Relationship Between Early Postoperative Change in Total Psoas Muscle Area and Long-term Prognosis in Esophagectomy for Patients with Esophageal Cancer

314 Background: As surgery for esophageal carcinoma in the elderly people has been increasing, sarcopenia is a severe problem not only in complications, but also in long-term prognosis. However, the relationship between perioperative skeletal muscle loss especially in the early postoperative period and long-term prognosis has not been clarified. Methods: This study retrospectively analyzed 152 patients with thoracic esophageal carcinoma who had underwent radical esophagectomy in our institution from April 2008 to March 2015 (Patients with postoperative hospital stay longer than 6 weeks were excluded). As an index of perioperative sarcopenia, total psoas muscle area (TPA) was measured before surgery (as baseline), at postoperative day (POD) 7 and postoperative month (POM) 6 from CT images. We investigated the correlation between the change of TPA and the postoperative survival. Results: Of 152 patients, 52 (34.2%) showed a TPA decrease from baseline to POD 7, and 98 (64.5%) showed a TPA decrease from baseline to POM 6. At the time of POD 7, overall survival (OS) decreased significantly in a TPA decrease group (P = 0.008, 5-year survival rate: non-decrease group 82.3% / decrease group 56.8%). Recurrence free survival (RFS) was also significantly decreased in a TPA decrease group (P < 0.001, 5-year recurrence free survival rate: non-decrease group 73.7% / decrease group 44.9%). On the other hand, at the time of POM 6, OS and also RFS had no significant difference between decrease and non-decrease groups. In univariate analysis for OS, pStage ≥3 and TPA decrease at POD 7 had poor prognosis. In multivariate analysis for OS, pStage ≥3 (HR:5.516, P < 0.001, 95%CI:2.634-11.551) and TPA decrease at POD 7 (HR:2.036, P = 0.047, 95%CI:1.010-4.103) were also independent poor prognostic factors. In the univariate analysis for RFS, pStage ≥3, TPA decrease at POD 7 and age ≥60 years had poor prognosis. In multivariate analysis, pStaeg ≥3 (HR:3.831, P < 0.001, 95%CI:2.182-6.728) and TPA decrease at POD 7 (HR:1.942, P = 0.021, 95%CI:1.104-3.416) were independent poor prognostic factors. Conclusions: Our findings suggest that the TPA decrease early in a postoperative period has poor prognosis on OS and also RFS.

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PS02.238: POSTOPERATIVE PROGNOSTIC NUTRITIONAL INDEX CAN PREDICT A LONG-TERM PROGNOSIS OF ESOPHAGEAL CANCER

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps02.238 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 189-190

Author(s):

Jun Takahashi ◽

Masaaki Saito ◽

Tamotsu Obitsu ◽

Daisuke Ishioka ◽

Hirokazu Kiyozaki ◽

...

Keyword(s):

