Abstract
Backgrounds: The relationship between sarcopenia, characterized by loss of muscle mass and strength, and survival outcomes of esophageal cancer is controversial. This study aimed to assess the effect of sarcopenia and skeletal muscle loss on overall survival (OS) and recurrence-free survival (RFS) of esophageal cancer patients. Methods: We retrospectively collected the medical records of 248 male patients diagnosed with squamous cell esophageal cancer and who underwent neoadjuvant chemoradiotherapy (NACRT) followed by surgery. We measured the cross-sectional area of the skeletal muscle at the L3 vertebra level using computed tomography images and calculated the skeletal muscle index (SMI). Sarcopenia was defined as SMI <52.4 cm2/m2, and excessive muscle loss was defined as SMI change <−10.0%/50 days during NACRT. Moreover, laboratory test results, such as albumin, prognostic nutritional index (PNI), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) before and after NACRT, were collected. Results: In the univariable Cox analysis, pre- (p = 0.689) and post-radiotherapy (RT) sarcopenia (p = 0.669) were not associated with OS. However, excessive muscle loss had a significant association with OS in both the univariable and multivariable analyses (all p = 0.001). Excessive muscle loss was also related to RFS in both the univariable (p = 0.011) and multivariable (p = 0.022) Cox analysis. Patients with excessive muscle loss had significantly lower levels of post-RT albumin (p < 0.001) and PNI (p < 0.001), higher levels of post-RT NLR (p = 0.031) and PLR (p = 0.071), larger decrease in albumin (p < 0.001) and PNI (p < 0.001) after NACRT, and larger increase in NLR (p = 0.051) and PLR (p = 0.088) after NACRT than in those with non-excessive muscle loss. Conclusion: Excessive muscle loss rather than pre- and post-RT sarcopenia was a significant prognostic factor for OS and RFS, and it was also related to nutritional and inflammatory markers.
Highlights
Esophageal cancer is the sixth leading cause of cancer-related deaths worldwide [1]
This study aimed to assess whether sarcopenia and loss of skeletal muscle affected survival outcomes of esophageal cancer patients who received neoadjuvant chemoradiotherapy (NACRT) followed by surgery
This study investigated the effect of sarcopenia and skeletal muscle loss during NACRT on survival outcomes of esophageal cancer patients who received NACRT followed by surgery
Summary
Esophageal cancer is the sixth leading cause of cancer-related deaths worldwide [1]. the combination of neoadjuvant chemoradiotherapy (NACRT) and surgery improved overall survival (OS)and was adopted as a standard treatment for advanced thoracic esophageal cancer [2], esophageal cancer remains an aggressive and fatal disease [3]. Malnutrition is a critical issue that contributes to poor treatment outcomes in esophageal cancer patients [4]. Recent studies on relationships among nutrition, inflammation, and cancer have revealed that nutritional status affects the immunologic reaction and treatment response to cancer therapy [5]. Clinicians and researchers have recently focused on sarcopenia, a condition characterized by the loss of muscle mass and strength in cancer patients [7]. Using computed tomography (CT)-based analysis, which is one of the most commonly used methods for evaluating muscle mass, recent studies reported that sarcopenia is a risk factor associated with poor survival of patients with various types of tumors [12,13,14]
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