Abstract
BackgroundSarcopenia is defined by a loss of skeletal muscle mass with or without loss of fat mass. Sarcopenia has been associated to reduced tolerance to treatment and worse prognosis in cancer patients, including patients undergoing surgery for limited oesophageal cancer. Concomitant chemo-radiotherapy is the standard treatment for locally-advanced tumour, not accessible to surgical resection. Using automated delineation of the skeletal muscle, we have investigated the prognostic value of sarcopenia in locally advanced oesophageal cancer (LAOC) patients treated by curative-intent chemo-radiotherapy.MethodsThe clinical, nutritional, anthropometric, and functional-imaging (18FDG-PET/CT) data were collected in 97 patients treated between 2006 and 2012 in our institution. The skeletal muscle area was automatically delineated on cross-sectional CT images acquired at the 3rd. lumbar vertebra level and divided by the patient’s squared height (SML3/h2) to obtain the Skeletal Muscle Index (SMI). The primary endpoint was overall survival probability.ResultsSeventy-six deaths were reported. The median survival time was 27 [95% Confidence Interval 23–40] months for the whole population. Univariate analyses (Cox Proportional Hazard Model) showed decreased survival probabilities in patients with reduced SMI, WHO > 0, Body Mass Index ≤21, and Nutritional Risk Index ≤97.5. Multivariate analyses showed that sarcopenia was the only significant prognostic factor (HR 2.32 [1.24–4.34], p = 0.008). Using Receiver Operating Characteristics curves, the Area Under the Curve (AUC) was 0.73 in males (p = 0.0002], the optimal threshold being 51.5 cm2/m2. In women, the AUC was 0.65 (p = 0.19).ConclusionSarcopenia is a powerful independent prognostic factor, associated with a rise of the overall mortality in patients treated exclusively by radiochemotherapy for a locally advanced oesophageal cancer. L3 CT images are easily gathered from 18FDG-PET/CT acquisitions.
Highlights
Oesophageal cancer is the 19th most common cancer in the European Union (EU) [1], with 45 900 new cases diagnosed in 2012
The main histology is Oesophageal Squamous Cell Carcinoma (SCC), which represents 90% of oesophageal cancers worldwide, and Oesophageal Adenocarcinoma (OA), of which mortality rate has increased in several countries in the EU [2]
Di Fiore et al showed that baseline nutritional status was predictive of response to treatment and survival in patients treated by definitive chemoradiotherapy for a locally advanced esophageal cancer (LAOC) [9]
Summary
Oesophageal cancer is the 19th most common cancer in the European Union (EU) [1], with 45 900 new cases diagnosed in 2012. For patients with limited disease, the reference treatment is surgical resection [3]. For patients unable to undergo surgery, because of a locally advanced disease or a surgical contraindication, the reference treatment is chemoradiotherapy [3, 4], i.e. a combination of FOLFOX/ cisplatin-FU and 5-6 weeks radiotherapy (1.8-2 Gy/fraction, 5 days per week) [3]. Di Fiore et al showed that baseline nutritional status was predictive of response to treatment and survival in patients treated by definitive chemoradiotherapy for a locally advanced esophageal cancer (LAOC) [9]. Using automated delineation of the skeletal muscle, we have investigated the prognostic value of sarcopenia in locally advanced oesophageal cancer (LAOC) patients treated by curative-intent chemo-radiotherapy.
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