Next Article in Journal
Targeting mTOR and Glycolysis in HER2-Positive Breast Cancer
Next Article in Special Issue
Landscape of Biomarkers and Actionable Gene Alterations in Adenocarcinoma of GEJ and Stomach—A Real World Data Analysis
Previous Article in Journal
MITF Promotes Cell Growth, Migration and Invasion in Clear Cell Renal Cell Carcinoma by Activating the RhoA/YAP Signal Pathway
Previous Article in Special Issue
Novel Histologic Categorization Based on Lauren Histotypes Conveys Prognostic Information for Gastroesophageal Junction Cancers—Analysis from a Large Single Center Cohort in Germany
Article

CT Body Composition of Sarcopenia and Sarcopenic Obesity: Predictors of Postoperative Complications and Survival in Patients with Locally Advanced Esophageal Adenocarcinoma

1
Department of Radiology, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
2
Department of Surgery, Campus Charité Mitte and Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
3
Department of Radiology, Kobe University Graduate School of Medicine, Kobe 6500017, Japan
4
Berlin Institute of Health (BIH), 10178 Berlin, Germany
5
Department of Hematology, Oncology and Cancer Immunology, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
*
Author to whom correspondence should be addressed.
Matthias Biebl and Dominik Geisel contributed equally to this work.
Academic Editor: Matthias Reeh
Cancers 2021, 13(12), 2921; https://doi.org/10.3390/cancers13122921
Received: 6 May 2021 / Revised: 6 June 2021 / Accepted: 8 June 2021 / Published: 11 June 2021
(This article belongs to the Special Issue Oesophageal Adenocarcinoma)
The incidence of esophageal cancer is constantly rising and patients are often diagnosed at an advanced stage. Surgical resection, if possible, is the curative treatment of choice. However, esophagectomy for cancer is a major surgical procedure and is associated with perioperative morbidity. Preoperative staging examinations are carried out on every patient, and imaging datasets contain valuable information about the patient’s physical condition beyond the routinely assessed tumor extent. In this study, the abdominal muscle and fat mass were quantified during the preoperative staging and postoperative follow-up of 85 patients with locally advanced esophageal adenocarcinoma, and these imaging biomarkers were correlated with surgical complications and patient outcomes. Our analysis showed that sarcopenic patients with low muscle mass were more likely to have major complications and that hospitalization was prolonged, especially in patients with sarcopenic obesity. Low preoperative muscle mass and its decrease during the follow-up also predicted poorer overall survival.
Background: To assess the impact of body composition imaging biomarkers in computed tomography (CT) on the perioperative morbidity and survival after surgery of patients with esophageal cancer (EC). Methods: Eighty-five patients who underwent esophagectomy for locally advanced EC after neoadjuvant therapy between 2014 and 2019 were retrospectively enrolled. Pre- and postoperative CT scans were used to assess the body composition imaging biomarkers (visceral (VAT) and subcutaneous adipose tissue (SAT) areas, psoas muscle area (PMA) and volume (PMV), total abdominal muscle area (TAMA)). Sarcopenia was defined as lumbar skeletal muscle index (LSMI) ≤38.5 cm2/m2 in women and ≤52.4 cm2/m2 in men. Patients with a body mass index (BMI) of ≥30 were considered obese. These imaging biomarkers were correlated with major complications, anastomotic leakage, postoperative pneumonia, duration of postoperative hospitalization, disease-free survival (DFS), and overall survival (OS). Results: Preoperatively, sarcopenia was identified in 58 patients (68.2%), and sarcopenic obesity was present in 7 patients (8.2%). Sarcopenic patients were found to have an elevated risk for the occurrence of major complications (OR: 2.587, p = 0.048) and prolonged hospitalization (32 d vs. 19 d, p = 0.040). Patients with sarcopenic obesity had a significantly higher risk for postoperative pneumonia (OR: 6.364 p = 0.018) and a longer postoperative hospital stay (71 d vs. 24 d, p = 0.021). Neither sarcopenia nor sarcopenic obesity was an independent risk factor for the occurrence of anastomotic leakage (p > 0.05). Low preoperative muscle biomarkers (PMA and PMV) and their decrease (ΔPMV and ΔTAMA) during the follow-up period significantly correlated with shorter DFS and OS (p = 0.005 to 0.048). Conclusion: CT body composition imaging biomarkers can identify high-risk patients with locally advanced esophageal cancer undergoing surgery. Sarcopenic patients have a higher risk of major complications, and patients with sarcopenic obesity are more prone to postoperative pneumonia. Sarcopenia and sarcopenic obesity are both subsequently associated with a prolonged hospitalization. Low preoperative muscle mass and its decrease during the postoperative follow-up are associated with lower DFS and OS. View Full-Text
Keywords: computed tomography; body composition; sarcopenia; sarcopenic obesity; esophageal cancer; surgery computed tomography; body composition; sarcopenia; sarcopenic obesity; esophageal cancer; surgery
Show Figures

Figure 1

MDPI and ACS Style

Fehrenbach, U.; Wuensch, T.; Gabriel, P.; Segger, L.; Yamaguchi, T.; Auer, T.A.; Beetz, N.L.; Denecke, C.; Kröll, D.; Raakow, J.; Knitter, S.; Chopra, S.; Thuss-Patience, P.; Pratschke, J.; Hamm, B.; Biebl, M.; Geisel, D. CT Body Composition of Sarcopenia and Sarcopenic Obesity: Predictors of Postoperative Complications and Survival in Patients with Locally Advanced Esophageal Adenocarcinoma. Cancers 2021, 13, 2921. https://doi.org/10.3390/cancers13122921

AMA Style

Fehrenbach U, Wuensch T, Gabriel P, Segger L, Yamaguchi T, Auer TA, Beetz NL, Denecke C, Kröll D, Raakow J, Knitter S, Chopra S, Thuss-Patience P, Pratschke J, Hamm B, Biebl M, Geisel D. CT Body Composition of Sarcopenia and Sarcopenic Obesity: Predictors of Postoperative Complications and Survival in Patients with Locally Advanced Esophageal Adenocarcinoma. Cancers. 2021; 13(12):2921. https://doi.org/10.3390/cancers13122921

Chicago/Turabian Style

Fehrenbach, Uli, Tilo Wuensch, Pia Gabriel, Laura Segger, Takeru Yamaguchi, Timo A. Auer, Nick L. Beetz, Christian Denecke, Dino Kröll, Jonas Raakow, Sebastian Knitter, Sascha Chopra, Peter Thuss-Patience, Johann Pratschke, Bernd Hamm, Matthias Biebl, and Dominik Geisel. 2021. "CT Body Composition of Sarcopenia and Sarcopenic Obesity: Predictors of Postoperative Complications and Survival in Patients with Locally Advanced Esophageal Adenocarcinoma" Cancers 13, no. 12: 2921. https://doi.org/10.3390/cancers13122921

Find Other Styles
Note that from the first issue of 2016, MDPI journals use article numbers instead of page numbers. See further details here.

Article Access Map by Country/Region

1
Back to TopTop