Decreases in the Psoas Muscle Index Correlate More Strongly with Survival than Other Prognostic Markers in Esophageal Cancer After Neoadjuvant Chemoradiotherapy Plus Esophagectomy

Abstract

Background Despite wide acknowledgement of the importance of sarcopenia and prognostic markers such as the neutrophil-to-lymphocyte ratio, the impact on cancer patient survival of the timing of sarcopenia's emergence and its severity is not well understood, nor is the association between sarcopenia and prognostic markers. The aim of this study, therefore, was to investigate the effect of the severity and timing of changes in the psoas muscle index (PMI) on survival of advanced esophageal squamous cell carcinoma (ESCC) patients receiving neoadjuvant chemoradiotherapy (NACRT) plus esophagectomy and the association between PMI and known prognostic markers. Methods Included in this study were 113 ESCC patients who underwent NACRT followed by esophagectomy. PMI and prognostic markers were measured at their initial visit, just before surgery (after NACRT), and 3 months postoperatively. Results All patients were classified into four groups according to the percent decrease in PMI after NACRT and after NACRT plus esophagectomy. Patients exhibiting a larger PMI decrease (C20%) after NACRT plus esophagectomy had significantly poorer overall survival than those showing a smaller PMI decrease. Furthermore, multivariable analysis showed that a larger decrease in PMI after NACRT plus esophagectomy was a significant risk factor for overall (P \ 0.0001) and recurrence-free (P = 0.0097) survival. Neither pretherapeutic PMI nor a decrease in PMI after NACRT significantly affected survival. PMI also showed weak, but significant, correlations with several prognostic markers postoperatively. Conclusions Decreased PMI after NACRT plus esophagectomy is a strong prognostic indicator in ESCC patients.

The impact of muscle mass loss and deteriorating physical function on prognosis in patients receiving hemodialysis

“…In this study, %PMI had a negative impact on prognosis, particularly in the lowest quartile (Q4, < −20.5%) group. A previous report on patients with esophageal cancer showed almost the same tendencies; those with larger decreases in the PMI (< 20%) had poor prognoses 16 .…”

“…Natural aging deteriorates muscle mass by approximately 1–2% annually 12 – 14 ; however, patients with high comorbidity lose their muscle mass rapidly 15 . For example, patients with esophageal cancer had decreased muscle mass (~ 18%) from the initial visit to 3 months after neoadjuvant chemoradiotherapy and esophagectomy 16 .…”

Prognostic role of low muscle mass and strength in palliative care patients with incurable cancer: a retrospective study

“…Psoas muscle index, which is a measure of muscle mass, was an independent prognostic factor in palliative care patients. PMI measurement has been widely used as an alternative method for evaluating all major skeletal muscles at the lumbar level, and PMI has been associated with prognosis in patients with cancer 22,23 and with surgical outcomes 24 . However, these previous studies have examined patients receiving anticancer therapy with a prognosis of more than several months.…”

Prognostic Role of Muscle Depletion in Palliative Care Patients With Incurable Cancer: A Retrospective Study

“…PMI, which is a measure of muscle mass, was an independent prognostic factor in palliative care patients. PMI measurement has been widely used as an alternative method for evaluating all major skeletal muscles at the lumbar level, and PMI has been associated with prognosis in patients with cancer [22,23] and with surgical outcomes [24]. However, the previous studies have examined patients receiving anticancer therapy with a prognosis of more than several months.…”