Impact on postoperative complications of changes in skeletal muscle mass during neoadjuvant chemotherapy for gastro-oesophageal cancer

Abstract

Background: Risk assessment is relevant to predict postoperative outcomes in patients with gastro-oesophageal cancer. This cohort study aimed to assess body composition changes during neoadjuvant chemotherapy and investigate their association with postoperative complications. Methods: Consecutive patients with gastro-oesophageal cancer undergoing neoadjuvant chemotherapy and surgery with curative intent between 2016 and 2019 were identified from a specific database and included in the study. CT images before and after neoadjuvant chemotherapy were used to assess the skeletal muscle index, sarcopenia, and subcutaneous and visceral fat index. Results: In a cohort of 199 patients, the mean skeletal muscle index decreased during neoadjuvant therapy (from 51⋅187 to 49⋅19 cm 2 /m 2 ; P < 0⋅001) and the rate of sarcopenia increased (from 42⋅2 to 54⋅3 per cent; P < 0⋅001). A skeletal muscle index decrease greater than 5 per cent was not associated with an increased risk of total postoperative complications (odds ratio 0⋅91, 95 per cent c.i. 0⋅52 to 1⋅59; P = 0⋅736) or severe complications (odds ratio 0⋅66, 0⋅29 to 1⋅53; P = 0⋅329). Conclusion: Skeletal muscle index decreased during neoadjuvant therapy but was not associated with postoperative complications.

Body Composition Changes in Gastric Cancer Patients during Preoperative FLOT Therapy: Preliminary Results of an Italian Cohort Study

“…Preoperative FLOT chemotherapy may further reduce SMI in GC patients and our results are consistent with findings of recent previous studies using other chemotherapy treatments [ 18 , 19 , 20 ]. Indeed, Den Boer et al [ 19 ] retrospectively assessed CT images of 199 patients with gastro-oesophageal cancer before and after neoadjuvant chemotherapy (epirubicin-cisplatin-capecitabine), which showed a significant reduction in SMI. Moreover, they found a significant reduction in SAI and a slight depletion in VAI.…”

“…The loss of muscle mass is often due to GC itself leading to inflammatory-based mechanisms, fat-free mass breakdown, insulin-resistance, anabolic resistance, anorexia, and dysphagia resulting from the obstructive effect of the tumor mass. Furthermore, chemotherapy could play a direct role in the loss of muscle mass and adipose tissue in various cancers [ 14 , 15 , 16 , 17 ], especially GC [ 18 , 19 , 20 ]. Hence, in this context, the most likely hypothesis would be a deleterious effect of FLOT regimen on body composition in GC patients, even though currently there is no available data.…”

Methodology, clinical applications, and future directions of body composition analysis using computed tomography (CT) images: A review

“…The CT-determined decrease in skeletal muscle mass as a surrogate for sarcopenia has been most extensively studied in patients with cancer. The decreased muscle mass correlates with decreased survival in breast [80], [81], [82], prostate [83], gastrointestinal [84], [85], [86], [87], [88], [89], [90]), urinary tract [91] and head and neck cancers, among others (Table 2). Furthermore, those patients who undergo chemotherapy for advanced or metastatic cancers who preserve skeletal muscle mass irrespective of other important prognostic factors appear to have a better overall survival [92], [93][94][95].…”

Influence of body composition measures on chyle leak after oesophagectomy

“…Influence of body composition measures on chyle leak after oesophagectomy tools for major surgery such as oesophagectomy (12)(13)(14)(15).…”