Impact of sarcopenia on outcomes of locally advanced esophageal cancer patients treated with neoadjuvant chemoradiation followed by surgery

Murimwa, Gilbert Z.; Venkat, Puja; Jin, William; Leuthold, Susan; Latifi, Kujtim; Almhanna, Khaldoun; Pimiento, José M.; Fontaine, Jacques-Pierre; Hoffe, Sarah E.; Frakes, Jessica M.

doi:10.21037/jgo.2017.06.11

Cited by 40 publications

(24 citation statements)

References 22 publications

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“…Several studies have investigated the effect of sarcopenia on the prognosis of esophageal cancer. However, the results were contradictory [17,18,[20][21][22][23]. 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].…”

Section: Discussionmentioning

confidence: 99%

“…However, the results were contradictory [17,18,[20][21][22][23]. 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].…”

Section: Discussionmentioning

confidence: 99%

“…However, the association between sarcopenia and patient survival remains controversial. While several studies showed that sarcopenia is a risk factor for poor survival [20][21][22], some others did not [17,18,23]. Furthermore, because most patients included in these studies received chemotherapy rather than chemoradiotherapy as a neoadjuvant treatment (NAT) [18,[20][21][22], changes in skeletal muscle mass and laboratory test results before and after NACRT have not been well-studied.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Yoon

Ahn

et al. 2020

Cancers

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“…The prevention and treatment of major complications have remained of paramount significance in improving the outcomes of patients, and the preoperative risk evaluation and clinical intervention are effective measures to prevent the occurrence of major complications. The role of sarcopenia as an effective predictor of postoperative complications has been reported in many clinical studies [51][52][53]. In patients with end-stage liver disease and awaiting transplantation, a model including sarcopenia could even surpass the MELD score in predicting waiting list mortality [54].…”

Section: Discussionmentioning

confidence: 99%

Computed Tomography-Assessed Sarcopenia Indexes Predict Major Complications following Surgery for Hepatopancreatobiliary Malignancy: A Meta-Analysis

et al. 2018

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Background: Computed tomography (CT)-assessed sarcopenia indexes have been reported to predict postoperative morbidity and mortality; however conclusions drawn from different indexes and studies remain controversial. Aim: The purpose of this meta-analysis was to evaluate various CT-assessed sarcopenia indexes as predictors of risk for major complications in patients undergoing hepatopancreatobiliary surgery for malignancy. Methods: Medline/PubMed, Web of Science, and Embase databases were systematically searched to identify relevant studies published before June 2018. PRISMA guidelines for systematic reviews were followed. The pooled risk ratio (RR) for major postoperative complications (Clavien-Dindo ≥III) was estimated in patients with sarcopenia versus patients without sarcopenia. Data extracted were meta-analyzed using Review Manager (version 5.3). Results: Twenty-eight studies comprising 6,656 patients were included in this study. CT-assessed sarcopenia indexes, such as skeletal muscle index (SMI, RR 1.36; 95% CI 1.14–1.63; p = 0.0008; I² = 24%), psoas muscle index (PMI, RR 1.35; 95% CI 1.15–1.58; p = 0.0002; I² = 0%), muscle attenuation (MA, RR 1.40; 95% CI 1.14–1.73; p = 0.002; I² = 4%), and intramuscular adipose tissue content (IMAC, RR 1.63; 95% CI 1.28–2.09; p < 0.0001; I² = 0%) were all predictors of postoperative major complications, although moderate heterogeneity existed and cutoffs for these indexes to define sarcopenia varied. Conclusions: All commonly used CT-assessed sarcopenia indexes, such as SMI, PMI, MA, and IMAC can predict the risk of major postoperative complications; however, a consensus on the cutoffs for these indexes to define sarcopenia is still lacking.

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“…Body composition parameters have therefore been increasingly studied in this disease setting as prognostic indicators as well as targets for supportive therapeutic interventions. For instance, several studies have found an association between sarcopenia and increased treatmentrelated toxicities [5,6], resistance to chemoradiotherapy (CRT) [7] and poor outcome [3,8].…”

Section: Introductionmentioning

confidence: 99%

Fat density is a novel prognostic marker in patients with esophageal cancer

Anciaux

Gossum

Wenglinski

et al. 2020

Clinical Nutrition ESPEN

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Background & aims: While long-term obesity is a well-known risk factor for esophageal adenocarcinoma (ADC), recent weight loss represents a significant concern in esophageal cancer (EC), in relation with dysphagia and disease aggressiveness. These phenomenons may diversely impact the adipose tissue density, suggested in other cancer settings as an important prognostic biomarker. The analysis of body mass composition (BMC) parameters, including adipose tissue attenuation is studied here in a population of EC operated with curative intent. Methods: BMC was retrospectively evaluated on Computed-Tomography (CT)-scan images from fluorodeoxyglucose (FDG)-positron-emitting (PET)/CT scans performed as a diagnostic procedure in a cohort of 145 EC patients operated with curative intent The mean subcutaneous (SFD) and visceral fat (VFD) density along with the index (area/height 2) (SF index (SFI), VF index (VFI)) were assessed on two adjacent slides at the third lumbar vertebra level by two independent investigators. Overall survival (OS) was calculated from the date of the baseline FDG-PET/CT scan. Results: Inter-observer correlations are excellent for all BMC parameters (r ¼ 0.94e0.99). As expected, weight loss is associated with worse outcome. We show that low SFD (HR 0.5 (95% CI: 0.3e0.7), p < 0.001) and low VFD (HR 0.6 (95% CI: 0.4e0.9), p ¼ 0.04) at diagnosis are associated with better OS. In contrast, body mass index (BMI) fails to show any relevance in predicting survival. Conclusions: Adipose tissue density is an important prognostic factor in EC.

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Impact of sarcopenia on outcomes of locally advanced esophageal cancer patients treated with neoadjuvant chemoradiation followed by surgery

Abstract: In our cohort of patients, sarcopenia was associated with a significant increase in acute grade ≥3 toxicity with chemoradiation, suggesting a potential role for neoadjuvant patient selection strategies. There was no difference in pathologic response or overall survival.

Cited by 40 publications

References 22 publications

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

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

Computed Tomography-Assessed Sarcopenia Indexes Predict Major Complications following Surgery for Hepatopancreatobiliary Malignancy: A Meta-Analysis

Fat density is a novel prognostic marker in patients with esophageal cancer

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