Skeletal muscle mass and quality before preoperative chemotherapy influence postoperative long-term outcomes in esophageal squamous cell carcinoma patients

Table 1 Clinicopathological characteristics of patients

	All	Preoperative	Preoperative	P value	Preoperative	Preoperative	P value
	n = 131	Low PMI, n = 36	High PMI, n = 95		High IMAC, n = 17	Low IMAC, n = 114
Age, yr	64 (44-78)	63 (50-75)	65 (44-78)	0.749	68 (44-74)	64 (45-78)	0.034
Gender (male/female)	120/11	28/8	92/3	0.001	15/2	105/9	0.635
Preoperative body mass index	21.4 (14.7-27.7)	19.9 (14.7-24.2)	21.6 (15.9-27.7)	0.001	21.6 (18.4-25.6)	21.2 (14.7-27.7)	0.194
PS ≥ 1	12 (9.2%)	4 (11.1%)	8 (8.4%)	0.736	1 (5.9%)	16 (9.6%)	0.708
ASA-PS (2/3)	112/19	30/6	82/13	0.782	14/3	98/16	0.713
Albumin (g/dL)	4.1 (2.9-4.9)	3.9 (3.1-4.8)	4.1 (2.9-4.9)	0.127	4.0 (3.5-4.5)	4.1 (2.9-4.9)	0.471
CRP (mg/dL)	0.11 (0.01-7.37)	0.11 (0.02-7.37)	0.11 (0.01-6.48)	0.905	0.16 (0.20-4.53)	0.10 (0.01-7.37)	0.160
Neutrophil-lymphocyte ratio	1.66 (0.24-22.33)	2.10 (0.29-14.06)	1.54 (0.24-22.33)	0.293	1.95 (0.59-7.73)	1.54 (0.24-22.33)	0.171
Prognostic nutritional index	49.05 (35.70-106.15)	46.65 (35.70-68.00)	49.30 (37.30-106.15)	0.098	48.40 (40.75-53.35)	49.33 (35.70-106.15)	0.135
mGPS (0/1/2)	105/21/5	27/8/1	78/13/4	0.515	12/5/0	93/16/5	0.232
GNRI	105.9 (81.7-121.4)	99.0 (86.8-108.8)	107.2 (81.7-121.4)	0.001	106.1 (86.1-121.4)	105.4 (97.3-111.6)	0.356
Clinical T-stage (1/2/3/4)	3/68/57/3	1/14/20/1	2/54/37/2	0.390	1/6/10/0	2/62/47/3	0.090
Clinical N-stage (0/1/2/3)	51/35/36/9	13/11/9/3	38/24/27/6	0.889	7/5/3/2	44/30/33/7	0.735
Clinical stage (II/III)	68/63	18/18	50/45	0.846	10/7	58/56	0.609
Tumor response to chemotherapy
CR/PR/SD/PD	2/79/42/8	0/21/13/2	2/58/29/6	0.852	0/6/9/2	2/73/33/6	0.090
Pre NAC PMI	4.94 (2.40-8.86)	3.66 (2.40-4.43)	5.39 (3.34-8.86)	0.001	4.76 (3.28-6.64)	5.01 (2.40-8.86)	0.558
Pre NAC IMAC	-0.46 (-1.07--0.19)	-0.47 (-1.07--0.28)	-0.46 (-1.06--0.19)	0.248	-0.32 (-0.75--0.19)	-0.48 (-1.07--0.33)	0.001
Operative time (min)	443 (328-882)	444 (328-882)	443 (339-786)	0.495	452 (328-882)	440 (350-786)	0.472
Intraoperative bleeding (mL)	730 (150-3015)	652 (330-2550)	732 (150-3015)	0.258	750 (450-2550)	718 (150-3015)	0.247
Postoperative complications (C-D ≥ 3)
Any complication	53 (40.5%)	16 (44.4%)	37 (38.9%)	0.690	5 (29.4%)	48 (42.1%)	0.430
Respiratory complication	28 (21.4%)	8 (22.2%)	20 (21.1%)	1.000	4 (23.5%)	24 (21.1%)	1.000
Anastomotic leakage	3 (2.3%)	2 (5.6%)	1 (1.1%)	0.183	0 (0%)	3 (2.6%)	1.000
Pathological tumor grading
G1/G2/G3/Gx	14/77/38/2	3/24/8/1	11/53/30/1	0.534	1/9/7/0	13/68/31/2	0.600
pT-Stage (0/1/2/3/4)	7/27/21/73/3	1/7/5/21/1	6/19/16/52/2	0.985	0/2/4/11/0	7/25/17/62/3	0.796
pN-Stage (0/1/2/3)	46/17/30/38	11/8/11/6	35/9/19/32	0.059	3/2/5/7	43/15/25/31	0.399
pStage (0/1/2/3)	4/18/36/73	0/6/10/20	4/12/26/53	0.640	0/2/2/13	4/16/34/60	0.279
Reoperation	4 (3.1%)	1 (2.8%)	3 (3.2%)	1.000	0 (0%)	4 (3.5%)	0.651
Length of hospital stay (d)	18 (11-225)	18 (11-225)	18 (11-112)	0.630	20 (11-225)	18 (11-112)	0.432
30 d mortality	0	0	0		0	0
90 d mortality	0	0	0		0	0
Harvested number of LNs	91 (42-194)	102 (44-194)	90 (42-184)	0.360	82 (49-130)	91 (42-194)	0.092

