ASO Author Reflections: The Impact of Early Skeletal Muscle Loss Within 1 Week After Esophagectomy on Long-term Prognosis in Patients with Esophageal Cancer

Abstract Background: The postoperative survival rate of patients with esophageal squamous cell carcinoma (ESCC) remains poor compared with other gastrointestinal cancers. We hypothesized that skeletal muscle loss in the postoperative acute phase might be a new predictor for long-term prognosis after highly invasive surgery such as ESCC surgery.Methods: The following items were retrospectively investigated. First, whether skeletal muscle loss occurred in the postoperative acute phase of ESCC was verified. Second, the preoperative and intraoperative factors involved in skeletal muscle loss in the postoperative acute phase of ESCC were investigated. Then, whether skeletal muscle loss in the postoperative acute phase affected long-term prognosis was examined. The medical records of consecutive patients who underwent radical esophagectomy for ESCC between January 2010 and June 2015 were retrospectively reviewed; 72 cases were eligible for this study. The total psoas major muscle mass index (TPI) at the level of the third lumbar vertebra (L3) was measured using computed tomography (CT) before surgery and three days after surgery. The long-term prognosis was estimated by the Kaplan-Meier method and the multivariate logistic regression model.Results: There was already a significant reduction of TPI in the acute phase up to POD 3 after ESCC surgery in comparison with the preoperative baseline TPI (P < 0.001). The TPI reduction rate was significantly milder in cases with less blood loss during surgery and in cases that underwent thoracoscopic esophagectomy than in cases that underwent open esophagectomy. The three-year overall survival rate was significantly different between the TPI reduction rate severe group and the TPI reduction rate mild group.Conclusion: skeletal muscle loss occurred even in the postoperative acute phase. Furthermore, it is very significant that skeletal muscle loss in the postoperative acute phase of ESCC surgery is involved in the long-term prognosis.

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Skeletal muscle loss in the postoperative acute phase after esophageal cancer surgery as a new prognostic factor

10.21203/rs.2.23396/v1 ◽

2020 ◽

Author(s):

Naoaki Maeda ◽

Yasuhiro Shirakawa ◽

Shunsuke Tanabe ◽

Kazufumi Sakurama ◽

Kazuhiro Noma ◽

...

Keyword(s):

Skeletal Muscle ◽

Survival Rate ◽

Acute Phase ◽

Psoas Muscle ◽

Muscle Loss ◽

Psoas Major Muscle ◽

Significant Difference ◽

Skeletal Muscle Loss ◽

Long Term Prognosis

Abstract Background: The postoperative survival rate of patients with esophageal squamous cell carcinoma (ESCC) remains poor compared with other gastrointestinal cancers. We hypothesized that skeletal muscle loss (SML) in the postoperative acute phase might be a new predictor for long-term prognosis after highly invasive surgery such as ESCC surgery.Methods: The following items were retrospectively investigated. First, whether SML occurred in the postoperative acute phase of ESCC was verified. Second, the preoperative and intraoperative factors involved in SML in the postoperative acute phase of ESCC were investigated. Then, whether SML in the postoperative acute phase affected long-term prognosis was examined. The medical records of consecutive patients who underwent radical esophagectomy for ESCC were retrospectively reviewed; 72 cases were eligible for this study.Results: There was already a significant difference between the total psoas major muscle mass index (TPI) of the acute phase up to 3 days after surgery and the preoperative baseline TPI. The psoas muscle loss index (PMLI) was significantly milder in cases with less blood loss during surgery and in cases that underwent thoracoscopic esophagectomy than in cases that underwent open esophagectomy. The three-year overall survival rate was significantly different between the PMLI severe group and the PMLI mild group.Conclusion: SML occurred even in the postoperative acute phase. Furthermore, it is very significant that SML in the postoperative acute phase of ESCC surgery is involved in the long-term prognosis.

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Skeletal muscle loss in the postoperative acute phase after esophageal cancer surgery as a new prognostic factor

World Journal of Surgical Oncology ◽

10.1186/s12957-020-01908-6 ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Naoaki Maeda ◽

Yasuhiro Shirakawa ◽

Shunsuke Tanabe ◽

Kazufumi Sakurama ◽

Kazuhiro Noma ◽

...

Keyword(s):

Skeletal Muscle ◽

Esophageal Cancer ◽

Prognostic Factor ◽

Acute Phase ◽

Cancer Surgery ◽

Muscle Loss ◽

Esophageal Cancer Surgery ◽

Skeletal Muscle Loss

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The Impact of Critical Illness on Skeletal Muscle Structure

10.1093/med/9780199653461.003.0034 ◽

2014 ◽

Author(s):

Catherine L Hough

Keyword(s):

Skeletal Muscle ◽

Critical Illness ◽

Thick Filament ◽

Muscle Membrane ◽

Type I ◽

Muscle Loss ◽

Muscle Structure ◽

Muscle Necrosis ◽

Skeletal Muscle Loss ◽

The Impact

Patients with critical illness are at risk of profound weakness and skeletal muscle loss, and recovery is marked by prolonged physical functional impairment in many survivors. Muscle and nerve abnormalities found in critically ill patients include loss of muscle mass, muscle membrane inexcitability, polyneuropathy, mitochondrial dysfunction with bioenergetic failure, as well as changes in skeletal muscle structure. The most common histological abnormalities are atrophy of both type I and II fibres and thick filament loss; muscle necrosis is less common. While recent studies have illuminated the pathogenesis of critical illness myopathy, additional high-quality translational research is needed to identify targets for therapeutic intervention.

