High sarcopenia levels appear to be negatively associated with overall survival (OS) in male patients with esophageal carcinoma treated with upfront chemoradiotherapy (CRT), according to results published in Digestive and Liver Disease.
In this retrospective study, researchers evaluated all patients with locally advanced esophageal carcinoma treated with upfront CRT at a single institution between June 2006 and August 2016. In total, 104 patients were assessed (male, 69%). The decision to undergo surgery was made after CRT (40–50 Gy). Muscle mass was measured on a single third lumbar vertebra CT-scan slice. The primary outcome was OS. Additional clinical parameters were analyzed with a cut-off based on the mean skeletal muscle lumbar index (SMI) of the population studied.
The findings revealed that average SMI was 46cm2/m2 in men (standard deviation (SD), ±9; extremes, 30–68) and 35 cm2/m2 in women (SD, ±5; extremes, 26–47), with 81% of patients being sarcopenic (n= 84). The 3-year OS rate was 34.6%. When using the mean SMI as a cut-off, sarcopenia was significantly associated with 3-year OS (43.3% vs. 26.2%, P =.02). Gender was the sole factor in which SMI affected the overall outcome. In men, there was a significant correlation between SMI and OS (P =.003), which remained significant upon multivariate analysis (P =.02). Moreover, multivariate analysis revealed that in men, both sarcopenia and surgery were significantly associated with OS (sarcopenia HR, 2.64; P =.02; surgery HR, 0.33; P =.003). No prognostic factor was significantly associated with OS in women.
Limitations of the study included its retrospective nature, single-center design, and observer bias due to the use of a single person measuring sarcopenia on CT sections. In addition, measurements of SMI were only quantitative.
The investigators recommended that “nutritional support must be considered an essential component of CRT, which is aimed to correct sarcopenia or stop its progression.”
Benadon B, Servagi-Verna S, Quero L, Cattan P, Guillerm S, Hennequin V, et al. Sarcopenia: An important prognostic factor for males treated for a locally advanced esophageal carcinoma (published online May 31, 2020). Digest Liver Dis. doi.org/10.1016/j.dld.2020.04.009