Oesophageal cancer survivors more prone to late-onset pneumonia

Oesophageal cancer survivors are more likely to develop late-onset pneumonia during their clinical course, a study suggests.

In oesophageal cancer survivors, the incidence of late-onset postoperative pneumonia is high, and this is an emerging problem, noted the researchers, led by Dr Hiroto Takiguchi from the Division of Pulmonary Medicine, Department of Medicine, Tamakyuryo Hospital, Machida, Tokyo, Japan, who presented their findings during a poster presentation at APSR 2023.

“Late-onset pneumonia is often recurrent and has a detrimental impact on the long-term prognosis of oesophageal cancer survivors regardless of cancer status,” they added. Postop pneumonia after oesophageal cancer can lead to more pain, prolonged hospital stay, and respiratory failure, which could subsequently lead to early recurrence and/or death. [Anticancer Res 2019;39:2671-2678]

Takiguchi and colleagues sought to evaluate the incidence and impact of late-onset pneumonia on the long-term prognosis of oesophageal cancer survivors who have survived for at least a year after oesophagectomy without cancer recurrence (n=185; mean age 66 years). More than 80 percent of the participants were men. About two-thirds were former smokers, while 18 percent were current smokers. Thirty-eight percent of participants had stage I disease.

After a median observation period of 49.1 months, 118 survived without cancer recurrence or new malignancies, 34 had recurrence, 22 developed new malignancies, and 11 died of non-cancer causes. [APSR 2023, abstract AP01-27]

The researchers defined late-onset pneumonia as the presence of new infiltrates on chest X-ray or thoracic CT scan that developed ≥1 year after oesophagectomy and of fever or emerging respiratory symptoms (such as cough, phlegm), which required antimicrobial therapy.

Of the 185 participants, 31 (16.8 percent) developed late-onset pneumonia. The median time to first late-onset pneumonia was 43.2 months. More than half (n=17) required hospitalization, while 13 had recurrence of late-onset pneumonia.

Risk factors

On multivariate analysis, risk factors associated with late-onset pneumonia were obstructive pulmonary dysfunction with smoking history (hazard ratio [HR], 2.8, 95 percent confidence interval [CI], 1.2–6.6), postop anastomotic leakage (HR, 2.7, 95 percent CI, 1.3–5.8), and postop skeletal muscle loss (HR, 2.8, 95 percent CI, 1.4–5.8).

“[These three factors] independently contribute to the development of late-onset pneumonia,” the researchers explained. The change in muscle volume was represented by the area of the bilateral psoas muscles on CT scan of the abdomen 3–12 months post oesophagectomy.

The probability of late-onset pneumonia was highest among those who had ≥2 risk factors as opposed to those who only had one or none. This was observed in both the overall cohort (p log-rank test for trend<0.0001) and the subgroup of participants who were hospitalized (p log-rank test for trend=0.0002).

In another study, short maximum phonation time (MPT; <15 secs [males] and <10 secs [females]) was identified as an independent risk factor of late-onset pneumonia following oesophagectomy (odds ratio, 2.26; p=0.026). Individuals who had short MPT had a significantly higher incidence of late-onset pneumonia as opposed to those who had normal MPT (≥15 secs [males] and ≥10 secs [females]; 18.6 percent vs 6.7 percent; p<0.001). This effect was sustained after adjusting for clinical characteristics (15.6 percent vs 4.7 percent; p=0.004). [Dis Esophagus 2023;doi:10.1093/dote/doad023]

Increased mortality risk

“Late-onset pneumonia [was] significantly associated with an increased risk of non-cancer deaths [on univariate analysis; HR, 12.4, 95 percent CI, 3.3–47.2],” added Takiguchi and colleagues. This effect was driven by pneumonia requiring hospitalization (HR, 21.2, 95 percent CI, 5.7–79.0) and recurrent pneumonia (HR, 18.0, 95 percent CI, 4.1–78.8).

The researchers underscored that clinicians must be aware of the probable short survival irrespective of cancer status when patients do develop pneumonia during follow-up post oesophagectomy.