Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan.
Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan.
Cancer Rep (Hoboken). 2024 Aug;7(8):e2084. doi: 10.1002/cnr2.2084.
Based on the JCOG1109 trial, it is suggested that the combination of docetaxel, cisplatin, and 5-fluorouracil (DCF) could potentially become a standard neoadjuvant chemotherapy regimen, alongside the conventional 5-fluorouracil and cisplatin (CF) therapy, for esophageal cancer. However, there are few reports on the impact of body composition changes associated with neoadjuvant chemotherapy on prognosis.
Our study aimed to explore the effect of different neoadjuvant chemotherapy regimens on body composition during treatment and the impacts of body composition changes on their prognosis.
This is a retrospective study of 215 patients with advanced thoracic esophageal cancer who had surgery after neoadjuvant chemotherapy from 2013 to 2019. Computed tomography scans were performed before and after neoadjuvant chemotherapy to assess body composition. Skeletal muscle mass index (SMI) was calculated by dividing total skeletal muscle mass at the 3rd lumbar level by the square of height, while visceral and subcutaneous fat masses were measured at the level of umbilicus. Patients in the lowest 25% of both sexes were classified into the low visceral fat and low subcutaneous fat groups, respectively. Of the patients enrolled, 178 were male and 37 were female. Among them, 91 had clinical Stage II disease, and 124 had clinical Stage III disease. Additionally, 146 patients received neoadjuvant chemotherapy CF, and 69 received neoadjuvant chemotherapy DCF. Comparing the DCF and CF groups, the DCF group consisted of significantly younger patients (p < .01), a higher proportion of males (p = .03), and a greater number of clinical Stage III cases (p < .01). However, although percent change in SMI and visceral fat mass was not significantly different between two regimens, percent change in subcutaneous fat mass was significant in the DCF group. The major prognostic factors for patients undergoing surgery after neoadjuvant chemotherapy for thoracic esophageal cancer were clinical Stage III, transition to low visceral fat, and response rating (SD/PD), while the specific neoadjuvant chemotherapy regimen did not significantly influence the outcomes.
This study suggests that prevention of the shift to low visceral fat throughout the neoadjuvant chemotherapy process should improve patient outcomes.
基于 JCOG1109 试验，多西他赛、顺铂和 5-氟尿嘧啶（DCF）联合方案可能成为食管癌新辅助化疗的标准方案，与传统的 5-氟尿嘧啶和顺铂（CF）疗法并列。然而，关于新辅助化疗相关的体成分变化对预后的影响的报告很少。
本研究旨在探讨不同新辅助化疗方案在治疗过程中对体成分的影响，以及体成分变化对其预后的影响。
这是一项回顾性研究，纳入了 2013 年至 2019 年期间接受新辅助化疗后手术的 215 例晚期胸段食管腺癌患者。在新辅助化疗前后进行 CT 扫描以评估体成分。通过将第 3 腰椎水平的总骨骼肌质量除以身高的平方计算骨骼肌质量指数（SMI），同时在脐水平测量内脏和皮下脂肪质量。将男女患者中内脏脂肪和皮下脂肪最低的 25%分别归类为低内脏脂肪和低皮下脂肪组。入组患者中，178 例为男性，37 例为女性。其中，91 例为临床Ⅱ期疾病，124 例为临床Ⅲ期疾病。此外，146 例患者接受新辅助化疗 CF，69 例患者接受新辅助化疗 DCF。与 CF 组相比，DCF 组患者更年轻（p<0.01），男性比例更高（p=0.03），临床Ⅲ期病例更多（p<0.01）。然而，尽管两种方案的 SMI 和内脏脂肪质量的百分比变化无显著差异，但 DCF 组的皮下脂肪质量百分比变化显著。接受新辅助化疗后行胸段食管癌手术的患者的主要预后因素为临床Ⅲ期、向低内脏脂肪转移和反应评分（SD/PD），而具体的新辅助化疗方案对结果无显著影响。
本研究表明，在新辅助化疗过程中预防向低内脏脂肪转移应能改善患者的预后。
