# Correlation of growth differentiation factor 15 level in esophageal cancer with cachectic indicators and postoperative infectious complication

## TL;DR

This study shows that higher levels of GDF15 in esophageal cancer patients are linked to worse health and more post-surgery infections.

## Contribution

The study identifies GDF15 as a potential biomarker for cachexia and postoperative complications in esophageal cancer.

## Key findings

- GDF15 levels correlated with age, diabetes, and markers of organ dysfunction and muscle loss.
- Higher GDF15 was an independent risk factor for postoperative infectious complications.
- A GDF15 cut-off of 930 pg/mL predicted infectious complications with moderate accuracy.

## Abstract

Patients with esophageal cancer (EC) usually have multiple comorbidities, particularly, high cachexia incidence, which may lead to increased postoperative complications. A novel inflammatory marker, growth differentiation factor 15 (GDF15), was recently reported to be associated with cancer cachexia. This study evaluated the correlation between clinical data suggestive of cachexia in patients with EC and circulating GDF15 levels.

Eighty patients with EC were enrolled in this study. Plasma samples were collected before initiating any cancer treatment. GDF15 was quantified using ELISA. Clinical information, including age, comorbidities, biochemical data, Controlling Nutritional Status score, and Psoas muscle index (PMI), was collected from the clinical records. Clinical impact of GDF15 was then evaluated and compared with cachectic indicators or postoperative results.

The median value of GDF15 was 1168 pg/mL (range 298–9100 pg/mL). GDF15 values statistically correlated with age, prevalence of diabetes, serum level of aspartate aminotransferase/γ-glutamyltransferase/creatinine/blood sugar/albumin, and PMI. Sixty-three patients finally underwent curative esophagectomy with right thoracic approach and gastric tube reconstruction. Patients with infectious complications had a statistically higher GDF15 than those without. The cut-off value was 930 pg/mL for detecting infectious complications, with an area under the receiver operating characteristic curve value of 0.685, and high GDF15 was detected as an independent risk factor for postoperative infectious complications.

GDF15 is potentially suggestive of general condition deterioration from aging, organ dysfunction, and decreased muscle mass, which may lead to cachexia in patients with EC. Moreover, patients with higher GDF15 are at a risk of postoperative infectious complications.

The online version contains supplementary material available at 10.1007/s10388-025-01157-0.