Loss of skeletal muscle mass during neoadjuvant treatments correlates with worse prognosis in esophageal cancer: a retrospective cohort study

Järvinen, Tommi; Ilonen, Ilkka; Kauppi, Juha; Salo, Jarmo A.; Räsänen, Jari

doi:10.1186/s12957-018-1327-4

Cited by 76 publications

(67 citation statements)

References 30 publications

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“…During the course of neoadjuvant therapy we observed a statistically significant loss of muscle mass and consequently increased percentage of sarcopenic patients in the whole study population. These findings have also been described in previous retrospective studies and have been associated with inferior survival [23, 24].…”

Section: Discussionsupporting

confidence: 87%

Skeletal muscle mass correlates with increased toxicity during neoadjuvant radiochemotherapy in locally advanced esophageal cancer: A SAKK 75/08 substudy

et al. 2019

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Background Sarcopenia, the critical depletion of skeletal muscle mass, is an independent prognostic factor in several tumor entities for treatment-related toxicity and survival. In esophageal cancer, there have been conflicting results regarding the value of sarcopenia as prognostic factor, which may be attributed to the heterogeneous patient populations and the retrospective nature of previous studies. The aim of our study was therefore to determine the impact of sarcopenia on prospectively collected specific outcomes in a subgroup of patients treated within the phase III study SAKK 75/08 with trimodality therapy (induction chemotherapy, radiochemotherapy and surgery) for locally advanced esophageal cancer. Methods Sarcopenia was assessed by skeletal muscle index at the 3rd lumbar vertebra (L3) in cross-sectional computed tomography scans before induction chemotherapy, before radiochemotherapy and after neoadjuvant therapy in a subgroup of 61 patients from four centers in Switzerland. Sarcopenia was determined by previously established cut-off values (Martin et al., PMID: 23530101) and correlated with prospectively collected outcomes including treatment-related toxicity, postoperative morbidity, treatment feasibility and survival. Results Using the published cut-off values, the prevalence of sarcopenia increased from 29.5% before treatment to 63.9% during neoadjuvant therapy (p < 0.001). Feasibility of neoadjuvant therapy and surgery was not different in initially sarcopenic and non-sarcopenic patients. We observed in sarcopenic patients significantly increased grade ≥ 3 toxicities during chemoradiation (83.3% vs 52.4%, p = 0.04) and a non-significant trend towards increased postoperative complications (66.7% vs 42.9%, p = 0.16). No difference in survival according to sarcopenia could be observed in this small study population. Conclusions Trimodality therapy in locally advanced esophageal cancer is feasible in selected patients with sarcopenia. Neoadjuvant chemoradiation increased the percentage of sarcopenia. Sarcopenic patients are at higher risk for increased toxicity during neoadjuvant radiochemotherapy and showed a non-significant trend to more postoperative morbidity.

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Section: Discussionsupporting

confidence: 87%

Skeletal muscle mass correlates with increased toxicity during neoadjuvant radiochemotherapy in locally advanced esophageal cancer: A SAKK 75/08 substudy

et al. 2019

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“…Kamitani et al also found that ∆SMI (%) <−12.5% was a significant prognostic factor for OS, and pre-and post-NAT sarcopenia were not associated with OS [29]. Similar to these results, Järvinen et al reported that a ∆SMI (%) <−2.98% during NAT was related to poor OS in the multivariable analysis, whereas post-NAT sarcopenia did not significantly affect OS and complication rates [30]. RFS was also analyzed in this study, but ∆SMI (%) <−2.98%, pre-and post-NAT sarcopenia all did not affect RFS.…”

Section: Discussionmentioning

confidence: 69%

“…In addition, only a few studies included patients who received NACRT instead of chemotherapy as a NAT, and none of these studies demonstrated a significant relationship between sarcopenia and OS [17,23]. Meanwhile, studies on the relationship between the amount of skeletal muscle loss and survival outcomes of esophageal cancer showed relatively consistent results for OS, although they still showed contradictory results for RFS [28][29][30][31][32]. Reisinger et al showed that the amount of muscle mass loss during NACRT was associated with postoperative mortality in patients with stage III-IV tumors [28].…”

Section: Discussionmentioning

confidence: 99%

Prognostic Impact of Sarcopenia and Skeletal Muscle Loss During Neoadjuvant Chemoradiotherapy in Esophageal Cancer

