Advertisement

Surgery Today

, Volume 49, Issue 12, pp 1022–1028 | Cite as

Association of skeletal muscle loss with the long-term outcomes of esophageal cancer patients treated with neoadjuvant chemotherapy

  • Naoki KamitaniEmail author
  • Kazuhiro Migita
  • Sohei Matsumoto
  • Kohei Wakatsuki
  • Tomohiro Kunishige
  • Hiroshi Nakade
  • Shintaro Miyao
  • Masayuki Sho
Original Article
  • 142 Downloads

Abstract

Purpose

To investigate the change in skeletal muscle mass and evaluate the prognostic impact of sarcopenia on esophageal cancer (EC) patients

Methods

The subjects of this retrospective study were 90 EC patients who were treated with neoadjuvant chemotherapy (NAC) and subsequent esophagectomy. The skeletal muscle index (SMI) was defined according to computed tomography (CT) imaging of the total cross-sectional muscle tissue, measured at the third lumbar level using a volume analyzer before NAC and surgery. The SMI was calculated by normalization according to height, and skeletal muscle loss (SML) was defined as (pre-NAC SMI value − preoperative SMI value) × 100/pre-NAC SMI.

Results

Sarcopenia was evident in 72 (80.0%) patients before NAC and 77 (85.6%) patients before NAC and surgery. The SMI value was decreased in 28 (68.9%) patients and the median SML was 3.3%. The 3-year overall survival rate was 68.9% in the low SML group and 0% in the high SML group (P < 0.001). Sarcopenia before NAC or surgery was not significantly associated with overall survival. Multivariable analysis identified high SML as an independent prognostic factor.

Conclusions

These results suggest that skeletal muscle loss is associated with a worse long-term outcome for EC patients treated with NAC.

Keywords

Esophageal cancer Sarcopenia Neoadjuvant chemotherapy 

Notes

Acknowledgements

This study did not receive funding from any organization.

Compliance with ethical standards

Conflict of interest

We have no conflicts of interest to declare.

