Dietmar Tamandl MD, Presenter: Nothing to Disclose

Matthias Paireder, Abstract Co-Author: Nothing to Disclose

Reza Asari, Abstract Co-Author: Nothing to Disclose

Sebastian Schoppmann MD, Abstract Co-Author: Nothing to Disclose

Ahmed Ba-Ssalamah MD, Abstract Co-Author: Speaker, Bayer AG Speaker, Siemens AG

To evaluate the predictive value of sarcopenia as a potential biomarker for survival in patients undergoing potentially curative resection of esophageal or esophagogastric cancer.

After IRB approval, 202 patients (49F/153M) were selected from the institutional database who underwent resection for esophageal cancer (EC) or cancer of the gastroesophageal junction (GEJ) between 2006 and 2013. Besides demographic and tumor-specific parameters, preoperative CT scans were used to assess established markers of sarcopenia and body composition (psoas muscle area, PMA; [lean] psoas muscle density, [L]PMD; lumbar skeletal muscle index, LSMI; intraabdominal fat, IAF; subcutaneous fat, SCF and retrorenal fat, RRF). Cox regression along with Kaplan Meier analysis was performed to assess the primary outcome parameter overall (OS) and recurrence free survival (RFS) after surgery. Median and interquartile range (IQR) was used for continuous variables.

202 patients underwent surgery in the observed time period, 28 had transhiatal extended gastrectomy and 174 had Ivor Lewis esophagectomy. The time period between preoperative CT scan and surgery was 15 days (7-34). Median age was 63.9 years (IQR, 56.4-70.0). 5-year OS and median OS was 39.8% and 41.4 months (95% confidence interval [CI] 21.4-61.4). Patients who were sarcopenic based on PMD (≤40 HU or LMPD≤0.75) showed impaired survival compared to individuals who were within physiologic range (HR 0.973, 95% CI 0.951-0.995, p=0.015). 1- and 3- year survival for sarcopenic vs. non-sarcopenic patients was 70.6% and 34.8% vs. 84.1 and 64.3%, p=0.002. Regarding parameters of body composition, only the ratio of PMA to RRF as a parameter of muscle mass in relation to visceral fat had an influence on survival (HR 0.806, 95%CI 0.652-0.996, p=0.046).

Patients who show signs of sarcopenia on preoperative CT images have impaired long-term outcome after surgery for esophageal or GEJ cancer.

Based on CT data, this readily available information can help to identify patients who might benefit from intense nutritional support before and probably after surgery for esophageal or GE-junction cancer.

Tamandl, D, Paireder, M, Asari, R, Schoppmann, S, Ba-Ssalamah, A, Markers of Sarcopenia Predict Adverse Long-term Outcome in Patients Undergoing Resection of Esophageal or Gastro-esophageal Junction Cancer.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14016919.html