European Radiology

, Volume 26, Issue 5, pp 1359–1367 | Cite as

Markers of sarcopenia quantified by computed tomography predict adverse long-term outcome in patients with resected oesophageal or gastro-oesophageal junction cancer

  • Dietmar TamandlEmail author
  • Matthias Paireder
  • Reza Asari
  • Pascal A. Baltzer
  • Sebastian F. Schoppmann
  • Ahmed Ba-Ssalamah



To assess the impact of sarcopenia and alterations in body composition parameters (BCPs) on survival after surgery for oesophageal and gastro-oesophageal junction cancer (OC).


200 consecutive patients who underwent resection for OC between 2006 and 2013 were selected. Preoperative CTs were used to assess markers of sarcopenia and body composition (total muscle area [TMA], fat-free mass index [FFMi], fat mass index [FMi], subcutaneous, visceral and retrorenal fat [RRF], muscle attenuation). Cox regression was used to assess the primary outcome parameter of overall survival (OS) after surgery.


130 patients (65 %) had sarcopenia based on preoperative CT examinations. Sarcopenic patients showed impaired survival compared to non-sarcopenic individuals (hazard ratio [HR] 1.87, 95 % confidence interval [CI] 1.15–3.03, p = 0.011). Furthermore, low skeletal muscle attenuation (HR 1.91, 95 % CI 1.12–3.28, p = 0.019) and increased FMi (HR 3.47, 95 % CI 1.27–9.50, p = 0.016) were associated with impaired outcome. In the multivariate analysis, including a composite score (CSS) of those three parameters and clinical variables, only CSS, T-stage and surgical resection margin remained significant predictors of OS.


Patients who show signs of sarcopenia and alterations in BCPs on preoperative CT images have impaired long-term outcome after surgery for OC.

Key Points

Sarcopenia is associated with impaired OS after surgery for oesophageal cancer.

Other body composition parameters are also associated with impaired survival.

This influence on survival is independent of established clinical parameters.

Sarcopenia provides a better estimation of cachexia than BMI.

Sarcopenia assessment could be considered in risk/benefit stratification before oesophagectomy.


Computed tomography Oesophageal cancer Sarcopenia Body composition measurements Outcome analysis 



Body composition parameters


Body mass index


Composite Sarcopenia Score


Fat-free mass (index)


Fat mass (index)


Fat-to-muscle ratio


Hounsfield unit


Oesophageal cancer


Overall survival


Positron-emission tomography


Retrorenal fat


Skeletal muscle index


Total muscle area



This paper was presented as an oral presentation at RSNA 2014. The scientific guarantor of this publication is Ahmed Ba-Ssalamah. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

The authors state that this work has not received any funding. One of the authors has significant statistical expertise (Pascal A. Baltzer). Institutional Review Board approval was obtained.

Written informed consent was waived by the Institutional Review Board. No study subjects or cohorts have been previously reported. Methodology: retrospective, observational, performed at one institution.

Supplementary material

330_2015_3963_MOESM1_ESM.xlsx (12 kb)
Table S1 Upper numbers denote the R-value (Pearson regression coefficient), lower numbers are p-values SMI skeletal muscle index, FFMi free fat mass index, HU hounsfield units, FMi fat mass index, FMR fat to muscle ratio, RRF retrorental fat (XLSX 12 kb)


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Copyright information

© European Society of Radiology 2015

Authors and Affiliations

  • Dietmar Tamandl
    • 1
    Email author
  • Matthias Paireder
    • 2
  • Reza Asari
    • 2
  • Pascal A. Baltzer
    • 1
  • Sebastian F. Schoppmann
    • 2
  • Ahmed Ba-Ssalamah
    • 1
  1. 1.Department of Biomedical Imaging and Image-guided Therapy, Comprehensive Cancer Center GET-UnitMedical University of ViennaViennaAustria
  2. 2.Department of Surgery, Upper-GI-Service, Comprehensive Cancer Center GET-UnitMedical University of ViennaViennaAustria

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