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  • Skeletal muscle mass recovery after oesophagectomy and neoadjuvant chemotherapy in oesophageal cancer: retrospective cohort study

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Original research
Skeletal muscle mass recovery after oesophagectomy and neoadjuvant chemotherapy in oesophageal cancer: retrospective cohort study
  1. Tsuyoshi Harada1,2,
  2. Tetsuya Tsuji1,3,
  3. Takumi Yanagisawa1,2,
  4. Junya Ueno1,
  5. Nanako Hijikata1,
  6. Aiko Ishikawa1,3,
  7. Keiichi Hiroshige4,
  8. Daisuke Kotani5,
  9. Takashi Kojima5 and
  10. Takeo Fujita6
  1. 1 Department of Rehabilitation Medicine, National Cancer Center-Hospital East, Kashiwa, Japan
  2. 2 Department of Rehabilitation Medicine, Keio University School of Medicine Graduate School of Medicine, Shinjuku-ku, Tokyo, Japan
  3. 3 Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan
  4. 4 Department of Physical Therapy, Kyushu Nutrition Welfare University, Kitakyushu, Fukuoka, Japan
  5. 5 Department of Gastrointestinal Oncology, National Cancer Center-Hospital East, Kashiwa, Chiba, Japan
  6. 6 Department of Esophageal Surgery, National Cancer Center-Hospital East, Kashiwa, Chiba, Japan
  1. Correspondence to Tsuyoshi Harada, Department of Rehabilitation Medicine, National Cancer Center-Hospital East, Kashiwa, Chiba 277-8577, Japan; tsuyoshi6167{at}gmail.com

Abstract

Objective Skeletal muscle mass (SMM) is an important biomarker for prognosis and health in older patients with cancer. Limited information is available on the recovery course of SMM after oesophagectomy following neoadjuvant chemotherapy (NAC) in older patients. This study was performed to investigate the recovery course of SMM after oesophagectomy following NAC and the preoperative predictors of delayed recovery in older patients with locally advanced oesophageal cancer (LAEC).

Methods This single-centre retrospective cohort study involved older (≥65 years) and non-older (<65 years) patients with LAEC who underwent oesophagectomy following NAC. The SMM index (SMI) was calculated using CT images. One-way analysis of variance and multivariate logistic regression analysis were performed.

Results In total, 110 older patients and 57 non-older patients were analysed. Loss of the SMI after NAC to 12 months postoperatively was significantly greater in older patients than in non-older patients (p<0.01). The significant preoperative predictor of delayed recovery of the SMI 12 months after surgery was loss of the SMI during NAC in older patients (per 1%: adjusted OR 1.249; 95% CI 1.131 to 1.403; p<0.001), but not in non-older patients (per 1%: OR 1.074; 95% CI 0.988 to 1.179; p=0.108).

Conclusions There is an especially large unmet need for preventing the long-term sequelae of SMM loss in older patients with LAEC after oesophagectomy following NAC. In older patients, loss of SMM during NAC is an especially useful biomarker for prescribing postoperative rehabilitation to prevent postoperative loss of SMM.

  • gastrointestinal (upper)
  • rehabilitation
  • supportive care
  • survivorship

Data availability statement

No data are available. The participants in this study did not agree to the public sharing of their data. The participants’ data are not available.

https://doi.org/10.1136/spcare-2023-004245

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    Data availability statement

    No data are available. The participants in this study did not agree to the public sharing of their data. The participants’ data are not available.

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    Footnotes

    • Contributors All authors made substantial contributions to the conception and design of the work. The first draft of the manuscript was written by TH, and all authors commented on the manuscript. TH is the guarantor. All authors read and approved the final manuscript. Data acquisition: TH, TT, TY, JU, DK, TK and TF. Quality control of data and algorithms: TH, TT and TF. Data analysis and interpretation: TH, TT, TY, JU, NH, AI, KH, DK, TK and TF. Statistical analysis: TH. Manuscript preparation: TH and TT. Manuscript editing: TH, TT, NH and AI. Manuscript review: TH, TT, TY, JU, NH, AI, KH, DK, TK and TF.

    • Funding This research was funded by the Japan Agency for Medical Research and Development (AMED) under grant number JP22ck0106755h0001 and the Japan Health Research Promotion Bureau under grant number 2023-younger-12.

    • Competing interests TH received research grants from the Japan Health Research Promotion Bureau. TT and TF received research grants from Japan Agency for Medical Research and Development (AMED).

    • Provenance and peer review Not commissioned; externally peer reviewed.