Developing sarcopenia during neoadjuvant therapy is associated with worse survival in esophageal adenocarcinoma patients

• Published in: Surgery Vol. 175; no. 3; pp. 718 - 725
• Main Authors: Pierce, Katherine, Philips, Prejesh, Egger, Michael E, Scoggins, Charles R, Martin, Robert CG
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2024
• Subjects: Adenocarcinoma - complications; Adenocarcinoma - surgery; Esophageal Neoplasms - complications; Esophageal Neoplasms - surgery; Humans; Neoadjuvant Therapy - adverse effects; Prognosis; Retrospective Studies; Sarcopenia - diagnosis; Sarcopenia - diagnostic imaging
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2023.09.017

Sarcopenia in cancer patients has been associated with mixed postoperative outcomes. The aim of this study was to evaluate whether the development of sarcopenia during the neoadjuvant period is predictive of postoperative mortality in esophageal adenocarcinoma patients. We queried a prospective database to retrieve the sarcopenic status of patients with esophageal adenocarcinoma who underwent cross-sectional imaging of the third lumbar vertebra at diagnosis and within 2 months of undergoing an esophagogastrectomy between 2014 and 2022. Of the 71 patients included in the study, 36 (50.7%) presented with sarcopenia at diagnosis. Of the 35 non-sarcopenic patients, 14 (40%) developed sarcopenia during the neo-adjuvant period. Patients who were not sarcopenic at diagnosis but developed sarcopenia preoperatively had significantly worse overall survival than patients sarcopenic at diagnosis and not sarcopenic preoperatively and patients experiencing no change in sarcopenic status (median 18 vs 47 vs 31 months; P = .02). Diagnostic and preoperative sarcopenic status alone were not significantly associated with overall survival (P = .48 and P = .56, respectively). Although 37 (52.1%) patients died, the cause of death was often not cancer-related (54.1%) and included acute respiratory failure, pneumonia, and cardiac arrest. No significant survival difference was observed when stratified by >10% weight loss (P = .9) or large loss in body mass index (P = .8). Developing sarcopenia during the neo-adjuvant period may be associated with worse overall survival in patients requiring esophagogastrectomy.