Abstract

Introduction: Esophageal Cancer is a global concern due to its high incidence and persistent high mortality rates. At the time of diagnosis, more than 50% of patients have unresectable disease or distant metastasis. Sarcopenia is considered an independent risk factor for prognosis. Thus, it is relevant to assess the presence of sarcopenia and see if it is associated with decreased survival.

Objectives: To identify a possible correlation between the presence of sarcopenia and the survival of patients with lymph nodes metastasis of EC and to evaluate the prevalence of sarcopenia in these patients.

Methodology: Sample of 26 patients with histological diagnosis of Esophageal Adenocarcinoma or Squamous Cell Carcinoma with lymph nodes metastasis, submitted to surgical ressection. The patient’s Muscle Mass Index (SMI) was measured using lumbar CT, at L3 level, in a single axial section, using appropriate software. The association of qualitative variables with the presence or absence of sarcopenia was assessed using the Pearson´s Chi-Square Test (χ²) or Fisher’s Exact Test. For continuous variables the T test was used. Survival curves were determined for overall survival and disease-free survival using Kaplan-Meier method and the log-rank test. A Cox regression was also performed.

Results: The average age of patients was 64 years, the majority being male (88,5%). 9 (34,6%) patients had sarcopenia. Sarcopenia was not significantly associated with a decrease in DFS (p = 0,1,75) or a decrease in OS (p = 0,113). Staging was associated with lower overall survival (p = 0,033). There was not significant association between sarcopenia and clinical anatomopathological factors.

Conclusion: Sarcopenia has not been shown to have an impact on the survival of patients with esophageal lymph nodes metastasis.

Keywords: Esophageal Cancer; Lymph Node Metastasis; Sarcopenia; Survival

References

1. Gupta Bhawna and Narinder Kumar. “Worldwide incidence, mortality and time trends for cancer of the oesophagus”. European Journal of Cancer Prevention: The Official Journal of the European Cancer Prevention Organisation (ECP)2 (2017): 107-118.
2. Deng Han-Yu., et al. “Preoperative sarcopenia is a predictor of poor prognosis of esophageal cancer after esophagectomy: a comprehensive systematic review and meta-analysis”. Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus3 (2019): doy115.
3. Global Burden of Disease Cancer Collaboration., et al. “The Global Burden of Cancer 2013”. JAMA Oncology4 (2015): 505-527.
4. Launoy Guy., et al. “Trends in net survival from esophageal cancer in six European Latin countries: results from the SUDCAN population-based study”. European Journal of Cancer Prevention: the Official Journal of the European Cancer Prevention Organisation (ECP) Trends in cancer net survival in six European Latin Countries: the SUDCAN study 26 (2017): S24-S31.
5. Quint LE., et al. “Incidence and distribution of distant metastases from newly diagnosed esophageal carcinoma”. Cancer7 (1995): 1120-1125.
6. Ryan Aoife M., et al. “Cancer-associated malnutrition, cachexia and sarcopenia: the skeleton in the hospital closet 40 years later”. The Proceedings of the Nutrition Society2 (2016): 199-211.
7. Abellan Van Kan G. “Epidemiology and consequences of sarcopenia”. The Journal of Nutrition, Health and Aging8 (2009): 708-712.
8. Cruz-Jentoft Alfonso J., et al. “Sarcopenia: revised European consensus on definition and diagnosis”. Age and Ageing4 (2019): 601.
9. Boshier PR., et al. “Assessment of body composition and sarcopenia in patients with esophageal cancer: a systematic review and meta-analysis”. Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus8 (2018).
10. Prado Carla M M., et al. “Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study”. The Lancet Oncology 9.7 (2008): 629-635.
11. Bray Freddie., et al. “Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries”. CA: A Cancer Journal for Clinicians6 (2018): 394-424.
12. Ferlay Jacques., et al. “Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012”. International Journal of Cancer5 (2015): E359-386.
13. Ferlay Jacques., et al. “Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008”. International Journal of Cancer12 (2010): 2893-2917.
14. Plukker JThM and HL Van Westreenen. “Staging in Eoesophageal cancer”. Best Practice and Research Clinical Gastroenterology5 (2006): 877-891.
15. Rice Thomas W., et al. “Esophageal Cancer: Associations With (pN+) Lymph Node Metastases”. Annals of Surgery 1 (2017): 122-129.
16. Vendrely Véronique., et al. “Prognostic factors in esophageal cancer treated with curative intent”. Digestive and Liver Disease: Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver 10 (2018): 991-996.
17. Betancourt-Cuellar Sonia L., et al. “Esophageal Cancer: Tumor-Node-Metastasis Staging”. Radiologic Clinics of North America2 (2021): 219-229.
18. Short Matthew W., et al. “Esophageal Cancer”. American Family Physician1 (2017): 22-28.
19. Torre Lindsey A., et al. “Global cancer statistics, 2012”. CA: A Cancer Journal for Clinicians2 (2015): 87-108.
20. Siegal Steve R., et al. “Sarcopenia is not associated with morbidity, mortality, or recurrence after esophagectomy for cancer”. American Journal of Surgery 5 (2018): 813-817.
21. Grotenhuis Brechtje A., et al. “Sarcopenia/Muscle Mass is not a Prognostic Factor for Short- and Long-Term Outcome After Esophagectomy for Cancer”. World Journal of Surgery11 (2016): 2698-2704.
22. Deng Han-Yu., et al. “Preoperative sarcopenia is a predictor of poor prognosis of esophageal cancer after esophagectomy: a comprehensive systematic review and meta-analysis”. Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus 3 (2019): doy115.
23. Oguma J., et al. “Prognostic significance of sarcopenia in patients undergoing esophagectomy for superficial esophageal squamous cell carcinoma”. Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus7 (2019): doy104.
24. Harada K., et al. “Prognostic and clinical impact of sarcopenia in esophageal squamous cell carcinoma”. Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus6 (2016): 627-633.
25. Işık A., et al. “Idiopathic Periportal Lymphadenopathy”. Gazi Medical Journal (2016).