Sarcopenic psoas muscle surface area predicts short and long-term mortality for oesophageal cancer patients

Background: Oesophagectomy is associated with high morbidity and mortality. Although efforts have been made to develop risk assessment tools, prognostic features that can be easily and objectively assessed from preoperative computed tomography are rarely used. Here we sought to evaluate whether the loss of skeletal muscle mass can predict short and long-term mortality after oesophagectomy. Methods: This study included consecutive patients with oesophageal cancer that underwent oesophagectomy at Tampere University Hospital from January 2007 to December 2018. Reviewers, blinded to both clinical details and postoperative outcomes, measured the average cross-sectional area of the bilateral psoas muscles at the L3 vertebra level. These measurements were then correlated with clinicopathological data and survival metrics. Results: A total of 97 patients [median age 64 (range, 43–78) years; 20% female] were enrolled, with a median follow-up time of 1,307 (range, 2–1,540) days. The median psoas muscle areas (PMAs) were 809 [interquartile range (IQR), 679–1,065] mm² among males and 508 (IQR, 382–661) mm² among females. Twenty-seven percent of patients were considered to have sarcopenic psoas muscle surface area. During neoadjuvant therapy, muscle area decreased on 92% of patients by median of 70 (IQR, 38–158) mm² (P<0.001). Patients with lower PMA had worse survival (90-day survival 77% vs. 99%, P<0.001; and 5-year survival 31% vs. 49%, P=0.02). Surprisingly, obesity was associated with improved survival in non-sarcopenic patients (5-year survival 71% vs. 44%, P<0.001). Conclusions: Sarcopenic patients had lower survival rates. Thus, enhancing preoperative care could improve outcomes in these fragile patients.