• Anna Schandl, Joonas H Kauppila, Poorna Anandavadivelan, Asif Johar, and Pernilla Lagergren.
• Surgical Care Science, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. anna.schandl@ki.se.
• Ann. Surg. Oncol. 2019 Aug 1; 26 (8): 2385-2391.

BackgroundMalnutrition after esophageal cancer surgery is associated with reduced health-related qualify of life. Therefore, a prediction model identifying patients at risk for severe weight loss after surgery was developed.MethodsData from a Swedish population-based cohort study, including 616 patients undergoing esophageal cancer surgery in 2001-2005, was used. Candidate predictors included risk factors available before and immediately after surgery. Severe weight loss was defined as ≥ 15% loss of body weight between the time of surgery and 6 months postoperatively. The prediction model was developed using multivariable models. The accuracy of the model was measured by the area under the receiver operating characteristics curve (AUC) with bootstrap validation. The model was externally validated in a hospital-based cohort of 91 surgically treated esophageal cancer patients in the United Kingdom in 2011-2016. Each predictor in the final model was assigned a corresponding risk score. The sum of risk scores was equivalent to an estimated probability for severe weight loss.ResultsAmong the 351 patients with 6 months follow-up data, 125 (36%) suffered from severe postoperative weight loss. The final prediction model included body mass index at diagnosis, preoperative weight loss, and neoadjuvant therapy. The AUC for the model was 0.78 (95% CI 0.74-0.83). In the validation cohort, the AUC was 0.76. A clinical risk assessment guide was derived from the prediction model.ConclusionsThis prediction model can preoperatively identify individuals with high risk of severe weight loss after esophageal cancer surgery. Intensive nutritional interventions for these patients are recommended.

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