Oesophageal cancer patients who suffer loss of muscle mass (sarcopenia) during neoadjuvant therapy survive, on average, 32 months less than patients with no sarcopenia.
This is the central finding of a recent study conducted at the Comprehensive Cancer Centre (CCC) of MedUni Vienna and Vienna General Hospital.
Oesophageal cancer is the eighth commonest type of cancer and sixth commonest cause of death from cancer in Austria. According to "Statistik Austria," approximately 420 people develop this type of cancer every year. This means that oesophageal cancer is a rare form of cancer but the number of cases has grown rapidly over the past few years. The number of cases in men has risen six-fold and has quadrupled in women, men being more likely to develop this type of cancer than women.
Apart from smoking and high alcohol consumption, risk factors for esophageal cancer also include gastro-esophageal reflux disease and the resulting cell changes in the lower part of the oesophagus (Barrett metaplasia). The standard treatment for patients in which the tumour is advanced but not yet metastasised, is to give chemotherapy or a combination of chemotherapy and radiotherapy prior to surgery (multimodal therapy). In local carcinomas that are not advanced, surgery is the treatment of choice.
In their study, experts in stomach and esophageal cancer from the Comprehensive Cancer Centre of MedUni Vienna and Vienna General Hospital (CCC GET-Unit, head: Sebastian Schoppmann) investigated to what extent sarcopenia and body composition changed during multimodal therapy and whether this has any influence upon long-term survival. The results show that patients who suffered sarcopenia (loss of muscle mass below a defined threshold) at any time during treatment had a poorer prognosis for survival: on average, their period of survival was 32 months shorter than that of patients who were not diagnosed with sarcopenia. Sarcopenia was therefore identified as an independent risk factor.
Says Matthias Paireder, department of surgery (head: Michael Gnant) of MedUni Vienna and Vienna General Hospital, member of the CCC-GET and lead author of the study: "Sarcopenia is not necessarily a side effect of chemotherapy. Many patients were already sarcopenic before the treatment and there was no significant progression of sarcopenia during treatment. The reasons for this loss of general muscle mass are poor nutrition and lack of exercise."
In a new study, the team headed up by Paireder and Schoppmann will investigate whether a programme that includes nutritional advice and physical training could significantly increase long-term survival for esophageal cancer patients.
Abstract
Background: Nutritional status and body composition parameters such as sarcopenia are important risk factors for impaired outcome in patients with esophageal cancer. This study was conducted to evaluate the effect of sarcopenia on long-term outcome after esophageal resection following neoadjuvant treatment.
Methods: Skeletal muscle index (SMI) and body composition parameters were measured in patients receiving neoadjuvant treatment for locally advanced esophageal cancer. Endpoints included relapse-free survival (RFS) and overall survival (OS).
Results: The study included 130 patients. Sarcopenia was found in 80 patients (61.5%). Patients with squamous-cell cancer (SCC) showed a decreased median SMI of 48 (range 28.4–60.8) cm/m2 compared with that of patients with adenocarcinoma (AC) of 52 (range 34.4–74.2) cm/m2, P < 0.001. The presence of sarcopenia had a significant impact on patient outcome: HR 1.69 (1.04–2.75), P = 0.036. Median OS was 20.5 (7.36–33.64) versus 52.1 (13.55–90.65) months in sarcopenic and non-sarcopenic patients, respectively. Sarcopenia was identified as an independent risk factor: HR 1.72 (1.049–2.83), P = 0.032.
Conclusion: Our data provide evidence that sarcopenia impacts long-term outcome after esophageal resection in patients who have undergone neoadjuvant therapy. Assessment of the body composition parameter can be a reasonable part of patient selection and may influence treatment methods.
Authors
M Paireder, R Asari, I Kristo, E Rieder, D Tamandl, A Ba-Ssalamah, SF Schoppmann
[link url="https://www.sciencedaily.com/releases/2017/02/170214095612.htm"]Medical University of Vienna material[/link]
[link url="http://www.ejso.com/article/S0748-7983(16)31034-4/abstract"]European Journal of Surgical Oncology abstract[/link]