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Published on: April 22, 2019
Prognostic Significance of the T12-SMI Before and After Neoadjuvant Chemoimmunotherapy for Esophageal Squamous Cell
Jun-Peng Lin1,2,3, Jia-Huang Hong1,2,3, Feng-Nian Zhuang1,2,3
1Department of Thoracic Oncology Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian Province, China.
Objectives:
This study evaluated the prognostic value of the 12th thoracic vertebra skeletal muscle mass index (T12-SMI) before and after neoadjuvant chemoimmunotherapy (NACI) in patients with esophageal squamous cell carcinoma (ESCC).
Methods:
We retrospectively analyzed 211 patients with ESCC who underwent NACI followed by esophagectomy between 2020 and 2022. According to their SMI at T12, the patients were divided into a muscle attenuation group (MAG) and a normal group (NG) before or after NACI. The perioperative outcomes and survival data were compared between the two groups.
Results:
The pathological complete response (pCR) rates and major pathological response rates were comparable between the MAG and NG before and after NACI (all P > 0.05). The postoperative complication rates and 90-day mortality rates were also comparable (all P > 0.05). However, compared with the NG, the MAG had significantly worse overall survival and disease-free survival, both before and after NACI (all P < 0.05). Multivariate analyses confirmed that muscle attenuation post-NACI was an independent prognostic factor for overall survival (hazard ratio 2.977; 95% confidence interval 1.733-5.113; P < 0.001) and disease-free survival (hazard ratio 2.355; 95% confidence interval 1.339-4.142; P = 0.003). Post-NACI, the MAG had higher overall recurrence rates (41.7% vs. 21.1%, P = 0.009), particularly for distant metastases (22.2% vs. 9.1%, P = 0.024).
Conclusion:
Sarcopenia at the T12 level after NACI is an independent predictor of poor survival for patients with ESCC and is associated with increased postoperative recurrence risk, especially for distant metastases.