Skeletal Muscle Loss After Esophagectomy Is an Independent Risk Factor for Patients with Esophageal Cancer

Nakashima, Yasuhiro; Saeki, Hiroshi; Hu, Qingjiang; Tsuda, Yasuo; Zaitsu, Yoko; Hisamatsu, Yosuke; Ando, Koji; Kimura, Yasue; Oki, Eiji; Mori, Masaki

doi:10.1245/s10434-019-07850-6

Cited by 33 publications

(29 citation statements)

References 24 publications

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“…Sarcopenia is a syndrome affecting innumerable people with cancers and is independent predictor of detrimental outcomes such as physical disability, poor quality of life, and reduced survival [16]. Sarcopenia is considered a signi cant constituent of cancer cachexia syndrome, and the pathophysiology is involved with the systemic in ammation, including anabolic and catabolic pathways [17].…”

Section: Discussionmentioning

confidence: 99%

Sarcopenia as a novel prognostic factor in the patients of primary localized gastrointestinal stromal tumor

Dong²

2020

Preprint

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Abstract Background : Sarcopenia predicts poor prognosis of a variety of gastrointestinal malignancies. However, there is a lack of study on the association between skeletal muscle index (SMI) and the prognosis of gastrointestinal stromal tumor (GIST). The aim of this study is to develop a novel nomogram based on sarcopenia for GIST patients to predict overall survival (OS) Methods : SMI was measured by computed tomography scan of 107 patients who underwent resection for primary localized gastrointestinal stromal tumor (GIST). Sarcopenia was defined by cutoff values for SMI as 40.1cm 2 /m 2 and 39.8 cm 2 /m 2 using optimum stratification for males and females respectively. Factors were included in the nomogram were specified by univariate and multiple Cox proportional hazard analysis. Concordance index (C-index) and calibration curves were conducted to measure the discrimination and accuracy of the nomogram. The utility of the nomogram was assessed by the decision curve analysis (DCA). Results: Twenty-eight (26.2%) of 107 patients were sarcopenic. Sarcopenia was correlated significantly with BMI, albumin, female sex, resection style, mitotic index, rupture status, survival. Sarcopenia was significantly related to decreased overall survival (p=0.003).The nomogram including sarcopenia status, resection style and mitotic index had an excellent discrimination with C-index 0.794. The calibration curves represented a good accordance between the actual observation and nomogram prediction for overall survival. Decision curve analysis illustrated that the nomogram was helpful in clinic . Conclusions: we developed a nomogram based on sarcopenia to predict overall survival after resection of GISTs which is an effective and favorable prognostication tool.

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Section: Discussionmentioning

confidence: 99%

Sarcopenia as a novel prognostic factor in the patients of primary localized gastrointestinal stromal tumor

Dong²

2020

Preprint

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“…The cross-sectional area of the Houns eld unit (−29 to 150) at the level of L3 on axial CT images was measured in the skeletal muscle area using SliceOmatic (Imagelabo, Canada) [22]. SMI was calculated as follows: cross-sectional skeletal muscle area ÷ (height 2 ) [4,5,8,9,22]. The ratio change of SMI was calculated as follows: [(post-SMI − pre-SMI) ÷ pre-SMI] × 100% [4,8,9].…”

Section: Ratio Change In Smimentioning

confidence: 99%

“…Skeletal muscle mass at pretreatment is an important factor for prognosis in elderly patients with solid tumors, including esophageal cancer [6,7]. In patients with esophageal cancer, a change in skeletal muscle mass index (SMI) within 6 months after esophagectomy is an important factor for overall survival, independent of pretreatment SMI [4,8,9]. A change in skeletal muscle mass is generally associated with four factors: aging, disease, physical function, and nutrition [10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

“…A change in skeletal muscle mass is generally associated with four factors: aging, disease, physical function, and nutrition [10][11][12][13][14]. In fact, previous studies reveal that patients with advanced pathological tumor stage and abundant preoperative SMI have a marked loss of skeletal muscle mass 4 months after esophagectomy [4,9]. However, no studies have investigated the impact of reversible factors, such as physical function and nutrition, on the change in skeletal muscle mass in elderly patients with esophageal cancer after esophagectomy.…”

Section: Introductionmentioning

confidence: 99%

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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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“…The current study 4 is the largest retrospective study (n = 218) to focus on postoperative changes in skeletal muscle after esophagectomy for patients with esophageal cancer. Postoperative severe loss of skeletal muscle observed 6 months after esophagectomy was significantly associated with poor survival of esophageal cancer patients.…”

Section: Presentmentioning

confidence: 99%

ASO Author Reflections: Significance of Skeletal Muscle Loss After Esophagectomy for Esophageal Cancer

Nakashima

Mori

2019

Ann Surg Oncol

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Esophagectomy and subsequent reconstruction with gastric conduit creation are associated with a risk of postoperative malnutrition via dysphagia due to anastomosis stricture, gastroesophageal reflux, gastric volume reduction, delayed food intake, impaired gastric emptying, and dumping symptoms. 1 Previous studies have focused on the impact of baseline measures of skeletal muscle mass, obtained before surgery, on postoperative complications, prognosis, and treatment outcomes. 2,3 However, to date, decreased skeletal muscle mass after esophagectomy for patients with esophageal cancer and its impact on postoperative long-term prognosis have not been fully investigated.

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Skeletal Muscle Loss After Esophagectomy Is an Independent Risk Factor for Patients with Esophageal Cancer

Cited by 33 publications

References 24 publications

Sarcopenia as a novel prognostic factor in the patients of primary localized gastrointestinal stromal tumor

Sarcopenia as a novel prognostic factor in the patients of primary localized gastrointestinal stromal tumor

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

ASO Author Reflections: Significance of Skeletal Muscle Loss After Esophagectomy for Esophageal Cancer

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