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Peer-reviewedCC BY 4.0Esophagus

Clinical predictors of early reflux and symptom severity after esophagectomy: a risk prediction tool

  • Zhao Xue1
  • Liu Beijia1
  • Xie Qin2
  • Liu Jiarui3
  • Wang Xiaowei3
  • Luo Lei4
  • Miao Yan2
4 affiliations
  1. 1Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, School of Medicine, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, Sichuan 610041 People’s Republic of China
  2. 2Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, Sichuan 610041 People’s Republic of China
  3. 3School of Nursing, Chengdu Medical College, Chengdu, Sichuan 610500 People’s Republic of China
  4. 4Department of General Office, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, Sichuan 610041 People’s Republic of China
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Abstract

Background: Reflux after curative esophagectomy is common and may persist, disrupting eating, sleep, and recovery, yet most prediction tools estimate risk only at a single late time point.

Methods: We retrospectively analyzed an esophagectomy derivation cohort (2018–2021; n = 488) and a temporal validation cohort (2023–2024; n = 143). Clinically significant reflux was defined as an EORTC QLQ-OES18 item 14 or 15 score ≥ 2. Time to first event within 12 months was modeled using a time-varying coefficient Cox model, and longitudinal symptom severity (1–4) was modeled using an ordinal mixed-effects model. Predictors were prespecified from routine pre-discharge variables. Model performance was assessed using time-dependent AUC and calibration.

Results: Cox analysis linked distal/esophagogastric junction tumors and higher BMI to increased early reflux risk, while neoadjuvant therapy, older age, and a longer oral-to-solid diet interval were protective. The ordinal mixed model showed greater symptom severity in women and in patients with distal/esophagogastric junction tumors, but lower severity with neoadjuvant therapy. Interactions suggested slower early symptom escalation with older age and steeper escalation with higher BMI or shorter oral-to-intake intervals. The time-varying Cox model showed good discrimination, with time-dependent AUCs at 1, 3, and 6 months of 0.702, 0.766, and 0.794 in the development cohort, and 0.708, 0.767, and 0.716 in the external validation cohort, with good calibration.

Conclusions: A pre-discharge, time-sensitive risk model with a web-based calculator may support risk-stratified early screening, education, and targeted supportive care after discharge to reduce reflux-related morbidity and protect postoperative health-related quality of life.

Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s10388-026-01225-z.

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Cite

BibTeXRIS
BibTeX
@article{xue2026clinical,
  title = {{Clinical predictors of early reflux and symptom severity after esophagectomy: a risk prediction tool}},
  author = {Zhao Xue and Liu Beijia and Xie Qin and Liu Jiarui and Wang Xiaowei and Luo Lei and Miao Yan},
  journal = {Esophagus},
  year = {2026},
  month = jun,
  doi = {10.1007/s10388-026-01225-z},
  url = {https://doi.org/10.1007/s10388-026-01225-z},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Clinical predictors of early reflux and symptom severity after esophagectomy: a risk prediction tool
AU  - Zhao Xue
AU  - Liu Beijia
AU  - Xie Qin
AU  - Liu Jiarui
AU  - Wang Xiaowei
AU  - Luo Lei
AU  - Miao Yan
PY  - 2026
DA  - 2026/06/30
JO  - Esophagus
DO  - 10.1007/s10388-026-01225-z
UR  - https://doi.org/10.1007/s10388-026-01225-z
AB  - Background: Reflux after curative esophagectomy is common and may persist, disrupting eating, sleep, and recovery, yet most prediction tools estimate risk only at a single late time point.  Methods: We retrospectively analyzed an esophagectomy derivation cohort (2018–2021; n = 488) and a temporal validation cohort (2023–2024; n = 143). Clinically significant reflux was defined as an EORTC QLQ-OES18 item 14 or 15 score ≥ 2. Time to first event within 12 months was modeled using a time-varying coefficient Cox model, and longitudinal symptom severity (1–4) was modeled using an ordinal mixed-effects model. Predictors were prespecified from routine pre-discharge variables. Model performance was assessed using time-dependent AUC and calibration.  Results: Cox analysis linked distal/esophagogastric junction tumors and higher BMI to increased early reflux risk, while neoadjuvant therapy, older age, and a longer oral-to-solid diet interval were protective. The ordinal mixed model showed greater symptom severity in women and in patients with distal/esophagogastric junction tumors, but lower severity with neoadjuvant therapy. Interactions suggested slower early symptom escalation with older age and steeper escalation with higher BMI or shorter oral-to-intake intervals. The time-varying Cox model showed good discrimination, with time-dependent AUCs at 1, 3, and 6 months of 0.702, 0.766, and 0.794 in the development cohort, and 0.708, 0.767, and 0.716 in the external validation cohort, with good calibration.  Conclusions: A pre-discharge, time-sensitive risk model with a web-based calculator may support risk-stratified early screening, education, and targeted supportive care after discharge to reduce reflux-related morbidity and protect postoperative health-related quality of life.  Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s10388-026-01225-z.
SN  - 1612-9059
SN  - 1612-9067
ER  -