance to decline in nutritional status during NA-CRTh in a patient with a phase angle of 6 and %PI of 50%. Quality of the prediction model was tested by the Hosmer and Lemeshow test (p = 0.97). The ROC-AUC was 0.70 (95% CI 0.58-0.81). Conclusion: Results of this study suggest that patients in a good nutritional status (i.e. higher phase angle) but with a poor nutritional intake (i.e. lower %PI) are at highest risk to decline in nutritional status during NA-CRTh. This give opportunities for targeted dietetic care in patients with esophageal cancer who receive NA-CRTh.