Factors responsible for the decline in physical fitness during neoadjuvant chemotherapy in older patients with esophageal cancer: an exploratory prospective cohort study
Menée à partir de données portant sur 69 patients atteints d'un cancer de l'oesophage (âge moyen : 72,9 ans), cette étude de cohorte prospective identifie les facteurs associés à une baisse d'activité physique pendant la chimiothérapie néoadjuvante
Purpose: The decline in physical fitness during neoadjuvant chemotherapy (NAC) impacts postoperative pneumonia and survival in older patients with locally advanced esophageal cancer (LAEC). However, information is lacking on the clinical mechanisms underlying the decline in physical fitness during NAC in older patients. This study investigated the factors responsible for the decline in physical fitness during NAC in older patients with LAEC.
Methods: This was a single-center exploratory prospective cohort study. A total of 80 patients with LAEC aged ≥ 65 years who were scheduled for curative esophagectomy after NAC were consecutively enrolled between October 2021 and December 2023. The decline in the incremental shuttle walking test (
ΔISWT; ΔISWT
= pre-NAC (m) − post-NAC (m)) was calculated to assess physical fitness. Significant factors responsible for
ΔISWT were detected using a multivariate regression model. Statistical significance was two-tailed at p
< 0.05.
Results: A total of 69 patients (mean age, 72.9 years) were analyzed. The mean ISWT distances before and after NAC were 418.7 m and 353.5 m, respectively; the mean
ΔISWT was 65.2 m. Significant responding factors for the decline in physical fitness during NAC were changes in skeletal muscle mass index (SMI; adjusted coefficient
− 14.239 cm2/m2, 95% confidence interval − 19.690 to − 8.788, p < 0.001) and decreased hemoglobin (Hb; vs. non-decreased Hb, adjusted coefficient 33.907, 95% confidence interval 9.913 to 64.288, p = 0.008) during NAC.
Conclusion: This prospective cohort study found that the significant factors for the decline in physical fitness during NAC were loss of skeletal muscle mass and decreased Hb during NAC in older patients with LAEC.
Supportive Care in Cancer , résumé 2025