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Sarcopenia and myosteatosis at presentation adversely affect survival after esophagectomy for esophageal cancer Cover

Sarcopenia and myosteatosis at presentation adversely affect survival after esophagectomy for esophageal cancer

Open Access
|Mar 2020

Figures & Tables

Figure 1

Cumulative survival Kaplan-Meier curve.

Figure 2

Kaplan-Meier survival curves for sarcopenia.

Figure 3

Kaplan-Meier survival curves for myosteatosis.

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
Complications (n (%))
In hospital mortality1 (4.3%)8 (6.9%)0.614 (0.073–5.158)0.650
Any complication11 (47.8%)54 (46.6%)1.052 (0.430–2.578)0.911
Conduit complications4 (17.4%)17 (14.7%)1.226 (0.371–4.049)0.738
Pleuropulmonary complications8 (34.8%)29 (25.0%)1.600 (0.615–4.160)0.332
Respiratory failure5 (21.7%)21 (18.1%)1.230 (0.410–3.689)0.711
Any other complications4 (17.4%)38 (32.8%)0.432 (0.137–1.359)0.143
Median survival [months]18.3 (CI 5.4–31.1)31.0 (CI 7.4–54.6)0.042
     1 year survival50.8%78.5%
     3 year survival32.9%47.7%
     5 year survival32.9%42.2%
myosteatosis (N = 72 (51.8%))no myosteatosis (N = 67 (48.2%))odds ratio (OR. 95% CI)p
Complications (n (%))
In hospital mortality7 (9.7%)2 (3.0%)3.500 (0.701–17.486)0.107
Any complication32 (44.4%)33 (49.3%)0.824 (0.423–1.607)0.570
Conduit complications5 (6.9%)16 (23.9%)0.238 (0.082–0.692)0.005
Pleuropulmonary complications17 (23.6%)20 (30.0%)0.726 (0.341–1.545)0.406
Respiratory failure14 (19.4%)12 (17.9%)1.066 (0.453–2.510)0.884
Any other complications24 (33.3%)18 (26.9%)1.361 (0.656–2.822)0.407
Median survival [months]19.0 (CI 13.3–24.7)57.1 (CI 15.2–99.0)0.044
1 year survival64.2%84.0%
3 year survival36.9%53.7%
5 year survival33.9%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-max30–83
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 %)
Planimetry data
Days between CT and esophagectomy
     all (mean ± SD)76.9 ± 52.3
     min-max6–192
     median84
Neoadjuvant (mean ± SD)115.2 ± 36.0
     min-max14–192
     median125
No neoadjuvant (mean ± SD)33.5 ± 28.5
     min-max6–141
     median23
SMA [cm2] (mean ± SD)
     male157.6 ± 28.0
     female103.9 ± 16.3
SMI [cm2/m2] (mean ± SD)
     male52.1 ± 9.5
     female39.8 ± 6.8
Muscle attenuation [HU] (mean ± SD)
     male31.2 ± 8.3
     female27.8 ± 8.7
sarcopenia (N, %)23 (16.5%)
myosteatosis (N, %)72 (51.8%)
Procedure data
Surgical approach (N, %)
     open87 (62.6%)
     MIE52 (37.4%)
Type of esophagectomy (N, %)
     Ivor-Lewis109 (78.4%)
     McKeown26 (18.7%)
     Transhiatal4 (2.9%)
Radicality (N, %)
     R0130 (93.5%)
     R15 (3.6%)
     R24 (2.9%)
Lymph nodes (mean ± SD) (N, %)23.4 ± 12.3
     min-max0–76
     median21
Cancer type (N, %)
     Adenocarcinoma74 (53.2%)
     Squamous cell carcinoma64 (46.0%)
GIST1 (0.7%)
Pathological Stage (AJCC 2017) (N, %)
     I51 (36.7%)
     II27 (19.4%)
     III36 (25.9%)
     IVA23 (16.5%)
     IVB2 (1.4%)
Complications (N, %)
In hospital mortality9 (6.5%)
Any complication65 (46.8%)
Conduit complications21 (15.1%)
Pleuropulmonary complications37 (26.6%)
Respiratory failure26 (18.7%)
Any other complications42 (30.2%)
Median survival [months] 26.8 (95% CI 8.1–45,7)
1 year survival73.7%
3 year survival45.1%
5 year survival40.3%

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%))pMyosteatosis (N = 72 (51.8%))No Myosteatosis (N = 67 (48.2%))p
Age at Surgery (mean ± SD)67.1 ± 7.863.3 ± 9.70.07667.1 ± 7.760.5 ± 10.0< 0.001
Female sex (n (%))3 (13.0%)19 (16.4%)0.68910 (13.9%)12 (17.9%)0.516
BMI (mean ± SD)23.8 ± 5.926.7 ± 4.40.00627.3 ± 4.925.2 ± 4.40.006
Days esophagectomy between CT (and mean ± SD)81.4 ± 57.676.1 ± 51.40.65478.8 ± 52.875.0 ± 52.10.666
Weight loss > 10% (n (%))11 (47.8%)35 (30.2%)0.10025 (34.7%)21 (31.3%)0.672
Neoadjuvant Therapy (n (%))14 (60.9%)60 (51.7%)0.42234 (47.2%)40 (59.7%)0.141
Cancer Type (n (%))0.8640.500
     Adenocarcinoma13 (56.6%)61 (52.6%)37 (51.4%)37 (55.2%)
     Squamous cell carcinoma10 (43.4%)54 (46.6%)35 (48.6%)29 (43.3%)
     GIST1 (0.8%)1 (1.5%)
Pathological Stage (AJCC 2017) (n (%))0.6500.546
     I8 (34.8%)43 (37.1%)26 (36.1%)25 (37.3%)
     II6 (26.1%)21 (18.1%)11 (15.3%)16 (23.9%)
     III4 (17.4%)32 (27.6%)21 (29.2%)15 (22.4%)
     IVA4 (17.4%)19 (16.4%)12 (16.7%)11 (16.4%)
     IVB1 (4.3%)1 (0.8%)2 (2.8%)0
Lymph nodes (mean ± SD)28.8 ± 10.523.9 ± 12.60.26624.4 ± 11.122.4 ± 13.50.337
Surgical approach0.2580.167
     open12 (52.2%)75 (64.7%)49 (68.1%)38 (56.7%)
     MIE11 (47.8%)41 (35.3%)23 (31.9%)29 (43.3%)
DOI: https://doi.org/10.2478/raon-2020-0016 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099
Language: English
Page range: 237 - 246
Submitted on: Jan 7, 2020
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Accepted on: Mar 3, 2020
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Published on: Mar 27, 2020
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year

© 2020 Matevz Srpcic, Taja Jordan, Karteek Popuri, Mihael Sok, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.