Prognostic Impact of Sarcopenic Obesity after Neoadjuvant Chemotherapy Followed by Surgery in Elderly Patients with Esophageal Squamous Cell Carcinoma
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Neoadjuvant Chemotherapy
2.3. Evaluation of Chemotherapy-related Toxicities and Postoperative Complications
2.4. Measurement and Definitions of Body Composition
2.5. Patient Data
2.6. Nutritional Screening
2.7. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. NAC-Related Factors
3.3. Operation-Related Factors
3.4. OS Rate
3.5. Prognostic Factors for OS in the Elderly Group
3.6. Characteristics of Sarcopenic Obesity in the Elderly Group
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Total | Elderly | Young | ||
---|---|---|---|---|
Variables | (n = 207) | (n = 91) | (n = 116) | p |
Age (years) | 68.9 ± 5.4 (60–81) | 74.1 ± 2.9 (70–81) | 64.9 ± 2.9 (60–69) | <0.01 |
Sex (male/female) | 169/38 | 73/18 | 96/20 | 0.71 |
ASA-PS (1/2) | 70/137 | 21/70 | 49/67 | <0.01 |
Body mass index (kg/m2) | 21.0 ± 2.8 (13.7–30.5) | 21.1 ± 2.8 (13.7–30.5) | 20.9 ± 2.8 (14.8–27.3) | 0.81 |
Body mass index >25 kg/m2 | 15 (7.3) | 6 (6.6) | 9 (7.7) | 0.79 |
Visceral fat mass (cm2) | 93.9 ± 55.9 | 94.9 ± 55.9 | 93.1 ± 56.1 | 0.81 |
Obese | 91 (44.0) | 41 (45.1) | 50 (43.1) | 0.78 |
Albumin (g/dL) | 4.13 ± 0.37 | 4.09 ± 0.41 | 4.16 ± 0.34 | 0.14 |
CCr | 75.9 ± 15.1 | 74.2 ± 15.1 | 77.3 ± 14.9 | 0.13 |
ChE | 292 ± 64 | 290 ± 61 | 294 ± 66 | 0.63 |
T-chol | 196 ± 36 | 189 ± 32 | 201 ± 39 | 0.02 |
Hb | 13.5 ± 1.5 | 13.5 ± 1.3 | 13.6 ± 1.7 | 0.54 |
SGA (A/B or C) | 149/58 | 53/38 | 96/20 | <0.01 |
Body weight loss rate (%) | 3.4 ± 5.5 | 3.4 ± 5.5 | 3.3 ± 5.5 | 0.83 |
Sarcopenia, n (%) | 142 (68.6) | 69 (75.8) | 73 (62.9) | 0.06 |
Sarcopenic obesity, n (%) | 58 (28.0) | 31 (34.1) | 27 (23.3) | 0.08 |
%VC | 101.4 ± 13.3 | 100.6 ± 15.1 | 102.1 ± 11.7 | 0.42 |
%FEV1.0 | 77.2 ± 8.0 | 76.9 ± 7.8 | 77.4 ± 8.2 | 0.62 |
Diabetes mellitus, n (%) | 32 (15.5) | 20 (21.9) | 12 (10.3) | 0.03 |
Cardiovascular disorder, n (%) | 97 (46.9) | 49 (53.8) | 48 (41.4) | 0.09 |
Cerebrovascular disorder, n (%) | 2 (0.9) | 2 (2.2) | 0(0) | 0.19 |
Malignant disease, n (%) | 40 (19.3) | 25 (27.5) | 15 (12.9) | 0.01 |
Chronic disease, n (%) | 32 (15.4) | 10 (10.9) | 22 (18.9) | 0.12 |
Primary tumor location (Ut/Mt/Lt) | 31/109/67 | 13/48/30 | 18/61/37 | 0.93 |
Clinical T (1/2/3) | 35/41/131 | 16/17/58 | 19/24/73 | 0.41 |
Clinical N (0/1/2/3) | 25/109/68/5 | 12/53/26/0 | 13/56/42/5 | 0.11 |
