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. 2020 Jun;11(3):756-767.
doi: 10.1002/jcsm.12540. Epub 2020 Feb 25.

Influence of body composition and muscle strength on outcomes after multimodal oesophageal cancer treatment

Eliza R C Hagens  1 , Minke L Feenstra  1 , Maarten A van Egmond  2 , Hanneke W M van Laarhoven  3 , Maarten C C M Hulshof  4 , Piers R Boshier  5   6 , Donald E Low  5 , Mark I van Berge Henegouwen  1 , Suzanne S Gisbertz  1
Affiliations

Influence of body composition and muscle strength on outcomes after multimodal oesophageal cancer treatment

Eliza R C Hagens et al. J Cachexia Sarcopenia Muscle. 2020 Jun.

Abstract

Background: Influence of sarcopenia in combination with other body composition parameters and muscle strength on outcomes after oesophageal surgery for oesophageal cancer remains unclear. The objectives were (i) to describe the incidence of sarcopenia in relation to adipose tissue quantity and distribution and muscle strength; (ii) to evaluate if neoadjuvant chemoradiation (nCRTx) influences body composition and muscle strength; and (iii) to evaluate the influence of body composition and muscle strength on post-operative morbidity and long-term survival.

Methods: This retrospective study included patients with oesophageal cancer who received nCRTx followed by surgery between January 2011 and 2016. Skeletal muscle, visceral, and subcutaneous adipose tissue cross-sectional areas were calculated based on computed tomography scans, and muscle strength was measured using hand grip tests, 30 seconds chair stand tests, and maximal inspiratory and expiratory pressure tests prior to nCRTx and after nCRTx.

Results: A total of 322 patients were included in this study. Sarcopenia was present in 55.6% of the patients prior to nCRTx and in 58.2% after nCRTx (P = 0.082). Patients with sarcopenia had a significantly lower muscle strength and higher fat percentage. The muscle strength and incidence of sarcopenia increased while the mean body mass index and fat percentage decreased during nCRTx. A body mass index above 25 kg/m2 was associated with anastomotic leakage (P = 0.032). Other body composition parameters were not associated with post-operative morbidity. A lower handgrip strength prior to nCRTx was associated with pulmonary and cardiac complications (P = 0.023 and P = 0.009, respectively). In multivariable analysis, a lower number of stands during the 30 seconds chair stand test prior to nCRTx (hazard ratio 0.93, 95% confidence interval 0.87-0.99, P = 0.017) and visceral adipose tissue of >128 cm2 after nCRTx (hazard ratio 1.81, 95% confidence interval 1.30-2.53, P = 0.001) were associated with worse overall survival.

Conclusions: Sarcopenia occurs frequently in patients with oesophageal cancer and is associated with less muscle strength and a higher fat percentage. Body composition changes during nCRTx did not influence survival. Impaired muscle strength and a high amount of visceral adipose tissue are associated with worse survival. Therefore, patients with poor fitness might benefit from preoperative nutritional and muscle strengthening guidance, aiming to increase muscle strength and decrease visceral adipose tissue. However, this should be confirmed in a large prospective study.

Keywords: Body composition; Complications; Muscle strength; Oesophageal cancer; Sarcopenia; Survival.

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Conflict of interest statement

E.H., M.F., M.E., M.H., P.B., and D.L. have nothing to declare. H.V.L. has served as a consultant for BMS, Celgene, Lilly, and Nordic and has received unrestricted research funding from Bayer, BMS, Celgene, Lilly, Merck Serono, MSD, Nordic, Philips, and Roche. M.V.B.H. is consultant for Mylan and Medtronic and Johnson & Johnson and has received research/travel grants from Olympus, Medtronic, and Stryker. S.G. is consultant for Medtronic and has received a research grant from Olympus. The authors certify that they comply with the ethical guidelines for publishing in the Journal of Cachexia, Sarcopenia and Muscle: update 2019.56

Figures

Figure 1
Figure 1
Flowchart patient selection. Insufficient quality for measurements includes the following: Tissue was cut off from the frame, and/or the CT scan was not in portal phase, and/or it was not a high‐resolution scan. CT, computed tomography; nCRTx, neoadjuvant chemoradiation.
Figure 2
Figure 2
Influence of body composition and muscle strength on post‐operative complications. T0 is prior to neoadjuvant therapy, and T1 is after neoadjuvant therapy and prior to surgery.
Figure 3
Figure 3
Kaplan–Meier survival curves. Change in fat percentage defined as at least 2% change, change in BMI defined as at least 1 unit change, change in skeletal muscle index defined as at least 1.5 cm2/m2 change. P values based on log‐rank test. BMI, body mass index; nCRTx, neoadjuvant chemoradiation.
See this image and copyright information in PMC

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