Cardiopulmonary exercise testing has greater prognostic value than sarcopenia in oesophago-gastric cancer patients undergoing neoadjuvant therapy and surgical resection
Cardiopulmonary exercise testing has greater prognostic value than sarcopenia in oesophago-gastric cancer patients undergoing neoadjuvant therapy and surgical resection
Background: Sarcopenia (low skeletal muscle mass), myosteatosis (low skeletal muscle radiation-attenuation) and fitness are independently associated with postoperative outcomes in oesophago-gastric cancer. This study aimed to investigate (1) the effect of neoadjuvant therapy (NAT) on sarcopenia, myosteatosis and cardiopulmonary exercise testing (CPET), (2) the relationship between these parameters, and (3) their association with postoperative morbidity and survival.Methods: Body composition analysis used single slice computed tomography (CT) images from chest (superior to aortic arch) and abdominal CT scans (third lumbar vertebrae). Oxygen uptake at anaerobic threshold (VO2 at AT) and at peak exercise (VO2 Peak) were measured using CPET. Measurements were performed before and after NAT and an adjusted regression model assessed their association.Results: Of the 184 patients recruited, 100 underwent surgical resection. Following NAT skeletal muscle mass, radiation-attenuation and fitness reduced significantly (p < 0.001). When adjusted for age, sex, and body mass index, only pectoralis muscle mass was associated with VO2 Peak (p = 0.001). VO2 at AT and Peak were associated with 1-year survival, while neither sarcopenia nor myosteatosis were associated with morbidity or survival.Conclusion: Skeletal muscle and CPET variables reduced following NAT and were positively associated with each other. Cardiorespiratory function significantly contributes to short-term survival after oesophago-gastric cancer surgery.Keywords: body composition; myosteatosis; neoadjuvant therapy; oxygen uptake; physical fitness; sarcopenia.
body composition, myosteatosis, neoadjuvant therapy, oxygen uptake, physical fitness, sarcopenia
1306-1316
West, Malcolm A.
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Baker, William Ca
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Rahman, Saqib
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Munro, Alicia
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Jack, Sandra
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Grocott, Michael Pw
1e87b741-513e-4a22-be13-0f7bb344e8c2
Underwood, Timothy J.
8e81bf60-edd2-4b0e-8324-3068c95ea1c6
Levett, Denny Zh
1743763a-2853-4baf-affe-6152fde8d05f
Wootton, Stephen
bf47ef35-0b33-4edb-a2b0-ceda5c475c0c
31 August 2021
West, Malcolm A.
98b67e58-9875-4133-b236-8a10a0a12c04
Baker, William Ca
379bc5c2-4a23-4482-a49f-5d20cc0c94bf
Rahman, Saqib
a2228883-fb64-4f47-8fd0-1a9832d04467
Munro, Alicia
38fb0bc1-7e2f-42a3-8b50-ad8fc90a600a
Jack, Sandra
a175e649-83e1-4a76-8f11-ab37ffd954ea
Grocott, Michael Pw
1e87b741-513e-4a22-be13-0f7bb344e8c2
Underwood, Timothy J.
8e81bf60-edd2-4b0e-8324-3068c95ea1c6
Levett, Denny Zh
1743763a-2853-4baf-affe-6152fde8d05f
Wootton, Stephen
bf47ef35-0b33-4edb-a2b0-ceda5c475c0c
West, Malcolm A., Baker, William Ca, Rahman, Saqib, Munro, Alicia, Jack, Sandra, Grocott, Michael Pw, Underwood, Timothy J., Levett, Denny Zh and Wootton, Stephen
(2021)
Cardiopulmonary exercise testing has greater prognostic value than sarcopenia in oesophago-gastric cancer patients undergoing neoadjuvant therapy and surgical resection.
Journal of Surgical Oncology, 124 (8), .
(doi:10.1002/jso.26652).
Abstract
Background: Sarcopenia (low skeletal muscle mass), myosteatosis (low skeletal muscle radiation-attenuation) and fitness are independently associated with postoperative outcomes in oesophago-gastric cancer. This study aimed to investigate (1) the effect of neoadjuvant therapy (NAT) on sarcopenia, myosteatosis and cardiopulmonary exercise testing (CPET), (2) the relationship between these parameters, and (3) their association with postoperative morbidity and survival.Methods: Body composition analysis used single slice computed tomography (CT) images from chest (superior to aortic arch) and abdominal CT scans (third lumbar vertebrae). Oxygen uptake at anaerobic threshold (VO2 at AT) and at peak exercise (VO2 Peak) were measured using CPET. Measurements were performed before and after NAT and an adjusted regression model assessed their association.Results: Of the 184 patients recruited, 100 underwent surgical resection. Following NAT skeletal muscle mass, radiation-attenuation and fitness reduced significantly (p < 0.001). When adjusted for age, sex, and body mass index, only pectoralis muscle mass was associated with VO2 Peak (p = 0.001). VO2 at AT and Peak were associated with 1-year survival, while neither sarcopenia nor myosteatosis were associated with morbidity or survival.Conclusion: Skeletal muscle and CPET variables reduced following NAT and were positively associated with each other. Cardiorespiratory function significantly contributes to short-term survival after oesophago-gastric cancer surgery.Keywords: body composition; myosteatosis; neoadjuvant therapy; oxygen uptake; physical fitness; sarcopenia.
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Accepted/In Press date: 14 August 2021
Published date: 31 August 2021
Additional Information:
National Institute for Health Research
(NIHR) ‐Research Patient Benefit Programme,
Grant/Award Number: PB‐PG‐0609‐18262
This work was undertaken whilst
MW and MPWG were funded by the National Institute of Health
Research and the Royal College of Anesthetists British Oxygen Company Fellowship awarded by the National Institute of Academic
Anesthesia for the Fit‐4‐Surgery programme of research. MPWG is
an NIHR Senior Investigator. Malcolm A West was supported by a
National Institute for Health Research Academic Clinical Lecturer
Award (CL‐2016‐26‐002). William CA Baker was supported by a
Royal College of Surgeons of England Intercalated Bachelor of
Science Degree in Surgery Award 2017/18. Michael PW Grocott was
supported by a National Institute for Health Research (NIHR)
who funded this work under the Research Patient Benefit
Programme (PB‐PG‐0609‐18262).
Keywords:
body composition, myosteatosis, neoadjuvant therapy, oxygen uptake, physical fitness, sarcopenia
Identifiers
Local EPrints ID: 451183
URI: http://eprints.soton.ac.uk/id/eprint/451183
ISSN: 0022-4790
PURE UUID: 4a24c759-f73d-4827-ac84-36aa3e8425c2
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Date deposited: 14 Sep 2021 16:08
Last modified: 17 Mar 2024 06:47
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Author:
William Ca Baker
Author:
Saqib Rahman
Author:
Alicia Munro
Author:
Sandra Jack
Author:
Denny Zh Levett
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