Sarcopenia and myosteatosis at presentation adversely affect survival after esophagectomy for esophageal cancer
, , and | Mar 27, 2020
About this article
Article Category: Research Article
Published Online: Mar 27, 2020
Page range: 237 - 246
Received: Jan 07, 2020
Accepted: Mar 03, 2020
DOI: https://doi.org/10.2478/raon-2020-0016
© 2020 Matevz Srpcic, Taja Jordan, Karteek Popuri, Mihael Sok, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
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Complication and survival data compared between sarcopenia/no sarcopenia and myosteatosis/no myosteatosis groups
| Sarcopenia (N = 23 (16.5%)) | No Sarcopenia (N = 116 (83.5%)) | Odds Ratio (OR. 95% CI) | p | |
|---|---|---|---|---|
| In hospital mortality | 1 (4.3%) | 8 (6.9%) | 0.614 (0.073–5.158) | 0.650 |
| Any complication | 11 (47.8%) | 54 (46.6%) | 1.052 (0.430–2.578) | 0.911 |
| Conduit complications | 4 (17.4%) | 17 (14.7%) | 1.226 (0.371–4.049) | 0.738 |
| Pleuropulmonary complications | 8 (34.8%) | 29 (25.0%) | 1.600 (0.615–4.160) | 0.332 |
| Respiratory failure | 5 (21.7%) | 21 (18.1%) | 1.230 (0.410–3.689) | 0.711 |
| Any other complications | 4 (17.4%) | 38 (32.8%) | 0.432 (0.137–1.359) | 0.143 |
| 18.3 (CI 5.4–31.1) | 31.0 (CI 7.4–54.6) | |||
| 1 year survival | 50.8% | 78.5% | ||
| 3 year survival | 32.9% | 47.7% | ||
| 5 year survival | 32.9% | 42.2% | ||
| In hospital mortality | 7 (9.7%) | 2 (3.0%) | 3.500 (0.701–17.486) | 0.107 |
| Any complication | 32 (44.4%) | 33 (49.3%) | 0.824 (0.423–1.607) | 0.570 |
| Conduit complications | 5 (6.9%) | 16 (23.9%) | 0.238 (0.082–0.692) | |
| Pleuropulmonary complications | 17 (23.6%) | 20 (30.0%) | 0.726 (0.341–1.545) | 0.406 |
| Respiratory failure | 14 (19.4%) | 12 (17.9%) | 1.066 (0.453–2.510) | 0.884 |
| Any other complications | 24 (33.3%) | 18 (26.9%) | 1.361 (0.656–2.822) | 0.407 |
| 19.0 (CI 13.3–24.7) | 57.1 (CI 15.2–99.0) | |||
| 1 year survival | 64.2% | 84.0% | ||
| 3 year survival | 36.9% | 53.7% | ||
| 5 year survival | 33.9% | 46.9% | ||
Demographic, preoperative, procedure and outcome data in all patients (N = 139)
| Demographic and preoperative data | |
|---|---|
| Age at Surgery (mean ± SD) [years] | 63.9 ± 9.5 |
| min-max | 30–83 |
| Gender (N, % female) | 22 (15.8%) |
| BMI (mean ± SD) [kg/ m2] | 26.3 ± 4.8 |
| Weight loss > 10% (N, %) | 46 (33.1%) |
| Neoadjuvant therapy (N, %) | 74 (53.2 %) |
| Days between CT and esophagectomy | |
| all (mean ± SD) | 76.9 ± 52.3 |
| min-max | 6–192 |
| median | 84 |
| Neoadjuvant (mean ± SD) | 115.2 ± 36.0 |
| min-max | 14–192 |
| median | 125 |
| No neoadjuvant (mean ± SD) | 33.5 ± 28.5 |
| min-max | 6–141 |
| median | 23 |
| SMA [cm2] (mean ± SD) | |
| male | 157.6 ± 28.0 |
| female | 103.9 ± 16.3 |
| SMI [cm2/m2] (mean ± SD) | |
| male | 52.1 ± 9.5 |
| female | 39.8 ± 6.8 |