Esophageal Cancer ◽

Conflicts Of Interest ◽

Prognostic Nutritional Index ◽

Pathological Stage ◽

Radical Esophagectomy ◽

Esophagus Cancer ◽

Nutritional Index ◽

Long Term Prognosis ◽

Advanced Pathological Stage

Abstract Background Recent reports indicate the nutritional and immune status often affect the long-term prognosis of patients with cancer. The preoperative prognostic nutritional index(PNI) is used as an evaluation of the perioperative nutritional status, and it is reported that the PNI level correlates with postoperative results. However, only a handful of reports have discussed the predictive prognostic potential of postoperative PNI. The aim of this study is to clarify the correlation of postoperative PNI level and long-term prognosis of patients with esophagus cancer who underwent esophagectomy. Methods A total of 29 patients with esophageal cancer who received neoadjuvant chemotherapy followed by radical esophagectomy from January 2011 to December 2014 were retrospectively reviewed. The calculation of PNI level is as follows: 10 × serum albumin level (g/dL) + 0.005 × total lymphocyte count (/mm3). The postoperative PNI level was measured three months after radical esophagectomy. The patients were stratified by postoperative PNI level by two groups using calculated cutoff level (PNI = 43.9) by receiver operating characteristic curve. The correlation of 3-year disease-free survival (DFS) and postoperative PNI level was evaluated. Results Of the total, 25 were male and 4 were female. The median age of patients was 68 years (31–79 years). Overall, patients received 1–2 cycles of preoperative chemotherapy with 5-FU and cisplatin. Of these 29 patients, 9 (31.0%) responded to chemotherapy (8 patients had a partial response and 1 had a complete response). The median postoperative PNI level was 47.2 (38.0–58.9). Univariate analyses showed that 3-year DFS was worse in patients with low postoperative PNI level (P = 0.017), advanced pathological stage (P = 0.029) and younger age (< 70 years) (P = 0.02). Multivariate analyses showed that low postoperative PNI level[hazard ratio (HR) 0.224, 95% confidence interval (CI) 0.060–0.83, P = 0.026] and advanced pathological stage (HR 3.197, 95% CI 1.13–9.06, P = 0.029) were independent predictors of 3-year DFS. Conclusion Our findings suggest that the postoperative PNI level may be a useful marker to predict a prognosis of patients with esophagus cancer. Nutrition intervention for undernourished patients after surgery may improve prognosis of patients with esophagus cancer. Disclosure All authors have declared no conflicts of interest.

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The impact of preoperative sarcopenia, defined based on psoas muscle area, on long-term outcomes of heart valve surgery

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2018.06.098 ◽

2019 ◽

Vol 157 (3) ◽

pp. 1071-1079.e3 ◽

Cited By ~ 12

Author(s):

Homare Okamura ◽

Naoyuki Kimura ◽

Keisuke Tanno ◽

Makiko Mieno ◽

Harunobu Matsumoto ◽

...

Keyword(s):

Heart Valve ◽

Psoas Muscle ◽

Valve Surgery ◽

Heart Valve Surgery ◽

Long Term Outcomes ◽

Muscle Area ◽

The Impact

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Propensity Score-Matched Analysis to Evaluate the Impact of Re-irradiation on Long-term Prognosis for Recurrent Esophageal Cancer

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2018.07.518 ◽

2018 ◽

Vol 102 (3) ◽

pp. e30-e31

Author(s):

Y. Huang ◽

J. Wu ◽

J. Li ◽

X. Zhang ◽

L. Tang

Keyword(s):

Esophageal Cancer ◽

Propensity Score ◽

Long Term Prognosis ◽

The Impact

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Tooth Loss Predicts Long-Term Prognosis of Esophageal Cancer After Esophagectomy

Annals of Surgical Oncology ◽

10.1245/s10434-019-07903-w ◽

2019 ◽

Vol 27 (3) ◽

pp. 683-690

Author(s):

Susumu Miura ◽

Tetsu Nakamura ◽

Takumi Hasegawa ◽

Yukiko Miura ◽

Gosuke Takiguchi ◽

...

Keyword(s):

Esophageal Cancer ◽

Tooth Loss ◽

Long Term Prognosis

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The Influence of Different Treatment Strategies on the Long-Term Prognosis of T1 Stage Esophageal Cancer Patients

Frontiers in Oncology ◽

10.3389/fonc.2021.700088 ◽

2021 ◽

Vol 11 ◽

Author(s):

Liang Pan ◽

Xingyu Liu ◽

Weidong Wang ◽

Linhai Zhu ◽

Wenfeng Yu ◽

...