Clinical stage (II/III) | 68/139 | 29/62 | 39/77 | 0.88 |
Elderly | Young | p | |
---|---|---|---|
Variables | (n = 91) | (n = 116) | |
Adverse events (≥ grade 3), n (%) | |||
Hematological | |||
Neutropenia | 40 (46.0) | 69 (59.5) | 0.06 |
Non-hematological adverse events | |||
Diarrhea | 3 (3.5) | 7 (6.0) | 0.52 |
Malaise | 8 (9.2) | 8 (6.9) | 0.6 |
Anorexia | 8 (9.2) | 8 (6.9) | 0.6 |
Incomplete case | 6 (6.6) | 8 (6.9) | 0.31 |
Operation time (min) | 497.4 ± 96.3 | 478.3 ± 89.1 | 0.14 |
Hospital stay (days) | 29.1 ± 17.9 | 27.7 ± 17.5 | 0.57 |
Surgery-related complications (≥Grade 3), n (%) | 29 (31.9) | 42 (36.2) | 0.55 |
Anastomotic | 4 (4.4) | 7 (6.0) | 0.75 |
Pneumonia | 7 (7.7) | 3 (2.6) | 0.11 |
Recurrent nerve paralysis | 2 (2.2) | 1 (0.9) | 0.58 |
SSI | 10 (11.0) | 12 (10.3) | 1.00 |
Chylothorax | 2 (2.2) | 2 (1.7) | 1.00 |
Arrhythmia | 0 (0) | 1 (0.9) | 1.00 |
Anastomosis stenosis | 15 (16.5) | 27 (23.3) | 0.30 |
Univariate | Multivariate | |||||
---|---|---|---|---|---|---|
Variables | n | HR (95%CI) | p | HR (95%CI) | p | |
Age, years | <75 | 57 | 2.11 (0.82–6.16) | |||
≥75 | 34 | 1 | 0.12 | |||
Sex | male | 73 | 2.78 (0.80–17.5) | |||
female | 18 | 1 | 0.11 | |||
cStage | III | 62 | 1.47 (0.57–4.49) | |||
II | 29 | 1 | 0.43 | |||
NAC | DCF | 24 | 1.79 (0.71–4.36) | |||
FP | 67 | 1 | 0.21 | |||
ASA-PS | 2 | 70 | 2.54 (0.73–16.1) | |||
1 | 21 | 1 | 0.16 | |||
DM | + | 20 | 2.11 (0.77–5.38) | |||
- | 71 | 1 | 0.14 | |||
Cardiovascular event | + | 49 | 1.06 (0.43–2.66) | |||
- | 42 | 1 | 0.88 | |||
Malignant disease | + | 25 | 1.87 (0.73–4.51) | |||
- | 66 | 1 | 0.18 | |||
SGA | A | 53 | 1.33 (0.54–3.42) | |||
B-C | 38 | 1 | 0.53 | |||
Sarcopenia | + | 69 | 6.11 (1.25–111.0) | |||
- | 22 | 1 | 0.02 | |||
Sarcopenic obesity | + | 31 | 3.52 (1.41–9.48) | 2.72 (1.06–7.76) | ||
- | 60 | 1 | <0.01 | 1 | 0.03 |
Sarcopenic Obesity | Non-Sarcopenic Obesity | ||
---|---|---|---|
Variables | (n = 31) | (n = 60) | p |
Age (years) | 73.6 ± 3.1 | 74.3 ± 2.9 | 0.36 |
Sex (male/female) | 27/4 | 46/14 | 0.28 |
ASA-PS (1/2) | 7/24 | 14/46 | 1.00 |
Body mass index (kg/m2) | 22.2 ± 2.3 | 20.4 ± 2.8 | <0.01 |
Body mass index >25 kg/m2 | 3 (9.7) | 3 (5.0) | 0.40 |
Visceral fat mass (cm²) | 134.7 ± 36.8 | 75.0 ± 53.3 | <0.01 |
Albumin (g/dL) | 4.10 ± 0.36 | 4.05 ± 0.44 | 0.21 |
CCr | 74.4 ± 12.5 | 74.1 ± 16.4 | 0.92 |
ChE | 307 ± 70 | 281 ± 54 | 0.06 |
T-chol | 188.8 ± 40.1 | 189.9 ± 28.5 | 0.88 |
