Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, 1 Kawasumi, Mizuho-ku, Nagoya, Aichi, Japan.
Esophagus. 2021 Apr;18(2):258-266. doi: 10.1007/s10388-020-00774-1. Epub 2020 Sep 5.
Sarcopenia is defined by low muscle mass and low muscle strength and is a prognostic factor of unfavorable outcomes in various diseases. The purpose of this study is to examine the correlation between skeletal muscle wasting (SMW) during neoadjuvant chemotherapy (NAC) and postoperative complications in patients with esophageal cancer, particularly in relation to anastomotic leakage.
The present study involved 99 patients with thoracic esophageal cancer and esophago-gastric junctional cancer who received NAC followed by radical esophagectomy between August 2008 to June 2019, and who were pStage 0-III. Patient demographics and clinical variables were retrospectively reviewed. For assessing the extent of SMW, the rate of change in skeletal muscle mass index (SMI) was measured from CT images at the level of the third lumbar vertebra. Factors associated with postoperative complications were also examined.
The median rate of change in total SMI in patients was - 1.87%. The decreased rates in SMI of the side abdominal muscles and rectus abdominis were significantly greater than that of the psoas major (side abdominal muscles: p = 0.0084, rectus abdominis: p = 0.036). Multivariate analysis showed a decreased rate in SMI, especially in the erector spinae muscle, and the Charlson comorbidity index (CCI) was significantly associated with Grade IIIa of higher anastomotic leakage (Grade ≥ IIIa) (SMI cutoff (favorable): ≤ - 7.84, p = 0.0040; CCI cutoff (favorable): ≥ 2, p = 0.0032).
In patients with esophageal cancer, SMI tend to decrease during NAC treatment. It is therefore important to prevent the additional impact that SMW during NAC has on postoperative anastomotic leakage.
肌少症是指肌肉量低和肌肉力量低，是各种疾病不良结局的预后因素。本研究旨在探讨新辅助化疗（NAC）期间骨骼肌减少症（SMW）与食管癌患者术后并发症的相关性，尤其是与吻合口漏的关系。
本研究纳入了 2008 年 8 月至 2019 年 6 月期间接受 NAC 后行根治性食管切除术的 99 例胸段食管和食管胃结合部癌患者，且分期为 p 期 0-III 期。回顾性分析患者的人口统计学和临床变量。为了评估 SMW 的程度，从第 3 腰椎水平的 CT 图像测量骨骼肌质量指数（SMI）的变化率。还检查了与术后并发症相关的因素。
患者总 SMI 的中位变化率为-1.87%。侧腹肌和腹直肌的 SMI 下降率明显大于腰大肌（侧腹肌：p=0.0084，腹直肌：p=0.036）。多变量分析显示，SMI 下降率，尤其是竖脊肌的下降率，与 Charlson 合并症指数（CCI）显著相关，CCI 与较高的吻合口漏（IIIa 级及以上）（SMI 截断值（有利）：≤-7.84，p=0.0040；CCI 截断值（有利）：≥2，p=0.0032）。
在食管癌患者中，NAC 治疗期间 SMI 趋于下降。因此，重要的是要防止 NAC 期间的 SMW 对术后吻合口漏产生额外的影响。