PMI: Psoas muscle mass index; IMAC: Intramuscular adipose tissue content.

Table 2 Univariate and multivariate analyses of factors associated with overall survival

		1-year survival	3-year survival	5-year survival	Univariate analysis	P	Multivariate analysis	P
					Log rank		HR, 95%CI
Age, yr	≥ 60	88.0	58.0	51.1	5.604	0.018	2.031	0.054
	< 60	91.9	75.7	75.7			0.986-4.183
BMI	< 22	92.0	64.0	59.8	0.108	0.743
	≥ 22	87.3	62.6	57.4
PS	0	89.8	65.7	59.6	1.640	0.200
	1	81.8	45.5	45.5
ASA	2	87.2	60.4	55.7	1.812	0.178
	3	100.0	78.9	73.3
Stage	II	86.4	65.2	59.0	0.051	0.821
	III	91.9	61.0	57.6
PNI	≥ 50	87.5	58.9	58.9	0.006	0.937
	< 50	90.3	66.5	57.9
NLR	≥ 2.5	93.5	54.2	54.2	0.600	0.439
	< 2.5	87.7	66.0	59.8
mGPS	0	88.4	64.9	59.9	0.493	0.483
	1-2	92.0	56.0	52.0
GNRI	≥ 98	87.8	62.1	56.8	0.498	0.480
	< 98	93.3	66.7	63.3
Operative time (min)	≥ 450	89.1	63.2	55.4	0.039	0.843
	< 450	89.1	63.1	60.3
Blood loss (mL)	≥ 730	93.7	64.8	61.4	0.570	0.450
	< 730	84.6	61.5	55.4
Postoperative complication	Present	88.1	63.7	57.5	0.026	0.873
	Absent	89.7	62.8	58.9
pT	0-2	90.9	80.0	69.1	5.350	0.021	1.966	0.025
	3-	87.7	50.3	50.3			1.089-3.550
pN	0	93.5	82.6	73.7	7.465	0.006	2.154	0.022
	1-	86.7	52.1	49.6			1.118-4.148
IMAC	< -0.40	89.4	65.5	61.9	5.093	0.024	2.089	0.022
	≥ -0.40	87.4	44.8	29.9			1.036-4.214
PMI	≥ 4.0	93.6	70.1	64.5	7.096	0.008	2.266	0.005
	< 4.0	76.7	44.2	41.3			1.282-4.006

BMI: Body mass index; PMI: Psoas muscle mass index; IMAC: Intramuscular adipose tissue content.