Tsuji Toshikatsu, Inaki Noriyuki, Kinoshita Jun, Moriyama Hideki, Yamamoto Daisuke, Saito Hiroto, Matsui Ryota, Hayashi Saki, Hayashi Kengo, Sakimura Yusuke, Doden Kenta
Department of Gastrointestinal Surgery/Breast Surgery, Graduate School of Medical Science, Kanazawa University Hospital, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan.
Esophagus. 2025 Sep 1. doi: 10.1007/s10388-025-01148-1.
Rikkunshito is a traditional Japanese herbal medicine known to alleviate chemotherapy-induced gastrointestinal symptoms. However, the clinical impact of rikkunshito on patients undergoing neoadjuvant or conversion chemotherapy followed by curative surgery for esophageal cancer remains unclear.
We analyzed 57 patients with esophageal cancer who underwent curative surgery with preoperative chemotherapy between April 2021 and December 2024. Patients who did and did not receive rikkunshito during chemotherapy were assigned to the rikkunshito and control groups, respectively. Nutritional status was evaluated using albumin levels, lymphocyte counts, prognostic nutritional index, geriatric nutritional risk index, body weight, and body mass index (BMI), and skeletal muscle area (SMA) at L3 before and after chemotherapy. Propensity score matching (PSM) based on baseline characteristics, including age, sex, initial BMI, clinical stage, chemotherapy regimen, and initial PNI and SMA was performed.
Overall, the rikkunshito group showed significantly lower rates of body weight (p = 0.016) and BMI loss (p = 0.011) than controls. Although SMA reduction did not reach statistical significance, a trend toward preservation was observed (p = 0.093). After PSM (n = 16 per group), the rikkunshito group showed a significantly lower reduction in body weight (p = 0.031), BMI (p = 0.016), and SMA (p < 0.001).
Rikkunshito administration during preoperative chemotherapy for esophageal cancer was associated with better preservation of body composition, including skeletal muscle mass. This suggests the potential role of rikkunshito as a supportive therapy to mitigate sarcopenia and nutritional decline during intensive treatment of esophageal cancer.
六君子汤是一种传统的日本草药，已知可缓解化疗引起的胃肠道症状。然而，六君子汤对接受新辅助化疗或转化化疗后行食管癌根治性手术的患者的临床影响尚不清楚。
我们分析了2021年4月至2024年12月期间接受术前化疗并进行根治性手术的57例食管癌患者。化疗期间接受和未接受六君子汤的患者分别被分配到六君子汤组和对照组。使用白蛋白水平、淋巴细胞计数、预后营养指数、老年营养风险指数、体重、体重指数（BMI）以及化疗前后L3水平的骨骼肌面积（SMA）评估营养状况。基于年龄、性别、初始BMI、临床分期、化疗方案以及初始PNI和SMA等基线特征进行倾向得分匹配（PSM）。
总体而言，六君子汤组的体重下降率（p = 0.016）和BMI下降率（p = 0.011）显著低于对照组。虽然SMA的减少未达到统计学意义，但观察到有保留的趋势（p = 0.093）。PSM后（每组n = 16），六君子汤组的体重（p = 0.031）、BMI（p = 0.016）和SMA（p < 0.001）下降明显更低。
食管癌术前化疗期间服用六君子汤与更好地保留身体成分（包括骨骼肌质量）相关。这表明六君子汤作为一种支持性疗法，在食管癌强化治疗期间减轻肌肉减少症和营养下降方面具有潜在作用。
