Skeletal Muscle Loss during Neoadjuvant Chemotherapy Is an Independent Risk Factor for Postoperative Infectious Complications in Patients with Advanced Esophageal Cancer

Motoori, Masaaki; Fujitani, Kazumasa; Sugimura, Keijiro; Miyata, Hiroshi; Nakatsuka, Rie; Nishizawa, Yujiro; Komatsu, Hisateru; Miyazaki, Shunichi; Komori, Takamichi; Kitajima, Masaki; Iwase, Kazuhiro; Yano, Masahiko

doi:10.1159/000490616

Cited by 35 publications

(28 citation statements)

References 27 publications

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“…Recent studies reported that skeletal muscle loss is closely correlated with febrile neutropenia and grade neutropenia (38). One of the reasons is that systemic inflammation due to febrile neutropenia (12). The reduction in skeletal muscle mass is caused by an imbalance in protein metabolism, which is characterized by a significantly smaller muscle fiber crosssectional area.…”

Section: Discussionmentioning

confidence: 99%

“…The addition of adjuvant chemotherapy can improve OS and the disease-free survival (DFS) (7,8). However, skeletal muscle mass and strength may furtherly be reduced during NAT (9), because of chemotherapy-related toxicities (10), disease progression (11) and adverse postoperative complications (12). Until now, whether sarcopenia would influence the survival rate of EC patients remains controversial (13,14).…”

Section: Introductionmentioning

confidence: 99%

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The Impact of Preoperative Sarcopenia on Survival Prognosis in Patients Receiving Neoadjuvant Therapy for Esophageal Cancer: A Systematic Review and Meta-Analysis

et al. 2021

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BackgroundSarcopenia is a poor prognostic factor in patients with esophageal cancer (EC). It can be aggravated by neoadjuvant therapy (NAT) that improves the prognosis of patients with EC. Until now, the impact of preoperative sarcopenia on survival prognosis in patients receiving NAT for EC remains unclear.MethodsWe systematically researched relevant studies in the PubMed, EMBASE, Web of Science, the Cochrane Library databases up to March 8, 2020. Prevalence of sarcopenia before and after NAT, overall survival (OS) and disease-free survival (DFS) were collected for analysis. Finally, eleven cohort studies were included.ResultsPooled analysis indicated that preoperative sarcopenia was negatively associated with OS. (HR = 1.290; 95% CI [1.078–1.543]; P = 0.005; I2 = 0.0%) and DFS (HR = 1.554; 95% CI [1.177–2.052]; P = 0.002; I2 = 0.0%) in the patients with EC receiving NAT. The prevalence of sarcopenia increased by 15.4% following NAT (95%CI [12.9%-17.9%]). Further subgroup analysis indicated that sarcopenia diagnosed following NAT (HR = 1.359; 95% CI [1.036–1.739]; P = 0.015; I2 = 6.9%) and age >65 years (HR = 1.381; 95% CI [1.090– 1.749]; P = 0.007; I2 = 0.0%) were the independent risk factors for decreased OS.ConclusionsClinicians should strengthen the screening of preoperative sarcopenia in patients of EC both receiving NAT and older than 65 years and give active nutritional support to improve the prognosis of patients.Systematic Review RegistrationInternational Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY), identifier INPLASY202050057.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Impact of Preoperative Sarcopenia on Survival Prognosis in Patients Receiving Neoadjuvant Therapy for Esophageal Cancer: A Systematic Review and Meta-Analysis

et al. 2021

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“…28 Skeletal muscle wasting remains to be one of the critical issues in cancer patients, leading to poor survival outcomes, treatment response, and multiple medical issues. 1,[5][6][7][8][9][10][11][12][13] Furthermore, several tumour-related and treatment-related factors can aggravate skeletal muscle degeneration. The tumour itself releases molecules and pro-inflammatory cytokines that can impair the protein synthesis and muscle regeneration mechanisms.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7][8][9][10] Skeletal muscle loss and cancer cachexia are also known to be relevant to several medical issues such as prolonged hospitalization, disability, postoperative infections, and other treatment-related toxicities. [11][12][13] Our previous study investigated the relationship between the amount of skeletal muscle loss and the survival outcomes of patients with oesophageal cancer, who received neoadjuvant chemoradiotherapy (NACRT) followed by surgery. 14 We calculated skeletal muscle index (SMI) through computed tomography (CT)-based analysis, one of the most common methods for skeletal muscle mass evaluation.…”

