Sarcopenia/Muscle Mass is not a Prognostic Factor for Short‐ and Long‐Term Outcome After Esophagectomy for Cancer

Grotenhuis, Brechtje A.; Shapiro, Joël; Adrichem, Stefan van; Vries, Marianne de; Koek, Marcel; Wijnhoven, Bas P. L.; Lanschot, J. Jan B. van

doi:10.1007/s00268-016-3603-1

Cited by 95 publications

(84 citation statements)

References 27 publications

(25 reference statements)

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“…A large number of studies evaluated the role of sarcopenia on survival outcomes after esophagectomy. In spite of some studies suggesting that sarcopenia had no impact on OS, [47][48][49] a recent meta-analysis 15 showed that sarcopenia is in fact an unfavorable prognostic factor. In contrast, sarcopenia in metastatic esophageal carcinoma setting was not associated with mortality.…”

Section: Discussionmentioning

confidence: 99%

Myosteatosis in a systemic inflammation‐dependent manner predicts favorable survival outcomes in locally advanced esophageal cancer

et al. 2019

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Increased adiposity and its attendant metabolic features as well as systemic inflammation have been associated with prognosis in locally advanced esophageal cancer (LAEC). However, whether myosteatosis and its combination with systemic inflammatory markers are associated with prognosis of esophageal cancer is unknown. Our study aimed to investigate the influence of myosteatosis and its association with systemic inflammation on progression‐free survival (PFS) and overall survival (OS) in LAEC patients treated with definitive chemoradiotherapy (dCRT). We retrospectively gathered information on 123 patients with LAEC submitted to dCRT at the University of Campinas Hospital. Computed tomography (CT) images at the level of L3 were analyzed to assess muscularity and adiposity. Systemic inflammation was mainly measured by calculating the neutrophil‐to‐lymphocyte ratio (NLR). Median PFS for patients with myosteatosis (n = 72) was 11.0 months vs 4.0 months for patients without myosteatosis (n = 51) (hazard ratio [HR]: 0.53; 95% confidence interval [CI], 0.34‐0.83; P = .005). Myosteatosis was also independently associated with a favorable OS. Systemic inflammation (NLR > 2.8) was associated with a worse prognosis. The combination of myosteatosis with systemic inflammation revealed that the subgroup of patients with myosteatosis and without inflammation presented less than half the risk of disease progression (HR: 0.47; 95% CI: 0.26‐0.85; P = .013) and death (HR: 0.39; 95% CI, 0.21‐0.72; P = .003) compared with patients with inflammation. This study demonstrated that myosteatosis without systemic inflammation was independently associated with favorable PFS and OS in LAEC patients treated with dCRT.

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Section: Discussionmentioning

confidence: 99%

Myosteatosis in a systemic inflammation‐dependent manner predicts favorable survival outcomes in locally advanced esophageal cancer

et al. 2019

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“…Current literature on the influence of body composition parameters [including body mass index (BMI), body fat percentage, skeletal muscle index, and sarcopenia] on post‐operative morbidity and long‐term survival in patients with oesophageal cancer after curative intent treatment is scarce, and literature on sarcopenia is often contradictory. Some studies show that sarcopenia is an independent predictor for development of post‐operative complications and overall and disease‐free survival while other studies did not find any correlation . Few studies take other factors such as muscle strength and fat percentage or fat distribution into consideration.…”

Section: Introductionmentioning

confidence: 99%

Influence of body composition and muscle strength on outcomes after multimodal oesophageal cancer treatment

