Objectives: Sarcopenia and changes in body composition following neoadjuvant chemotherapy (NAC) may affect clinical outcome. We assessed the associations between CT body composition changes following NAC and outcomes in oesophageal cancer. Methods: A total of 35 patients who received NAC followed by oesophagectomy, and underwent CT assessment pre- and post-NAC were included. Fat mass (FM), fat-free mass (FFM), subcutaneous fat to muscle ratio (FMR) and visceral to subcutaneous adipose tissue ratio (VA/SA) were derived from CT. Changes in FM, FFM, FMR, VA/SA and sarcopenia were correlated to chemotherapy dose reductions, postoperative complications, length of hospital stay (LOS), circumferential resection margin (CRM), pathological chemotherapy response, disease-free survival (DFS) and overall survival (OS). Results: Nine (26 %) patients were sarcopenic before NAC and this increased to 15 (43 %) after NAC. Average weight loss was 3.7 %±6.4 (SD) in comparison to FM index (-1.2±4.2), FFM index (-4.6±6.8), FMR (-1.2±24.3) and VA/SA (-62.3±12.7). Changes in FM index (p=0.022), FMR (p=0.028), VA/SA (p=0.024) and weight (p=0.007) were significant univariable factors for CRM status. There was no significant association between changes in body composition and survival. Conclusions: Loss of FM, differential loss of VA/SA and skeletal muscle were associated with risk of CRM positivity. Key Points: • Changes in CT body composition occur after neoadjuvant chemotherapy in oesophageal cancer. • Sarcopenia was more prevalent after neoadjuvant chemotherapy. • Fat mass, fat-free mass and weight decreased after neoadjuvant chemotherapy. • Changes in body composition were associated with CRM positivity. • Changes in body composition did not affect perioperative complications and survival.
Bibliographical noteFunding Information:
The scientific guarantor of this publication is Prof. Vicky Goh. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This study has received funding by the Department of Health via the National Institute of Health Research Biomedical Research Centre award to Guy’s and St Thomas’ NHS Foundation Trust in partnership with King’s College London and King’s College Hospital NHS Foundation Trust; and from the Comprehensive Cancer Imaging Centre, funded by the Cancer Research UK and Engineering and Physical Sciences Research Council in association with the Medical Research Council and Department of Health. Dr. Connie Yip receives funding support from the National Medical Research Council, Singapore. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was not required for this study because anonymised patient data was used with no intervention or patient contact. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.
Copyright: European Society of Radiology 2014
- Body composition
- Neoadjuvant chemotherapy
- Oesophageal cancer