Section: Introductionmentioning

confidence: 99%

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Machine learning model for predicting excessive muscle loss during neoadjuvant chemoradiotherapy in oesophageal cancer

Yoon

Noh

et al. 2021

J cachexia sarcopenia muscle

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Background Excessive skeletal muscle loss during neoadjuvant concurrent chemoradiotherapy (NACRT) is significantly related to survival outcomes of oesophageal cancer. However, the conventional method for measuring skeletal muscle mass requires computed tomography (CT) images, and the calculation process is labour-intensive. In this study, we built machine-learning models to predict excessive skeletal muscle loss, using only body mass index data and blood laboratory test results. Methods We randomly split the data of 232 male patients treated with NACRT for oesophageal cancer into the training (70%) and test (30%) sets for 1000 iterations. The naive random over sampling method was applied to each training set to adjust for class imbalance, and we used seven different machine-learning algorithms to predict excessive skeletal muscle loss. We used five input variables, namely, relative change percentage in body mass index, albumin, prognostic nutritional index, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio over 50 days. According to our previous study results, which used the maximal χ 2 method, 10.0% decrease of skeletal muscle index over 50 days was determined as the cut-off value to define the excessive skeletal muscle loss. ResultsThe five input variables were significantly different between the excessive and the non-excessive muscle loss group (all P < 0.001). None of the clinicopathologic variables differed significantly between the two groups. The ensemble model of logistic regression and support vector classifier showed the highest area under the curve value among all the other models [area under the curve = 0.808, 95% confidence interval (CI): 0.708-0.894]. The sensitivity and specificity of the ensemble model were 73.7% (95% CI: 52.6%-89.5%) and 74.5% (95% CI: 62.7%-86.3%), respectively. Conclusions Machine learning model using the ensemble of logistic regression and support vector classifier most effectively predicted the excessive muscle loss following NACRT in patients with oesophageal cancer. This model can easily screen the patients with excessive muscle loss who need an active intervention or timely care following NACRT.

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Survival impact of surgical site infection in esophageal cancer surgery: A multicenter retrospective cohort study

Matsuda

Maruyama

Akagi

et al. 2023

Annals of Gastroent Surgery

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Aim This study was performed to evaluate the oncological impact of surgical site infection (SSI) and pneumonia on long‐term outcomes after esophagectomy. Methods The Japan Society for Surgical Infection conducted a multicenter retrospective cohort study involving 407 patients with curative stage I/II/III esophageal cancer at 11 centers from April 2013 to March 2015. We investigated the association of SSI and postoperative pneumonia with oncological outcomes in terms of relapse‐free survival (RFS) and overall survival (OS). Results Ninety (22.1%), 65 (16.0%), and 22 (5.4%) patients had SSI, pneumonia, and both SSI and pneumonia, respectively. The univariate analysis demonstrated that SSI and pneumonia were associated with worse RFS and OS. In the multivariate analysis, however, only SSI had a significant negative impact on RFS (HR, 1.63; 95% confidence interval, 1.12–2.36; P = 0.010) and OS (HR, 2.06; 95% confidence interval, 1.41–3.01; P < 0.001). The presence of both SSI and pneumonia and the presence of severe SSI had profound negative oncological impacts. Diabetes mellitus and an American Society of Anesthesiologists score of III were independent predictive factors for both SSI and pneumonia. The subgroup analysis showed that three‐field lymph node dissection and neoadjuvant therapy canceled out the negative oncological impact of SSI on RFS. Conclusion Our study demonstrated that SSI, rather than pneumonia, after esophagectomy was associated with impaired oncological outcomes. Further progress in the development of strategies for SSI prevention may improve the quality of care and oncological outcomes in patients undergoing curative esophagectomy.

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Skeletal Muscle Loss during Neoadjuvant Chemotherapy Is an Independent Risk Factor for Postoperative Infectious Complications in Patients with Advanced Esophageal Cancer

Cited by 35 publications

References 27 publications

The Impact of Preoperative Sarcopenia on Survival Prognosis in Patients Receiving Neoadjuvant Therapy for Esophageal Cancer: A Systematic Review and Meta-Analysis

The Impact of Preoperative Sarcopenia on Survival Prognosis in Patients Receiving Neoadjuvant Therapy for Esophageal Cancer: A Systematic Review and Meta-Analysis

Machine learning model for predicting excessive muscle loss during neoadjuvant chemoradiotherapy in oesophageal cancer

Survival impact of surgical site infection in esophageal cancer surgery: A multicenter retrospective cohort study

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