T. Makino1, T. Ishida1, K. Tanaka1, M. Yamasaki1, M. Mori1, Y. Doki1 1Osaka University,Gastroenterological Surgery,Suita, OSAKA, Japan
Introduction: Although some studies reported the association of sarcopenia with clinical outcomes of maltiple types of cancers, the association remains to be elucidated in esophageal cancer (EC). The aim of this study was to clarify the influence of muscle mass measurement on the clinical outcomes of multidisciplinary treatments for patients with esophageal cancer (EC).
Methods: A total of 165 EC patients who underwent neoadjuvant chemotherapy (NAC) followed by esophagectomy were analyzed. The cross-sectional area of psoas muscle was measured by computed tomography at third lumbar vertebra and the Psoas Muscle Index (PMI) was calculated (adjusted by height) . Pre- and post-NAC PMI were evaluated to investigate their associations with response and adverse events of NAC and postoperative complications in addition to long-term survivals. The cut-off values of PMI were set at 6.36 cm2/m2 for male and 3.92 cm2/m2 for female, which has been reported as PMI values of "healthy" subjects.
Results: The PMI significantly decreased after NAC from 7.17 to 6.96 cm2/m2 (p=0.0008) , particularly in males (from 7.45 to 7.23 cm2/m2, P=0.0001), while PMI showed no fluctuation in females (from 5.21 to 5.17 cm2/m2, P=0.810). Pre-NAC PMI (low vs high group) was significantly associated with clinical response to NAC (response rate 65.1 vs 80.3%; P=0.0494), adverse events of NAC (neutropenia: 93.0 vs 78.7%; P=0.0337, febrile neutropenia: 53.5 vs 34.3%; P=0.0278, and hyponatremia: 51.2 vs 31.2 %; P=0.0190). Meanwhile, post-NAC PMI correlated with development of overall postoperative complications (56.9 vs 33.3%; P=0.0046), in particular, pneumonia (31.4 vs 9.7% P=0.0008). Neither pre- nor post-NAC PMI was associated with patient survival.
Conclusion: Sarcopenia determined by PMI measurement via CT before and after NAC could be used to predict tumor response, adverse events of NAC, and postoperative complications in multidisciplinary treatments for EC patients.