Decreased core muscle size is associated with worse patient survival following esophagectomy for cancer

Dis Esophagus. Sep-Oct 2013;26(7):716-22. doi: 10.1111/dote.12020. Epub 2013 Jan 25.

Abstract

Preoperative risk assessment, particularly for patient frailty, remains largely subjective. This study evaluated the relationship between core muscle size and patient outcomes following esophagectomy for malignancy. Using preoperative computed tomography scans in 230 subjects who had undergone transhiatal esophagectomy for cancer between 2001 and 2010, lean psoas area (LPA), measured at the fourth lumbar vertebra, was determined. Cox proportional hazards regression was employed to analyze overall survival (OS) and disease-free survival (DFS) adjusted for age, gender, and stage, and the Akaike information criterion was used to determine each covariate contribution to OS and DFS. Univariate analysis demonstrated that increasing LPA correlated with both OS (P = 0.017) and DFS (P = 0.038). In multivariate analysis controlling for patient and tumor characteristics, LPA correlated with OS and DFS in patients who had not received neoadjuvant treatment (n = 64), with higher LPA associated with improved OS and DFS. Moreover, LPA was of equivalent, or slightly higher importance than pathologic stage. These measures were not predictive among patients (n = 166) receiving neoadjuvant chemoradiation. Core muscle size appears to be an independent predictor of both OS and DFS, as significant as tumor stage, in patients following transhiatal esophagectomy. Changes in muscle mass related to preoperative treatment may confound this effect. Assessment of core muscle size may provide an additional objective measure for risk stratification prior to undergoing esophagectomy.

Keywords: esophageal cancer; esophageal surgery; risk stratification.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenocarcinoma / mortality
  • Adenocarcinoma / surgery*
  • Adenocarcinoma / therapy
  • Aged
  • Carcinoma, Squamous Cell / mortality
  • Carcinoma, Squamous Cell / surgery*
  • Carcinoma, Squamous Cell / therapy
  • Chemoradiotherapy
  • Combined Modality Therapy
  • Disease-Free Survival
  • Esophageal Neoplasms / mortality
  • Esophageal Neoplasms / surgery*
  • Esophageal Neoplasms / therapy
  • Esophagectomy*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Neoplasm Staging
  • Organ Size
  • Prognosis
  • Proportional Hazards Models
  • Psoas Muscles / anatomy & histology*
  • Psoas Muscles / diagnostic imaging
  • Retrospective Studies
  • Risk Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome