Case Control Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2023; 15(4): 621-633
Published online Apr 27, 2023. doi: 10.4240/wjgs.v15.i4.621
Skeletal muscle mass and quality before preoperative chemotherapy influence postoperative long-term outcomes in esophageal squamous cell carcinoma patients
Daichi Ichinohe, Takahiro Muroya, Harue Akasaka, Kenichi Hakamada
Daichi Ichinohe, Takahiro Muroya, Harue Akasaka, Kenichi Hakamada, Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki 0368562, Aomori, Japan
Author contributions: Ichinohe D contributed to conception, methodology, investigation, data curation, original drafting, reviewing, and editing of the manuscript, and generation of figures; Muroya T contributed to conception, methodology, data curation, and generation of figures; Akasaka H contributed to data curation; Hakamada K contributed to reviewing and editing of the manuscript, and supervised the study.
Institutional review board statement: The Institutional Review Board of Hirosaki University Hospital provided approval for this study (Approval No. 2020-038).
Informed consent statement: With regard to informed consent, Hirosaki University Hospital uses an opt-out format on its website and does not obtain individual consent.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to disclose.
Data sharing statement: Data available upon reasonable request. Please contact daichii@hirosaki-u.ac.jp.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kenichi Hakamada, MD, PhD, Professor, Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki 0368562, Aomori, Japan. hakamada@hirosaki-u.ac.jp
Received: November 11, 2022
Peer-review started: November 11, 2022
First decision: January 23, 2023
Revised: February 8, 2023
Accepted: March 23, 2023
Article in press: March 23, 2023
Published online: April 27, 2023
Abstract
BACKGROUND

Previous reports have focused on muscle mass as a prognostic factor in esophageal cancer.

AIM

To investigate how preoperative body type influences the prognosis of patients with esophageal squamous cell carcinoma who underwent neoadjuvant chemotherapy (NAC) and surgery.

METHODS

The subjects were 131 patients with clinical stage II/III esophageal squamous cell carcinoma who underwent subtotal esophagectomy after NAC. Skeletal muscle mass and quality were calculated based on computed tomography images prior to NAC, and their statistical association with long-term outcomes was examined retrospectively in this case-control study.

RESULTS

The disease-free survival rates in the low psoas muscle mass index (PMI) group vs the high PMI group were 41.3% vs 58.8% (P = 0.036), respectively. In the high intramuscular adipose tissue content (IMAC) group vs the low IMAC group, the disease-free survival rates were 28.5% vs 57.6% (P = 0.021), respectively. The overall survival (OS) rates for the low PMI group vs the high PMI group were 41.3% vs 64.5% (P = 0.008), respectively, and for the high IMAC group vs the low IMAC group, they were 29.9% vs 61.9% (P = 0.024), respectively. Analysis of the OS rate revealed significant differences in patients aged 60 years or older (P = 0.018), those with pT3 or above disease (P = 0.021), or those with lymph node metastasis (P = 0.006), aside from PMI and IMAC. Multivariate analysis demonstrated that pT3 or above [hazard ratio (HR): 1.966, 95% confidence interval (CI): 1.089-3.550, P = 0.025), lymph node metastasis (HR: 2.154, 95%CI: 1.118-4.148, P = 0.022), low PMI (HR: 2.266, 95%CI: 1.282-4.006, P = 0.005), and high IMAC (HR: 2.089, 95%CI: 1.036-4.214, P = 0.022) were significant prognostic factors for esophageal squamous cell carcinoma.

CONCLUSION

Skeletal muscle mass and quality before NAC in patients with esophageal squamous cell carcinoma are significant prognostic factors for postoperative OS.

Keywords: Esophageal squamous cell carcinoma, Muscle mass, Muscle quality, Neoadjuvant chemotherapy, Body composition

Core Tip: Esophageal cancer patients are often nutritionally malnourished, and their muscle mass is often decreased. In addition to loss of muscle mass, it is often associated with loss of muscle quality. In this study, the prognosis of esophageal squamous cell carcinoma patients was found to be influenced by muscle composition before preoperative chemotherapy. The prognosis is not only affected by muscle mass but also by muscle quality.