237. PRE-NEOADJUVANT CHEMOTHERAPY SARCOPENIA IS PREDICTIVE OF MORTALITY IN ESOPHAGOGASTRIC ADENOCARCINOMA PATIENTS

Abstract

Abstract Background Sarcopenia is defined as a loss of skeletal muscle mass and function. Preoperative sarcopenia amongst patients with esophageal cancer has been linked to mortality, various postoperative complications and the severity of these complications. The majority of this evidence comes from populations with squamous cell carcinoma or where neoadjuvant chemoradiotherapy was used. Whether sarcopenia is associated with neoadjuvant chemotherapy (NAC) for esophagogastric adenocarcinoma (EGA) and any link to mortality is not fully understood. Methods Patients diagnosed with EGA between January 2017 and December 2021 and undergoing NAC followed by esophagectomy from a single high-volume center had their pre-NAC CT scans assessed for radiological sarcopenia. Skeletal muscle index (SMI) was calculated from muscle area measured on CT scans at the level of third lumbar vertebra. Previously published SMI cut off values for radiologically defined sarcopenia were used (52.4 cm2 for men and 38.5 cm2 for women). A cox-regression model was used to investigate mortality between those with sarcopenia and those without. Results There were 191 patients included in the analysis. Pre-NAC sarcopenia was associated with increased mortality (Hazard ratio 1.59, 1.00–2.54 p = 0.046). 5-year survival for sarcopenic and non-sarcopenic patients was 27.8% (17.1%, 45.2%) and 35.6% (21.3%, 59.5%), respectively. Median survival was 2.72 and 4.09 years, respectively. Conclusion EGA patients with sarcopenia pre-NAC have a significantly higher chance of mortality in the 5-years following their surgery. Strategies to treat sarcopenia and prevent its further development should be investigated with the aim to increase survival in this cohort.