Division of Esophageal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
Clinical Research Promotion Unit of Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan.
Ann Surg Oncol. 2017 Nov;24(12):3741-3747. doi: 10.1245/s10434-017-6020-2. Epub 2017 Aug 31.
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.
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).
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 cm/m. 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.
The study findings suggest that skeletal muscle wasting from baseline has a negative impact on cancer recurrence and survival.
根治性治疗期间的骨骼肌消耗是食管癌患者面临的一个重要问题。然而，新辅助化疗后手术是否会导致骨骼肌变化从而对预后产生不利影响尚未明确。本研究旨在确定新辅助化疗后手术治疗的晚期食管癌患者的骨骼肌变化与生存之间的关系。
本研究回顾性分析了 66 例接受新辅助化疗后行食管癌切除术的胸段食管癌患者。研究调查了术前和术后 4 个月第三腰椎总肌肉横截面积变化与术后复发和总生存（OS）之间的相关性。
在 66 例患者中，39 例（59%）在食管癌手术后 4 个月从基线开始出现骨骼肌减少。手术后 4 个月骨骼肌指数的变化为-1.2cm/m。多变量分析显示非鳞状细胞癌亚型（危险比[HR]2.57；p=0.029）、病理分期（HR 5.73；p<0.01）和骨骼肌消耗（HR 每减少 1 个骨骼肌指数单位，1.16；p=0.015）是与 OS 较差相关的独立预后因素。此外，病理分期（HR 6.03；p<0.01）和骨骼肌消耗（HR 每减少 1 个骨骼肌指数单位，1.11；p=0.048）也是与无复发生存时间较差相关的独立预后因素。
研究结果表明，基线骨骼肌消耗对癌症复发和生存有负面影响。
