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

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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.

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References

  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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. Klein CA, Stoecklein NH. Lessons from an aggressive cancer: evolutionary dynamics in esophageal carcinoma. Cancer Res. 2009;69:5285–8.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  10. Kleinberg L, Forastiere AA. Chemoradiation in the management of esophageal cancer. J Clin Oncol. 2007;25:4110–7.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  15. Japan Esophageal Society. Japanese Classification of Esophageal Cancer. 10th ed. Tokyo: Kanehara; 2008.

    Google Scholar 

  16. Sobin L, Gospodarowicz M, Wittekind C. TNM classification of malignant tumors. 7th ed. Oxford: Wiley; 2010.

    Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

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Acknowledgements

This study did not receive funding from any organization.

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Authors and Affiliations

  1. Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522, Nara, Japan

    Naoki Kamitani, Kazuhiro Migita, Sohei Matsumoto, Kohei Wakatsuki, Tomohiro Kunishige, Hiroshi Nakade, Shintaro Miyao & Masayuki Sho

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  1. Naoki Kamitani
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  2. Kazuhiro Migita
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  3. Sohei Matsumoto
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  4. Kohei Wakatsuki
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Correspondence to Naoki Kamitani.

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Kamitani, N., Migita, K., Matsumoto, S. et al. Association of skeletal muscle loss with the long-term outcomes of esophageal cancer patients treated with neoadjuvant chemotherapy. Surg Today 49, 1022–1028 (2019). https://doi.org/10.1007/s00595-019-01846-1

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  • DOI: https://doi.org/10.1007/s00595-019-01846-1

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