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Prognostic value of sarcopenia in patients treated by Radiochemotherapy for locally advanced oesophageal cancer

BACKGROUND: Sarcopenia is defined by a loss of skeletal muscle mass with or without loss of fat mass. Sarcopenia has been associated to reduced tolerance to treatment and worse prognosis in cancer patients, including patients undergoing surgery for limited oesophageal cancer. Concomitant chemo-radio...

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Autores principales: Mallet, Romain, Modzelewski, Romain, Lequesne, Justine, Mihailescu, Sorina, Decazes, Pierre, Auvray, Hugues, Benyoucef, Ahmed, Di Fiore, Fréderic, Vera, Pierre, Dubray, Bernard, Thureau, Sébastien
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7245030/
https://www.ncbi.nlm.nih.gov/pubmed/32443967
http://dx.doi.org/10.1186/s13014-020-01545-z
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author Mallet, Romain
Modzelewski, Romain
Lequesne, Justine
Mihailescu, Sorina
Decazes, Pierre
Auvray, Hugues
Benyoucef, Ahmed
Di Fiore, Fréderic
Vera, Pierre
Dubray, Bernard
Thureau, Sébastien
author_facet Mallet, Romain
Modzelewski, Romain
Lequesne, Justine
Mihailescu, Sorina
Decazes, Pierre
Auvray, Hugues
Benyoucef, Ahmed
Di Fiore, Fréderic
Vera, Pierre
Dubray, Bernard
Thureau, Sébastien
author_sort Mallet, Romain
collection PubMed
description BACKGROUND: Sarcopenia is defined by a loss of skeletal muscle mass with or without loss of fat mass. Sarcopenia has been associated to reduced tolerance to treatment and worse prognosis in cancer patients, including patients undergoing surgery for limited oesophageal cancer. Concomitant chemo-radiotherapy is the standard treatment for locally-advanced tumour, not accessible to surgical resection. Using automated delineation of the skeletal muscle, we have investigated the prognostic value of sarcopenia in locally advanced oesophageal cancer (LAOC) patients treated by curative-intent chemo-radiotherapy. METHODS: The clinical, nutritional, anthropometric, and functional-imaging ((18)FDG-PET/CT) data were collected in 97 patients treated between 2006 and 2012 in our institution. The skeletal muscle area was automatically delineated on cross-sectional CT images acquired at the 3rd. lumbar vertebra level and divided by the patient’s squared height (SML3/h(2)) to obtain the Skeletal Muscle Index (SMI). The primary endpoint was overall survival probability. RESULTS: Seventy-six deaths were reported. The median survival time was 27 [95% Confidence Interval 23–40] months for the whole population. Univariate analyses (Cox Proportional Hazard Model) showed decreased survival probabilities in patients with reduced SMI, WHO > 0, Body Mass Index ≤21, and Nutritional Risk Index ≤97.5. Multivariate analyses showed that sarcopenia was the only significant prognostic factor (HR 2.32 [1.24–4.34], p = 0.008). Using Receiver Operating Characteristics curves, the Area Under the Curve (AUC) was 0.73 in males (p = 0.0002], the optimal threshold being 51.5 cm(2)/m(2). In women, the AUC was 0.65 (p = 0.19). CONCLUSION: Sarcopenia is a powerful independent prognostic factor, associated with a rise of the overall mortality in patients treated exclusively by radiochemotherapy for a locally advanced oesophageal cancer. L3 CT images are easily gathered from (18)FDG-PET/CT acquisitions.
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spelling pubmed-72450302020-06-01 Prognostic value of sarcopenia in patients treated by Radiochemotherapy for locally advanced oesophageal cancer Mallet, Romain Modzelewski, Romain Lequesne, Justine Mihailescu, Sorina Decazes, Pierre Auvray, Hugues Benyoucef, Ahmed Di Fiore, Fréderic Vera, Pierre Dubray, Bernard Thureau, Sébastien Radiat Oncol Research BACKGROUND: Sarcopenia is defined by a loss of skeletal muscle mass with or without loss of fat mass. Sarcopenia has been associated to reduced tolerance to treatment and worse prognosis in cancer patients, including patients undergoing surgery for limited oesophageal cancer. Concomitant chemo-radiotherapy is the standard treatment for locally-advanced tumour, not accessible to surgical resection. Using automated delineation of the skeletal muscle, we have investigated the prognostic value of sarcopenia in locally advanced oesophageal cancer (LAOC) patients treated by curative-intent chemo-radiotherapy. METHODS: The clinical, nutritional, anthropometric, and functional-imaging ((18)FDG-PET/CT) data were collected in 97 patients treated between 2006 and 2012 in our institution. The skeletal muscle area was automatically delineated on cross-sectional CT images acquired at the 3rd. lumbar vertebra level and divided by the patient’s squared height (SML3/h(2)) to obtain the Skeletal Muscle Index (SMI). The primary endpoint was overall survival probability. RESULTS: Seventy-six deaths were reported. The median survival time was 27 [95% Confidence Interval 23–40] months for the whole population. Univariate analyses (Cox Proportional Hazard Model) showed decreased survival probabilities in patients with reduced SMI, WHO > 0, Body Mass Index ≤21, and Nutritional Risk Index ≤97.5. Multivariate analyses showed that sarcopenia was the only significant prognostic factor (HR 2.32 [1.24–4.34], p = 0.008). Using Receiver Operating Characteristics curves, the Area Under the Curve (AUC) was 0.73 in males (p = 0.0002], the optimal threshold being 51.5 cm(2)/m(2). In women, the AUC was 0.65 (p = 0.19). CONCLUSION: Sarcopenia is a powerful independent prognostic factor, associated with a rise of the overall mortality in patients treated exclusively by radiochemotherapy for a locally advanced oesophageal cancer. L3 CT images are easily gathered from (18)FDG-PET/CT acquisitions. BioMed Central 2020-05-22 /pmc/articles/PMC7245030/ /pubmed/32443967 http://dx.doi.org/10.1186/s13014-020-01545-z Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Mallet, Romain
Modzelewski, Romain
Lequesne, Justine
Mihailescu, Sorina
Decazes, Pierre
Auvray, Hugues
Benyoucef, Ahmed
Di Fiore, Fréderic
Vera, Pierre
Dubray, Bernard
Thureau, Sébastien
Prognostic value of sarcopenia in patients treated by Radiochemotherapy for locally advanced oesophageal cancer
title Prognostic value of sarcopenia in patients treated by Radiochemotherapy for locally advanced oesophageal cancer
title_full Prognostic value of sarcopenia in patients treated by Radiochemotherapy for locally advanced oesophageal cancer
title_fullStr Prognostic value of sarcopenia in patients treated by Radiochemotherapy for locally advanced oesophageal cancer
title_full_unstemmed Prognostic value of sarcopenia in patients treated by Radiochemotherapy for locally advanced oesophageal cancer
title_short Prognostic value of sarcopenia in patients treated by Radiochemotherapy for locally advanced oesophageal cancer
title_sort prognostic value of sarcopenia in patients treated by radiochemotherapy for locally advanced oesophageal cancer
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7245030/
https://www.ncbi.nlm.nih.gov/pubmed/32443967
http://dx.doi.org/10.1186/s13014-020-01545-z
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