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Prognostic Impact of Sarcopenic Obesity after Neoadjuvant Chemotherapy Followed by Surgery in Elderly Patients with Esophageal Squamous Cell Carcinoma

1
Department of Endoscopy, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan
2
Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan
3
Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan
4
Department of Clinical Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan
5
Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(9), 2974; https://doi.org/10.3390/jcm9092974
Received: 6 August 2020 / Revised: 3 September 2020 / Accepted: 11 September 2020 / Published: 15 September 2020
(This article belongs to the Section Gastroenterology & Hepatopancreatobiliary Medicine)
We evaluated the impact of body composition on clinical outcomes after neoadjuvant chemotherapy (NAC) followed by surgery for elderly cStage II/III esophageal squamous cell carcinoma (ESCC). Ninety-one patients ≥70 years old and 116 patients <70 years old with ECSS who underwent NAC between January 2013 and June 2018 at the Aichi Cancer Center were included. Body composition as assessed from computed tomography (CT), American Society of Anesthesiologists physical status (ASA-PS), and subjective global assessment (SGA) was assessed before initiation of NAC. Although elderly patients showed significantly poorer ASA-PS (p < 0.01) and SGA (p < 0.01), and significantly more frequent history of malignancy (p < 0.05), no significant differences were identified in the frequencies of adverse events, postoperative complications, or in cancer-specific survival (p = 0.65, hazard ratio 1.15), or overall survival (p = 0.42, hazard ratio 1.26). However, multivariate analysis identified sarcopenic obesity as the only independent predictor of prognosis in elderly patients. Sarcopenic obesity was associated with higher body mass index (p = 0.04), better SGA (p < 0.01), and lower pre-treatment weight loss (p = 0.03). NAC was as effective and safe for elderly patients without sarcopenic obesity as for young patients. However, diagnosing sarcopenic obesity based on clinical findings is difficult, so the preoperative CT assessment of sarcopenic obesity is important. View Full-Text
Keywords: elderly patient; esophageal squamous cell carcinoma; neoadjuvant chemotherapy; sarcopenia obesity elderly patient; esophageal squamous cell carcinoma; neoadjuvant chemotherapy; sarcopenia obesity
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Onishi, S.; Tajika, M.; Tanaka, T.; Yamada, K.; Abe, T.; Higaki, E.; Hosoi, T.; Inaba, Y.; Muro, K.; Shimizu, M.; Niwa, Y. Prognostic Impact of Sarcopenic Obesity after Neoadjuvant Chemotherapy Followed by Surgery in Elderly Patients with Esophageal Squamous Cell Carcinoma. J. Clin. Med. 2020, 9, 2974.

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