title: Assessment of sarcopenia and changes in body composition after neoadjuvant chemotherapy and associations with clinical outcomes in oesophageal cancer.
abstract: OBJECTIVE
  Sarcopenia and changes in body composition following neoadjuvant chemotherapy (NAC) may affect clinical outcome. We assessed the associations between CT body composition changes following NAC and outcomes in oesophageal cancer.
  
  
  METHODS
  A total of 35 patients who received NAC followed by oesophagectomy, and underwent CT assessment pre- and post-NAC were included. Fat mass (FM), fat-free mass (FFM), subcutaneous fat to muscle ratio (FMR) and visceral to subcutaneous adipose tissue ratio (VA/SA) were derived from CT. Changes in FM, FFM, FMR, VA/SA and sarcopenia were correlated to chemotherapy dose reductions, postoperative complications, length of hospital stay (LOS), circumferential resection margin (CRM), pathological chemotherapy response, disease-free survival (DFS) and overall survival (OS).
  
  
  RESULTS
  Nine (26 %) patients were sarcopenic before NAC and this increased to 15 (43 %) after NAC. Average weight loss was 3.7 % ± 6.4 (SD) in comparison to FM index (-1.2 ± 4.2), FFM index (-4.6 ± 6.8), FMR (-1.2 ± 24.3) and VA/SA (-62.3 ± 12.7). Changes in FM index (p = 0.022), FMR (p = 0.028), VA/SA (p = 0.024) and weight (p = 0.007) were significant univariable factors for CRM status. There was no significant association between changes in body composition and survival.
  
  
  CONCLUSIONS
  Loss of FM, differential loss of VA/SA and skeletal muscle were associated with risk of CRM positivity.
  
  
  CONCLUSIONS
  • Changes in CT body composition occur after neoadjuvant chemotherapy in oesophageal cancer. • Sarcopenia was more prevalent after neoadjuvant chemotherapy. • Fat mass, fat-free mass and weight decreased after neoadjuvant chemotherapy. • Changes in body composition were associated with CRM positivity. • Changes in body composition did not affect perioperative complications and survival.
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK, connie.yip@kcl.ac.uk.
authors.forename: Connie
authors.initials: C
authors.lastname: Yip
authors.forename: Vicky
authors.initials: V
authors.lastname: Goh
authors.forename: Andrew
authors.initials: A
authors.lastname: Davies
authors.forename: James
authors.initials: J
authors.lastname: Gossage
authors.forename: Rosalind
authors.initials: R
authors.lastname: Mitchell-Hay
authors.forename: Orla
authors.initials: O
authors.lastname: Hynes
authors.forename: Nick
authors.initials: N
authors.lastname: Maisey
authors.forename: Paul
authors.initials: P
authors.lastname: Ross
authors.forename: Andrew
authors.initials: A
authors.lastname: Gaya
authors.forename: David B
authors.initials: DB
authors.lastname: Landau
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Cook
authors.forename: Nyree
authors.initials: N
authors.lastname: Griffin
authors.forename: Robert
authors.initials: R
authors.lastname: Mason
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001823:Body Composition; D001835:Body Weight; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects*; D011859:Radiography; D012189:Retrospective Studies; D055948:Sarcopenia / Q000209:etiology*
chemical_list: D000970:Antineoplastic Agents