Samenvatting

Although neoadjuvant chemoradiotherapy (nCRT) is frequently used in esophageal cancer patients
undergoing treatment with curative intent, it can negatively impact patients’ physical fitness. A decline in physical
fitness during chemoradiotherapy may be an indication of vulnerability. The aim of this study was to evaluate
whether changes in physical fitness, weight, and fat-free mass index (FFMI) during nCRT can predict the risk
of postoperative pneumonia. A retrospective longitudinal observational cohort study was performed in patients
who received curative treatment for esophageal cancer between September 2016 and September 2018 in a highvolume
center for esophageal cancer surgery. Physical fitness (handgrip strength, leg extension strength, and
exercise capacity), weight, and FFMI were measured before and after chemoradiotherapy. To be included in the data
analyses, pre- and post-nCRT data had to be available of at least one of the outcome measures. Logistic regression
analyses were performed to evaluate the predictive value of changes in physical fitness, weight, and FFMI during
nCRT on postoperative pneumonia, as defined by the Uniform Pneumonia Scale. In total, 91 patients were included
in the data analyses. Significant associations were found between the changes in handgrip strength (odds ratio [OR]
0.880, 95% confidence interval [CI]: 0.813–0.952) and exercise capacity (OR 0.939, 95%CI: 0.887–0.993) and the
occurrence of postoperative pneumonia. All pneumonias occurred in patients with declines in handgrip strength and
exercise capacity after nCRT. A decrease of handgrip strength and exercise capacity during nCRT predicts the
risk of pneumonia after esophagectomy for cancer.Measuring physical fitness before and after chemoradiotherapy
seems an adequate method to identify patients at risk of postoperative pneumonia.