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Decreases in the Psoas Muscle Index Correlate More Strongly with Survival than Other Prognostic Markers in Esophageal Cancer After Neoadjuvant Chemoradiotherapy Plus Esophagectomy

World Journal of Surgery volume 44, pages 1559–1568 (2020)Cite this article

Abstract

Background

Despite wide acknowledgement of the importance of sarcopenia and prognostic markers such as the neutrophil-to-lymphocyte ratio, the impact on cancer patient survival of the timing of sarcopenia’s emergence and its severity is not well understood, nor is the association between sarcopenia and prognostic markers. The aim of this study, therefore, was to investigate the effect of the severity and timing of changes in the psoas muscle index (PMI) on survival of advanced esophageal squamous cell carcinoma (ESCC) patients receiving neoadjuvant chemoradiotherapy (NACRT) plus esophagectomy and the association between PMI and known prognostic markers.

Methods

Included in this study were 113 ESCC patients who underwent NACRT followed by esophagectomy. PMI and prognostic markers were measured at their initial visit, just before surgery (after NACRT), and 3 months postoperatively.

Results

All patients were classified into four groups according to the percent decrease in PMI after NACRT and after NACRT plus esophagectomy. Patients exhibiting a larger PMI decrease (≥20%) after NACRT plus esophagectomy had significantly poorer overall survival than those showing a smaller PMI decrease. Furthermore, multivariable analysis showed that a larger decrease in PMI after NACRT plus esophagectomy was a significant risk factor for overall (P < 0.0001) and recurrence-free (P = 0.0097) survival. Neither pretherapeutic PMI nor a decrease in PMI after NACRT significantly affected survival. PMI also showed weak, but significant, correlations with several prognostic markers postoperatively.

Conclusions

Decreased PMI after NACRT plus esophagectomy is a strong prognostic indicator in ESCC patients.

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Acknowledgements

This work was supported, in part, by Grants-in-Aid for Scientific Research from the Ministry of Education, Culture, Science, Sports and the Japan Science and Technology Agency.

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The authors have received no grant support or other forms of assistance.

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Affiliations

  1. Department of General Thoracic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan

    Yuta Kawakita, Satoru Motoyama, Yusuke Sato, Akiyuki Wakita, Yushi Nagaki, Kazuhiro Imai & Yoshihiro Minamiya

  2. Department of Comprehensive Cancer Control, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan

    Satoru Motoyama

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  1. Yuta Kawakita
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  2. Satoru Motoyama
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Correspondence to Yuta Kawakita.

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Informed consent for use of their clinical information in future medical research was obtained from all patients prior to surgery.

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This retrospective single-center observational study was approved by the Ethics Committee of Akita University (Approval Number: 547).

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Kawakita, Y., Motoyama, S., Sato, Y. et al. Decreases in the Psoas Muscle Index Correlate More Strongly with Survival than Other Prognostic Markers in Esophageal Cancer After Neoadjuvant Chemoradiotherapy Plus Esophagectomy. World J Surg 44, 1559–1568 (2020). https://doi.org/10.1007/s00268-019-05344-w

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