Journal Article

Markers of sarcopenia quantified by computed tomography predict adverse long-term outcome in patients with resected oesophageal or gastro-oesophageal junction cancer

Baltzer, Pascal A., Paireder, Matthias, Asari, Reza, Ba-Ssalamah, Ahmed, Tamandl, Dietmar, Schoppmann, Sebastian F.

2016

Overview

Objectives To assess the impact of sarcopenia and alterations in body composition parameters (BCPs) on survival after surgery for oesophageal and gastro-oesophageal junction cancer (OC). Methods 200 consecutive patients who underwent resection for OC between 2006 and 2013 were selected. Preoperative CTs were used to assess markers of sarcopenia and body composition (total muscle area [TMA], fat-free mass index [FFMi], fat mass index [FMi], subcutaneous, visceral and retrorenal fat [RRF], muscle attenuation). Cox regression was used to assess the primary outcome parameter of overall survival (OS) after surgery. Results 130 patients (65 %) had sarcopenia based on preoperative CT examinations. Sarcopenic patients showed impaired survival compared to non-sarcopenic individuals (hazard ratio [HR] 1.87, 95 % confidence interval [CI] 1.15–3.03, p = 0.011). Furthermore, low skeletal muscle attenuation (HR 1.91, 95 % CI 1.12–3.28, p = 0.019) and increased FMi (HR 3.47, 95 % CI 1.27–9.50, p = 0.016) were associated with impaired outcome. In the multivariate analysis, including a composite score (CSS) of those three parameters and clinical variables, only CSS, T-stage and surgical resection margin remained significant predictors of OS. Conclusion Patients who show signs of sarcopenia and alterations in BCPs on preoperative CT images have impaired long-term outcome after surgery for OC. Key Points • Sarcopenia is associated with impaired OS after surgery for oesophageal cancer . • Other body composition parameters are also associated with impaired survival . • This influence on survival is independent of established clinical parameters . • Sarcopenia provides a better estimation of cachexia than BMI . • Sarcopenia assessment could be considered in risk / benefit stratification before oesophagectomy .

• Publisher: Springer Berlin Heidelberg,Springer Nature B.V
• Subject: Aged / Body composition / Body mass index / Diagnostic Radiology / Esophageal cancer / Esophageal Neoplasms - surgery / Esophagectomy / Esophagogastric Junction - surgery / Esophagus - surgery / Female / Gastrointestinal / Humans / Imaging / Internal Medicine / Interventional Radiology / Male / Medicine / Medicine & Public Health / Middle Aged / Morbidity / Mortality / Musculoskeletal system / Neuroradiology / Patients / Postoperative Complications - diagnostic imaging / Prognosis / Proportional Hazards Models / Radiology / Retrospective Studies / Sarcopenia / Sarcopenia - diagnostic imaging / Stomach Neoplasms - surgery / Surgery / Survival Analysis / Tomography / Tomography, X-Ray Computed / Treatment Outcome / Ultrasound / Vertebrae