Sarcopenia, myosteatosis, and weight loss as determinants of survival and toxicity in patients with resectable esophageal and gastroesophageal junction (GEJ) cancer receiving preoperative chemoradiotherapy (CRT)

Abstract

Background: Abnormal body composition (sarcopenia, myosteatosis, and significant weight loss of≥8% (SWL)) has been associated with poor outcomes. This study evaluated sarcopenia, low skeletal muscle attenuation (SMA), and SWL as factors associated with toxicity, recurrence free survival (RFS), and overall survival (OS) with neoadjuvant CRT, in patients with resectable esophageal/GEJ cancer. Methods: We retrospectively reviewed all pts with resectable esophageal/GEJ cancer treated with curative intent preoperative CRT (paclitaxel/carboplatin) from 2010- 2013. Pretreatment CT scans were used to measure skeletal muscle index (SMI) and SMA to determine sarcopenia and myosteatosis, respectively. SWL was determined from the first dietitian recorded body weight and pre-morbid body weight. Treatment delays/modifications (TDM) were used as surrogates for toxicity. Results: Of 88 evaluable patients, 76 (86%) were males with a median age of 62. Histology includes: 72 (82%) adenocarcinoma; 13 (15%) squamous cell carcinoma, 3 (3%) other. Sarcopenia, myosteatosis, and SWL were present in 35 (40%), 46 (52%) and 40 (45%) patients, respectively. By univariate analysis, sarcopenia and SWL were associated with shorterOS and RFS (Sarcopenia p=0.009 and p=0.042, respectively, SWL p=0.012 and p=0.061, respectively). Myosteatosis was associated with TDM (p=0.001). On multivariate analysis, sarcopenia and SWL were associated with shorter OS and RFS, independent of stage and performance status (PS). Conclusions: Sarcopenia and SWL are associated with shorter OS and RFS independent of stage and PS. Myosteatosis is associated with treatment-related toxicities. These results highlight the prognostic and predictive utility of body composition analysis in survival and treatment related toxicities in esophageal/GEJ cancer patients treated with curative intent preoperative CRT. (Table Presented).