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Introduction <p>Osteopenia, marked by low bone mineral density, is a sign of patient frailty and has been linked to poor survival in patients with esophageal squamous cell carcinoma. However, its impact on overall survival (OS) and disease-free survival (DFS) in patients with esophageal adenocarcinoma is still unclear.</p> Aim <p>Our aim was to assess the impact of osteopenia on long-term survival in patients with resectable esophageal adenocarcinoma.</p> Methods <p>This was a retrospective study (January 2014–December 2024) including patients with resectable Siewert I–II esophageal adenocarcinoma who underwent Ivor-Lewis esophagectomy. Osteopenia was defined as reduced bone mineral density (&lt;160 Hounsfield units) measured at the level of the first lumbar vertebra on preoperative computed tomography scan.</p> Results <p>Overall, 338 patients were included. The prevalence of osteopenia was 27.8%. Anastomotic leak (22.3% vs. 11.9%; <i>p</i>=0.04), pneumonia (17.1% vs. 6.9%; <i>p</i>=0.01), and 90-day mortality (8.5% vs. 2.1%; <i>p</i>=0.02) were higher in patients with osteopenia. On multivariate analysis, osteopenia was an independent predictor of pneumonia (hazard ratio [HR] 1.42; 95% confidence interval [CI] 1.06–1.86) and 90-day mortality (HR 1.35; 95% CI 1.12–1.95) but not anastomotic leak (HR 1.51; 95% CI 0.91–1.76). Patients with osteopenia had significantly lower 60-month OS probability&#xa0;(49.9% vs. 70.5%; <i>p</i>&lt;0.001) and DFS probability&#xa0;(45.7% vs. 61.5%; <i>p</i>=0.002). Osteopenia independently predicted poorer OS (HR 2.03; 95% CI 1.54–2.95) and DFS (HR 1.51; 95% CI 1.12–2.35).</p> Conclusions <p>Osteopenia may affect up to one-third of patients with esophageal adenocarcinoma. Osteopenia was independently associated with postoperative pneumonia and 90-day mortality and poor long-term survival. Patients with osteopenia have lower OS and DFS than those without osteopenia.</p>

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Prognostic Impact of Osteopenia in Patients with Resectable Esophageal Adenocarcinoma: A Retrospective Study

  • 期刊论文

  • 发表日期：

    2025年12月29日

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  • Alberto Aiolfi,
  • Davide Bona,
  • Gianluca Bonitta,
  • Quan Wang,
  • Domenico Albano,
  • Giulia Bonavina,
  • Rosario Caruso,
  • Giuseppe Banfi,
  • Luca Maria Sconfienza,
  • Luigi Bonavina

摘要

Introduction

Osteopenia, marked by low bone mineral density, is a sign of patient frailty and has been linked to poor survival in patients with esophageal squamous cell carcinoma. However, its impact on overall survival (OS) and disease-free survival (DFS) in patients with esophageal adenocarcinoma is still unclear.

Aim

Our aim was to assess the impact of osteopenia on long-term survival in patients with resectable esophageal adenocarcinoma.

Methods

This was a retrospective study (January 2014–December 2024) including patients with resectable Siewert I–II esophageal adenocarcinoma who underwent Ivor-Lewis esophagectomy. Osteopenia was defined as reduced bone mineral density (<160 Hounsfield units) measured at the level of the first lumbar vertebra on preoperative computed tomography scan.

Results

Overall, 338 patients were included. The prevalence of osteopenia was 27.8%. Anastomotic leak (22.3% vs. 11.9%; p=0.04), pneumonia (17.1% vs. 6.9%; p=0.01), and 90-day mortality (8.5% vs. 2.1%; p=0.02) were higher in patients with osteopenia. On multivariate analysis, osteopenia was an independent predictor of pneumonia (hazard ratio [HR] 1.42; 95% confidence interval [CI] 1.06–1.86) and 90-day mortality (HR 1.35; 95% CI 1.12–1.95) but not anastomotic leak (HR 1.51; 95% CI 0.91–1.76). Patients with osteopenia had significantly lower 60-month OS probability (49.9% vs. 70.5%; p<0.001) and DFS probability (45.7% vs. 61.5%; p=0.002). Osteopenia independently predicted poorer OS (HR 2.03; 95% CI 1.54–2.95) and DFS (HR 1.51; 95% CI 1.12–2.35).

Conclusions

Osteopenia may affect up to one-third of patients with esophageal adenocarcinoma. Osteopenia was independently associated with postoperative pneumonia and 90-day mortality and poor long-term survival. Patients with osteopenia have lower OS and DFS than those without osteopenia.