Top

Published in:

Open Access 01-11-2017 | Thoracic Oncology

Negative Impact of Skeletal Muscle Wasting After Neoadjuvant Chemotherapy Followed by Surgery on Survival for Patients with Thoracic Esophageal Cancer

Authors: Shuhei Mayanagi, MD, PhD, Yasuhiro Tsubosa, MD, PhD, Katsuhiro Omae, PhD, Masahiro Niihara, MD, PhD, Tsuneyuki Uchida, MD, Takahiro Tsushima, MD, Tomoya Yokota, MD, PhD, Hiroshi Sato, MD, PhD, Tateaki Naito, MD, PhD, Hirofumi Yasui, MD

Published in: Annals of Surgical Oncology | Issue 12/2017

Abstract

Background

Skeletal muscle wasting during curative treatment is an important issue faced by esophageal cancer patients. However, it has not been clarified whether skeletal muscle change during neoadjuvant chemotherapy followed by surgery adversely affects prognosis. This study aimed to determine the relation between skeletal muscle change and survival for patients with advanced esophageal cancer who underwent neoadjuvant chemotherapy followed by surgery.

Methods

This study retrospectively analyzed 66 patients with thoracic esophageal cancer who had undergone neoadjuvant chemotherapy followed by esophagectomy. The study investigated the correlation between the change in the total muscle cross-sectional area at the third lumbar vertebra before and 4 months after surgery as well as the postoperative recurrence and overall survival (OS).

Results

Of the 66 patients, 39 (59%) showed a skeletal muscle decrease from baseline to 4 months after esophagectomy. The change in the skeletal muscle index from baseline to 4 months after surgery was −1.2 cm²/m². Multivariable analysis showed that nonsquamous cell carcinoma subtype (hazard ratio [HR] 2.57; p = 0.029), pathologic stage (HR 5.73; p < 0.01), and skeletal muscle wasting (HR per 1 unit decrease in skeletal muscle index, 1.16; p = 0.015) were the independent prognostic factors associated with worse OS. Additionally, pathologic stage (HR 6.03; p < 0.01) and skeletal muscle wasting (HR per 1 unit decrease in skeletal muscle index, 1.11; p = 0.048) also were found to be independent prognostic factors associated with worse recurrence-free survival.

Conclusions

The study findings suggest that skeletal muscle wasting from baseline has a negative impact on cancer recurrence and survival.

Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136:E359–86.CrossRefPubMed

Fearon K, Arends J, Baracos V. Understanding the mechanisms and treatment options in cancer cachexia. Nat Rev Clinl Oncol. 2013;10:90–9.CrossRef

van Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012;366:2074–84.CrossRefPubMed

Ando N, Kato H, Igaki H, et al. A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907). Ann Surg Oncol. 2012;19:68–74.CrossRefPubMed

Awad S, Tan B, Cui H, et al. Marked changes in body composition following neoadjuvant chemotherapy for oesophagogastric cancer. Clin Nutr. 2012;31:74–7.CrossRefPubMed

Sheetz KH, Zhao L, Holcombe SA, et al. Decreased core muscle size is associated with worse patient survival following esophagectomy for cancer. Dis Esophagus. 2013;26:716–22.PubMedPubMedCentral

Yip C, Goh V, Davies A, 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.CrossRefPubMed

Jung H-W, Kim JW, Kim J-Y, et al. Effect of muscle mass on toxicity and survival in patients with colon cancer undergoing adjuvant chemotherapy. Support Care Cancer. 2015;23:687–94.CrossRefPubMed

Lieffers JR, Bathe OF, Fassbender K, Winget M, Baracos VE. Sarcopenia is associated with postoperative infection and delayed recovery from colorectal cancer resection surgery. Br J Cancer. 2012;107:931–6.CrossRefPubMedPubMedCentral

10.

Reisinger KW, van Vugt JL, Tegels JJ, et al. Functional compromise reflected by sarcopenia, frailty, and nutritional depletion predicts adverse postoperative outcome after colorectal cancer surgery. Ann Surg. 2015;261:345–52.CrossRefPubMed

11.

Harimoto N, Shirabe K, Yamashita YI, et al. Sarcopenia as a predictor of prognosis in patients following hepatectomy for hepatocellular carcinoma. Br J Surg. 2013;100:1523–30.CrossRefPubMed

12.

Itoh S, Shirabe K, Matsumoto Y, et al. Effect of body composition on outcomes after hepatic resection for hepatocellular carcinoma. Ann Surg Oncol. 2014;21:3063–8.CrossRefPubMed

13.

Voron T, Tselikas L, Pietrasz D, et al. Sarcopenia impacts on short- and long-term results of hepatectomy for hepatocellular carcinoma. Ann Surg. 2015;261:1173–83.CrossRefPubMed

14.

Peng P, Hyder O, Firoozmand A, et al. Impact of sarcopenia on outcomes following resection of pancreatic adenocarcinoma. J Gastrointest Surg. 2012;16:1478–86.CrossRefPubMedPubMedCentral

15.

