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Prognostic Value of Sarcopenia and Systemic Inflammation Markers in Patients Undergoing Definitive Radiotherapy for Esophageal Cancer

Authors Liang H, Peng H, Chen L

Received 29 October 2020

Accepted for publication 18 December 2020

Published 11 January 2021 Volume 2021:13 Pages 181—192


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Eileen O'Reilly

Huanwei Liang,1,* Huajian Peng,2,* Long Chen1

1Department of Radiotherapy, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi Zhuang Autonomous Region, People’s Republic of China; 2Department of Thoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Long Chen
Department of Radiotherapy, Guangxi Medical University Cancer Hospital, He Di Road 71, Nanning, 530021 Guangxi Zhuang Autonomous Region, People’s Republic of China
Tel +86-771- 5330700
Fax +86 771- 5312000

Objective: To determine the independent and combined prognostic value of sarcopenia and systemic inflammatory markers in esophageal cancer patients undergoing definitive radiotherapy.
Methods: Sarcopenia was diagnosed on the basis of the skeletal muscle index (SMI) as determined by the skeletal muscle area at the third lumbar (L3) region and body height. The optimal cutoff value of systemic inflammatory markers was determined by the receiver-operating curve (ROC). Logistic regression was used to analyze the correlation among different variables. Cox proportional hazards model was used to identify the factors significantly correlated to overall survival (OS). Based on the results of multivariate survival analysis, a nomogram was established to predict the survival rate. The accuracy of the nomogram was evaluated by the coordination index and the calibration curve.
Results: A total of 100 esophageal cancer patients were included, of which 77 exhibited sarcopenia. The lymphocyte–monocyte ratio (LMR) was significantly correlated to the risk of sarcopenia (OR = 0.637, 95% CI, 0.452– 0.898, P = 0.010). In addition, sarcopenia (P = 0.002, HR = 3.991, 95% CI: 1.653– 9.638) and LMR < 2.67 (P < 0.001, HR = 2.665, 95% CI: 1.563– 4.543) were independent predictors of OS. Two nomograms with good predictive accuracy were established.
Conclusion: Sarcopenia and LMR can independently predict the survival of patients with esophageal cancer receiving definitive radiotherapy and have good combined prognostic value.

Keywords: esophageal cancer, definitive radiotherapy, sarcopenia, lymphocyte-monocyte ratio, survival

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