Association between body composition, survival, and toxicity in advanced esophagogastric cancer patients receiving palliative chemotherapy

Abstract

Background Palliative systemic treatment in patients with advanced or metastatic esophagogastric cancer may result in improved overall survival and quality of life but can also lead to considerable toxicity. In various cancer types, severe muscle mass depletion (sarcopenia) and poor muscle strength are associated with decreased survival and increased chemotherapy‐related toxicity. The aim of this study is to determine the impact of body composition on survival and chemotherapy toxicity in esophagogastric cancer patients treated with first‐line palliative chemotherapy. Methods A total of 88 patients with advanced esophagogastric cancer treated with standard first‐line palliative systemic therapy consisting of capecitabine and oxaliplatin (CapOx) between January 2010 and February 2017 were included. Skeletal muscle index (SMI), reflecting muscle mass, and skeletal muscle density (SMD), associated with muscle strength, were measured using pre‐treatment of all patients and evaluation computed tomography scans after three treatment cycles of 65 patients and were used to determine sarcopenia and sarcopenic obesity (i.e. sarcopenia and body mass index >25 kg/m 2 ). The associations between body composition (SMI, SMD, sarcopenia, and sarcopenic obesity) and survival and toxicity were assessed using univariable and multivariable Cox and logistic regression analyses, respectively. Results Of 88 patients, 75% was male, and median age was 63 (interquartile range 56–69) years. The majority of patients had an adenocarcinoma (83%). Before start of treatment, 49% of the patients were sarcopenic, and 20% had sarcopenic obesity. Low SMD was observed in 50% of patients. During three cycles CapOx, SMI significantly decreased, with a median decrease of 4% (interquartile range −8.6–−0.4). Median progression‐free and overall survival were 6.9 and 10.1 months. SMI, SMD, sarcopenia, and sarcopenic obesity (both pre‐treatment and after three cycles) were neither associated with progression‐free nor overall survival. Pre‐treatment SMD was independently associated with grade 3–4 toxicity (odds ratio 0.94; 95% confidence interval 0.89–1.00) and sarcopenic obesity with grade 2–4 neuropathy (odds ratio 3.82; 95% confidence interval 1.20–12.18). Conclusions Sarcopenia was not associated with survival or treatment‐related toxicity in advanced esophagogastric cancer patients treated with CapOx. Pre‐treatment sarcopenic obesity was independently associated with the occurrence of grade 2–4 neurotoxicity and skeletal muscle density with grade 3–4 toxicity.

Prognostic role of body composition parameters in gastric/gastroesophageal junction cancer patients from the EXPAND trial

“…In our analysis, BMI was only weakly prognostic in the log rank test and lacked prognostic impact in the Cox regression analyses ( Figure S3 and Tables and ). This is in accordance with recently published data from a smaller cohort of metastatic gastric or GEJ cancer patients where BMI also lacked prognostic impact …”

“…This is in accordance with recently published data from a smaller cohort of metastatic gastric or GEJ cancer patients where BMI also lacked prognostic impact. 21 As expected, gender, age, and ethnic background were significantly related to differences in muscle and adipose tissue parameters ( Table 1). [22][23][24] Specifically, Asian compared with non-Asian patients were characterized by markedly lower VAT and markedly higher SMI and MA values ( Table 1).…”

“…Furthermore, in a very recent study in n = 88 advanced gastric and GEJ cancer patients, neither baseline SMI nor MA was prognostic for PFS or OS . As there are significant differences in patient characteristics, compared with our data set, they may most likely account for the differences.…”

“…27 Furthermore, in a very recent study in n = 88 advanced gastric and GEJ cancer patients, neither baseline SMI nor MA was prognostic for PFS or OS. 21 As there are significant differences in patient characteristics, compared with our data set, they may most likely account for the differences. Overall, a growing body of evidence exists, demonstrating that muscle mass, as represented by SMI, influences the efficacy of chemotherapy in different cancer entities, which may very well explain the prognostic role for PFS found in our cohort.…”

Myosteatosis in a systemic inflammation‐dependent manner predicts favorable survival outcomes in locally advanced esophageal cancer

“…15 In contrast, it was not yet associated with survival outcomes in metastatic settings. 16 Decreased muscle radiodensity, mainly caused by intramyocellular triglycerides (myosteatosis), is also associated with poor survival outcomes in distinct tumours. 12,[17][18][19] Importantly, myosteatosis is not directly biologically correlated with sarcopenia, nor is part of cachexia definition.…”