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Cancer Epidemiology, Biomarkers & Prevention
Cancer Epidemiology, Biomarkers & Prevention
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Low Subcutaneous Adiposity and Mortality in Esophageal Cancer

Margaret J. Zhou, Luke Tseng, Xiaotao Guo, Zhezhen Jin, Stuart Bentley-Hibbert, Sherry Shen, James L. Araujo, Cathy F. Spinelli, Nasser K. Altorki, Joshua R. Sonett, Alfred I. Neugut and Julian A. Abrams
Margaret J. Zhou
1Department of Medicine, Columbia University Irving Medical Center, New York, New York.
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Luke Tseng
1Department of Medicine, Columbia University Irving Medical Center, New York, New York.
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Xiaotao Guo
2Department of Radiology, Columbia University Irving Medical Center, New York, New York.
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Zhezhen Jin
3Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York.
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Stuart Bentley-Hibbert
2Department of Radiology, Columbia University Irving Medical Center, New York, New York.
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Sherry Shen
1Department of Medicine, Columbia University Irving Medical Center, New York, New York.
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James L. Araujo
4Department of Gastroenterology, SUNY Downstate Health Sciences University, New York, New York.
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Cathy F. Spinelli
5Department of Thoracic Surgery, Weill Cornell Medical Center, New York, New York.
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Nasser K. Altorki
5Department of Thoracic Surgery, Weill Cornell Medical Center, New York, New York.
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Joshua R. Sonett
6Department of Thoracic Surgery, Columbia University Irving Medical Center, New York, New York.
7Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York.
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Alfred I. Neugut
1Department of Medicine, Columbia University Irving Medical Center, New York, New York.
7Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York.
8Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York.
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Julian A. Abrams
1Department of Medicine, Columbia University Irving Medical Center, New York, New York.
7Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York.
8Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York.
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  • For correspondence: ja660@cumc.columbia.edu
DOI: 10.1158/1055-9965.EPI-20-0737 Published January 2021
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Abstract

Background: Recent data suggest that subcutaneous adiposity represents an independent prognostic marker in cancer. We aimed to determine whether subcutaneous adiposity estimated by the subcutaneous adiposity tissue index (SATI) was associated with mortality in esophageal cancer.

Methods: We conducted a retrospective analysis of a prospectively enrolled cohort from 2009 to 2015 with esophageal cancer at two major cancer centers. CT scans for initial staging were used to quantify adiposity and skeletal muscle areas. Subjects were categorized as above or below median SATI using sex-specific values. Sarcopenia was defined using previously established skeletal muscle area cutoffs. Cox proportional hazards modeling was performed to determine associations between SATI and all-cause mortality.

Results: Of the original 167 patients, 78 met inclusion criteria and had CT images available. Mean age was 67 years, 81.8% had adenocarcinoma, and 58.9% had stage 3 or 4 disease. Median follow-up time was 29.5 months. Overall 5-year survival was 38.9% [95% confidence interval (CI), 26.8–50.7]. Lower body mass index, higher Charlson comorbidity score, and more advanced stage were independently associated with low SATI. Patients with low SATI had increased mortality (unadjusted HR 2.23; 95% CI, 1.20–4.12), even when adjusted for sarcopenia or for percent weight loss. In a multivariable model including age, histology, stage, and receipt of curative surgery, the association between low SATI and mortality was attenuated (adjusted HR 1.64; 95% CI, 0.81–3.34).

Conclusions: Low subcutaneous adiposity as estimated by SATI may be associated with increased mortality in esophageal cancer.

Impact: Interventions to reduce loss of subcutaneous fat may improve survival in esophageal cancer.

Footnotes

  • Note: Supplementary data for this article are available at Cancer Epidemiology, Biomarkers & Prevention Online (http://cebp.aacrjournals.org/).

  • Cancer Epidemiol Biomarkers Prev 2021;30:114–22

  • Received May 13, 2020.
  • Revision received July 10, 2020.
  • Accepted September 28, 2020.
  • Published first October 2, 2020.
  • ©2020 American Association for Cancer Research.
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Cancer Epidemiology Biomarkers & Prevention: 30 (1)
January 2021
Volume 30, Issue 1
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Low Subcutaneous Adiposity and Mortality in Esophageal Cancer
Margaret J. Zhou, Luke Tseng, Xiaotao Guo, Zhezhen Jin, Stuart Bentley-Hibbert, Sherry Shen, James L. Araujo, Cathy F. Spinelli, Nasser K. Altorki, Joshua R. Sonett, Alfred I. Neugut and Julian A. Abrams
Cancer Epidemiol Biomarkers Prev January 1 2021 (30) (1) 114-122; DOI: 10.1158/1055-9965.EPI-20-0737

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Low Subcutaneous Adiposity and Mortality in Esophageal Cancer
Margaret J. Zhou, Luke Tseng, Xiaotao Guo, Zhezhen Jin, Stuart Bentley-Hibbert, Sherry Shen, James L. Araujo, Cathy F. Spinelli, Nasser K. Altorki, Joshua R. Sonett, Alfred I. Neugut and Julian A. Abrams
Cancer Epidemiol Biomarkers Prev January 1 2021 (30) (1) 114-122; DOI: 10.1158/1055-9965.EPI-20-0737
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