Relationship Between Sarcopenia And Clinical Efficacy And Prognosis Of Elderly Patients With Esophageal Cancer Treated With Radiotherapy

Objective:To evaluate clinical value of the third lumbar skeletal muscle index（L3 SMI）sarcopenia in diagnosis of sarcopenia;To analyze the effects of sarcopenia on efficacy,adverse effects and long-term survival in elderly patients with esophageal cancer.Methods:The clinical data of 234 patients with esophageal cancer treated in the Department Radiotherapy,Affiliated Hospital of Yangzhou university from January 2013 to December 2018 were retrospectively analyzed.Computed tomography（CT）images were download from Picture Archiving and Communication System（PACS）,and the skeletal muscle area（SMA）at the level of the third lumbar（L3）of the CT image were measured,The SMI（cm2/m2）=SMA（cm2）/height square（m2）was used to calculate the SMI of the third lumbar.According to the diagnostic criteria for sarcopenia proposed by Professor Yu Zhen’s team,40.8cm 2/m2 for the male,and 34.9cm/m2for the female.IBM SPSS 19.0 software was used for statistical analysis,and chi-square test was used for measurement data comparison.Logistic regression model was used to analyze the relationship between clinical data and sarcopenia.In terms of prognosis,Kaplan-Meier method was used to draw survival curves and log-rank test was used to compare differences between groups.Univariate and multivariate analyses were performed by Cox proportional risk regression model.Results:1.The gender,clinical tumor stage（cT）,clinical node stage（cN）,clinical stage（cTNM）,nutritional intervention and body mass index（BMI）was correlated with sarcopenia（P<0.05）.Male elderly patients with locally advanced esophageal cancer and low BMI have a higher probability of developing sarcopenia and need nutritional support therapy during radiotherapy and chemotherapy.2.The hemoglobin（Hb）,albumin（ALB）,prealbumin（PALB）,blood urea nitrogen（BUN）and LMR were correlated with sarcopenia（P<0.05）.Elderly patients with low Hb,albumin and PALB as well as high LMR and BUN were more likely to develop sarcopenia.3.The gender,cT stage and BMI were independent risk factors for sarcopenia in elderly patients with esophageal cancer（P<0.05）.Elderly men with low BMI and locally advanced esophageal cancer are more likely to develop sarcopenia.4.Whether nutritional intervention is associated with SMI in elderly patients with esophageal cancer during treatment（P<0.05）.5.The skeletal muscle index（SMI）was significantly increased after nutritional intervention.6.Sarcopenia is associated with adverse events to radiotherapy and chemotherapy.There is a higher probability of radiation esophagitis and anemia in elderly patients with esophageal cancer complicated with sarcopenia.7.The 1-year,3-year,5-year PFS and OS rates of patients with sarcopenia were lower than those of patients without sarcopenia.Elderly patients with radiotherapy for esophageal cancer with sarcopenia had shorter PFS and OS.8.The cT stage,cN stage,cTNM stage,nutritional intervention,BMI,treatment method,sarcopenia,and LMR were correlated with the prognosis of elderly patients with radiotherapy for esophageal cancer（P<0.05）.9.The cT stage,cTNM stage,BMI,treatment method,sarcopenia and nutritional intervention are independent risk factors affecting the prognosis of elderly esophageal cancer patients.The prognosis of elderly esophageal cancer patients with low BMI,low L3 SMI,no nutritional intervention and receiving radiotherapy alone were poor.10.The 1-year,3-year and 5-year PFS rates and OS rates in patients without nutritional support were lower than those in patients with nutritional support.Nutritional support therapy can improve prognosis in elderly patients with esophageal cancer.Conclusion:1.Sarcopenia has a good predictive value for the efficacy evaluation and prognosis evaluation of radiotherapy in elderly patients with esophageal cancer.Patients with sarcopenia have a higher incidence of mild to moderate adverse reactions,and their efficacy and prognosis are worse.2.Sarcopenia is an independent risk factor affecting the prognosis of elderly patients with esophageal cancer treated with radiotherapy.Assessment of patients with sarcopenia and nutritional support are important to improve the prognosis of patients.