Association of skeletal muscle loss with the long-term outcomes of esophageal cancer patients treated with neoadjuvant chemotherapy

Kamitani, Naoki; Migita, Kazuhiro; Matsumoto, Sohei; Wakatsuki, Kohei; Kunishige, Tomohiro; Nakade, Hiroshi; Miyao, Shintaro; Sho, Masayuki

doi:10.1007/s00595-019-01846-1

Cited by 26 publications

(19 citation statements)

References 25 publications

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“…A multicenter retrospective study enrolled 193 patients with borderline resectable PC and locally advanced PC and the results obtained showed that patients who experienced an increase in skeletal muscle mass during NT could gain a chance of surgical resection. 46 By contrast, the studies conducted by Okuno et al 24 and Kamitani et al 23 did not confirm the significant correlation between a change in skeletal muscle mass and the pathologic response to NAC. Inadequate intakes of energy and nutrients as a result of the tumor burden in cancer patients, as well as the activation of systemic inflammation and oxidative stress, increase malnutrition risk, resulting in alternations in body composition.…”

Section: Discussionmentioning

confidence: 84%

“…20,21 Major muscle mass loss during NT has been reported to be an independent risk factor for long-term survival among patients with ovarian cancer, oesophageal cancer (EC) and colorectal liver metastases (CRLM). 22,23,24 Additionally, a strong link between skeletal muscle loss during NAT and poor postoperative outcome in patients with stage III-IV EC was identified in a retrospective study. 25 However, there is growing recognition that adipose tissue wasting is a central component of cancer-related weight loss.…”

Section: Introductionmentioning

confidence: 98%

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Marked loss of adipose tissue during neoadjuvant therapy as a predictor for poor prognosis in patients with gastric cancer: A retrospective cohort study

Zhang

Jiang

et al. 2021

J Human Nutrition Diet

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Background:The influence of body composition changes during neoadjuvant treatment (NT) on long-term survival in patients with gastric cancer (GC) undergoing radical gastrectomy remains unclear. The present study aimed to explore the association between changes in body composition during NT and survival in patients with GC.Methods: GC patients treated with NT and radical gastrectomy between 2015 and 2018 were included in this retrospective study. Skeletal muscle mass, visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were measured by computer tomography before and after NT. Body composition changes during NT were compared with Kaplan-Meier curves. Univariate and multivariate regression analyses were applied to determine the predictors of overall survival (OS) and disease-free survival (DFS).Results: In total, 157 GC patients were studied. A marked loss of adipose tissue was associated with poor nutritional status. The median follow-up time for all patients was 25 months. Patients with marked VAT loss (≥ 35.7%) during NT had significantly shorter OS (p = 0.028) and DFS (p = 0.03). Similarly, poorer OS (p = 0.033) and DFS (p = 0.003) were observed in patients with marked SAT loss (≥ 30.1%) during NT. Changes in skeletal muscle mass and body weight during NT were not associated with survival. Marked VAT loss accompanied by marked SAT loss was an independent predictor of OS (hazards ratio = 2.447; p = 0.045) and DFS (hazards ratio = 2.674; p = 0.018). Conclusions: Patients with locally advanced GC have a worse survival when they experienced marked loss of adipose tissue during NT.

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Section: Discussionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 98%

Marked loss of adipose tissue during neoadjuvant therapy as a predictor for poor prognosis in patients with gastric cancer: A retrospective cohort study

Zhang

Jiang

et al. 2021

J Human Nutrition Diet

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“…In addition, only a few studies included patients who received NACRT instead of chemotherapy as a NAT, and none of these studies demonstrated a significant relationship between sarcopenia and OS [17,23]. Meanwhile, studies on the relationship between the amount of skeletal muscle loss and survival outcomes of esophageal cancer showed relatively consistent results for OS, although they still showed contradictory results for RFS [28][29][30][31][32]. Reisinger et al showed that the amount of muscle mass loss during NACRT was associated with postoperative mortality in patients with stage III-IV tumors [28].…”

Section: Discussionmentioning

confidence: 99%

“…Reisinger et al showed that the amount of muscle mass loss during NACRT was associated with postoperative mortality in patients with stage III-IV tumors [28]. Kamitani et al also found that ∆SMI (%) <−12.5% was a significant prognostic factor for OS, and pre-and post-NAT sarcopenia were not associated with OS [29]. Similar to these results, Järvinen et al reported that a ∆SMI (%) <−2.98% during NAT was related to poor OS in the multivariable analysis, whereas post-NAT sarcopenia did not significantly affect OS and complication rates [30].…”

Section: Discussionmentioning

confidence: 99%

Prognostic Impact of Sarcopenia and Skeletal Muscle Loss During Neoadjuvant Chemoradiotherapy in Esophageal Cancer