Hb | 13.8 ± 1.1 | 13.3 ± 1.3 | 0.06 |
SGA (A/B or C) | 26/5 | 27/33 | <0.01 |
Body weight loss rate (%) | 1.7 ± 3.2 | 4.3 ± 6.2 | 0.03 |
%VC | 98.6 ± 16.2 | 101.6 ± 14.6 | 0.38 |
%FEV1.0 | 77.0 ± 6.9 | 76.8 ± 8.3 | 0.90 |
Diabetes mellitus, n (%) | 7 (22.6) | 13 (21.7) | 1.00 |
Cardiovascular disorder, n (%) | 17 (54.8) | 32 (53.3) | 1.00 |
Cerebrovascular disorder, n (%) | 1 (3.2) | 1 (1.7) | 1.00 |
Malignant disease, n (%) | 9 (29.0) | 16 (26.7) | 0.81 |
Chronic disease, n (%) | 3 (9.7) | 7 (11.6) | 1.00 |
Sarcopenic Obesity | Non-Sarcopenic Obesity | ||
---|---|---|---|
Variables | (n = 31) | (n = 60) | p |
Adverse events (≥ grade 3), n (%) | |||
Hematological | |||
Neutropenia | 11 (43.2) | 29 (58.3) | 0.49 |
Non-hematological adverse events | |||
Diarrhea | 0 (0) | 3 (3.8) | 0.54 |
Malaise | 2 (6.8) | 6 (6.8) | 1.00 |
Anorexia | 2 (6.8) | 6 (6.8) | 1.00 |
Incomplete case | 2(6.5) | 4(6.7) | 1.00 |
Operation time (min) | 522.7 ± 92.6 | 484.0 ± 96.2 | 0.06 |
Hospital stay (days) | 33.4 ± 20.9 | 26.8 ± 15.8 | 0.09 |
Surgery related complications (≥grade 3), n (%) | 13 (41.9) | 16 (26.7) | 0.15 |
Anastomotic | 3 (9.7) | 1 (1.7) | 0.11 |
Pneumonia | 5 (16.1) | 2 (3.3) | 0.04 |
Recurrent nerve paralysis | 1 (3.2) | 1 (1.7) | 1.00 |
SSI | 3 (9.7) | 7 (11.7) | 1.00 |
Chylothorax | 1 (3.2) | 1 (1.7) | 1.00 |
Arrhythmia | 0 (0) | 0 (0) | 1.00 |
Anastomosis stenosis | 8 (25.8) | 7 (11.7) | 0.13 |
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Onishi, S.; Tajika, M.; Tanaka, T.; Yamada, K.; Abe, T.; Higaki, E.; Hosoi, T.; Inaba, Y.; Muro, K.; Shimizu, M.; et al. 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. https://doi.org/10.3390/jcm9092974
Onishi S, Tajika M, Tanaka T, Yamada K, Abe T, Higaki E, Hosoi T, Inaba Y, Muro K, Shimizu M, et al. Prognostic Impact of Sarcopenic Obesity after Neoadjuvant Chemotherapy Followed by Surgery in Elderly Patients with Esophageal Squamous Cell Carcinoma. Journal of Clinical Medicine. 2020; 9(9):2974. https://doi.org/10.3390/jcm9092974
Chicago/Turabian StyleOnishi, Sachiyo, Masahiro Tajika, Tsutomu Tanaka, Keisaku Yamada, Tetsuya Abe, Eiji Higaki, Takahiro Hosoi, Yoshitaka Inaba, Kei Muro, Masahito Shimizu, and et al. 2020. "Prognostic Impact of Sarcopenic Obesity after Neoadjuvant Chemotherapy Followed by Surgery in Elderly Patients with Esophageal Squamous Cell Carcinoma" Journal of Clinical Medicine 9, no. 9: 2974. https://doi.org/10.3390/jcm9092974