Prognostic Significance of Sarcopenia in Patients with Unresectable Advanced Esophageal Cancer.

Sachiyo Onishi,Yasumasa Niwa,Kei Muro,Nobumasa Mizuno,Masahiro Tajika,Tetsuya Abe,Kazuo Hara,Takeshi Kodaira,Takamichi Kuwahara,Yoshitaka Inaba,Tsutomu Tanaka,Masahito Shimizu,Yutaka Hirayama,Nozomi Okuno

doi:10.3390/jcm8101647

Sachiyo Onishi, Yasumasa Niwa + Show 12 more

Open Access

https://doi.org/10.3390/jcm8101647

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Abstract

The prognostic significance of sarcopenia in unresectable advanced esophageal cancer remains unclear. Our study retrospectively evaluated 176 consecutive Japanese patients with esophageal squamous cell carcinoma who had been diagnosed with unresectable advanced cancer in Aichi Cancer Center Hospital between January 2007 and December 2014. Skeletal muscle mass was calculated from abdominal computed tomography (CT) scans before treatment, and patients were divided into sarcopenic and non-sarcopenic groups. Sarcopenia was present in 101 patients (57.4%). Eighty-two patients in the sarcopenic group and 63 patients in the non-sarcopenic group died during follow-up (mean: 20.3 months). The overall survival (OS) rate was significantly lower in the sarcopenic group compared to the non-sarcopenic group (2-year OS: 9.8% vs. 23.7%, p < 0.01). Cox regression analysis revealed only pretreatment sarcopenia as an independent prognostic factor (hazard ratio (HR): 1.48, 95% confidence interval (CI): 1.04–2.10, p = 0.03). In the sarcopenic group, withdrawn cases, for whom the planned treatment was discontinued for some reason, showed a significantly lower OS rate compared to complete cases (1-year OS: 11.0% vs. 59.9%, p < 0.01). The most common reason for discontinuation was aspiration pneumonia (64.5%). Presence of sarcopenia was an independent prognostic factor for unresectable advanced esophageal cancer. Identifying the presence of sarcopenia prior to treatment may improve the prognosis.

Highlights

Esophageal cancer is the sixth most common cause of cancer-related deaths worldwide [1]
A recent comprehensive systematic review and meta-analysis of 11 cohort studies consisting of a total of 1520 patients with esophageal cancer after esophagectomy showed that patients with sarcopenia correlated significantly with lower 3- and 5-year overall survival (OS) rates compared to patients without sarcopenia [20,21]
We investigated the prevalence of sarcopenia and the impact of sarcopenia on OS in patients with unresectable advanced esophageal cancer

Summary

Introduction

Esophageal cancer is the sixth most common cause of cancer-related deaths worldwide [1]. Curative surgery is the standard treatment for patients with resectable esophageal cancer, about 50% of patients with esophageal cancer have unresectable advanced tumor due to radiographically visible metastases. Treatment for such patients is commonly palliative chemotherapy to prolong survival, but response rates are 35–45%, and survival is typically prolonged by only a few months [2]. Secondary sarcopenia related to malignant disease has been reported in recent years and has been recognized as indicating poor prognosis in patients with various malignancies [6,7,8,9,10,11,12], including lung, gastrointestinal, pancreatic, hepatic, breast, urothelial, and colorectal cancers. We examined the prevalence of sarcopenia in unresectable advanced esophageal cancer and investigated the impact on prognosis

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