Prognostic Impact of Preoperative Psoas muscle index as nutritional status on patients with esophageal cancer receiving neoadjuvant therapy.

Abstract Background It has been reported that preoperative nutritional status in some gastrointestinal cancers has a significant impact on postoperative prognosis. However, there are few reports on esophageal cancer, especially esophageal cancer that has undergone neoadjuvant therapy and surgery. Psoas muscle index (PMI) is widely known as an index for assessing preoperative nutritional status, and has recently been reported for its prognostic value in many malignancies. Therefore, we investigated and evaluated the clinical results in our hospital by the PMI method. Methods We retrospectively investigated esophageal cancer in patients (clinical Stage II or III) who underwent neoadjuvant therapy and surgical treatment (R0 cases) from January 2008 to December 2015. Applicable 63 cases were entered accordingly. In our hospital, nutritional supplements are used as nutritional management during preoperative adjuvant therapy, and these are administered to patients who have difficulty ingesting nutrition by feeding tube or total parenteral nutrition. The target value for nutritional supplement administration was 36 kcal/kg. Taking into account that esophageal cancer and chemotherapy were being performed on the Harris–Benedict\u0027s basal energy expenditure (25 kcal/kg), we multiplied by 1.44 (active factor; 1.2, stress factor; 1.2) and set 36 kcal/kg as a guide. PMI was evaluated before neoadjuvant therapy and before surgery. We defined sarcopenia by PMI of the third lumbar vertebra (L3) by a computed tomography (CT) examination using 3D image analysis software SYNAPSE VINCENT® (Fujifilm, Tokyo), Result The prevalence of sarcopenia decreased from 74.6% (47/63) to 69.84% (44/63) during the pretherapeutic to preoperative point (p=0.691), suggesting improved nutritional status. Regarding PMI divided by cutoff value for each gender (The cutoff value was the PMI mean value −2 SD (6.36 cm2/ m2 for males and 3.92 cm2/ m2 for females) of healthy persons under the age of 50, which was reported as a standard for low skeletal muscle mass in Japanese individuals), there was an improvement observed in preoperative compared to pretherapeutic point, but it was not obtained as a significant difference. (Pretherapeutic PMI; 0.87±0.06 (mean±SD), Preoperative PMI; 0.89±0.06 (mean±SD), p=0.18). In overall survival (OS) and disease free survival (DFS), there was no significant difference in the short-term results with and without sarcopenia in the pretherapeutic group (OS; p=0.17, DFS; p=0.17). There was a significant difference with and without sarcopenia in the preoperative group in terms of OS and DFS (OS; p=0.045, DFS; p=0.043), which was short-term due to nutritional intervention during preoperative adjuvant therapy. It was suggested that the results would be improved. Conclusions Improving nutritional status before surgery was shown to improve short-term prognosis in patients with esophageal cancer. It is hence suggested that it is important to maintain or improve nutritional status by intervention from the time of neoadjuvant therapy.