TORONTO—Sarcopenia before neoadjuvant treatment of esophagogastric adenocarcinoma is associated with significantly higher mortality rates in the five years after surgery, according to a study by researchers from the United Kingdom.

“Sarcopenia is a very important topic in clinical medicine and oncology because it is recognized as an independent risk factor for bad outcomes,” Vivek Kaul, MD, the Segal-Watson Professor of Medicine at the University of Rochester Medical Center and Strong Memorial Hospital, in New York, told Gastroenterology & Endoscopy News. “These patients have a poor prognosis, and in this group, sarcopenia adds another layer of morbidity and mortality to preexisting cachexia and malnutrition related to esophageal cancer,” added Dr. Kaul, who was not involved in the study.

Preoperative sarcopenia has been linked to mortality and postoperative complications in patients with esophagogastric adenocarcinoma (EGA), but the relationship between sarcopenia and mortality in EGA patients undergoing neoadjuvant chemotherapy (NAC) is not well understood.

To explore the relationship between pre-NAC sarcopenia and mortality, researchers at the Royal Victoria Infirmary in Newcastle upon Tyne assessed the incidence of sarcopenia in patients diagnosed with EGA who were undergoing NAC followed by esophagectomy. The investigators studied data from 223 patients who were treated at one high-volume center between January 2017 and December 2021 and had their pre-NAC CT scans assessed for radiological sarcopenia. Each patient’s skeletal muscle index (SMI) was calculated from muscle area measured at the level of the third lumbar vertebra. Patients were then identified as sarcopenic or non-sarcopenic based on previously published SMI cutoff values for radiologically defined sarcopenia (52.4 cm² for men and 38.5 cm² for women). The investigators used a Cox regression model to compare mortality rates in the two groups.

Presenting their findings at the 2023 ISDE World Congress for Esophageal Diseases (Diseases Esophagus 2023;36[suppl 2]:abstract 237), the researchers reported that pre-NAC sarcopenia was associated with significantly increased mortality (hazard ratio, 1.67; 95% CI, 1.03-2.56; P=0.037). Sarcopenic patients had a five-year survival of 29.9% and median survival of 2.75 years, while the non-sarcopenic group had a five-year survival of 42% and median survival of 4.21 years.

“This is an important study,” Dr Kaul said. “It investigates a relatively less known factor that has a significant impact on mortality in this population. We need to identify those EGA patients at highest risk for sarcopenia, and address that problem with measures such as protein intake, physiotherapy, exercise and nutrition supplements as part of their overall management plan. We know that sarcopenia is potentially reversible. Now it’s a matter of applying that knowledge to this patient population.”

Future studies, he suggested, should investigate the benefit of various interventions and hopefully demonstrate the survival advantage of those strategies. “Randomized controlled trials would be a logical next step in this line of investigation for this patient population.”

—Alexis Campbell

Dr. Kaul reported no relevant financial disclosures. He is a member of the Gastroenterology & Endoscopy News editorial board.