Evaluating the Impact of Post-Esophagectomy Exercise on 2- and 5-Year Survival: Findings from the PERFECT Trial

David Binyam; J K van Vulpen; R van Hillegersberg; J P Ruurda; G A P Nieuwenhuijzen; E A Kouwenhoven; E van der Wall; R P R Groenendijk; D L van der Peet; C Rosman; B P L Wijnhoven; M I van Berge Henegouwen; H W M van Laarhoven; P D Siersema; Anne M May; A E Hiensch

doi:10.1249/MSS.0000000000003559

Evaluating the Impact of Post-Esophagectomy Exercise on 2- and 5-Year Survival: Findings from the PERFECT Trial

Med Sci Sports Exerc. 2024 Sep 18. doi: 10.1249/MSS.0000000000003559. Online ahead of print.

Authors

Affiliations

¹ Julius Center for Health Sciences and Primary career, University Medical Center Utrecht, Utrecht, THE NETHERLANDS.
² Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, THE NETHERLANDS.
³ Department of Surgery UMC Utrecht Cancer Center, Utrecht, THE NETHERLANDS.
⁴ Department of Surgery Catharina Hospital Eindhoven, Eindhoven, THE NETHERLANDS.
⁵ Department of Surgery Ziekenhuisgroep Twente, Almelo/Hengelo, THE NETHERLANDS.
⁶ Department of Medical Oncology University Medical Center Utrecht, Utrecht, THE NETHERLANDS.
⁷ Department of Surgery IJsselland Hospital, Capelle a/d IJssel, THE NETHERLANDS.
⁸ Department of Surgery Amsterdam UMC, University of Amsterdam, Amsterdam, THE NETHERLANDS.
⁹ Departement of Surgery, Radboud University Medical Center, Nijmegen, THE NETHERLANDS.
¹⁰ Department of Surgery, Erasmus University Medical Center, Rotterdam, THE NETHERLANDS.
¹¹ Department of Gastroenterology and Hepatology Erasmus University Medical Center, Rotterdam, THE NETHERLANDS.

PMID: 39293388
DOI: 10.1249/MSS.0000000000003559

Abstract

Purpose: Despite recent treatment advances, esophageal cancer still has poor survival and a high morbidity. Exploratory evidence suggests that exercise can reduce cancer-related mortality and recurrence rates. Here, we investigated the effects of an exercise intervention in the first year after esophagectomy on survival in participants of the Physical ExeRcise Following Esophageal Cancer Treatment (PERFECT)-trial.

Methods: In the PERFECT-trial, esophageal cancer patients who had undergone esophagectomy were randomized to a 12-week exercise program (EX) or the control group (CG). We assessed 2- and 5-year (progression-free) survival. (Un)adjusted Cox Proportional-Hazards models were used to calculate hazard ratios (HRs) for comparison between the trial arms. Sensitivity analyses, excluding patients with events within the exercise intervention period, were performed.

Results: In total, 120 participants (EX = 61; CG = 59) were included in the PERFECT-trial. After 2-year follow-up, no significant difference in the risk of death or progression between EX and CG was found (adjusted HR = 1.65, 95% CI [0.75-3.63] and 1.38, 95% CI [0.76-2.50], respectively). After excluding patients with events during the intervention period (EX = 8; CG = 4), 2-year HRs for death (1.03, 95% CI [0.41-2.56]) and progression (1.26, 95% CI [0.64-2.48]) both decreased and remained insignificant. No significant effects were found on 5-year mortality (1.03, 95% CI [0.57-1.84]) and progression (1.21, 95% CI [0.72-2.04]) either. Sensitivity-analysis resulted in attenuated 5-year HRs for mortality (0.82, 95% CI [0.42-1.58]) and progression (1.08, 95% CI [0.61-1.92]).

Conclusions: The results indicate no benefit of a 12-week exercise program in the first year post-esophagectomy on 2- and 5-year (progression-free) survival in esophageal cancer patients. The absence of beneficial effects may be explained by the relatively short exercise program, which was performed after treatment completion.