Abstract
BackgroundThe prognostic value of a low skeletal mass index (SMI) has been investigated in locally advanced oesophageal (LAE) cancer at diagnosis. However, nothing is known about its evolution and clinical impact between initial diagnosis and recurrence.MethodsA total of 89 patients treated for LAE cancer between January 2009 and December 2019 were included in this study. Computed tomography (CT) scans before treatment and at recurrence were evaluated. SMI and other body composition parameters were analysed by the L3 scan method.ResultsParticipants were aged 66.0 (36.0–86) years. The incidence of low SMI increased by 12.3% between diagnosis and recurrence (70.7% vs. 83.0%, respectively) over a median follow-up of 16.9 (1.7–101.6) months. Patients with high SMI at diagnosis showed loss of muscle mass (58.0 vs. 55.2 cm2/m2, respectively; P < 0.001) and decreased body mass index (BMI) (27.9 vs. 26.3 kg/m2, respectively; P = 0.05), but fat mass was increased (68.9 vs. 72.0 cm2/m2, respectively; P = 0.01). Patients with low SMI at diagnosis showed no significant changes in body composition parameters and no improvement of SMI, even with nutritional support. Low SMI (hazard ratio [HR]: 1.8; 95% confidence interval [CI]: 1.02–3.16) was an independent predictor (P = 0.041) of high nutritional risk index (HR: 1.79; 95% CI: 1.03–3.11; P = 0.039) at diagnosis.ConclusionsThe percentage of patients with a low SMI increased during follow-up. Our data suggest that an assessment of skeletal muscle parameters and nutrition support may be more useful in patients with a high SMI.
Highlights
The prognostic value of a low skeletal mass index (SMI) has been investigated in locally advanced oesophageal (LAE) cancer at diagnosis
It was previously shown that assessment of skeletal muscle mass (SMM) using the cross-sectional area of a single vertebral slice at lumbar L3 thanks computed tomography (CT) scan is well correlated with whole-body skeletal muscle volume
We evaluated the change of skeletal muscle mass between the time of initial diagnosis and recurrence in patients with locally advanced oesophageal cancer
Summary
The prognostic value of a low skeletal mass index (SMI) has been investigated in locally advanced oesophageal (LAE) cancer at diagnosis. It was previously shown that assessment of SMM using the cross-sectional area of a single vertebral slice at lumbar L3 thanks computed tomography (CT) scan is well correlated with whole-body skeletal muscle volume. Prado et al showed for the first time that muscle loss at the start of treatment, as assessed by L3 (CT scan), is a poor prognostic factor for solid tumours [9]. It is important to note that in most studies, sarcopenia is considered to be the same as low skeletal muscle mass (SMM) even though their definition is somewhat different
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