Originally published as JCO Early Release 10.1200/JCO.2008.20.5864 on March 16 2009

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Predictors of Postoperative Quality of Life After Esophagectomy for Cancer

From the Unit of Esophageal and Gastric Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Departments of Social Medicine and Clinical Sciences of South Bristol, University of Bristol; and Division of Surgery, Head and Neck, University Hospitals Bristol National Health Service Foundation Trust, Bristol, United Kingdom.

Corresponding author: Therese Djärv, PhD, Unit of Esophageal and Gastric Research P9:03, Department of Molecular Medicine and Surgery, Karolinska Institutet, SE-171 76 Stockholm, Sweden; e-mail: therese.djarv{at}karolinska.se.

Purpose To identify factors predictive of health-related quality of life (HRQL) 6 months after surgery for esophageal cancer.

Patients and Methods A Swedish nationwide population-based study of patients undergoing esophagectomy for cancer was undertaken between 2001 and 2005. Clinical details (sex, age, body mass index [BMI], comorbidity) and tumor details (histology, stage, and location) were prospectively recorded and validated. HRQL questionnaires (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaires C30 and OES18) were used to assess HRQL 6 months postoperatively. HRQL outcome was categorized as good or poor by collapsing the four response categories. Logistic regression models adjusting for potential confounding factors were used to assess the association between preoperative patient and tumor characteristics and HRQL outcome 6 months after surgery.

Results A total of 355 patients (77% of eligible) responded to the HRQL questionnaires. Age, sex, and BMI showed no associations with HRQL 6 months after surgery, but patients with comorbidity, a more advanced tumor stage (III to IV), or a tumor located in the middle or upper esophagus had an increased risk of poor HRQL. Patients with adenocarcinoma had a lower risk of poor HRQL than patients with squamous cell carcinoma.

Conclusion Knowledge of risk factors for poor postoperative HRQL may be relevant for clinical decision making. More research to see whether these factors are further predictive of poor HRQL in long-term survivors is needed.

Supported by the Swedish Cancer Society; the Karolinska Institutet (T.D.); the Swedish Cancer Society, Karolinska Institutet (P.L.); and Karolinska University Hospital (P.L.).

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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