Utsunomiya Daichi, Kubo Yuto, Horonushi Shotaro, Nozaki Ryoko, Igaue Shota, Kakuta Ryota, Akimoto Eigo, Kubo Kentaro, Kurita Daisuke, Ishiyama Koshiro, Oguma Junya, Daiko Hiroyuki
Department of Esophageal Surgery, National Cancer Center Hospital, 5-5-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan.
Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo, 113-8421, Japan.
Esophagus. 2025 Jul 24. doi: 10.1007/s10388-025-01145-4.
Perioperative low skeletal muscle mass (SMM) is a risk factor for poor prognosis in patients with esophageal cancer. However, the impact of long-term continuous SMM loss after esophagectomy on the prognosis of patients with esophageal cancer has been unclear. We aimed to evaluate whether long-term SMM loss after esophagectomy influences the prognosis of patients with esophageal cancer.
This study included 134 patients with esophageal cancer who underwent minimally invasive esophagectomy between October 2018 and October 2020. We retrospectively investigated the continuous decrease in skeletal muscle mass index (SMI) until 12 months after surgery and its relationship with recurrence. The patients were classified into three groups (short, middle, and long-term) by lowest SMI at 4, 8, and 12 months after surgery compared with preoperative SMI.
The overall survival did not differ significantly among the three groups. The long-term group was significantly associated with shortened recurrence-free survival (RFS) compared with the short-term and middle-term groups (3-year RFS rate, short-term group: 88.9% vs. middle-term group: 93.1% vs. long-term group: 72.5%, p = 0.043). The RFS was worse in the long-term SMM group than in middle-term SMM group (p = 0.072). The multivariate analysis identified the long-term group, Charlson Comorbidity Index ≧1, and pathological stage ≧ III, as independent factors associated with recurrence for patients with esophageal cancer.
Long-term postoperative SMI reduction, as well as oncological factors, are significant predictors of late recurrence in patients with esophageal cancer.
围手术期低骨骼肌质量（SMM）是食管癌患者预后不良的危险因素。然而，食管癌切除术后长期持续的SMM丢失对患者预后的影响尚不清楚。我们旨在评估食管癌切除术后长期SMM丢失是否会影响食管癌患者的预后。
本研究纳入了2018年10月至2020年10月期间接受微创食管癌切除术的134例食管癌患者。我们回顾性调查了术后12个月内骨骼肌质量指数（SMI）的持续下降情况及其与复发的关系。根据术后4、8和12个月时的最低SMI与术前SMI相比，将患者分为三组（短期、中期和长期）。
三组患者的总生存期无显著差异。与短期和中期组相比，长期组的无复发生存期（RFS）显著缩短（3年RFS率，短期组：88.9%，中期组：93.1%，长期组：72.5%，p = 0.043）。长期SMM组的RFS比中期SMM组更差（p = 0.072）。多因素分析确定长期组、Charlson合并症指数≧1和病理分期≧III是食管癌患者复发的独立相关因素。
术后长期SMI降低以及肿瘤学因素是食管癌患者晚期复发的重要预测因素。