Yoon

Ahn

et al. 2020

Cancers

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Backgrounds: The relationship between sarcopenia, characterized by loss of muscle mass and strength, and survival outcomes of esophageal cancer is controversial. This study aimed to assess the effect of sarcopenia and skeletal muscle loss on overall survival (OS) and recurrence-free survival (RFS) of esophageal cancer patients. Methods: We retrospectively collected the medical records of 248 male patients diagnosed with squamous cell esophageal cancer and who underwent neoadjuvant chemoradiotherapy (NACRT) followed by surgery. We measured the cross-sectional area of the skeletal muscle at the L3 vertebra level using computed tomography images and calculated the skeletal muscle index (SMI). Sarcopenia was defined as SMI <52.4 cm2/m2, and excessive muscle loss was defined as SMI change <−10.0%/50 days during NACRT. Moreover, laboratory test results, such as albumin, prognostic nutritional index (PNI), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) before and after NACRT, were collected. Results: In the univariable Cox analysis, pre- (p = 0.689) and post-radiotherapy (RT) sarcopenia (p = 0.669) were not associated with OS. However, excessive muscle loss had a significant association with OS in both the univariable and multivariable analyses (all p = 0.001). Excessive muscle loss was also related to RFS in both the univariable (p = 0.011) and multivariable (p = 0.022) Cox analysis. Patients with excessive muscle loss had significantly lower levels of post-RT albumin (p < 0.001) and PNI (p < 0.001), higher levels of post-RT NLR (p = 0.031) and PLR (p = 0.071), larger decrease in albumin (p < 0.001) and PNI (p < 0.001) after NACRT, and larger increase in NLR (p = 0.051) and PLR (p = 0.088) after NACRT than in those with non-excessive muscle loss. Conclusion: Excessive muscle loss rather than pre- and post-RT sarcopenia was a significant prognostic factor for OS and RFS, and it was also related to nutritional and inflammatory markers.

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“…Patients treated with NAC were signi cantly associated with a lower preoperative SMI and BMI (Table 3) and had a signi cantly lower preoperative SMI compared with patients who did not receive NAC (Figure 3). NAC reduced skeletal muscle mass by approximately 3% because of side effects, such as fatigue, loss of appetite, and decreased exercise tolerance accompanied by thrombocytopenia [31][32][33][34][35]. It has also been revealed that patients with a low preoperative SMI have less marked loss of SMI after esophagectomy [9].…”

Section: Discussionmentioning

confidence: 99%

Predictors of changes in skeletal muscle mass after esophagectomy in elderly patients with esophageal cancer

Harada¹,

Tatematsu

Ueno

et al. 2021

Preprint

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Purpose : Although a change in skeletal muscle mass index (SMI) 4 months after esophagectomy impacts prognosis, predictors of a change in SMI have not been revealed. The purpose of this exploratory retrospective study was to clarify the predictors of a change in SMI after curative esophagectomy in elderly patients with esophageal cancer.Methods : Fifty-four patients who underwent esophagectomy and perioperative rehabilitation from 2015 to 2018 were enrolled. Preoperative and postoperative SMI (cm 2 /m 2 ) were calculated using computed tomography images. The ratio change in SMI was calculated as follows: (postoperative SMI − preoperative SMI) ÷ preoperative SMI × 100%. Potential predictors of a change in SMI ratio were analyzed by multiple regression. Results : The mean ratio change in SMI 4 months after esophagectomy was −7.1% ± 9.4%. The ratio change in quadriceps muscle strength in the first month after surgery ([postoperative strength − preoperative strength] ÷ preoperative strength × 100%) (standardized β = .273, p = .038) and neoadjuvant chemotherapy (NAC) (standardized β = .398, p = .006) were predictors of the ratio change in SMI independent of age, sex, pathological stage, and preoperative SMI. Conclusion : Quadriceps muscle weakness in the first month after esophagectomy and NAC were predictors of the ratio change in SMI after esophagectomy. Continuous postoperative comprehensive rehabilitation and supportive care may inhibit loss of skeletal muscle mass.

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Association of skeletal muscle loss with the long-term outcomes of esophageal cancer patients treated with neoadjuvant chemotherapy

Cited by 26 publications

References 25 publications

Marked loss of adipose tissue during neoadjuvant therapy as a predictor for poor prognosis in patients with gastric cancer: A retrospective cohort study

Marked loss of adipose tissue during neoadjuvant therapy as a predictor for poor prognosis in patients with gastric cancer: A retrospective cohort study

Prognostic Impact of Sarcopenia and Skeletal Muscle Loss During Neoadjuvant Chemoradiotherapy in Esophageal Cancer

Predictors of changes in skeletal muscle mass after esophagectomy in elderly patients with esophageal cancer

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