Department of Surgery and Cancer, Imperial College London, London, UK.
Department of Thoracic Surgery and Thoracic Oncology, Virginia Mason Medical Center, Seattle, WA, USA.
Dis Esophagus. 2021 Nov 11;34(11). doi: 10.1093/dote/doab016.
This study seeks to define long-term variation in body composition in patients undergoing esophagectomy for cancer and to associate those changes with survival. Assessment of skeletal muscle, visceral (VAT) and subcutaneous adipose tissue (SAT) was performed using computed tomography (CT) images routinely acquired: at diagnosis; after neoadjuvant therapy, and; >6 months after esophagectomy. In cases where multiple CT scans were performed >6 months after surgery, all available images were assessed. Ninty-seven patients met inclusion criteria with a median of 2 (range 1-10) postoperative CT images acquired between 0.5 and 9.7 years after surgery. Following surgical treatment of esophageal cancer, patients lost on average 13.3% of their skeletal muscle, 64.5% of their VAT and 44.2% of their SAT. Sarcopenia at diagnosis was not associated with worse overall survival (66.3% vs. 68.5%; P = 0.331). Sarcopenia 1 year after esophagectomy was however associated with lower 5-year overall survival (53.8% vs. 87.5%; P = 0.019). Survival was lower in those patients who had >10% decrease in skeletal muscle index (SMI; 33.3% vs. 72.1%; P = 0.003) and >40% decrease in SAT 1 year after surgery (40.4% vs. 67.4%; P = 0.015). On multivariate analysis, a decline in SMI 1 year after surgery was predictive of worse survival (HR 0.38, 95%CI 0.20-0.73; P = 0.004). This study provides new insight relating to long-term variation in body composition in patients undergoing esophagectomy for cancer. Findings provide further evidence of the importance of body composition, in particular depletion of skeletal muscle, in predicting survival following esophagectomy.
本研究旨在定义接受食管癌切除术的患者的身体成分的长期变化，并将这些变化与生存相关联。使用计算机断层扫描（CT）图像常规评估骨骼肌、内脏（VAT）和皮下脂肪组织（SAT）：在诊断时；新辅助治疗后；以及食管癌手术后>6 个月。在手术后多次进行 CT 扫描>6 个月的情况下，评估所有可用的图像。97 例患者符合纳入标准，手术后中位数为 2（范围 1-10）次 CT 图像，手术时间为 0.5 至 9.7 年。食管癌手术后，患者平均失去 13.3%的骨骼肌、64.5%的 VAT 和 44.2%的 SAT。诊断时的肌肉减少症与总体生存率较差无关（66.3%比 68.5%；P=0.331）。然而，食管癌手术后 1 年的肌肉减少症与较低的 5 年总体生存率相关（53.8%比 87.5%；P=0.019）。在那些骨骼肌指数（SMI）下降超过 10%（33.3%比 72.1%；P=0.003）和手术后 1 年 SAT 下降超过 40%的患者中，生存率较低（40.4%比 67.4%；P=0.015）。多变量分析显示，手术后 1 年 SMI 的下降是生存不良的预测因素（HR 0.38，95%CI 0.20-0.73；P=0.004）。本研究提供了关于癌症患者接受食管癌切除术的身体成分长期变化的新见解。这些发现进一步证明了身体成分的重要性，特别是骨骼肌的消耗，对预测食管癌手术后的生存具有重要意义。