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Prognostic Significance of Skeletal Muscle Loss During Early Postoperative Period in Elderly Patients with Esophageal Cancer

Annals of Surgical Oncology ◽

10.1245/s10434-019-07616-0 ◽

2019 ◽

Vol 26 (11) ◽

pp. 3727-3735 ◽

Cited By ~ 6

Author(s):

Keita Takahashi ◽

Masayuki Watanabe ◽

Ryotaro Kozuki ◽

Tasuku Toihata ◽

Akihiko Okamura ◽

...

Keyword(s):

Skeletal Muscle ◽

Esophageal Cancer ◽

Elderly Patients ◽

Postoperative Period ◽

Prognostic Significance ◽

Early Postoperative Period ◽

Muscle Loss ◽

Skeletal Muscle Loss

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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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The impact of skeletal muscle loss for hepatocellular carcinoma treated with lenvatinib.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.493 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 493-493

Author(s):

Mao Okada ◽

Hiroyuki Nakanishi ◽

Masayuki Kurosaki ◽

Kento Inada ◽

Sakura Kirino ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Skeletal Muscle ◽

Dose Intensity ◽

Muscle Loss ◽

Muscle Area ◽

Chronological Change ◽

Significant Difference ◽

Skeletal Muscle Loss ◽

Tki Treatment ◽

The Impact

493 Background: Many previous reports have shown that skeletal muscle loss (SML) is one of the prognostic factors for hepatocellular carcinoma (HCC) patients treated with sorafenib. However, there are few reports about the impact of SML for the HCC patients treated with lenvatinib. Therefore, we evaluated the relation between SML and overall survival (OS) of HCC patients treated with lenvatinib (LEN). Methods: We retrospectively analyzed 50 HCC patients treated with LEN from April 2018 to February 2019. We included 36 patients who continued LEN more than 8 weeks and evaluated CT scans before treatment and after 8 weeks. Skeletal muscle area was measured on axial image at the level of the third lumber vertebra (L3) using sliceOmatic. Skeletal Mass Index (SMI) was calculated by dividing the muscle area (㎠) with square of height (㎡). The definition of myopenia is based on the guideline described by the Japan Society of Hepatology (42㎠/㎡ in men and 38 ㎠/㎡ in women). ΔSMI is a chronological change of SMI for 8 weeks. We calculated decreasing rate of ΔSMI. We evaluated the relation between chronological change of SMI and OS. Results: The patients with myopenia at baseline were 12 (33.3 %). The decreasing rate of ΔSMI at 8 weeks was -2.57 % [-5.9, 0.2]. SMI had decreased in 27 patients (75 %) for 8 weeks. There was no significant difference between OS and baseline myopenia (p = 0.2), ALBI grade (p = 0.2), BCLC stage (p = 0.5), up to 7 in or out (p = 0.35), previous TKI treatment (p = 0.15), metastasis (p = 0.91), or vascular invasion (p = 0.12). However, the patients who had decreased SMI had significantly poor prognosis (p = 0.028). In backgrounds, there was no significant difference between patients with or without decreasing of ΔSMI, such as baseline myopenia (p = 0.7), ALBI grade (p = 0.4), BCLC stage (p = 1.0), Child Pugh score (p = 0.8), age (p = 0.6), sex (p = 0.3), up to7 in or out (p = 1.0), previous TKI treatment (p = 0.3), and relative dose intensity at 4 weeks (p = 0.9). Conclusions: There was no significant correlation between baseline myopenia and OS. However, chronological decreasing of SMI for 8 weeks was a prognostic factor of HCC patients treated with LEN. Therefore, monitoring and preventing of decreasing of skeletal muscle mass may be important.

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170 SKELETAL MUSCLE LOSS DURING NEOADJUVANT CHEMOTHERAPY IS A PREDICTOR OF MAJOR POSTOPERATIVE COMPLICATIONS IN PATIENTS WITH ESOPHAGUS CANCER

Diseases of the Esophagus ◽

10.1093/dote/doab052.170 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Kazuya Higashizono ◽

Shinsuke Sato ◽

Erina Nagai ◽

Yusuke Taki ◽

Masato Nishida ◽

...

Keyword(s):

Skeletal Muscle ◽

Esophageal Cancer ◽

Postoperative Complications ◽

Neoadjuvant Chemotherapy ◽

Surgical Stress ◽

Univariate Analysis ◽

Muscle Loss ◽

Cross Sectional ◽

Skeletal Muscle Index ◽

Skeletal Muscle Loss

Abstract It is known that various factors, including surgical stress, nutritional deficits and sarcopenia, affect the incidence of postoperative complications. The aim of this study is to identify the predictors of major complications (Clavien-Dindo ≥II) after esophageal resection following neoadjuvant chemotherapy (NAC). Methods Forty-nine patients with esophageal cancer undergoing NAC and surgery between January 2017 and December 2019 were identified from our surgery database and retrospectively analyzed. Onodera prognostic nutritional index (PNI) was used as the indicator of nutritional status. For the evaluation of skeletal muscle mass, computed tomography imaging of the total cross-sectional muscle tissue measured at the third lumbar level defined the skeletal muscle index (SMI). Images were collected before and after NAC. Univariate and multivariate logistic regression analyses were used to assess the association between various predictors and major postoperative complications. Results Of the Forty-nine patients, 20 patients (40.8%) had major complication after surgery. Of the 20 patients, 5 had pneumonia and 4 had anastomotic leakage. Nine patients (18.3%) complete planned dose of NAC. SMI reduction was observed in 42 patients (85.7%) during NAC. According to univariate analysis, SMI reduction during NAC, and PNI before chemotherapy were significantly associated with major postoperative complications (P = 0.032, P = 0.035, respectively). According to multivariate analysis, SMI reduction during NAC is an independent predictor for the incidence of major postoperative complications (P = 0.0034). Conclusion Skeletal muscle loss during neoadjuvant chemotherapy can be an useful predictor of major postoperative complications in patients with esophageal cancer.

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