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Background <p>Reflux after curative esophagectomy is common and may persist, disrupting eating, sleep, and recovery, yet most prediction tools estimate risk only at a single late time point.</p> Methods <p>We retrospectively analyzed an esophagectomy derivation cohort (2018–2021; n = 488) and a temporal validation cohort (2023–2024; n = 143). Clinically significant reflux was defined as an EORTC QLQ-OES18 item 14 or 15 score ≥ 2. Time to first event within 12&#xa0;months was modeled using a time-varying coefficient Cox model, and longitudinal symptom severity (1–4) was modeled using an ordinal mixed-effects model. Predictors were prespecified from routine pre-discharge variables. Model performance was assessed using time-dependent AUC and calibration.</p> Results <p>Cox analysis linked distal/esophagogastric junction tumors and higher BMI to increased early reflux risk, while neoadjuvant therapy, older age, and a longer oral-to-solid diet interval were protective. The ordinal mixed model showed greater symptom severity in women and in patients with distal/esophagogastric junction tumors, but lower severity with neoadjuvant therapy. Interactions suggested slower early symptom escalation with older age and steeper escalation with higher BMI or shorter oral-to-intake intervals. The time-varying Cox model showed good discrimination, with time-dependent AUCs at 1, 3, and 6&#xa0;months of 0.702, 0.766, and 0.794 in the development cohort, and 0.708, 0.767, and 0.716 in the external validation cohort, with good calibration.</p> Conclusions <p>A pre-discharge, time-sensitive risk model with a web-based calculator may support risk-stratified early screening, education, and targeted supportive care after discharge to reduce reflux-related morbidity and protect postoperative health-related quality of life.</p>

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Clinical predictors of early reflux and symptom severity after esophagectomy: a risk prediction tool

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月30日

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  • Zhao Xue,
  • Liu Beijia,
  • Xie Qin,
  • Liu Jiarui,
  • Wang Xiaowei,
  • Luo Lei,
  • Miao Yan

摘要

Background

Reflux after curative esophagectomy is common and may persist, disrupting eating, sleep, and recovery, yet most prediction tools estimate risk only at a single late time point.

Methods

We retrospectively analyzed an esophagectomy derivation cohort (2018–2021; n = 488) and a temporal validation cohort (2023–2024; n = 143). Clinically significant reflux was defined as an EORTC QLQ-OES18 item 14 or 15 score ≥ 2. Time to first event within 12 months was modeled using a time-varying coefficient Cox model, and longitudinal symptom severity (1–4) was modeled using an ordinal mixed-effects model. Predictors were prespecified from routine pre-discharge variables. Model performance was assessed using time-dependent AUC and calibration.

Results

Cox analysis linked distal/esophagogastric junction tumors and higher BMI to increased early reflux risk, while neoadjuvant therapy, older age, and a longer oral-to-solid diet interval were protective. The ordinal mixed model showed greater symptom severity in women and in patients with distal/esophagogastric junction tumors, but lower severity with neoadjuvant therapy. Interactions suggested slower early symptom escalation with older age and steeper escalation with higher BMI or shorter oral-to-intake intervals. The time-varying Cox model showed good discrimination, with time-dependent AUCs at 1, 3, and 6 months of 0.702, 0.766, and 0.794 in the development cohort, and 0.708, 0.767, and 0.716 in the external validation cohort, with good calibration.

Conclusions

A pre-discharge, time-sensitive risk model with a web-based calculator may support risk-stratified early screening, education, and targeted supportive care after discharge to reduce reflux-related morbidity and protect postoperative health-related quality of life.