Abstract
BackgroundSarcopenia has been associated with treatment-related toxicities and poor survival in cancer patients. Our aim was to investigate the prevalence of sarcopenia in postoperative recurrent esophageal squamous cell carcinoma (ESCC) patients receiving chemoradiotherapy (CRT) and evaluate associations with treatment-related toxicity and prognosis.MethodsOne hundred and eighty-four patients with postoperative locoregional recurrent ESCC receiving CRT between January 2014 and December 2016 were included. The skeletal muscle area (SMA) was measured at the third lumbar vertebra level. Sarcopenia was defined as skeletal muscle index (SMI = SMA/height2) less than 47.24/cm2/m2 for men and 36.92/cm2/m2 for women. Association of sarcopenia with overall survival (OS) was analyzed using univariate and multivariate cox regression models.ResultsSarcopenia was observed in 94 of 184 (51.1%) patients. Sarcopenic patients had significantly higher rates of grade 3-4 toxicities compared to those without sarcopenia (36.2% vs 21.1%, p = 0.034). The survival rate at 12 and 24 months was 36.2% and 3.2% in the sarcopenic patients and 57.8% and 17.8% in the non-sarcopenic patients (p < 0.001). Multivariate cox regression analysis showed that sarcopenia was significantly associated with decreased OS (HR = 1.729, 95% CI 1.231-2.428, p = 0.002).ConclusionsSarcopenia is an independent indicator of poor survival in postoperative locoregional recurrent ESCC patients treated with CRT. Early nutritional interventions before treatment may improve the prognosis.
Highlights
Esophageal cancer (EC) is one of the most common cancers worldwide and esophageal squamous cell carcinoma (ESCC) accounts for about 70% of all cases [1]
Our aim was to investigate the prevalence of sarcopenia in postoperative recurrent esophageal squamous cell carcinoma (ESCC) patients receiving chemoradiotherapy (CRT) and evaluate associations with treatment-related toxicity and prognosis
Multivariate cox regression analysis showed that sarcopenia was significantly associated with decreased overall survival (OS) (HR = 1.729, 95% CI 1.231-2.428, p = 0.002)
Summary
Esophageal cancer (EC) is one of the most common cancers worldwide and esophageal squamous cell carcinoma (ESCC) accounts for about 70% of all cases [1]. 43%-53% of patients develop locoregional recurrence or distant metastasis [5]. For these patients, palliative chemotherapy or chemoradiotherapy (CRT) are commonly used to control cancer-related symptoms and prolong survival. Palliative chemotherapy or chemoradiotherapy (CRT) are commonly used to control cancer-related symptoms and prolong survival These approaches have been demonstrated to be effective in around 50% of patients [6], it is associated with severe hematological and gastrointestinal toxicities. Sarcopenia has been associated with treatment-related toxicities and poor survival in cancer patients. Our aim was to investigate the prevalence of sarcopenia in postoperative recurrent esophageal squamous cell carcinoma (ESCC) patients receiving chemoradiotherapy (CRT) and evaluate associations with treatment-related toxicity and prognosis
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