The Clinical Significance Of Postoperative Physical Activity And Vitamin D Supplementation In Esophageal Cancer

Background:Physical activity has been reported to positively influence quality of life and survival in certain cancers.However,the associations between them in esophageal cancer(EC)are previously undefined.The aims of this study are to investigate whether physically active EC patients have improved quality of life and lower risk of recurrence or death compared with physically inactive patients.Methods:We evaluated the relationships between postoperative leisure time physical activity and quality of life and recurrence and death among patients diagnosed with EC.We respectively used generalized estimating equations and Cox proportional regression to analysis quality of life and survival,adjusting for known potential confounding factors.Results:1.A total of 303 EC patients were included in our study.There were 157 patients in the<9 MET hours per week group and 146 patients in the>9 MET hours per week group.In addition,there were only 146 EC survivors,accounting for 48.18%,at 3 years of follow-up.Among them,67 cases reported their physical activity levels were less than 9 MET hours per week,whereas 79 reported their physical activity levels were 9 or more MET hours per week.2.The positive relationships were found between leisure time physical activity and certain aspects of quality of life,including global health(?=-5.764,95%CI-10.172--1.356,P=0,010),physical functioning(?=-6.003,95%CI-11.809--0.197,P=0.043),emotional functioning ?=-8.198,95%CI-15.813--0.582,P=0.035),social functioning(?=-8.548,95%CI-16.632--0.464,P=0.038),insomnia(?=9.029,95%CI-0.409-17.649,P=0.040)and appetite(??17.351,95%CI 2.699-32.003,P=0.020)assessed by QLQ-C30 as well as eating(?=11.507,95%CI 1.689-21.325,P=0.022),reflux(?=13.274,95%CI 0.525-26.024,P=0.041)and trouble with taste(?=16.350,95%CI 2.777-29.915,P=0.018)assessed by QLQ-OES18.Overall,more leisure time physical activity can develop quality of life.3.According to Kaplan-Meier analysis,the significant associations were found between leisure time physical activity and risk of recurrence or all-cause mortality.Compared with inactive ones,patients who had more activity tended to prolong overall survival(OS)(P=0.002)and disease-free survival(DFS)(P<0.001).In multivariate Cox regression analysis,physical activity was independent prognostic factors for OS(P=0.014;HR 0.666;95%CI 0.481-0.921)and DFS(P<0.001;HR 0.306;95%CI 0.218-0.429).Conclusions:Leisure time physical activity was significantly associated with quality of life and risk of recurrence and death of EC patients.More leisure time physical activity after esophagectomy was associated with better quality of life as well as lower recurrence and mortality risks.Background:Vitamin D can exert anticancer effect beyond bone and calcium metabolism.We aimed to investigate whether postoperative vitamin D supplementation affects quality of life(QOL)and survival in esophageal cancer(EC)patients.Methods:We utilized the widely used EORTC QLQ-C30 and QLQ-OES18 to assess QOL.Generalized estimating equations(GEEs)were used to analysis the association of vitamin D supplement use with QOL.Kaplan-Meier method and Cox regression model were used to evaluate the prognostic value of vitamin D supplementation.Results:1.A total of 303 patients were eventually recruited in our study.49(16.2%)patients regularly used vitamin D supplementation after surgery.However,254(83.8%)patients were vitamin D supplementation non-users.Additionally,there were only 181 EC survivors at 2 years of follow-up.32 cases took regularly vitamin D supplementation among these survivors,whereas 149 did not.2.The significant associations were observed between vitamin D supplement use and certain aspects of QOL,including global health(?=-2.985,95%CI-5.880--0.089,P=0.043),physical functioning(?=-3.640,95%CI-6.085--1.196,P=0.004),social functioning ?=-6.347,95%CI-11.178--1.516,P=0.010),fatigue(?=6.110,95%CI 0.531-11.689,P=0.032)and appetite loss(?=10.435,95%CI 1.107-19.763,P=0.028)measured by QLQ-C30 as well as eating(?=5.365,95%CI 0.876-9.853,P=0.019)and trouble with taste(?=8.491,95%CI 0.882-16.100,P=0.029)measured by QLQ-OES18.It suggested that vitamin D users were more likely to have better QOL.3.Kaplan-Meier analysis revealed that vitamin D supplement use was significantly associated with improved disease-free survival(DFS)(P=0.030),but not related to overall survival(OS)(P=0.303).The multivariable analysis further demonstrated vitamin D supplement use as an independent prognostic factor for DFS(P=0.040;HR 0.610;95%CI 0.381-0.978).Conclusions:Our results showed that vitamin D supplement use could serve as a promising intervention to enhancing QOL and prolonging DFS in EC.