Prognostic Significance of Sarcopenia and Systemic Inflammatory Response in Patients With Esophageal Cancer

Abstract

Background/Aim: The association between the presence of sarcopenia and systemic inflammatory response is unclear in patients with esophageal cancer. This study was performed to investigate the relationship between sarcopenia and systemic inflammatory response and clarify the effect of these factors on the prognosis in patients with esophageal cancer. Patients and Methods: This study included 163 patients with esophageal cancer. The patients' body composition was assessed before esophagectomy using multifrequency bioelectrical impedance. The relationship between sarcopenia and inflammatory factors were investigated before surgery. Results: Sarcopenia was significantly associated with a high C-reactive protein-to-albumin (CRP/Alb) ratio (p=0.046). Patients with sarcopenia significantly associated with worse overall survival (OS) (p=0.025) and tended to show a worse recurrence-free survival (RFS) (p=0.065). A high CRP/Alb ratio was significantly associated with worse OS and RFS. Multivariate analysis revealed that among all inflammatory factors, only a high CRP/Alb ratio was an independent prognostic factor for RFS (p=0.022). Conclusion: Sarcopenia is associated with systemic inflammatory response such as high CRP/Alb ratio, while the latter is an independent prognostic marker in patients with esophageal cancer. Esophageal cancer is a highly aggressive malignant disease and has a high metastatic potential (1). Despite the development of multimodal therapies such as surgery, chemotherapy, and chemoradiation therapy, postoperative recurrence is observed in more than half of patients who have undergone transthoracic esophagectomy, and the prognosis of patients with esophageal cancer remains poor (2-4). In addition to various clinicopathological factors and the tumor stage, some other prognostic indicators have been discovered in previous studies of esophageal cancer because of the poor prognosis (5-7). Inflammatory factors are reportedly prognostic factors of cancer, and the close correlation between cancer and inflammation was first discovered by Virchow in 1863 (8). Many inflammatory markers that can be used to predict prognosis have been reported, such as the C-reactive protein (CRP)-to-albumin ratio (CRP/Alb ratio), modified Glasgow prognostic score (mGPS), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR). These markers reportedly associated with the prognosis of various types of cancer, including esophageal cancer (9-14). Sarcopenia, which is characterized by loss of skeletal muscle mass (SMM), has been mainly studied in older people and is known to impair physical performance and survival in this population (15-17). Sarcopenia has recently received great attention in the oncology field and is recognized as an important factor in predicting long-term prognosis in patients undergoing surgery for various types of cancer (18-21). The reason for the relationship between sarcopenia and poor cancer prognosis remains unclear, but inflammation may play a role (22). Previous evidence has support...

Bioelectrical Impedance Analysis for the Assessment of Sarcopenia in Patients with Cancer: A Systematic Review

“…For articles that remained after the initial screen, 65 full texts were reviewed for eligibility. Ultimately, 24 studies were selected for inclusion in the systematic review-18 articles [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43]47] and 6 abstracts [33, 44-46, 48, 53]-with a total of 3,607 patients. Table 2 provides an overview of included studies regarding number of study participants, cancer types, inclusion criteria, and stage of care when the BIA assessment was conducted.…”

“…In 13 studies, BIA-defined sarcopenia was associated with adverse clinical outcomes in adults with cancer [29,30,32,34,36,37,39,45,47,48,51,53]. Sarcopenia was associated with worse overall survival in five studies [27,34,42,48,51] and severe surgical complications (e.g., infection, hematological) in four studies [30,32,37,47]. Other outcomes included worse pathological response in patients with esophageal cancer treated with chemotherapy [36], worse inflammatory response in patients with esophageal cancer treated with surgery [34] (which may preclude worse surgical response, e.g., more infections, higher reoperation rates), and higher patient-reported pain, fatigue, insomnia, and constipation [42].…”

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

“…Several studies have investigated the effect of sarcopenia on the prognosis of esophageal cancer. However, the results were contradictory [17,18,[20][21][22][23]. 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].…”

“…While several studies showed that sarcopenia is a risk factor for poor survival [20][21][22], some others did not [17,18,23]. Furthermore, because most patients included in these studies received chemotherapy rather than chemoradiotherapy as a neoadjuvant treatment (NAT) [18,[20][21][22], changes in skeletal muscle mass and laboratory test results before and after NACRT have not been well-studied. Therefore, this study aimed to assess whether sarcopenia and loss of skeletal muscle affected survival outcomes of esophageal cancer patients who received NACRT followed by surgery.…”

Safety analysis of early oral feeding after esophagectomy in patients complicated with diabetes

“…And inflammatory response is one of the main manifestations of postoperative. Changes in serum inflammatory cytokines can objectively reflect the state of postoperative inflammatory response of patients [27].…”