The impact of sarcopenia on esophageal cancer treatment outcome

Mpamaugo, Chinenyenwa (2019) The impact of sarcopenia on esophageal cancer treatment outcome. Master Essay, University of Pittsburgh.

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Abstract

Objective: Esophageal cancer is of public health significance as the eighth most common cancer worldwide and the 6th leading cause of cancer deaths. The treatment options include medical (chemoradiation) and surgical (esophagectomy) interventions. The favored surgical method, minimally invasive esophagectomy (MIE), is associated with significant morbidity and mortality. Currently, research is focused on determining prognostic indicators for outcomes following MIE, one of which is sarcopenia. Sarcopenia has been found to be associated with increased morbidity following chemoradiation, but little is known about its effect on perioperative complications following MIE. We hypothesize that sarcopenia is associated with perioperative complications and worse overall survival for patients receiving MIE as seen in patients receiving chemoradiation.
Method: In a retrospective study of 102 patients with esophageal cancer who underwent minimally invasive esophagectomy available CT images of each patient, taken within three months prior to the date of surgery, were analyzed to measure total skeletal muscle cross-sectional area. These values were then used to calculate the skeletal muscle index (SMI), which is skeletal muscle mass cross-sectional area normalized by height (cm2/m2). This value was used to identify patients with sarcopenia, defined as SMI less than 52.4 cm2/m2 for men and SMI less than 35 cm2/m2 for women. We then evaluated the association of sarcopenia with outcomes after MIE.
Results: Among the 102 patients who underwent MIE, the prevalence of sarcopenia was 49.0% of which 46 (53.5%) of men and 4 (25%) of women were classified as having sarcopenia. The perioperative 30-day mortality was 0%. Those with sarcopenia were found to have an increase in perioperative morbidity including pneumonia (p = .032) and anastomotic leak (p = .049). Sarcopenia was also found to have a significant effect on overall survival with an over two-time increase from 28 months for patients with sarcopenia to 62 months for patients without (p=0.0065).
Conclusions: This analysis demonstrates that sarcopenia, was associated with an increase in perioperative complications such as pneumonia, and anastomotic leak. Overall survival appeared to be decreased in patients with sarcopenia. This essay demonstrates that regardless of treatment method, sarcopenia leads to more complications for patients with esophageal cancer due to poorer treatment response thus decreasing overall survival and increasing mortality.

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Details

Item Type:	Other Thesis, Dissertation, or Long Paper (Master Essay)
Status:	Unpublished
Creators/Authors:	Creators Email Pitt Username ORCID Mpamaugo, Chinenyenwa csm59@pitt.ed csm59
Contributors:	Contribution Contributors Name Email Pitt Username ORCID Committee Chair Finegold, David dnf@pitt.edu UNSPECIFIED UNSPECIFIED Committee Member Elias, Thistle elias@pitt.edu UNSPECIFIED UNSPECIFIED Committee Member Diergaarde, Brenda diergaardeb@upmc.edu UNSPECIFIED UNSPECIFIED
Date:	26 April 2019
Date Type:	Submission
Number of Pages:	26
Institution:	University of Pittsburgh
Schools and Programs:	School of Public Health > Multidisciplinary MPH
Degree:	MPH - Master of Public Health
Thesis Type:	Master Essay
Refereed:	Yes
Date Deposited:	14 Oct 2019 17:37
Last Modified:	14 Oct 2019 17:37
URI:	http://d-scholarship.pitt.edu/id/eprint/36634

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