Sarcopenia and low visceral adiposity were independent predictors of lower survival in patients with metastatic esophageal cancer, according to results of a retrospective study presented at the ASCO20 Virtual Scientific Program.
Although sarcopenia, defined as a decrease in skeletal muscle mass, has emerged as a prognostic factor in the setting of advanced cancer, only limited evidence exists related to its impact on the survival of patients with metastatic esophageal cancer for whom cancer-related cachexia compounded by tumor-related dysphagia is common.
This analysis included 200 patients with metastatic esophageal cancer treated at the Princess Margaret Cancer Center in Toronto, Canada, from 2006 to 2014.
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Body composition at presentation with respect to skeletal muscle index, subcutaneous adipose tissue (SAT), and visceral adipose tissue (VAT) were measured using baseline computed tomography scans performed at the level of the L3 vertebra. The presence of sarcopenia was defined according to previously published cutoffs based on body mass index (BMI) and sex, and high visceral and subcutaneous adiposity were identified in those patients falling into the highest tertile of VAT and SAT measurements, respectively. Quality of life (QOL) assessments were performed prospectively using 2 separate, validated measures, including the Functional Assessment of Cancer Therapy-Esophageal (FACT-E) survey.
The median age at diagnosis of patients included in this study was approximately 62 years, with 51% of patients having a BMI characterizing them as overweight/obese. Baseline body composition included sarcopenia, high VAT, and high SAT in 52%, 33%, and 34% of patients, respectively.
Following adjustment for confounding factors on multivariable analysis, sarcopenia was independently associated with lower survival compared with nonsarcopenia in these patients (adjusted hazard ratio [aHR], 1.50; P =.02). In contrast, every 100 cm2 increase in VAT was independently associated with a decreased risk of death (aHR, 0.76; P =.03). However, neither SAT nor BMI was independently associated with survival in these patients.
Regarding QOL measurements, sarcopenia was significantly associated with worse physical well-being on the FACT-E survey (P =.14), although only 20% of patients completed QOL surveys.
In their concluding comments, the study authors noted that “future work should focus on potential rehabilitation strategies such as nutritional support and exercise training to offset the poor prognosis associated with sarcopenia and reduced adiposity.”
Disclosure: Multiple authors declared affiliations with industry. Please refer to the original abstract for a full list of disclosures.
Reference
Soriano J, Hueniken, K, Bajwa JK, et al. Impact of body measurements (BM) on overall survival (OS) and quality of life (QoL) in real-world patients (pts) with metastatic esophageal cancer. Presented at: ASCO20 Virtual Scientific Program. J Clin Oncol. 2020;38(suppl):abstr 4544.
