Preoperative sarcopenia is a predictor of poor prognosis of esophageal cancer after esophagectomy: a comprehensive systematic review and meta-analysis

Deng, Han‐Yu; Zha, Panpan; Peng, Lei; Hou, Lingmi; Huang, Kaili; Li, Xiaoyun

doi:10.1093/dote/doy115

Cited by 106 publications

(86 citation statements)

References 38 publications

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“…On the other hand, preoperative sarcopenia was also pointed out in 89% of this study's cohort. However, it was not found to be associated with the long-term prognosis despite previously published reports (30).The reason for it might be that most cases in this study had sarcopenia, and there was no statistical difference with the TPI reduction rate about with or without sarcopenia. Furthermore, as an operative procedure, it might be a good option to select thoracoscopic surgery from the viewpoint of skeletal muscle loss using the TPI reduction rate as a new parameter of invasiveness or disuse.…”

Section: Discussioncontrasting

confidence: 70%

“…Although there have been some reports that perioperative skeletal muscle loss was a prognostic predictor after surgeries for cancers including ESCC (8)(9)(10)(11)(12)(13)(14)30), they examined skeletal muscle loss in the preoperative phase or the postoperative chronic phase (about 1 or more months after surgery). Surprisingly, in the present study, the TPI reduction rate on POD 3 after ESCC surgery was an independent long-term predictor of prognosis that was as signi cant as pathological stage and neoadjuvant treatment.…”

Section: Discussionmentioning

confidence: 99%

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Skeletal muscle loss in the postoperative acute phase after esophageal cancer surgery as a new prognostic factor

Maeda

Shirakawa

Tanabe

et al. 2020

Preprint

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Background: The postoperative survival rate of patients with esophageal squamous cell carcinoma (ESCC) remains poor compared with other gastrointestinal cancers. We hypothesized that skeletal muscle loss in the postoperative acute phase might be a new predictor for long-term prognosis after highly invasive surgery such as ESCC surgery.Methods: The following items were retrospectively investigated. First, whether skeletal muscle loss occurred in the postoperative acute phase of ESCC was verified. Second, the preoperative and intraoperative factors involved in skeletal muscle loss in the postoperative acute phase of ESCC were investigated. Then, whether skeletal muscle loss in the postoperative acute phase affected long-term prognosis was examined. The medical records of consecutive patients who underwent radical esophagectomy for ESCC between January 2010 and June 2015 were retrospectively reviewed; 72 cases were eligible for this study. The total psoas major muscle mass index (TPI) at the level of the third lumbar vertebra (L3) was measured using computed tomography (CT) before surgery and three days after surgery. The long-term prognosis was estimated by the Kaplan-Meier method and the multivariate logistic regression model.Results: There was already a significant reduction of TPI in the acute phase up to POD 3 after ESCC surgery in comparison with the preoperative baseline TPI (P < 0.001). The TPI reduction rate was significantly milder in cases with less blood loss during surgery and in cases that underwent thoracoscopic esophagectomy than in cases that underwent open esophagectomy. The three-year overall survival rate was significantly different between the TPI reduction rate severe group and the TPI reduction rate mild group.Conclusion: skeletal muscle loss occurred even in the postoperative acute phase. Furthermore, it is very significant that skeletal muscle loss in the postoperative acute phase of ESCC surgery is involved in the long-term prognosis.

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Section: Discussioncontrasting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Skeletal muscle loss in the postoperative acute phase after esophageal cancer surgery as a new prognostic factor

Maeda

Shirakawa

Tanabe

et al. 2020

Preprint

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“…Then, we chose the newest meta‐analysis with the largest number of studies. Finally, 54 health‐related outcomes extracted from 30 meta‐analyses 10,22‐50 were reported in this umbrella review. These 54 outcomes were mainly about prognostic outcomes of tumor, postoperative outcomes, age‐related outcomes, metabolic outcomes, and other outcomes.…”

