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Prognostic significance of compound physiology variables in oesophageal cancer

By Arfon G Powell, Catherine Eley, Alexandra coxon, Carven Chin, Damian M. Bailey, Wyn G Lewis

Posted 19 Apr 2020
medRxiv DOI: 10.1101/2020.04.16.20067769

Aims: Objective identification of patient risk profile in Oesophageal Cancer (OC) surgery is critical. This study aimed to evaluate to what extent cardiorespiratory fitness and select metabolic factors predict clinical outcome. Methods: Consecutive 186 patients were recruited (median age 69 yr. 160 male, 138 neoadjuvant therapy). All underwent pre-operative cardiopulmonary exercise testing to determine peak oxygen uptake (V O2Peak), anaerobic threshold (AT), and ventilatory equivalent for carbon dioxide (V E/V CO2). Cephalic venous blood was assayed for serum C-reactive protein (CRP), albumin, and full blood count. Primary outcome measures were Morbidity Severity Score (MSS), and Overall Survival (OS). Results: MSS (Clavien-Dindo >2) developed in 33 (17.7%) and was related to elevated CRP (AUC 0.69, p=0.001) and lower V O2Peak (AUC 0.33, p=0.003). Dichotomisation of CRP (above 10mg/L) and V O2Peak (below 18.6mL/kg/min) yielded adjusted Odds Ratios (OR) for MSS CD>2, of 4.01 (p=0.002) and 3.74 (p=0.002) respectively. OC recurrence occurred in 36 (19.4%) and 69 (37.1%) patients died. On multivariable analysis; pTNM stage (Hazard Ratio (HR) 2.20, p=0.001), poor differentiation (HR 2.20, p=0.010), resection margin positivity (HR 2.33, p=0.021), and MSS (HR 4.56, p<0.001) were associated with OS. Conclusions: CRP and V O2Peak are collective independent risk factors that can account for over half of OC survival variance.

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