References

  1. 1.
    Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on sarcopenia in older people. Age Ageing. 2010;39:412–23.CrossRefGoogle Scholar
  2. 2.
    Harimoto N, Shirabe K, Yamashita YI, Ikegami T, Yoshizumi T, Soejima Y, et al. Sarcopenia as a predictor of prognosis in patients following hepatectomy for hepatocellular carcinoma. Br J Surg. 2013;100:1523–30.CrossRefGoogle Scholar
  3. 3.
    Miyamoto Y, Baba Y, Sakamoto Y, Ohuchi M, Tokunaga R, Kurashige J, et al. Sarcopenia is a negative prognostic factor after curative resection of colorectal cancer. Ann Surg Oncol. 2015;22:2663–8.CrossRefGoogle Scholar
  4. 4.
    Murimwa GZ, Venkat PS, Jin W, Leuthold S, Latifi K, Almhanna K, et al. Impact of sarcopenia on outcomes of locally advanced esophageal cancer patients treated with neoadjuvant chemoradiation followed by surgery. J Gastrointest Oncol. 2017;8:808–15.CrossRefGoogle Scholar
  5. 5.
    Ota T, Ishikawa T, Endo Y, Matsumura S, Yoshida J, Yasuda T, et al. Skeletal muscle mass as a predictor of the response to neo-adjuvant chemotherapy in locally advanced esophageal cancer. Med Oncol. 2019;36:15.CrossRefGoogle Scholar
  6. 6.
    Paireder M, Asari R, Kristo I, Rieder E, Tamandl D, Ba-Ssalamah A, et al. Impact of sarcopenia on outcome in patients with esophageal resection following neoadjuvant chemotherapy for esophageal cancer. Eur J Surg Oncol. 2017;43:478–84.CrossRefGoogle Scholar
  7. 7.
    Fukushima H, Kataoka M, Nakanishi Y, Sakamoto K, Takemura K, Suzuki H, et al. Posttherapeutic skeletal muscle mass recovery predicts favorable prognosis in patients with advanced urothelial carcinoma receiving first-line platinum-based chemotherapy. Urol Oncol. 2018;36(156):e9–16.Google Scholar
  8. 8.
    Klein CA, Stoecklein NH. Lessons from an aggressive cancer: evolutionary dynamics in esophageal carcinoma. Cancer Res. 2009;69:5285–8.CrossRefGoogle Scholar
  9. 9.
    Cunningham D, Allum WH, Stenning SP, Thompson JN, Van de Velde CJH, Nicolson M, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006;355:11–20.CrossRefGoogle Scholar
  10. 10.
    Kleinberg L, Forastiere AA. Chemoradiation in the management of esophageal cancer. J Clin Oncol. 2007;25:4110–7.CrossRefGoogle Scholar
  11. 11.
    Yamasaki M, Yasuda T, Yano M, Hirao M, Kobayashi K, Fujitani K, et al. Multicenter randomized phase II study of cisplatin and fluorouracil plus docetaxel (DCF) compared with cisplatin and fluorouracil plus Adriamycin (ACF) as preoperative chemotherapy for resectable esophageal squamous cell carcinoma (OGSG1003). Ann Oncol. 2017;28:116–20.CrossRefGoogle Scholar
  12. 12.
    Liu J, Motoyama S, Sato Y, Wakita A, Kawakita Y, Saito H, et al. Decreased skeletal muscle mass after neoadjuvant therapy correlates with poor prognosis in patients with esophageal cancer. Anticancer Res. 2016;36:6677–86.CrossRefGoogle Scholar
  13. 13.
    Jarvinen T, Ilonen I, Kauppi J, Salo J, Rasanen J. Loss of skeletal muscle mass during neoadjuvant treatments correlates with worse prognosis in esophageal cancer: a retrospective cohort study. World J Surg Oncol. 2018;16:27.CrossRefGoogle Scholar
  14. 14.
    Okuno M, Goumard C, Kopetz S, Vega EA, Joechle K, Mizuno T, et al. Loss of muscle mass during preoperative chemotherapy as a prognosticator for poor survival in patients with colorectal liver metastases. Surgery. 2019;165:329–36.CrossRefGoogle Scholar
  15. 15.
    Japan Esophageal Society. Japanese Classification of Esophageal Cancer. 10th ed. Tokyo: Kanehara; 2008.Google Scholar
  16. 16.
    Sobin L, Gospodarowicz M, Wittekind C. TNM classification of malignant tumors. 7th ed. Oxford: Wiley; 2010.Google Scholar
  17. 17.
    Prado CM, Lieffers JR, McCargar LJ, Reiman T, Sawyer MB, Martin L, et al. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol. 2008;9:629–35.CrossRefGoogle Scholar
  18. 18.
    Grotenhuis BA, Shapiro J, van Adrichem S, de Vries M, Koek M, Wijnhoven Bas PL, et al. Sarcopenia/muscle mass is not a prognostic factor for short- and long-term outcome after esophagectomy for cancer. World J Surg. 2016;40:2698–704.CrossRefGoogle Scholar
  19. 19.
    Mayanagi S, Tsubosa Y, Omae K, Niihara M, Uchida T, Tsushima T, et al. Negative impact of skeletal muscle wasting after neoadjuvant chemotherapy followed by surgery on survival for patients with thoracic esophageal cancer. Ann Surg Oncol. 2017;24:3741–7.CrossRefGoogle Scholar
  20. 20.
    Evans WJ, Morley JE, Argiles J, Bales C, Baracos V, Guttridge D, et al. Cachexia: a new definition. Clin Nutr. 2008;27:793–9.CrossRefGoogle Scholar
  21. 21.
    Sato S, Kunisaki C, Suematsu H, Tanaka Y, Miyamoto H, Kosaka T, et al. Impact of sarcopenia in patients with unresectable locally advanced esophageal cancer receiving chemoradiotherapy. Vivo. 2018;32:603–10.Google Scholar
  22. 22.
    Yip C, Goh V, Davies A, Gossage J, Mitchell-Hay R, Hynes O, et al. Assessment of sarcopenia and changes in body composition after neoadjuvant chemotherapy and associations with clinical outcomes in oesophageal cancer. Eur Radiol. 2014;24:998–1005.CrossRefGoogle Scholar
  23. 23.
    Awad S, Tan BH, Cui H, Bhalla A, Fearon KC, Parsons SL, et al. Marked changes in body composition following neoadjuvant chemotherapy for oesophagogastric cancer. Clin Nutr. 2012;31:74–7.CrossRefGoogle Scholar
  24. 24.
    Ryan AM, Reynolds JV, Healy L, Byrne M, Moore J, Brannelly N, et al. Enteral nutrition enriched with eicosapentaenoic acid (EPA) preserves lean body mass following esophageal cancer surgery: results of a double-blinded randomized controlled trial. Ann Surg. 2009;249:355–63.CrossRefGoogle Scholar
  25. 25.
    Ritch CR, Cookson MS, Clark PE, Chang SS, Fakhoury K, Ralls V, et al. Perioperative oral nutrition supplementation reduces prevalence of sarcopenia following radical cystectomy: results of a prospective randomized controlled trial. J Urol. 2019;201:470–7.CrossRefGoogle Scholar
  26. 26.
    Koya S, Kawaguchi T, Hashida R, Hirota K, Bekki M, Goto E, et al. Effects of in-hospital exercise on sarcopenia in hepatoma patients who underwent transcatheter arterial chemoembolization. J Gastroenterol Hepatol. 2019;34:580–8.PubMedGoogle Scholar
  27. 27.
    Suzuki G, Yamazaki H, Ogo E, Abe T, Eto H, Murai K, et al. Multimodal approach for cervical esophageal carcinoma: role of neoadjuvant chemotherapy. Anticancer Res. 2014;34:1989–92.PubMedGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Naoki Kamitani
    • 1
    Email author
  • Kazuhiro Migita
    • 1
  • Sohei Matsumoto
    • 1
  • Kohei Wakatsuki
    • 1
  • Tomohiro Kunishige
    • 1
  • Hiroshi Nakade
    • 1
  • Shintaro Miyao
    • 1
  • Masayuki Sho
    • 1
  1. 1.Department of SurgeryNara Medical UniversityKashiharaJapan

Personalised recommendations