Hagens

Feenstra

Egmond

et al. 2020

J cachexia sarcopenia muscle

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Background Influence of sarcopenia in combination with other body composition parameters and muscle strength on outcomes after oesophageal surgery for oesophageal cancer remains unclear. The objectives were (i) to describe the incidence of sarcopenia in relation to adipose tissue quantity and distribution and muscle strength; (ii) to evaluate if neoadjuvant chemoradiation (nCRTx) influences body composition and muscle strength; and (iii) to evaluate the influence of body composition and muscle strength on post‐operative morbidity and long‐term survival. Methods This retrospective study included patients with oesophageal cancer who received nCRTx followed by surgery between January 2011 and 2016. Skeletal muscle, visceral, and subcutaneous adipose tissue cross‐sectional areas were calculated based on computed tomography scans, and muscle strength was measured using hand grip tests, 30 seconds chair stand tests, and maximal inspiratory and expiratory pressure tests prior to nCRTx and after nCRTx. Results A total of 322 patients were included in this study. Sarcopenia was present in 55.6% of the patients prior to nCRTx and in 58.2% after nCRTx (P = 0.082). Patients with sarcopenia had a significantly lower muscle strength and higher fat percentage. The muscle strength and incidence of sarcopenia increased while the mean body mass index and fat percentage decreased during nCRTx. A body mass index above 25 kg/m2 was associated with anastomotic leakage (P = 0.032). Other body composition parameters were not associated with post‐operative morbidity. A lower handgrip strength prior to nCRTx was associated with pulmonary and cardiac complications (P = 0.023 and P = 0.009, respectively). In multivariable analysis, a lower number of stands during the 30 seconds chair stand test prior to nCRTx (hazard ratio 0.93, 95% confidence interval 0.87–0.99, P = 0.017) and visceral adipose tissue of >128 cm2 after nCRTx (hazard ratio 1.81, 95% confidence interval 1.30–2.53, P = 0.001) were associated with worse overall survival. Conclusions Sarcopenia occurs frequently in patients with oesophageal cancer and is associated with less muscle strength and a higher fat percentage. Body composition changes during nCRTx did not influence survival. Impaired muscle strength and a high amount of visceral adipose tissue are associated with worse survival. Therefore, patients with poor fitness might benefit from preoperative nutritional and muscle strengthening guidance, aiming to increase muscle strength and decrease visceral adipose tissue. However, this should be confirmed in a large prospective study.

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“…Although there have been some reports that perioperative skeletal muscle loss was a prognostic predictor after surgeries for cancers including ESCC (8)(9)(10)(11)(12)(13)(14)30), they examined skeletal muscle loss in the preoperative phase or the postoperative chronic phase (about 1 or more months after surgery). Surprisingly, in the present study, the TPI reduction rate on POD 3 after ESCC surgery was an independent long-term predictor of prognosis that was as signi cant as pathological stage and neoadjuvant treatment.…”

Section: Discussionmentioning

confidence: 99%

Skeletal muscle loss in the postoperative acute phase after esophageal cancer surgery as a new prognostic factor

Maeda

Shirakawa

Tanabe

et al. 2020

Preprint

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Background: The postoperative survival rate of patients with esophageal squamous cell carcinoma (ESCC) remains poor compared with other gastrointestinal cancers. We hypothesized that skeletal muscle loss in the postoperative acute phase might be a new predictor for long-term prognosis after highly invasive surgery such as ESCC surgery.Methods: The following items were retrospectively investigated. First, whether skeletal muscle loss occurred in the postoperative acute phase of ESCC was verified. Second, the preoperative and intraoperative factors involved in skeletal muscle loss in the postoperative acute phase of ESCC were investigated. Then, whether skeletal muscle loss in the postoperative acute phase affected long-term prognosis was examined. The medical records of consecutive patients who underwent radical esophagectomy for ESCC between January 2010 and June 2015 were retrospectively reviewed; 72 cases were eligible for this study. The total psoas major muscle mass index (TPI) at the level of the third lumbar vertebra (L3) was measured using computed tomography (CT) before surgery and three days after surgery. The long-term prognosis was estimated by the Kaplan-Meier method and the multivariate logistic regression model.Results: There was already a significant reduction of TPI in the acute phase up to POD 3 after ESCC surgery in comparison with the preoperative baseline TPI (P < 0.001). The TPI reduction rate was significantly milder in cases with less blood loss during surgery and in cases that underwent thoracoscopic esophagectomy than in cases that underwent open esophagectomy. The three-year overall survival rate was significantly different between the TPI reduction rate severe group and the TPI reduction rate mild group.Conclusion: skeletal muscle loss occurred even in the postoperative acute phase. Furthermore, it is very significant that skeletal muscle loss in the postoperative acute phase of ESCC surgery is involved in the long-term prognosis.

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Sarcopenia/Muscle Mass is not a Prognostic Factor for Short‐ and Long‐Term Outcome After Esophagectomy for Cancer

Cited by 95 publications

References 27 publications

Myosteatosis in a systemic inflammation‐dependent manner predicts favorable survival outcomes in locally advanced esophageal cancer

Myosteatosis in a systemic inflammation‐dependent manner predicts favorable survival outcomes in locally advanced esophageal cancer

Influence of body composition and muscle strength on outcomes after multimodal oesophageal cancer treatment

Skeletal muscle loss in the postoperative acute phase after esophageal cancer surgery as a new prognostic factor

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