University of Oulu

Schandl, A., Kauppila, J.H., Anandavadivelan, P. et al. Ann Surg Oncol (2019) 26: 2385.

Predicting the risk of weight loss after esophageal cancer surgery

Saved in:
Author: Schandl, Anna1; Kauppila, Joonas H.2,3; Anandavadivelan, Poorna1;
Organizations: 1Surgical Care Science, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
2Cancer and Translational Medicine Research Unit, Medical Research Center Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland
3Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
4Department of Surgery and Cancer, Imperial College, London, UK
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.3 MB)
Persistent link:
Language: English
Published: Springer Nature, 2019
Publish Date: 2019-10-11


Background: Malnutrition 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.

Methods: Data 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.

Results: Among 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.

Conclusions: This 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.

see all

Series: Annals of surgical oncology
ISSN: 1068-9265
ISSN-E: 1534-4681
ISSN-L: 1068-9265
Volume: 26
Issue: 8
Pages: 2385 - 2391
DOI: 10.1245/s10434-019-07352-5
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Funding: The project was funded by the Swedish Cancer Society (Grant Number: 140323), the Stockholm Cancer Society (Grant Number: 141223), Sigrid Jusélius Foundation and Orion Research Foundation.
Copyright information: © The Author(s) 2019. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.