Changes in Components of Sarcopenia Diagnostic Criteria Throughout the Surgical Treatment of Oesophagogastric Cancer Surgery: A Prospective Longitudinal Study.

Low skeletal muscle index (SMI) and myosteatosis were highly prevalent preoperatively in oesophagogastric cancer surgery patients.

• Both low CT-defined SMI and myosteatosis were present in 50% of patients preoperatively.
• 48 patients were included preoperatively, predominantly male (63%) with a mean (SD) age of 64 (10.1) years.
• Low SMI was defined using published CT thresholds.
• Myosteatosis was also defined using published CT thresholds.

Low fat-free mass index (FFMI), low hand grip strength, and low walk speed were less prevalent preoperatively compared to low SMI and myosteatosis.

• Only 6% of patients had low FFMI preoperatively.
• Low hand grip strength (HGS) was present in 17% of patients preoperatively.
• Low walk speed was present in only 6% of patients preoperatively.
• FFMI cut points were <17 kg/m2 for men and <15 kg/m2 for women.
• Strength and function were measured using HGS (kg) and 6-metre walk test (metres/second), respectively.

The prevalence of sarcopenia defined by CT (Sarcopenia-CT) was low preoperatively and did not significantly change at 1 year postoperatively.

• Sarcopenia-CT prevalence was 15% preoperatively and 12% at 1 year (p = 0.32).
• Sarcopenia was defined using the European Working Group on Sarcopenia in Older People 2019 (EWGSOP2) criteria.
• 25 patients were available at the 1-year timepoint.
• The change in prevalence was not statistically significant.

The prevalence of sarcopenia defined by bioimpedance spectroscopy (Sarcopenia-BIS) was very low preoperatively and remained low at 1 year postoperatively.

• Sarcopenia-BIS prevalence was 2% preoperatively and 3% at 1 year (p = 0.60).
• Body composition was assessed using bioimpedance spectroscopy (BIS) as well as computed tomography (CT).
• The change in prevalence was not statistically significant.
• 25 patients were assessed at the 1-year timepoint.

Sarcopenia diagnostic criteria components were assessed at multiple timepoints throughout the surgical treatment period.

• Assessments were conducted preoperatively, at 2 weeks, 6 weeks, and 12 weeks post-discharge, and at 6 months and 12 months postoperatively.
• This was a prospective observational study including OG cancer surgery patients from 2018 to 2021.
• Both CT and BIS were used for body composition assessment.
• 48 patients were included preoperatively and 25 patients completed the 1-year assessment.

Low muscle mass with adequate strength and function, rather than full sarcopenia, was identified as a prominent feature in oesophagogastric cancer surgery patients.

• Despite 50% of patients having low SMI preoperatively, sarcopenia prevalence was only 15% (CT) and 2% (BIS) preoperatively.
• The discordance between high prevalence of low SMI/myosteatosis and low prevalence of sarcopenia indicates that many patients had low muscle mass without corresponding deficits in strength or function.
• The authors note that 'low muscle mass, with adequate strength and function, is a prominent feature.'
• Given the negative outcomes associated with low SMI, the authors concluded that muscle assessment remains 'a valuable and clinically meaningful measure.'