Esophageal cancer
Prognostic impacts of postoperative change in skeletal muscle mass in older patients with esophageal cancer undergoing perioperative rehabilitation
- Author(s)：
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Tsuyoshi Harada1, Noriatsu Tatematsu2, Junya Ueno1, Yu Koishihara1, Nobuko Konishi1, Takuya Fukushima3,
Tetsuya Tsuji4, Hisashi Fujiwara5, Takeo Fujita5 - Affiliation(s)：
- 1Department of Musculoskeletal and rehabilitation, National Cancer Center Hospital East, 2Department of Integrated Health Sciences, Nagoya University,3Department of Musculoskeletal and rehabilitation, National Cancer Center Hospital,4Department of Rehabilitation Medicine, School of Medicine, Keio University,5Department of Esophageal Surgery, National Cancer Center Hospital East
[Background]
In esophageal cancer (EC), change in skeletal muscle mass after esophagectomy is an important independent prognostic factor. However, there are few reports of older patients undergoing perioperative rehabilitation. The aim of this retrospective study was to clarify the impacts of the postoperative change ratio of skeletal muscle mass index (SMI%) on prognosis in older patients with esophageal cancer undergoing perioperative rehabilitation.
[Methods]
Subjects were older patients (over 70 years) with EC undergoing R0 esophagectomy and perioperative rehabilitation from 2015 to 2020. The SMI% was measured from CT images before and 4 months after esophagectomy. The cut-off point of the SMI% was defined by Youden's index from receiver operating characteristic analysis. Time-to-event analyses were performed with Cox proportional hazards model and Log-rank test to clarify the impacts of the SMI% on 3y-overall survival (3y-OS) and 3y-relapse-free survival (3y-RFS).
[Results]
A total of 166 patients (mean age: 75±4 years) was analyzed. The mean SMI% was -6.1±9.1%. The cut-off point of the SMI% was defined as -6.05% [AUC 0.729 (95% CI 0.566-0.893)]. The SMI% [HR 12.88 (95% CI 1.544-107.442), p=0.018] affected 3y-OS independent of age, sex, neoadjuvant chemotherapy, Charlson's comorbidity index, clinical stage and preoperative usual gait speed. Then, a smoothed spline curve showed dose-dependency between the SMI% and the risk of death. Patients with minor loss of SMI (> -6.05%) showed significantly higher 3-OS rate compared with those with a major loss of SMI (<-6.05%) (3 years-survival rates 97% vs. 79%, p<0.001). The SMI% [HR 0.832 (95% CI 0.330-2.096), p=0.696] was not associated with 3y-RFS.
[Conclusion]
The change in SMI 4 months after esophagectomy was an independent factor for 3y-OS, with a dose-dependency relationship. Not only perioperative rehabilitation but also postoperative continuous rehabilitation may be important for prognosis in older patients with EC.
Stromal expression of cancer-associated fibroblast-related molecules is strongly associated with worse relapse-free and overall survival times in patients with esophageal squamous cell carcinoma.
- Author(s)：
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Yasuyuki Kanke1, Naoto Yamauchi1, Katsuharu Saito1, Hirokazu Okayama1, Shoki Yamada2, Shotaro Nakajima1,
Hiroyuki Hanayama1, Yohei Watanabe1, Motonobu Saito1, Zenichiro Saze1, Tomoyuki Momma1, Kosaku Mimura1, Shinji Oki1, Yuko Hashimoto2, Koji Kono1 - Affiliation(s)：
- 1Department of Gastrointestinal Surgery, Fukushima Medical University, 2Department of Diagnostic Pathology, Fukushima Medical University
Cancer-associated fibroblasts (CAFs) in the tumor microenvironment play an essensial role in the tumor progression of esophageal squamous cell carcinoma (ESCC). The present study aimed to investigate the expression of CAF-related molecules, versican, periostin and lumican, in cancer stroma, to provide prognostic stratification for patients with ESCC after surgery. A total of 106 patients with ESCC who underwent curative esophagectomy without preoperative chemotherapy or radiotherapy were enrolled. The expression of CAF-related stromal proteins, including versican, periostin and lumican, was examined using immunohistochemistry, and the prognostic values was assessed by Kaplan-Meier survival analysis, and univariate and multivariate Cox regression models.The expression of versican, periostin and lumican was found specifically in the stromal component of ESCC. Kaplan-Meier analysis demonstrated that, compared with a low expression level, a high expression level of versican, perisotin or lumican in the cancer stroma was significantly associated with worse relapse-free survival (RFS) and overall times in patients with ESCC. The prognostic values of stromal versican and lumican remained significant in a stratified analysis of stage I patients.Moreover, univariate and multivariate analysis revealed that high stromal versican or lumican expression was an independent prognostic factor for RFS in the patients. The present study demonstrated that CAF-related molecules, including versican, periostin and lumican, were expressed in the stromal of ESCC, and that stromal expression of versican and lumican in particular may have clinical utility as a prognostic biomarker for poor RFS in postoperative patients with ESCC.
