Prognostic impact of sarcopenia in patients with locally advanced adenocarcinoma of the esophagogastric junction treated with neoadjuvant chemoradiotherapy

Jiao Ming; Rongxu Du; Jianhao Geng; Shuai Li; Zhiyan Liu; Yong Cai; Xianggao Zhu; Yangzi Zhang; Hongzhi Wang; Zhilong Wang; Lei Tang; Xiaotian Zhang; Zhi Peng; Aiwen Wu; Zhaode Bu; Yifan Peng; Yan Yan; Zhongwu Li; Yongheng Li; Ziyu Li; Weihu Wang

doi:10.3389/fnut.2023.988632

Prognostic impact of sarcopenia in patients with locally advanced adenocarcinoma of the esophagogastric junction treated with neoadjuvant chemoradiotherapy

Front Nutr. 2023 Jan 26:10:988632. doi: 10.3389/fnut.2023.988632. eCollection 2023.

Authors

Jiao Ming¹, Rongxu Du¹, Jianhao Geng¹, Shuai Li¹, Zhiyan Liu¹, Yong Cai¹, Xianggao Zhu¹, Yangzi Zhang¹, Hongzhi Wang¹, Zhilong Wang², Lei Tang², Xiaotian Zhang³, Zhi Peng³, Aiwen Wu⁴, Zhaode Bu⁴, Yifan Peng⁴, Yan Yan⁵, Zhongwu Li⁶, Yongheng Li¹, Ziyu Li⁴, Weihu Wang¹

Affiliations

¹ Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, China.
² Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Medical Imaging, Peking University Cancer Hospital and Institute, Beijing, China.
³ Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Oncology, Peking University Cancer Hospital and Institute, Beijing, China.
⁴ Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Beijing, China.
⁵ Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Endoscopy Center, Peking University Cancer Hospital and Institute, Beijing, China.
⁶ Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Pathology, Peking University Cancer Hospital and Institute, Beijing, China.

Abstract

Background: Few studies have evaluated the significance of sarcopenia in predicting the outcomes of patients with adenocarcinoma of the esophagogastric junction (AEG), especially those who received neoadjuvant chemoradiotherapy (NCRT). We aimed to identify the sarcopenic status and its impact on the outcomes of patients with locally advanced AEG who received NCRT followed by radical surgery or systemic therapy.

Materials and methods: Patients with T3-4N+M0 AEG with accessible abdominal computed tomography (CT) before and after NCRT were retrospectively analyzed. Body composition parameters, particularly the skeletal muscle index (SMI), were assessed using a CT-based method, and sarcopenia was defined using a predetermined SMI cutoff value. Survival analysis was conducted using the Kaplan-Meier method. A Cox proportional hazards regression model was used to identify independent prognostic factors. Receiver operating characteristic curve analysis was carried out, and the area under the curve (AUC) was calculated to test the prognostic accuracy of different factors.

Results: A total of 63 patients were enrolled, 65.1 and 79.4% of whom developed pre- and post-NCRT sarcopenia, respectively. Patients with pre-NCRT sarcopenia had lower radical surgery rates (70.7 vs. 95.5%, p = 0.047) than those without sarcopenia; however, sarcopenic status did not affect other short-term outcomes, including treatment-related toxicity and efficacy. Pre-NCRT sarcopenia was identified as an independent predictive factor for poor overall survival (OS) [adjusted hazard ratio (HR), 6.053; p = 0.002] and progression-free survival (PFS) (adjusted HR, 2.873; p = 0.031). Compared with nutritional indices such as the Nutritional Risk Screening 2002, weight loss during NCRT, and post-NCRT sarcopenia, pre-NCRT sarcopenia was regarded as the best predictive index for the 5-year OS (AUC = 0.735) and PFS rates (AUC = 0.770).

Conclusion: Pre-NCRT sarcopenia may be an independent predictive factor for OS and PFS rates in patients with locally advanced AEG receiving multimodal treatment.

Keywords: adenocarcinoma of the esophagogastric junction; neoadjuvant chemoradiotherapy; nutritional indices; prognosis; sarcopenia.

Grants and funding

This study was supported by the following programs: Capital’s Funds for Health Improvement and Research (No. 2020-2-1027), Beijing Municipal Science and Technology Commission (No. Z181100001718192), and National Natural Science Foundation (No. 82073333).