Skeletal muscle measured at T12 is a prognostic biomarker in oesophageal cancer patients
McSweeney, D Radhakrishna, Ganesh Green, Andrew Bromiley, P. A. McWilliam, Alan
McSweeney, D
Radhakrishna, Ganesh
Green, Andrew
Bromiley, P. A.
McWilliam, Alan
Citations
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Abstract
Purpose or Objective
Sarcopenia is emerging as a prognostic factor for multiple patient groups treated with radiotherapy (RT) where it is
associated with increased toxicity and decreased overall survival. Sarcopenia is typically assessed via the skeletal muscle
index (SMI): skeletal muscle area at L3 normalised by patient height. Therefore, cohorts where routine imaging does not
include L3 are often neglected.
Patients with oesophageal cancer are known to experience malnutrition and weight loss, associated with poorer outcomes.
In this work, we explore the utility of SMI, measured at T12, as a prognostic factor in patients with oesophageal cancer
treated with concurrent chemoradiotherapy (CCRT). We then compare sarcopenia with other measures of patient frailty:
performance status (PS) and body mass index (BMI).
Materials and Methods
103 patients with oesophageal cancer treated with CCRT, 50Gy in 25 fractions, were retrospectively collected.
Patient characteristics are shown in Table 1. T12 was manually identified on RT planning scans. An in-house artificial
intelligence algorithm was then used to segment the skeletal muscle compartment at T12 and segmentations were visually
assessed for accuracy.
Muscle area was extracted and SMI at T12 calculated for all patients with successful delineations. Prognostic
value was investigated using Kaplan-Meier curves (split on sex-specific median SMI) and a multivariable Cox model
controlling for biological sex, age, tumour volume, PS and BMI. The primary endpoint was overall survival.
Results
After removing segmentation failures, 98 patients were available. Kaplan-Meier curves did not show significant differences
in overall survival when split on sex-specific median SMI (Figure 1; log-rank p=0.074). However, in multivariable analysis,
SMI was significantly associated with survival (HR=0.73, p=0.044), where a higher SMI seems to be protective (Table 2). The
results suggest that there is an interaction between SMI and other factors in the multivariable model, showing that SMI
provides additional prognostic information beyond PS and BMI.
Conclusion
We show that SMI, evaluated at T12 using routine planning scans, is a prognostic factor in patients with oesophageal cancer
treated with CCRT, with increased muscle mass being protective. Results from our multivariable Cox model show that SMI
provides additional information beyond PS and BMI. Although our results require further validation, SMI shows promise for
patient treatment stratification.
Description
Date
2022
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
McSweeney D, Radhakrishna G, Green A, Bromiley PA, van Herk M, McWilliam A. Skeletal muscle measured at T12 is a prognostic biomarker in oesophageal cancer patients. Radiotherapy and Oncology. 2022 May;170:S1084-S5. PubMed PMID: WOS:000806779900109.