Keyword(s):

Esophageal Cancer ◽

Cancer Patients ◽

Tumor Size ◽

Factors Affecting ◽

Ajcc Stage ◽

Size Grade ◽

T1 Stage ◽

Long Term Prognosis ◽

Better Than

ObjectiveTo compare the long-term prognosis effects of non-esophagectomy and esophagectomy on patients with T1 stage esophageal cancer.MethodsAll esophageal cancer patients in the study were included from the National Surveillance Epidemiology and End Results (SEER) database between 2005-2015. These patients were classified into non-esophagectomy group and esophagectomy group according to therapy methods and were compared in terms of esophagus cancer specific survival (ECSS) and overall survival (OS) rates.ResultsA total of 591 patients with T1 stage esophageal cancer were enrolled in this study, including 212 non-esophagectomy patients and 111 esophagectomy patients in the T1a subgroup and 37 non-esophagectomy patients and 140 esophagectomy patients in the T1b subgroup. In all T1 stage esophageal cancer patients, there was no difference in the effect of non-esophagectomy and esophagectomy on postoperative OS, but postoperative ECSS in patients treated with non-esophagectomy was significantly better than those treated with esophagectomy. Cox proportional hazards regression model analysis showed that the risk factors affecting ECSS included race, primary site, tumor size, grade, and AJCC stage but factors affecting OS only include tumor size, grade, and AJCC stage in T1 stage patients. In the subgroup analysis, there was no difference in either ECSS or OS between the non-esophagectomy group and the esophagectomy group in T1a patients. However, in T1b patients, the OS after esophagectomy was considerably better than that of non-esophagectomy.ConclusionsNon-esophagectomy, including a variety of non-invasive procedures, is a safe and available option for patients with T1a stage esophageal cancer. For some T1b esophageal cancer patients, esophagectomy cannot be replaced at present due to its diagnostic and therapeutic effect on lymph node metastasis.

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PS01.137: CLINICAL IMPACT OF SURGICAL APGAR SCORE IN PREDICTING POSTOPERATIVE COMPLICATIONS AND LONG-TERM PROGNOSIS AFTER ESOPHAGECTOMY

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.137 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 88-89

Author(s):

Sonoko Ishida ◽

Akio Nakagawa ◽

Tetsu Nakamura ◽

Taro Oshikiri ◽

Hiroshi Hasegawa ◽

...

Keyword(s):

Esophageal Cancer ◽

Postoperative Complications ◽

Apgar Score ◽

Scoring System ◽

Clinical Stage ◽

Risk Calculator ◽

Poor Prognostic Factor ◽

Long Term Prognosis ◽

Surgical Apgar Score

Abstract Background Surgical Apgar Score (SAS) is a risk calculator, and is known to predict postoperative complications after surgery. Because it applies three intraoperative parameters, namely estimated blood loss, lowest mean arterial pressure, and lowest heart rate, actual surgical stress is reflected to its scoring system and many studies have reported its usefulness. And in recent years, close relationship between postoperative complications and long-term prognosis has been reported, but there are almost no studies about the relevance between risk calculator of complications and long-term prognosis. Methods A total of 400 patients who underwent esophagectomy for esophageal cancer between January 2007 and January 2017 at our institution were included in this study. Clinicopathological and intraoperative data to calculate SAS were collected from medical records, and a 10-point scoring system based on the original method was used to assign points. Complications classified as Clavien-Dindo grade III or higher were defined as postoperative complications. The relationship between SAS and postoperative complications and long-term prognosis was investigated. Results Postoperative complications occurred in 145 cases (36%). From ROC analysis, we set the SAS cut-off value to 5 points in this study. There were no significant differences in patient's background between the group of SAS ≤ 5 and > 5. Multivariate logistic regression analysis showed that hypertension (P = 0.049) and SAS ≤ 5 (P < 0.0001) were significant predictive factors for postoperative complications. In the prognostic analysis, log-rank analysis showed that patients with SAS ≤ 5 had a significantly poorer prognosis than those with SAS > 5 (P = 0.043), especially in clinical stage 2 or higher esophageal cancer (P = 0.027). In the multivariate analysis, SAS ≤ 5 was revealed to be a significantly poor prognostic factor in clinical stage 2 or higher esophageal cancer (P = 0.029). Conclusion The Surgical Apgar Score can predict postoperative complications, and is also useful to predict long-term prognosis after esophagectomy for esophageal cancer. Disclosure All authors have declared no conflicts of interest.

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