Association Between Sarcopenia and Clinical Outcomes in Patients With Esophageal Cancer Under Neoadjuvant Therapy

Abstract

Background/Aim: This study aimed to evaluate the association of sarcopenia and Clinical Outcomes with esophageal cancer under neoadjuvant chemoradiotherapy (CRT). Patients and Methods: A retrospective study assessing patients with esophageal cancer who underwent CRT between 2001 and 2014 was conducted in the medical center. Hospital patients' records on sarcopenia and treatment outcomes were statistically analyzed. Results: The sarcopenia group had significantly lower body mass index than the non-sarcopenia group. CRT-related severe adverse events with mucositis, fever, and neutropenic fever were greater in the sarcopenia group. Overall survival and disease-free survival were significantly better in the nonsarcopenia group. Sarcopenic patients who received nutritional support with enteral access had less severe mucositis. There was no difference in mortality of sarcopenia patients with nutritional support via enteral access or without. Moreover, sarcopenia and advanced tumor stage were independent factors for mortality outcome. Conclusion: Sarcopenia before CRT may be associated with increased toxicities and worse overall survival/ disease-free survival in esophageal cancer patients.

Association between preoperative potential sarcopenia and survival of cancer patients undergoing major surgical procedures

“…In addition, the diagnosis of PS was an independent risk factor for mortality. The data revealed that the risk of sarcopenia and low muscle strength are associated with a worse postoperative outcome, corroborating the results of other authors [26][27][28][29] .…”

“…For instance, gastric cancer, whose treatment is predominantly surgical, is the fifth most common cancer and the third leading cause of death by cancer worldwide 1. Huang et al (2020) 29 showed that the overall and diseasefree survival were lower among the sarcopenic patients receiving neoadjuvant treatment for esophageal cancer.…”

“…This may reduce the occurrence of complications and death. For though there is great advancement in nutritional therapy, in surgical techniques and in fast track type, multimodal programs of postoperative recovery acceleration [46][47][48] , the cancer patients, the malnourished, and the sarcopenic ones still present with increased risk of morbidity and mortality 12,13,29,32,49 .…”

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

“…The timing of sarcopenia diagnosis varied among the included studies: before NAT (5), after NAT (5), or two time periods measured (1). Six studies reported prevalence of sarcopenia before or/and after neoadjuvant therapy, all eleven studies reported OS, but only three studies reported DFS (11,20,25). The follow-up time was relatively short with a median time ranging from 11 to 39 months, and some studies did not provide a follow-up time (14,23,25).…”

Evaluation of Sarcopenia, Frailty, and Inflammation on Adverse Events and Survival Outcomes in Patients with Oral Cavity Squamous Cell Carcinoma under Adjuvant Chemoradiotherapy

“…The prevalence of sarcopenia in our cohort (64%) is consistent with the previously published prevalence [ 6 ]. Many studies have demonstrated that sarcopenia is associated with increased chemotherapy dose-limiting toxicity [ 9 ], CRT toxicity [ 7 , 8 , 9 , 36 ], and radiation treatment breaks [ 7 , 9 ]. However, an association between CRT-related hematologic toxicity and sarcopenia has not been demonstrated in OSCC.…”