Among patients diagnosed with esophageal cancer, their ability to swallow at diagnosis may be associated with outcomes and the occurrence of other adverse events after undergoing treatment for their disease, according to a retrospective study.1

“The dysphagia score might also be useful in predicting the response to DCF chemotherapy and the long-term survival of patients with [esophageal cancer] undergoing DCF chemotherapy,” the researchers wrote.

The study evaluated dysphagia among 434 consecutive patients with esophageal cancer who underwent treatment with docetaxel, cisplatin, and 5-fluorouracil (DCF), and sought to define relationships between dysphagia score at diagnosis and clinicopathological factors.

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Dysphagia was given a score from 0 to 4. Approximately half of patients (47.8%) had a score of 0, with smaller percentages scoring a 1 (18.9%), 2 (12.0%), 3 (13.6%), and 4 (7.6%).

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Dysphagia score at baseline was associated with weight loss at presentation, body weight, BMI, and serum albumin. A score of 3 or greater was also significantly associated with a greater incidence of grade 3/4 febrile neutropenia (79.3% vs 35.7% for lower scores; P <.001) and incidence of grade 3/4 diarrhea (63.0% vs 28.1%; P <.001). Dysphagia score was an independent predictor of both febrile neutropenia and diarrhea.

Finally, compared with patients with lower dysphagia scores, those with higher scores had worse response to chemotherapy. Response rate was 65.2% for those with higher scores compared with 78.7% for lower scores (P =.008). Five-year overall survival was also significantly worse (35.4% vs 56.4%; P =.001).

“Although the specific cause remains unclear, high dysphagia scores were correlated with larger, more advanced tumors,” the researchers wrote. “Therefore, these patients might have developed chemoresistance due to insufficient drug delivery inside the tumor, tumor heterogeneity, or local hypoxia, which are often associated with large tumors. Immunity deterioration, due to malnutrition, could also be correlated with resistance to treatments, including chemotherapy.”


Hagi T, Makino T, Tamasaki M, et al. Dysphagia score as a predictor of adverse events due to triplet chemotherapy and oncological outcomes in 434 consecutive patients with esophageal cancer [published online August 26, 2019]. Ann Surg Oncol. doi: 10.1245/s10434-019-07744-7