The Geriatric Nutritional Risk Index and pulmonary function predict non-esophageal cancer-related mortality after...

Numerous studies have investigated prognostic factors for esophageal cancer after curative surgery; however, little is known about the risk factors for non-esophageal cancer-related death. This study identifies predictors of non-esophageal cancer mortality following esophagectomy.

We retrospectively analyzed 398 patients who underwent thoracic subtotal esophagectomy for thoracic esophageal or esophagogastric junction cancer from 2009 to 2022. Patients with non-curative resection, special histology, or in-hospital death were excluded. Cause-specific Cox regression was used to assess predictors of non-esophageal cancer-related death. The cumulative incidence function (CIF) was estimated while taking competing risks into account, and Gray's test was applied for group comparisons.

During follow-up, 181 patients died: 118 from esophageal cancer, and 63 from other causes. Non-esophageal cancer-related deaths were due to respiratory diseases (n = 23), second cancers (n = 15), and other causes (n = 25). Patients who died of non-esophageal cancer-related causes had lower Geriatric Nutritional Risk Index (GNRI) and body mass index, were older, and more frequently had hypertension compared with the other groups. CIF analysis revealed that non-esophageal cancer-related deaths increased gradually over 10 years and beyond, while respiratory-related deaths tended to occur within the first 10 years. Multivariable analysis revealed that age, percent vital capacity (%VC), and GNRI were independent predictors.

Lower GNRI and %VC were independent predictors of non-esophageal cancer-related death among patients undergoing curative esophagectomy for esophageal cancer. Assessment of preoperative nutritional and pulmonary status may help identify vulnerable patients and guide postoperative management and supportive care.