|Table of Contents|

The effect of sarcopenia on postoperative pneumonia in esophageal squamous cell carcinoma patients after neoadjuvant chemotherapy

Journal Of Modern Oncology[ISSN:1672-4992/CN:61-1415/R]

Issue:
2024 18
Page:
3475-3481
Research Field:
Publishing date:

Info

Title:
The effect of sarcopenia on postoperative pneumonia in esophageal squamous cell carcinoma patients after neoadjuvant chemotherapy
Author(s):
LI Pengling1; YOU Zhenbing2; LENG Xuechun2; ZHANG Mingzhi2; XU Keping2; TIAN Wenze2
1.Department of Respiratory and Critical Care Medicine;2.Department of Thoracic Surgery,the Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University,Jiangsu Huai'an 223300,China.
Keywords:
esophageal cancer; sarcopenia; neoadjuvant chemotherapy; pneumonia; skeletal muscle index
PACS:
R735.1
DOI:
10.3969/j.issn.1672-4992.2024.18.012
Abstract:
Objective:To explore the impact of sarcopenia on postoperative pneumonia in esophageal squamous cell carcinoma patients undergoing radical esophagectomy after neoadjuvant chemotherapy.Methods:Retrospective analysis was made on the clinical data of 130 esophageal squamous cell carcinoma undergoing radical resection of esophageal cancer after neoadjuvant chemotherapy in our hospital from January 2020 to June 2023.The correlation between clinical pathological indicators,skeletal muscle indicators before and after neoadjuvant therapy and postoperative pneumonia was statistically analyzed.Results:The proportion of postoperative pneumonia in esophageal squamous cell carcinomapatients receiving neoadjuvant chemotherapy was 20.0%.The proportion of patients with pneumonia in groups of ≥65 years old,pathological T stage,sarcopenia before chemotherapy,sarcopenia before surgery,and skeletal muscle transition loss were significantly higher than that of patients without pneumonia (P＜0.05).The skeletal muscle index before chemotherapy,preoperative skeletal muscle index,and preoperative serum albumin indicators were significantly lower than those in the non-pneumonia group,with statistically significant differences (t=2.262,2.812,3.050,P＜0.05).Logistic multivariate analysis showed that comorbidities with sarcopenia (before chemotherapy),skeletal muscle transition loss,higher pathological T stage,serum prealbumin<200 g/L,and high NLR were risk factors for postoperative pneumonia in esophageal squamous cell carcinoma patients after neoadjuvant therapy (Wald values were 6.257,16.257,4.548,6.375,7.243,P＜0.05,respectively).Conclusion:The combination of sarcopenia before neoadjuvant chemotherapy and skeletal muscle transition loss during neoadjuvant chemotherapy increase the risk of postoperative pneumonia in esophageal squamous cell carcinoma patients after neoadjuvant therapy,which has good clinical value in predicting pneumonia before surgery.

References:

