Prognostic value of preoperative total psoas muscle area on long-term outcome in surgically treated oesophageal cancer patients

Abstract

OBJECTIVES: Although a decrease in psoas muscle area (PMA) has been reported as a risk factor for survival in several malignancies, there have been few studies regarding its prognostic value in oesophageal cancer. We investigated the prognostic role of PMA and its F-18 fluorodeoxyglucose uptake in patients who had surgically treated oesophageal cancer.

METHODS: From 2004 to 2013, 131 patients who underwent surgical resection and complete lymph node dissection for oesophageal cancer were retrospectively reviewed. The PMA and mean standardized uptake value (SUVmean) of the psoas muscle were measured at the L3 spine level on preoperative positron emission tomography/computed tomography images.

RESULTS: The mean age was 63.38 ± 8.47 years and male patients were 125 (95.4%). The pathological stage I, II and III were 38 (29.0%), 41 (31.3%) and 52 (39.7%), respectively. The mean body mass index (BMI), PMA and SUVmean of the psoas muscle were 59.50 ± 10.14, 14.42 ± 4.30 and 1.51 ± 0.27, respectively. Operative mortality occurred in 7 (5.3%) patients. The BMI and PMA were lower in patients with operative mortality than in patients who survived. The median follow-up time was 32.52 months. A multivariate analysis revealed that PMA was an adverse risk factor for overall survival (OS) (hazard ratio, HR = 0.930; P= 0.004), whereas BMI was related to OS. The 3-year OS rates were 64.9% in high-PMA (≥15.8) patients; however, it was only 37.1% in low-PMA (less than 15.8) patients (P= 0.002). Akaike information criterion was the lowest by including PMA in the multivariate model.

CONCLUSIONS: Decreased PMA was an adverse significant prognostic factor for OS in patients with oesophageal cancer.