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Front Oncol. 2019 May 8;9:366. doi: 10.3389/fonc.2019.00366. eCollection 2019.

Relationship Between Sarcopenia and Prognosis in Patient With Concurrent Chemo-Radiation Therapy for Esophageal Cancer.

Ma DW1,2, Cho Y2,3, Jeon MJ2,3, Kim JH1,2, Lee IJ2,3, Youn YH1,2, Park JJ1,2, Jung DH1,2, Park H1,2, Lee CG3,4, Kim JW2,3, Jeung HC1,2.

Author information

1
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.
2
Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
3
Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea.
4
Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.

Abstract

Background: Sarcopenia, defined as skeletal muscle loss, has been known as a poor prognosis factor in various malignant diseases The aim of this study is to investigate the effect of sarcopenia on prognosis in patients with esophageal cancer who received concurrent chemo- and radiotherapy (CCRT). Methods: We retrospectively collected clinical data of 287 patients with esophageal cancer who were treated by definite CCRT at Gangnam Severance and Severance hospital from August 2005 to December 2014. The cross-sectional area of muscle at the level of the third lumbar vertebra was measured using pre- and post-CCRT computed tomography images. Sarcopenia was defined as skeletal muscle index <49 cm2/m2 for men and of <31 cm2/m2 for women by Korean-specific cutoffs. Overall survival (OS) and progression free survival (PFS) were analyzed according to sarcopenia. Results: Sarcopenia identified before CCRT did not affect OS and PFS. However, patients with post-CCRT sarcopenia showed shorter OS and PFS than patients without it (median OS: 73 months vs. 28 months; median PFS: 34 months vs. 25 months, respectively). Post-CCRT sarcopenia was an independent prognostic factor of poor OS (hazards ratio: 1.697; 95% confidence interval: 1.036-2.780; P = 0.036). In multivariate analysis, male sex (P = 0.004) and presence of CCRT-related complications, such as esophagitis or general weakness were significantly associated with post-CCRT sarcopenia (P = 0.016). Conclusions: Sarcopenia after CCRT can be a useful predictor for long-term prognosis in patients with esophageal cancer. To control CCRT-related complications may be important to prevent skeletal muscle loss during CCRT.

KEYWORDS:

complication; concurrent chemo- and radiotherapy; esophageal cancer; prognosis; sarcopenia

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