Factors associated with marked reduction in tongue pressure in patients with esophageal cancer during neoadjuvant chemotherapy.

BACKGROUND: Tongue pressure is a predictor of postoperative aspiration. This study aimed to examine changes in tongue pressure during neoadjuvant chemotherapy (NAC), identify associated factors, and investigate whether these changes are related to other functional outcomes, including exercise capacity and muscle function. METHODS: This prospective, single-center, observational study enrolled 68 patients with esophageal cancer scheduled to undergo NAC. Patients were classified into marked reduction (n=17) and remaining (n=51) groups based on the rate of change in tongue pressure. Tongue pressure, muscle function, walking ability, and exercise capacity were evaluated before and after NAC. Multivariate logistic regression analysis was performed to identify the factors significantly associated with a marked reduction in tongue pressure. Spearman's correlation analysis was used to evaluate the relationships between the rate of change in tongue pressure and the rates of change in each functional parameter. RESULTS: Multivariable logistic regression analysis identified age and the number of days during NAC when oral intake was not possible as significant independent factors associated with a marked reduction in tongue pressure. Spearman's correlation analysis revealed no significant correlations between the rate of change in tongue pressure during NAC and the rates of change in handgrip strength, isometric knee extensor strength, 30-s chair stand test performance, quadriceps thickness, maximum inspiratory pressure, maximum expiratory pressure, 10-m walk test result, or 6-min walk distance. CONCLUSIONS: These findings underscore the importance of incorporating swallowing function, including tongue pressure, into prehabilitation programs.