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


CONCLUSIONS
Patients who show signs of sarcopenia and alterations in BCPs on preoperative CT images have impaired long-term outcome after surgery for OC.


CONCLUSIONS
• 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.
Department of Biomedical Imaging and Image-guided Therapy, Comprehensive Cancer Center GET-Unit, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. dietmar.tamandl@meduniwien.ac.at.
Dietmar
D
Tamandl
Department of Surgery, Upper-GI-Service, Comprehensive Cancer Center GET-Unit, Medical University of Vienna, Vienna, Austria.
Matthias
M
Paireder
Department of Surgery, Upper-GI-Service, Comprehensive Cancer Center GET-Unit, Medical University of Vienna, Vienna, Austria.
Reza
R
Asari
Department of Biomedical Imaging and Image-guided Therapy, Comprehensive Cancer Center GET-Unit, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
Pascal A
PA
Baltzer
Department of Surgery, Upper-GI-Service, Comprehensive Cancer Center GET-Unit, Medical University of Vienna, Vienna, Austria.
Sebastian F
SF
Schoppmann
Department of Biomedical Imaging and Image-guided Therapy, Comprehensive Cancer Center GET-Unit, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
Ahmed
A
Ba-Ssalamah
D000368:Aged; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy; D004943:Esophagogastric Junction / Q000601:surgery; D004947:Esophagus / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D055948:Sarcopenia / Q000000981:diagnostic imaging*; D013274:Stomach Neoplasms / Q000601:surgery*; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
Body composition measurements; Computed tomography; Oesophageal cancer; Outcome analysis; Sarcopenia