Prognostic impact of shift to low visceral fat mass after neoadjuvant chemotherapy in patients with esophageal cancer

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY Accounts of Chemical Research Pub Date : 2024-08-19 DOI:10.1002/cnr2.2084

Sachiyo Onishi, Masahiro Tajika, Tsutomu Tanaka, Keisaku Yamada, Yoshitaka Inaba, Tetsuya Abe, Kei Muro, Masahito Shimizu, Yasumasa Niwa

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Abstract

Background

Based on the JCOG1109 trial, it is suggested that the combination of docetaxel, cisplatin, and 5-fluorouracil (DCF) could potentially become a standard neoadjuvant chemotherapy regimen, alongside the conventional 5-fluorouracil and cisplatin (CF) therapy, for esophageal cancer. However, there are few reports on the impact of body composition changes associated with neoadjuvant chemotherapy on prognosis.

Aim

Our study aimed to explore the effect of different neoadjuvant chemotherapy regimens on body composition during treatment and the impacts of body composition changes on their prognosis.

Methods and results

This is a retrospective study of 215 patients with advanced thoracic esophageal cancer who had surgery after neoadjuvant chemotherapy from 2013 to 2019. Computed tomography scans were performed before and after neoadjuvant chemotherapy to assess body composition. Skeletal muscle mass index (SMI) was calculated by dividing total skeletal muscle mass at the 3rd lumbar level by the square of height, while visceral and subcutaneous fat masses were measured at the level of umbilicus. Patients in the lowest 25% of both sexes were classified into the low visceral fat and low subcutaneous fat groups, respectively. Of the patients enrolled, 178 were male and 37 were female. Among them, 91 had clinical Stage II disease, and 124 had clinical Stage III disease. Additionally, 146 patients received neoadjuvant chemotherapy CF, and 69 received neoadjuvant chemotherapy DCF. Comparing the DCF and CF groups, the DCF group consisted of significantly younger patients (p < .01), a higher proportion of males (p = .03), and a greater number of clinical Stage III cases (p < .01). However, although percent change in SMI and visceral fat mass was not significantly different between two regimens, percent change in subcutaneous fat mass was significant in the DCF group. The major prognostic factors for patients undergoing surgery after neoadjuvant chemotherapy for thoracic esophageal cancer were clinical Stage III, transition to low visceral fat, and response rating (SD/PD), while the specific neoadjuvant chemotherapy regimen did not significantly influence the outcomes.

Conclusion

This study suggests that prevention of the shift to low visceral fat throughout the neoadjuvant chemotherapy process should improve patient outcomes.

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食管癌患者接受新辅助化疗后内脏脂肪量减少对预后的影响。

背景：根据JCOG1109试验，多西他赛、顺铂和5-氟尿嘧啶（DCF）联合疗法有可能成为食管癌的标准新辅助化疗方案，与传统的5-氟尿嘧啶和顺铂（CF）疗法并驾齐驱。目的：我们的研究旨在探讨不同的新辅助化疗方案在治疗过程中对身体成分的影响，以及身体成分变化对预后的影响：这是一项回顾性研究，研究对象为2013年至2019年期间接受新辅助化疗后进行手术的215例晚期胸部食管癌患者。在新辅助化疗前后进行了计算机断层扫描，以评估身体组成。骨骼肌质量指数（SMI）的计算方法是将第3腰椎水平的骨骼肌总质量除以身高的平方，而内脏和皮下脂肪质量则是在脐部水平测量的。体重最低的 25% 男女患者分别被划分为低内脏脂肪组和低皮下脂肪组。在登记的患者中，男性 178 人，女性 37 人。其中，91 人处于临床 II 期，124 人处于临床 III 期。此外，146 名患者接受了 CF 新辅助化疗，69 名患者接受了 DCF 新辅助化疗。DCF 组与 CF 组相比，DCF 组患者的年龄明显更小（P这项研究表明，在整个新辅助化疗过程中防止内脏脂肪向低脂肪转移应能改善患者的预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.