Yoon

Ahn

et al. 2020

Cancers

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Backgrounds: The relationship between sarcopenia, characterized by loss of muscle mass and strength, and survival outcomes of esophageal cancer is controversial. This study aimed to assess the effect of sarcopenia and skeletal muscle loss on overall survival (OS) and recurrence-free survival (RFS) of esophageal cancer patients. Methods: We retrospectively collected the medical records of 248 male patients diagnosed with squamous cell esophageal cancer and who underwent neoadjuvant chemoradiotherapy (NACRT) followed by surgery. We measured the cross-sectional area of the skeletal muscle at the L3 vertebra level using computed tomography images and calculated the skeletal muscle index (SMI). Sarcopenia was defined as SMI <52.4 cm2/m2, and excessive muscle loss was defined as SMI change <−10.0%/50 days during NACRT. Moreover, laboratory test results, such as albumin, prognostic nutritional index (PNI), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) before and after NACRT, were collected. Results: In the univariable Cox analysis, pre- (p = 0.689) and post-radiotherapy (RT) sarcopenia (p = 0.669) were not associated with OS. However, excessive muscle loss had a significant association with OS in both the univariable and multivariable analyses (all p = 0.001). Excessive muscle loss was also related to RFS in both the univariable (p = 0.011) and multivariable (p = 0.022) Cox analysis. Patients with excessive muscle loss had significantly lower levels of post-RT albumin (p < 0.001) and PNI (p < 0.001), higher levels of post-RT NLR (p = 0.031) and PLR (p = 0.071), larger decrease in albumin (p < 0.001) and PNI (p < 0.001) after NACRT, and larger increase in NLR (p = 0.051) and PLR (p = 0.088) after NACRT than in those with non-excessive muscle loss. Conclusion: Excessive muscle loss rather than pre- and post-RT sarcopenia was a significant prognostic factor for OS and RFS, and it was also related to nutritional and inflammatory markers.

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“…28 Prevalence of sarcopenia in studies on correlation between muscle area and survival in esophageal cancer can range widely from 16%-80%. [29][30][31] Choosing the right cutoff values for defining sarcopenia and myosteatosis can be challenging. In keeping with the definition of sarcopenia as absolute muscle mass below the 5th percentile of the population 32 proposed using the 5th percentile for cutoff values for SMI and MA in non-elderly (age 20-60) to avoid age related muscle loss.…”

Section: Discussionmentioning

confidence: 99%

Sarcopenia and myosteatosis at presentation adversely affect survival after esophagectomy for esophageal cancer

Srpčič

Jordan

Popuri

et al. 2020

Radiology and Oncology

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BackgroundEsophageal cancer remains a disease with poor survival and many complications. Measuring muscle mass and quality can identify patients with diminished muscle mass (sarcopenia) and muscle fat infiltration (myosteatosis). We studied the impact of sarcopenia and myosteatosis in resectable esophageal cancer on overall survival and complications.Patients and methods139 patients received a radical esophagectomy. Skeletal muscle area (SMA) and muscle attenuation (MA) in CT images at L3 level were recorded and groups with and without sarcopenia and myosteatosis were compared for overall survival (OS), perioperative mortality, conduit complications, pleuropulmonary complications, respiratory failure requiring mechanical ventilation and other significant complications.ResultsPrevalence of sarcopenia and myosteatosis at presentation was 16.5% and 51.8%, respectively. Both were associated with decreased OS. Median survival was 18.3 months (CI 5.4–31.1) vs 31.0 months (CI 7.4–54.6) for sarcopenia/no sarcopenia (log rank p = 0.042) and 19.0 months (CI 13.3–24.7) vs 57.1 months (CI 15.2–99.0) for myosteatosis (log rank p = 0.044), respectively. A relationship between sarcopenia and myosteatosis and other negative outcomes after esophagectomy could not be established.ConclusionsSarcopenia and myosteatosis before esophagectomy are associated with decreased overall survival but not with more frequent perioperative complications. Identification of patients at risk can guide therapeutic decisions and interventions aimed at replenishing muscle reserves.

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Loss of skeletal muscle mass during neoadjuvant treatments correlates with worse prognosis in esophageal cancer: a retrospective cohort study

Cited by 76 publications

References 30 publications

Skeletal muscle mass correlates with increased toxicity during neoadjuvant radiochemotherapy in locally advanced esophageal cancer: A SAKK 75/08 substudy

Skeletal muscle mass correlates with increased toxicity during neoadjuvant radiochemotherapy in locally advanced esophageal cancer: A SAKK 75/08 substudy

Prognostic Impact of Sarcopenia and Skeletal Muscle Loss During Neoadjuvant Chemoradiotherapy in Esophageal Cancer

Sarcopenia and myosteatosis at presentation adversely affect survival after esophagectomy for esophageal cancer

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