A high ratio of visceral fat area to psoas muscle area predicts poor overall survival for esophageal cancer patients receiving definitive chemoradiotherapy.

PURPOSE: The ratio of visceral fat area to psoas muscle area (V/P ratio) is a computed tomography (CT)-derived marker of visceral adiposity relative to skeletal muscle mass. We evaluated the prognostic value of the V/P ratio in patients with esophageal cancer undergoing definitive chemoradiotherapy (CRT).

METHODS

The subjects of this retrospective analysis were 73 patients treated with definitive CRT between 2008 and 2017. The V/P ratio was measured at the third lumbar vertebra on CT. We performed multivariate Cox regression for overall survival (OS) and cancer-specific survival (CSS).

RESULTS

The median V/P ratio was 5.31 (interquartile range, 2.60-9.46). The visceral fat area (p < 0.001), body mass index (BMI) (p < 0.001), proportion of patients with a Charlson comorbidity index (CCI) ≥ 1 (p = 0.001), and age-adjusted CCI (p = 0.003) were significantly associated with the V/P ratio. After adjustment for clinical factors, the V/P ratio was found to be an independent prognostic factor for OS (HR 2.11 per 1-SD increase; 95% CI, 1.35-3.29; p = 0.001) and CSS (HR 2.49; 95% CI, 1.55-4.00; p < 0.001). The association persisted in non-obese patients.

CONCLUSION

The V/P ratio was associated with poor OS for esophageal cancer patients receiving definitive CRT, even for those who were not obese.