| Muscle attenuation [HU] (mean ± SD) | |
| male | 31.2 ± 8.3 |
| female | 27.8 ± 8.7 |
| sarcopenia (N, %) | 23 (16.5%) |
| myosteatosis (N, %) | 72 (51.8%) |
| Surgical approach (N, %) | |
| open | 87 (62.6%) |
| MIE | 52 (37.4%) |
| Type of esophagectomy (N, %) | |
| Ivor-Lewis | 109 (78.4%) |
| McKeown | 26 (18.7%) |
| Transhiatal | 4 (2.9%) |
| Radicality (N, %) | |
| R0 | 130 (93.5%) |
| R1 | 5 (3.6%) |
| R2 | 4 (2.9%) |
| Lymph nodes (mean ± SD) (N, %) | 23.4 ± 12.3 |
| min-max | 0–76 |
| median | 21 |
| Cancer type (N, %) | |
| Adenocarcinoma | 74 (53.2%) |
| Squamous cell carcinoma | 64 (46.0%) |
| GIST | 1 (0.7%) |
| Pathological Stage (AJCC 2017) (N, %) | |
| I | 51 (36.7%) |
| II | 27 (19.4%) |
| III | 36 (25.9%) |
| IVA | 23 (16.5%) |
| IVB | 2 (1.4%) |
| In hospital mortality | 9 (6.5%) |
| Any complication | 65 (46.8%) |
| Conduit complications | 21 (15.1%) |
| Pleuropulmonary complications | 37 (26.6%) |
| Respiratory failure | 26 (18.7%) |
| Any other complications | 42 (30.2%) |
| 1 year survival | 73.7% |
| 3 year survival | 45.1% |
| 5 year survival | 40.3% |
Demographic, preoperative, pathological and procedure data compared between sarcopenia/no sarcopenia and myosteatosis/no myosteatosis groups
| Sarcopenia (N = 23 (16.5%)) | No Sarcopenia (N = 116 (83.5%)) | p | Myosteatosis (N = 72 (51.8%)) | No Myosteatosis (N = 67 (48.2%)) | p | |
|---|---|---|---|---|---|---|
| Age at Surgery (mean ± SD) | 67.1 ± 7.8 | 63.3 ± 9.7 | 0.076 | 67.1 ± 7.7 | 60.5 ± 10.0 | |
| Female sex (n (%)) | 3 (13.0%) | 19 (16.4%) | 0.689 | 10 (13.9%) | 12 (17.9%) | 0.516 |
| BMI (mean ± SD) | 23.8 ± 5.9 | 26.7 ± 4.4 | 27.3 ± 4.9 | 25.2 ± 4.4 | ||
| Days esophagectomy between CT (and mean ± SD) | 81.4 ± 57.6 | 76.1 ± 51.4 | 0.654 | 78.8 ± 52.8 | 75.0 ± 52.1 | 0.666 |
| Weight loss > 10% (n (%)) | 11 (47.8%) | 35 (30.2%) | 0.100 | 25 (34.7%) | 21 (31.3%) | 0.672 |
| Neoadjuvant Therapy (n (%)) | 14 (60.9%) | 60 (51.7%) | 0.422 | 34 (47.2%) | 40 (59.7%) | 0.141 |
| Cancer Type (n (%)) | 0.864 | 0.500 | ||||
| Adenocarcinoma | 13 (56.6%) | 61 (52.6%) | 37 (51.4%) | 37 (55.2%) | ||
| Squamous cell carcinoma | 10 (43.4%) | 54 (46.6%) | 35 (48.6%) | 29 (43.3%) | ||
| GIST | 1 (0.8%) | 1 (1.5%) | ||||
| Pathological Stage (AJCC 2017) (n (%)) | 0.650 | 0.546 | ||||
| I | 8 (34.8%) | 43 (37.1%) | 26 (36.1%) | 25 (37.3%) | ||
| II | 6 (26.1%) | 21 (18.1%) | 11 (15.3%) | 16 (23.9%) | ||
| III | 4 (17.4%) | 32 (27.6%) | 21 (29.2%) | 15 (22.4%) | ||
| IVA | 4 (17.4%) | 19 (16.4%) | 12 (16.7%) | 11 (16.4%) | ||
| IVB | 1 (4.3%) | 1 (0.8%) | 2 (2.8%) | 0 | ||
| Lymph nodes (mean ± SD) | 28.8 ± 10.5 | 23.9 ± 12.6 | 0.266 | 24.4 ± 11.1 | 22.4 ± 13.5 | 0.337 |
| Surgical approach | 0.258 | 0.167 | ||||
| open | 12 (52.2%) | 75 (64.7%) | 49 (68.1%) | 38 (56.7%) | ||
| MIE | 11 (47.8%) | 41 (35.3%) | 23 (31.9%) | 29 (43.3%) |