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Prognostic Impact of the Loss of Skeletal Muscle Mass During Neoadjuvant Chemotherapy on Older Patients with Esophageal Cancer

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

Abstract

Background

In older adults, skeletal muscle mass is an important factor for health and prognosis. The loss of SMM during neoadjuvant therapy affects the prognosis of patients with locally advanced esophageal cancer. However, information is limited regarding this possibility in older patients. This study aimed to establish the prognostic impact of SMM loss during neoadjuvant chemotherapy on older patients with locally advanced esophageal cancer.

Methods

This was a single-center retrospective cohort study. Patients age 65 years or older had undergone R0 curative esophagectomy after NAC. The skeletal muscle mass index before and after NAC was calculated from computed tomography images. The percentage change in the SMI during NAC (SMI%) was calculated from the SMI before and after NAC.

Results

The study analyzed 150 patients with a mean age of 71.1 ± 3.7 years. The mean value of the SMI was 42.7 ± 7.2 cm2/m2 before NAC, and the SMI% was − 6.4% ± 5.9%. The cutoff of SMI% for overall survival was defined by the log-rank test as − 12%. The Cox proportional hazard model showed that major loss of the SMI (≥ 12%) significantly influenced OS (hazard ratio, 2.490; 95% confidence interval, 1.121–5.529; p = 0.025) independently of age, sex, pathologic T and N factors, or treatment regimen.

Conclusions

Major SMI loss has an impact on OS after R0 curative esophagectomy for older patients with locally advanced esophageal cancer.

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Acknowledgment

The authors thank the members of the Departments of Rehabilitation Medicine, Esophageal Surgery, and Gastrointestinal Oncology for their support. This research would not have been possible without their cooperation. We thank Cathel Kerr, BSc, PhD, from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.

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Authors and Affiliations

  1. Department of Rehabilitation, National Cancer Center Hospital East, Kashiwa, Chiba, Japan

    Tsuyoshi Harada MSc, Tetsuya Tsuji MD, PhD, Junya Ueno, Yu Koishihara MSc, Nobuko Konishi MSc, Nanako Hijikata MD & Aiko Ishikawa MD, PhD

  2. Department of Rehabilitation Medicine, Keio University Graduate School, Shinjuku, Tokyo, Japan

    Tsuyoshi Harada MSc

  3. Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan

    Tetsuya Tsuji MD, PhD & Aiko Ishikawa MD, PhD

  4. Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan

    Daisuke Kotani MD, PhD & Takashi Kojima MD, PhD

  5. Department of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan

    Hisashi Fujiwara MD, PhD & Takeo Fujita MD, PhD

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  1. Tsuyoshi Harada MSc
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Correspondence to Tetsuya Tsuji MD, PhD.

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Harada, T., Tsuji, T., Ueno, J. et al. Prognostic Impact of the Loss of Skeletal Muscle Mass During Neoadjuvant Chemotherapy on Older Patients with Esophageal Cancer. Ann Surg Oncol 29, 8131–8139 (2022). https://doi.org/10.1245/s10434-022-12379-2

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