［1］ MAO YS,GAO SG,WANG Q,et al.Analysis of a registry database for esophageal cancer from high-volume centers in China ［J］.Dis Esophagus，2020,33(8):doz091.
［2］ ZHENG XD,LI SC,LU C,et al.Safety and efficacy of minimally invasive McKeown esophagectomy in 1023 consecutive esophageal cancer patients:a single-center experience ［J］.J Cardiothorac Surg，2022,17(1):36.
［3］ LI J,MA S.History and current situation of neoadjuvant treatment for locally advanced esophageal cancer ［J］.Thorac Cancer，2021,12(17):2293-2299.
［4］ MOTOYAMA S,YAMAMOTO H,MIYAT H,et al.Impact of certification status of the institute and surgeon on short-term outcomes after surgery for thoracic esophageal cancer:evaluation using data on 16,752 patients from the National Clinical Database in Japan ［J］.Esophagus，2020,17(1):41-49.
［5］ GUO X,KE W,YANG X,et al.Association of DLT versus SLT with postoperative pneumonia during esophagectomy in China:a retrospective comparison study ［J］.BMC Anesthesiol，2023,23(1):301.
［6］ PARK A,ORLANGINI MF,SZOR DJ,et al.The impact of sarcopenia on esophagectomy for cancer:a systematic review and meta-analysis ［J］.BMC Surg,2023,23(1):240.
［7］ CHEN F,CHI J,ZHAO B,et al.Impact of preoperative sarcopenia on postoperative complications and survival outcomes of patients with esophageal cancer:a meta-analysis of cohort studies ［J］.Dis Esophagus，2022,35(9):doab100.
［8］ ZHUANG CL,HUANG DD,PANG WY,et al.Sarcopenia is an independent predictor of severe postoperative complications and long-term survival after radical gastrectomy for gastric cancer:Analysis from a Large-Scale Cohort ［J］.Medicine (Baltimore)，2016,95(13):e3164.
［9］ 中华人民共和国卫生部.医院感染诊断标准(试行)［J］．中华医学杂志,2001,81(5):61-67. Ministry of Health of the Peoples Republic of China.Diagnostic criteria for nosocomial infections(proposed) ［J］.Natl Med J China,2001,81(5):314-320.
［10］ BHARAT A,CRABTREE T.Management of advanced-stage operable esophageal cancer［J］.Surg Clin North Am，2012,92(5):1179-1197.
［11］ 程良,付茂勇,杨毫,等.食管鳞癌新辅助化疗的研究进展［J］.中华消化外科杂志,2019,18(6):604-606. CHENG Liang,FU Maoyong,YANG Hao,et al.Research progress of neoadjuvant chemotherapy for esophageal squamous cell carcinoma ［J］.Chin J Dig Surg,2019,18(6):604-606.
［12］ VAN HAGEN P,HULSHOF MC,VAN LANSCHOT JJ,et al.Preoperative chemoradiotherapy for esophageal or junctional cancer［J］.N Engl J Med,2012,366(22):2074-2084.
［13］ YANG H,LIU H,CHEN Y,et al.Neoadjuvant chemoradiotherapy followed by surgery versus surgery alone for locally advanced squamous cell carcinoma of the esophagus (NEOCRTEC5010):a phase III multicenter,randomized,open-label clinical trial［J］.J Clin Oncol,2018,36(27):2796-2803.
［14］ SCHLICK C,ELLIS RJ,ETKIN CD,et al.Experiences of gender discrimination and sexual harassment among residents in general surgery programs across the US［J］.JAMA Surg,2021,156(10):942-952.
［15］ MATSUDA S,KITAGAWA Y,OKUI J,et al.Old age and intense chemotherapy exacerbate negative prognostic impact of postoperative complication on survival in patients with esophageal cancer who received neoadjuvant therapy:a nationwide study from 85 Japanese esophageal centers［J］.Esophagus，2023,20(3):445-454.
［16］ NISHIGORI T,OKABE H,TANAKA E,et al.Sarcopenia as a predictor of pulmonary complications after esophagectomy for thoracic esophageal cancer ［J］.J Surg Oncol，2016,113(6):678-684.
［17］ TAN X,PENG H,GU P,et al.Prognostic significance of the L3 skeletal muscle index and advanced lung cancer inflammation index in elderly patients with esophageal cancer ［J］.Cancer Manag Res，2021,13:3133-3143.
［18］ FUKUSHIMA T,WATANABE N,OKITA Y,et al.The evaluation of the association between preoperative sarcopenia and postoperative pneumonia and factors for preoperative sarcopenia in patients undergoing thoracoscopic-laparoscopic esophagectomy for esophageal cancer ［J］.Surg Today，2023,53(7):782-790.
［19］ NISHI S,MIKI Y,IMAI T,et al.The evaluation of sarcopenia before neoadjuvant chemotherapy is important for predicting postoperative pneumonia in patients with esophageal cancer ［J］.Dig Surg，2023,40(5):153-160.
［20］ PAIREDER M,ASARI R,KRISTO I,et al.Impact of sarcopenia on outcome in patients with esophageal resection following neoadjuvant chemotherapy for esophageal cancer ［J］.Eur J Surg Oncol，2017,43(2):478-484.
［21］ JOGIAT UM,BARACOS V,TURNER SR,et al.Changes in sarcopenia status predict survival among patients with resectable esophageal cancer ［J］.Ann Surg Oncol，2023,30(12):7412-7421.
［22］ PIERCE K,PHILIPS P,EGGER ME,et al.Developing sarcopenia during neoadjuvant therapy is associated with worse survival in esophageal adenocarcinoma patients［J］.Surgery,2024,175(3):718-725.
［23］ KANEMURA T,TAKEOKA T,SUGASE T,et al.Significance of comprehensive analysis of preoperative sarcopenia based on muscle mass,muscle strength,and physical function for the prognosis of patients with esophageal cancer ［J］.Ann Surg Oncol,2024,31(2):818-826.
［24］ MIYATA H,SUGIMURA K,MOTOORI M,et al.Clinical assessment of sarcopenia and changes in body composition during neoadjuvant chemotherapy for esophageal cancer ［J］.Anticancer Res，2017,37(6):3053-3059.
［25］ ELLIOTT JA,DOYLE SL,MUROHY CF,et al.Sarcopenia:Prevalence,and impact on operative and oncologic outcomes in the multimodal management of locally advanced esophageal cancer ［J］.Ann Surg，2017,266(5):822-830.
［26］ KITA R,MIYATA H,SUGIMURA K,et al.Clinical effect of enteral nutrition support during neoadjuvant chemotherapy on the preservation of skeletal muscle mass in patients with esophageal cancer ［J］.Clin Nutr，2021,40(6):4380-4385.
［27］ HARADA T,TSUJI T,UENO J,et al.Prognostic impact of the loss of skeletal muscle mass during neoadjuvant chemotherapy on older patients with esophageal cancer ［J］.Ann Surg Oncol，2022,29(13):8131-8139.
［28］ HIGASHIZONO K,SATO S,NAKATANI E,et al.Skeletal muscle loss during neoadjuvant chemotherapy predicts the incidence of postoperative infectious complications in esophageal cancer patients undergoing esophagectomy ［J］.Cancer Diagn Progn，2023,3(1):67-74.
［29］ MOTOOR M,FUJITANI K,SUGIMURA K,et al.Skeletal muscle loss during neoadjuvant chemotherapy is an independent risk factor for postoperative infectious complications in patients with advanced esophageal cancer ［J］.Oncology，2018,95(5):281-287.
［30］ ISHIDA T,MAKINO T,YAMASAKI M,et al.Impact of measurement of skeletal muscle mass on clinical outcomes in patients with esophageal cancer undergoing esophagectomy after neoadjuvant chemotherapy ［J］.Surgery，2019,166(6):1041-1047.

Memo

Memo:
江苏省卫生健康委员会医学科研面上项目（编号：H2023083）；江苏省医学重点学科建设单位项目（编号：JWDS202233）
Last Update: 1900-01-01