Section: Resultsmentioning

confidence: 99%

Sarcopenia and adverse health‐related outcomes: An umbrella review of meta‐analyses of observational studies

et al. 2020

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Objective The purpose of this umbrella review was to assess the associations between sarcopenia and adverse health‐related outcomes. Design An umbrella review of meta‐analyses of observational studies. Setting and Participants Patients with sarcopenia and controls without sarcopenia were included. Measures The PubMed, Web of Science and Embase were searched for relevant systematic review and meta‐analysis. AMSTAR and GRADE system were used for methodological quality and evidence quality assessments, respectively. Results Totally 54 outcomes extracted from 30 meta‐analyses were analyzed. Twenty out of 21 prognostic outcomes indicated that sarcopenia was significantly associated with poorer prognosis of gastric cancer, hepatocellular cancer, urothelial cancer, head and neck cancer, hematological malignancy, pancreatic cancer, breast cancer, colorectal cancer, lung cancer, esophageal cancer, and ovarian cancer. Besides, 10 out of 16 postoperative outcomes suggested that sarcopenia significantly increased the risk of multiple postoperative complications and prolonged the length of hospitalization of patients with digestive cancer. In age‐related outcomes, sarcopenia significantly increased the risk of dysphagia, cognitive impairment, fractures, falls, hospitalization, and all‐cause mortality of elderly populations. Moreover, sarcopenia was also associated with higher level of albuminuria, risk of depression, and several metabolic diseases. Conclusions and Implications Sarcopenia significantly affected a wide range of adverse health‐related outcomes, particularly in patients of tumor and elderly populations. Because evidences of most outcomes were rated as “low” and “very low,” more prospective cohort studies are required in the future.

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“…A large number of studies evaluated the role of sarcopenia on survival outcomes after esophagectomy. In spite of some studies suggesting that sarcopenia had no impact on OS, [47][48][49] a recent meta-analysis 15 showed that sarcopenia is in fact an unfavorable prognostic factor. In contrast, sarcopenia in metastatic esophageal carcinoma setting was not associated with mortality.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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Increased adiposity and its attendant metabolic features as well as systemic inflammation have been associated with prognosis in locally advanced esophageal cancer (LAEC). However, whether myosteatosis and its combination with systemic inflammatory markers are associated with prognosis of esophageal cancer is unknown. Our study aimed to investigate the influence of myosteatosis and its association with systemic inflammation on progression‐free survival (PFS) and overall survival (OS) in LAEC patients treated with definitive chemoradiotherapy (dCRT). We retrospectively gathered information on 123 patients with LAEC submitted to dCRT at the University of Campinas Hospital. Computed tomography (CT) images at the level of L3 were analyzed to assess muscularity and adiposity. Systemic inflammation was mainly measured by calculating the neutrophil‐to‐lymphocyte ratio (NLR). Median PFS for patients with myosteatosis (n = 72) was 11.0 months vs 4.0 months for patients without myosteatosis (n = 51) (hazard ratio [HR]: 0.53; 95% confidence interval [CI], 0.34‐0.83; P = .005). Myosteatosis was also independently associated with a favorable OS. Systemic inflammation (NLR > 2.8) was associated with a worse prognosis. The combination of myosteatosis with systemic inflammation revealed that the subgroup of patients with myosteatosis and without inflammation presented less than half the risk of disease progression (HR: 0.47; 95% CI: 0.26‐0.85; P = .013) and death (HR: 0.39; 95% CI, 0.21‐0.72; P = .003) compared with patients with inflammation. This study demonstrated that myosteatosis without systemic inflammation was independently associated with favorable PFS and OS in LAEC patients treated with dCRT.

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Preoperative sarcopenia is a predictor of poor prognosis of esophageal cancer after esophagectomy: a comprehensive systematic review and meta-analysis

Cited by 106 publications

References 38 publications

Skeletal muscle loss in the postoperative acute phase after esophageal cancer surgery as a new prognostic factor

Skeletal muscle loss in the postoperative acute phase after esophageal cancer surgery as a new prognostic factor

Sarcopenia and adverse health‐related outcomes: An umbrella review of meta‐analyses of observational studies

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

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