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Quantity and Quality of Skeletal Muscle as an Important Predictor of Clinical Outcomes in Patients with Esophageal Cancer Undergoing Esophagectomy after Neoadjuvant Chemotherapy

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Sarcopenia was previously linked to clinical outcomes for several cancer types, including esophageal cancer (EC), but most studies only measured the quantity of skeletal muscle mass. We aim to assess the clinical significance of evaluating the quantity and quality of skeletal muscle in patients with EC who underwent neoadjuvant chemotherapy (NAC) followed by esophagectomy.

Methods

We included 333 consecutive patients with EC who underwent NAC followed by esophagectomy. The psoas muscle index (PMI) and intracellular muscle adipose tissue content (IMAC) were measured by computed tomography. We defined low PMI combined with high IMAC as severe sarcopenia, and assessed its impact on clinical outcomes.

Results

Thirty-seven patients (11.1%) had severe sarcopenia. Compared with patients without severe sarcopenia, those with severe sarcopenia showed a significantly worse NAC response rate (54.1% vs 74.7%; P = 0.008), worse pathological response rate (24.3% vs 40.2%, P = 0.061), higher morbidity rate (67.6% vs 38.5%; P = 0.001), particularly for pneumonia (32.4% vs 14.9% P = 0.007) and expectoration disorder (37.8% vs 13.5% P < 0.001), and unfavorable survival (3-year overall survival rate: 54.1% vs 66.6% P = 0.027). Multivariable analysis of overall survival showed that severe sarcopenia (HR 1.68, P = 0.025) and cT (HR 1.52, P = 0.032) were independent prognostic factors of poor outcome.

Conclusions

PMI combined with IMAC represents a new criterion for sarcopenia that might be useful for predicting NAC response, postoperative complications, and long-term survival in patients with EC undergoing multidisciplinary treatments.

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Data Availability

The data that support the findings of this study are available on request from the corresponding author, Tomoki Makino. The data are not publicly available due to their containing information that could compromise the privacy of research participants.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan

    Tomo Ishida MD, Tomoki Makino MD, PhD, FACS, Makoto Yamasaki MD, PhD, Kotaro Yamashita MD, PhD, Koji Tanaka MD, PhD, Takuro Saito MD, PhD, Kazuyoshi Yamamoto MD, PhD, Tsuyoshi Takahashi MD, PhD, Yukinori Kurokawa MD, PhD, Kiyokazu Nakajima MD, PhD, Hidetoshi Eguchi MD, PhD & Yuichiro Doki MD, PhD

  2. Department of Surgery, Osaka General Medical Center, Osaka, Japan

    Masaaki Motoori MD, PhD

  3. Department of Surgery, Faculty of Medicine, Kinki University, Osaka, Japan

    Yutaka Kimura MD, PhD

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Corresponding author

Correspondence to Tomoki Makino MD, PhD, FACS.

Ethics declarations

The authors declare that they have no conflict of interest.

Ethics Approval and Consent to Participate

The Human Ethics Review Committee of Osaka University Graduate School of Medicine approved the protocol for this retrospective study, and each participant provided signed consent. All procedures were in accordance with the Declaration of Helsinki.

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Consent for publication has been obtained from individuals whose data are included in this paper.

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10434_2021_10025_MOESM3_ESM.tiff

Supplementary file3. Figure S1:Overall and recurrence free survival in patients treated foresophageal carcinoma, classified by either the PMI or the IMAC value. Red lines indicatepatients with normal values. Blue lines indicate patients with low PMI or high IMAC values.(A, D O verall survival , B, E ) recurrence free survival , and (C,F) cancer specific survivalPMI: psoas muscle index; IMAC: intramuscular adipose tissue content (TIFF 32221 kb)

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Ishida, T., Makino, T., Yamasaki, M. et al. Quantity and Quality of Skeletal Muscle as an Important Predictor of Clinical Outcomes in Patients with Esophageal Cancer Undergoing Esophagectomy after Neoadjuvant Chemotherapy. Ann Surg Oncol 28, 7185–7195 (2021). https://doi.org/10.1245/s10434-021-10025-x

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