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. 2019 Nov;8(16):6967-6976.
doi: 10.1002/cam4.2593. Epub 2019 Oct 1.

Myosteatosis in a systemic inflammation-dependent manner predicts favorable survival outcomes in locally advanced esophageal cancer

Camila T B Gabiatti  1 , Mariane C L Martins  1 , Daniela L Miyazaki  1 , Leandro P Silva  1 , Fabiana Lascala  1 , Ligia T Macedo  1 , Maria Carolina Santos Mendes  1 , José Barreto Campello Carvalheira  1
Affiliations

Myosteatosis in a systemic inflammation-dependent manner predicts favorable survival outcomes in locally advanced esophageal cancer

Camila T B Gabiatti et al. Cancer Med. 2019 Nov.

Abstract

Increased adiposity and its attendant metabolic features as well as systemic inflammation have been associated with prognosis in locally advanced esophageal cancer (LAEC). However, whether myosteatosis and its combination with systemic inflammatory markers are associated with prognosis of esophageal cancer is unknown. Our study aimed to investigate the influence of myosteatosis and its association with systemic inflammation on progression-free survival (PFS) and overall survival (OS) in LAEC patients treated with definitive chemoradiotherapy (dCRT). We retrospectively gathered information on 123 patients with LAEC submitted to dCRT at the University of Campinas Hospital. Computed tomography (CT) images at the level of L3 were analyzed to assess muscularity and adiposity. Systemic inflammation was mainly measured by calculating the neutrophil-to-lymphocyte ratio (NLR). Median PFS for patients with myosteatosis (n = 72) was 11.0 months vs 4.0 months for patients without myosteatosis (n = 51) (hazard ratio [HR]: 0.53; 95% confidence interval [CI], 0.34-0.83; P = .005). Myosteatosis was also independently associated with a favorable OS. Systemic inflammation (NLR > 2.8) was associated with a worse prognosis. The combination of myosteatosis with systemic inflammation revealed that the subgroup of patients with myosteatosis and without inflammation presented less than half the risk of disease progression (HR: 0.47; 95% CI: 0.26-0.85; P = .013) and death (HR: 0.39; 95% CI, 0.21-0.72; P = .003) compared with patients with inflammation. This study demonstrated that myosteatosis without systemic inflammation was independently associated with favorable PFS and OS in LAEC patients treated with dCRT.

Keywords: cachexia; esophageal neoplasms; myosteatosis; sarcopenia; survival analysis.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Representative computed tomography images in patients with (A—43 y old man with squamous cell carcinoma; BMI = 19.9; NLR = 8.8; PLR = 1871.0) and without (B—57 y old man with squamous cell carcinoma; BMI = 21.3; NLR = 2.4; PLR = 67.3) myosteatosis with LAEC treated with dCRT. PFS (C) and OS (D) in patients with and without myosteatosis with LAEC treated with dCRT. Color legend: Subcutaneous (blue), visceral (yellow), intramuscular adipose tissue (green), and skeletal muscle mass (red). BMI, body mass index; dCRT, definitive chemoradiotherapy; LAEC, locally advanced esophageal cancer; NLR, neutrophil‐lymphocyte ratio; PLR, platelet‐to‐lymphocyte ratio
Figure 2
Figure 2
Progression‐free survival (A) and overall survival (B) according to neutrophil‐to‐lymphocyte ratio and myosteatosis in patients with locally advanced esophageal cancer treated with definitive chemoradiotherapy
See this image and copyright information in PMC

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