Persistent and developed radiological myosteatosis, not sarcopenia, during neoadjuvant chemotherapy is associated with postoperative complications and survival among patients with locally advanced esophageal adenocarcinoma.

BACKGROUND

Among patients with esophageal adenocarcinoma, changing radiological metrics of body composition in the form of sarcopenia and myosteatosis are associated with postoperative complications and impaired survival. However, whether changes in these radiological metrics during neoadjuvant chemotherapy affect these outcomes remains unexplored.

METHODS

From 01/2014-01/2023, a single center retrospective study was performed. Patients with locally advanced esophageal adenocarcinoma treated with neoadjuvant taxane based chemotherapy and en bloc resection were identified. Contrast infused pre-treatment and pre-surgery computed tomography scans were reviewed and skeletal muscle index (SMI) and skeletal muscle density (SMD) calculated. Pathological sarcopenia and myosteatosis were defined by the lowest sex-specific quartile of pre-treatment SMI/SMD values. Clinical and survival outcomes were compared between 'persistent'/'developed' sarcopenia and myosteatosis and the rest of the cohort. Data is reported with hazard ratio (HR).

RESULTS

Of the 387 patients identified, 105 were included in the final analysis. 'Developed'/'persistent' sarcopenia and myosteatosis was identified in 36/105 (34.3%) and 33/105 (31.4%) patients respectively. Unlike sarcopenia, 'developed'/'persistent' myosteatosis was associated with a higher incidence of major postoperative complications (11/72(15.3% vs 12/33(36.4%),p = 0.009). On multivariate analysis pathologically positive lymph nodes (ypN1 HR 4.2, p = 0.010, ypN2 HR 3.8, p = 0.029 and ypN3 HR 9.1, p=<0.001), poor tumor differentiation (HR 3.4, p = 0.001) and 'developed'/'persistent' myosteatosis (HR 2.1, p = 0.046) were independently associated with impaired overall survival. Measurements of sarcopenia were not associated with these outcomes.

CONCLUSION

In patients with locally advanced esophageal adenocarcinoma treated with neoadjuvant chemotherapy and en bloc resection, radiological measurements of myosteatosis, rather than sarcopenia, seem to be better associated with postoperative and survival outcomes than sarcopenia.