Hand grip strength and peak expiratory flow rate as predictors of overall survival after esophagectomy for esophageal cancer

Objective Esophageal cancer is one of the most lethal cancers worldwide. Previous studies have shown that reduced skeletal and respiratory muscle strength is correlated with increased postoperative complications. This study investigated the relationship between hand grip strength (HGS) and respiratory muscle strength assessed as peak expiratory flow (PEF) rate. We also examined the association of these factors with long-term prognosis in patients who had undergone radical esophagectomy for esophageal cancer. Methods We reviewed 392 patients who underwent radical subtotal esophagectomy from 2007 to 2023. HGS and PEF rate were measured preoperatively. Data analysis included univariable and multivariable Cox regression to identify prognostic factors for overall survival (OS). Results During a median follow-up of 36 months, 171 patients died, with 68.1% of deaths attributable to the primary disease. Because a weak correlation was observed between HGS and PEF rate (r = 0.353), separate multivariate analyses were performed for each factor to investigate their relationship to prognosis. Multivariable analysis identified PEF rate as an independent prognostic factor for OS (HR 0.991, 95% CI 0.984–0.999; P = .028), along with clinical stage (HR 1.345, 95% CI 1.188–1.521; P < .001), age (HR 1.026, 95% CI 1.007–1.046; P = .008), and surgical approach (open vs. minimally invasive; HR 0.674, 95% CI 0.490–0.928; P = .015). HGS was also identified as an independent prognostic factor for OS (HR 0.974, 95% CI 0.955–0.994; P = .012) along with clinical stage (HR 1.321, 95% CI 1.168–1.495; P < .001). Conclusions HGS and PEF rate are independent predictors of OS after esophagectomy.