Project 466518

Background: Sarcopenia is defined as the chronic decrease in muscle mass and function. It is part of the aging process, and can be accelerated by disease and malnutrition. In esophageal cancer, sarcopenia is associated with worse survival, increased post-operative complications, and increased risk of malnutrition. Patients with esophageal cancer are higher risk for sarcopenia because the cancer obstructs passage of food into the stomach, patients fast in the post-operative period to facilitate GI tract healing, and the energy requirements of the tumor 'steal' nutrients away from the body's intended purpose.Objectives:Exploring the clinical implications of sarcopenia in esophageal cancer, this research will 1) examine the changes in sarcopenia over a patient's treatment course; and 2) examine the effect of sarcopenia on survival, post-operative complications, and adverse events from chemoradiotherapy.Methods: Patients with esophageal cancer undergo multiple computed tomography (CT) scans during their treatment course and sarcopenia can be measured with the skeletal muscle index calculated from these scans. Study 1 will develop a retrospective cohort study to examine changes in sarcopenia by comparing the skeletal muscle indices across three distinct CT scans: staging, post-chemoradiotherapy, and 6-month post-operative. Data from this retrospective study will be used to guide the prospective second study. Study 2 will develop a multi-institutional prospective cohort study to examine the effect of sarcopenia on clinical outcomes.Significance: This research will solidify our understanding of sarcopenia's prognostic effect in esophageal cancer, which can improve patient outcomes by guiding the development of nutritional interventions for those at-risk.