Grotenhuis B, Shapiro J, van Adrichem S, 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(11):2698–2704.

16.

Tamandl D, Paireder M, Asari R, Baltzer P, Schoppmann S, Ba Ssalamah A. Markers of sarcopenia quantified by computed tomography predict adverse long-term outcome in patients with resected oesophageal or gastro-oesophageal junction cancer. Eur Radiol. 2016;26:1359–67.CrossRefPubMed

17.

Tan BHL, Brammer K, Randhawa N, et al. Sarcopenia is associated with toxicity in patients undergoing neoadjuvant chemotherapy for oesophago-gastric cancer. Eur J Surg Oncol. 2015;41:333–8.CrossRefPubMed

18.

Sobin LH, Gospodarowicz MK, Wittekind C. TNM Classification of Malignant Tumors. 7th ed. Wiley-Blackwell, Oxford, 2010.

19.

Mitsiopoulos N, Baumgartner RN, Heymsfield SB, Lyons W, Gallagher D, Ross R. Cadaver validation of skeletal muscle measurement by magnetic resonance imaging and computerized tomography. J Appl Physiol Bethesda MD 1985. 1998;85:115–22.

20.

Prado CMM, Lieffers J, McCargar 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.CrossRefPubMed

21.

Rutten IJG, van Dijk DPJ, Kruitwagen RFPM, Beets-Tan RGH, Olde Damink SWM, van Gorp T. Loss of skeletal muscle during neoadjuvant chemotherapy is related to decreased survival in ovarian cancer patients. J Cachexia Sarcopenia Muscle. 2016;7:458–66.CrossRefPubMedPubMedCentral

22.

Straub RH, Cutolo M, Buttgereit F, Pongratz G. Energy regulation and neuroendocrine-immune control in chronic inflammatory diseases. J Intern Med. 2010;267:543–60.CrossRefPubMed

23.

Ballard Barbash R, Friedenreich C, Courneya K, Siddiqi S, McTiernan A, Alfano C. Physical activity, biomarkers, and disease outcomes in cancer survivors: a systematic review. J Natl Cancer Institute. 2012;104:815–40.CrossRef

24.

Fairey A, Courneya K, Field C, Bell G, Jones L, Mackey J. Randomized controlled trial of exercise and blood immune function in postmenopausal breast cancer survivors. J Appl Physiol. 2005;98:1534–40.CrossRef

25.

Allgayer H, Nicolaus S, Schreiber S. Decreased interleukin-1 receptor antagonist response following moderate exercise in patients with colorectal carcinoma after primary treatment. Cancer Detect Prev. 2004;28:208–13.CrossRefPubMed

26.

Ida S, Watanabe M, Yoshida N, et al. Sarcopenia is a predictor of postoperative respiratory complications in patients with esophageal cancer. Ann Surg Oncol. 2015;22:4432–7.CrossRefPubMed

27.

Nishigori T, Okabe H, Tanaka E, Tsunoda S, Hisamori S, Sakai Y. Sarcopenia as a predictor of pulmonary complications after esophagectomy for thoracic esophageal cancer. J Surg Oncol. 2016;113:678–84.CrossRefPubMed

Title: Negative Impact of Skeletal Muscle Wasting After Neoadjuvant Chemotherapy Followed by Surgery on Survival for Patients with Thoracic Esophageal Cancer
Authors: Shuhei Mayanagi, MD, PhD
Yasuhiro Tsubosa, MD, PhD
Katsuhiro Omae, PhD
Masahiro Niihara, MD, PhD
Tsuneyuki Uchida, MD
Takahiro Tsushima, MD
Tomoya Yokota, MD, PhD
Hiroshi Sato, MD, PhD
Tateaki Naito, MD, PhD
Hirofumi Yasui, MD
Publication date: 01-11-2017
Publisher: Springer International Publishing
Published in: Annals of Surgical Oncology / Issue 12/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-017-6020-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Negative Impact of Skeletal Muscle Wasting After Neoadjuvant Chemotherapy Followed by Surgery on Survival for Patients with Thoracic Esophageal Cancer

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 12/2017

Conversion to Complete Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Malignant Peritoneal Mesothelioma After Bidirectional Chemotherapy

Patients Treated with Preoperative Chemoradiation for Pancreatic Ductal Adenocarcinoma have Impaired Bone Density, a Predictor of Distant Metastasis

Validation of the 8th Edition of the AJCC TNM Staging System for Gastric Cancer using the National Cancer Database

Patient Age and Tumor Subtype Predict the Extent of Axillary Surgery Among Breast Cancer Patients Eligible for the American College of Surgeons Oncology Group Trial Z0011

Anatomy of the Transverse Mesocolon Based on Embryology for Laparoscopic Complete Mesocolic Excision of Right-Sided Colon Cancer

Hospitalization in the Year Preceding Major Oncologic Surgery Increases Risk for Adverse Postoperative Events