Wakefield Connor J, Hamati Fadi, Karush Justin M, Arndt Andrew T, Geissen Nicole, Liptay Michael J, Borgia Jeffrey A, Basu Sanjib, Seder Christopher W
Rush University Medical Center, Department of Cardiovascular and Thoracic Surgery, Chicago, IL, USA.
Rush University Medical Center, Departments of Pathology and Cell & Molecular Medicine, Chicago, IL, USA.
J Thorac Dis. 2021 Feb;13(2):861-869. doi: 10.21037/jtd-20-2608.
The impact of sarcopenia on the outcome of esophageal cancer patients remains unknown in North American populations. The current study aims to investigate if sarcopenia at the time of esophagectomy for locally-advanced esophageal cancer (LAEC) is associated with survival.
Patients who underwent induction therapy followed by esophagectomy for LAEC between 2010-2018 at a single institution were identified. Exclusion criteria included follow-up less than 90 days and distant metastatic disease at the time of surgery. Demographic, treatment, and outcome data were retrospectively collected. Computed tomography (CT) scans following induction therapy were analyzed to calculate skeletal muscle index (SMI). Overall survival (OS) and disease-free survival (DFS) were examined using Kaplan-Meier and Cox Proportional Hazard regression analysis.
Overall, 52 patients met inclusion criteria with a median BMI of 25 (IQR, 22.4-29.1) kg/m and age of 65 (IQR, 57-70) years. Sarcopenia was present in 75% (39/52) of patients at the time of surgery. Sarcopenic patients had a lower median BMI and higher median age when compared to non-sarcopenic patients. There was no difference in gender, race, stage, operative technique, post-operative complications, or hospital length of stay between sarcopenic and non-sarcopenic patients. With a median follow-up of 24.9 months, patients with sarcopenia at the time of esophagectomy had worse OS [median 24.3 (IQR, 9.9-34.5) 50.9 (IQR, 25.6-50.9) months, P=0.0292] and DFS [median 11.7 (IQR, 6.4-25.8) 29.4 (IQR, 12.8-26.7) months, P=0.0387] compared to non-sarcopenic patients.
Sarcopenia is associated with reduced overall and DFS in patients undergoing esophagectomy for LAEC.
在北美人群中，肌肉减少症对食管癌患者预后的影响尚不清楚。本研究旨在调查局部晚期食管癌（LAEC）行食管切除时的肌肉减少症是否与生存率相关。
确定2010年至2018年在单一机构接受诱导治疗后行LAEC食管切除术的患者。排除标准包括随访时间少于90天以及手术时存在远处转移性疾病。回顾性收集人口统计学、治疗和结局数据。分析诱导治疗后的计算机断层扫描（CT）扫描结果以计算骨骼肌指数（SMI）。使用Kaplan-Meier和Cox比例风险回归分析检查总生存期（OS）和无病生存期（DFS）。
总体而言，52例患者符合纳入标准，中位BMI为25（IQR，22.4 - 29.1）kg/m，年龄为65（IQR，57 - 70）岁。手术时75%（39/52）的患者存在肌肉减少症。与非肌肉减少症患者相比，肌肉减少症患者的中位BMI较低，中位年龄较高。肌肉减少症患者与非肌肉减少症患者在性别、种族、分期、手术技术、术后并发症或住院时间方面无差异。中位随访24.9个月，食管切除时存在肌肉减少症的患者的OS [中位24.3（IQR，9.9 - 34.5）对50.9（IQR，25.6 - 50.9）个月，P = 0.0292]和DFS [中位11.7（IQR, 6.4 - 25.8）对29.4（IQR，12.8 - 26.7）个月，P = 0.0387]较非肌肉减少症患者更差。
肌肉减少症与LAEC行食管切除术患者的总生存期和DFS降低相关。
