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European Radiology
Published in: European Radiology 5/2016

01-05-2016 | Gastrointestinal

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

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

Published in: European Radiology | Issue 5/2016

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Abstract

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.
Appendix
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Metadata
Title
Markers of sarcopenia quantified by computed tomography predict adverse long-term outcome in patients with resected oesophageal or gastro-oesophageal junction cancer
Authors
Dietmar Tamandl
Matthias Paireder
Reza Asari
Pascal A. Baltzer
Sebastian F. Schoppmann
Ahmed Ba-Ssalamah
Publication date
01-05-2016
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 5/2016
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-015-3963-1

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