European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2025
Risk of fracture among esophageal cancer survivors: A population-based retrospective cohort study.
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Kim Seonghye, Han Kyung-Do, Jung Jinhyung, Min Byung-Hoon, Lee You-Bin, Yoon Dong Woog, Cho Jong Ho, Shin Dong Wook
Аннотация
OBJECTIVE: Evidence regarding the occurrence of fracture in esophageal cancer (EC) survivors remains limited. We aimed to investigate the risk of fractures among EC survivors who received curative-intent surgery.
METHODS: We conducted a population-based retrospective cohort study using the Korean National Health Insurance Service database (2009-2022), including patients who underwent surgery for EC (n = 4847) and their 1:3 propensity score matched controls (n = 14,541). We performed competing risk analyses to estimate the risk of fractures.
RESULTS: We observed 305 incident fractures among EC survivors (24 [0.50 %], 119 [2.46 %], and 195 [4.02 %] at 1, 3, and 5 years post-surgery, respectively) and 980 fractures among matched controls (118 [0.81 %], 342 [2.35 %], and 557 [3.83 %]) during mean follow-up periods of 5.3 ± 3.7 and 8.1 ± 2.9 years, respectively. EC survivors had a significantly higher fracture risk than controls, with cause-specific hazard ratios of 1.46 (95 % confidence interval [CI] 1.28-1.66) for any fracture, 1.66 (95 % CI 1.31-2.10) for vertebral fracture, and 1.68 (95 % CI 1.28-2.21) for hip fracture, although risk was not significant within the first year after surgery. EC survivors are at a greater risk of fractures than controls regardless of treatment modality, with the highest fracture risk present among those receiving radiation therapy (RT) along with surgery.
CONCLUSION: EC survivors had persistently higher risks of any, vertebral, and hip fracture than non-cancer controls, except for during the first year after surgery. The risk of fracture was prominent among EC survivors who received surgery combined with RT.
METHODS: We conducted a population-based retrospective cohort study using the Korean National Health Insurance Service database (2009-2022), including patients who underwent surgery for EC (n = 4847) and their 1:3 propensity score matched controls (n = 14,541). We performed competing risk analyses to estimate the risk of fractures.
RESULTS: We observed 305 incident fractures among EC survivors (24 [0.50 %], 119 [2.46 %], and 195 [4.02 %] at 1, 3, and 5 years post-surgery, respectively) and 980 fractures among matched controls (118 [0.81 %], 342 [2.35 %], and 557 [3.83 %]) during mean follow-up periods of 5.3 ± 3.7 and 8.1 ± 2.9 years, respectively. EC survivors had a significantly higher fracture risk than controls, with cause-specific hazard ratios of 1.46 (95 % confidence interval [CI] 1.28-1.66) for any fracture, 1.66 (95 % CI 1.31-2.10) for vertebral fracture, and 1.68 (95 % CI 1.28-2.21) for hip fracture, although risk was not significant within the first year after surgery. EC survivors are at a greater risk of fractures than controls regardless of treatment modality, with the highest fracture risk present among those receiving radiation therapy (RT) along with surgery.
CONCLUSION: EC survivors had persistently higher risks of any, vertebral, and hip fracture than non-cancer controls, except for during the first year after surgery. The risk of fracture was prominent among EC survivors who received surgery combined with RT.