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Reynolds JV, Donlon NE, Elliott JA, Moran B, Temperley H, Nugent TS, Davern M, King S, Conroy M, Lysaght J, Ravi N, Ryan C, Finn S, Norris S, Donohoe CL. Incidence and Impact of Non-alcoholic Fatty Liver Disease (NAFLD) in Patients with Adenocarcinoma of the Esophagus Treated with Curative Intent. World J Surg 2023; 47:227-235. [PMID: 36264338 DOI: 10.1007/s00268-022-06781-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Esophageal adenocarcinoma (EAC) is associated with visceral obesity (VO). Non-alcoholic fatty liver disease (NAFLD) is common within this phenotype; however, its incidence and clinical significance in EAC have not been studied. STUDY DESIGN A total of 559 patients with hepatic stetatosis (HS) defined by unenhanced CT were enrolled. In a sub-study, in 140 consecutive patients a liver biopsy was taken intraoperatively to study HS and non-alcoholic steatohepatitis (NASH). Postoperative complications were defined as per the Esophageal Complications Consensus Group (ECCG). Liver biochemistry was measured peri-operatively, with an ALT > 5 defined as acute liver injury (ALI). Mann-Whitney U test or Fisher's exact test was utilized and the Kaplan-Meier method for survival. RESULTS 42% (n = 234/559) of patients had CT-defined HS. HS was associated with VO in 56% of cases, metabolic syndrome (Met S) in 37% and type 2 diabetes in 25%, compared with 44, 21, and 15% in non-HS patients (p < 0.01). Pathologic HS was present in 32% (45/140) and graded as mild, moderate, and severe in 73, 24, and 3%, respectively, with NASH reported in 16% and indefinite/borderline NASH in 42% of HS cases. Postoperative ALI was similar (p = 0.88) in both HS (10%) and non-HS cohorts (11%). Operative complication severity was similar in both cohorts. 5-yr survival was 53% (HS) vs 50% (p = 0.890). CONCLUSION This study establishes for the first time the incidence and clinical impact of NAFLD in EAC patients undergoing surgery and highlights no major impact on oncologic outcomes, nor in the severity of complications.
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Affiliation(s)
- John V Reynolds
- Department of Surgery, Trinity College Dublin, and the Trinity St. James's Cancer Institute Dublin, Dublin, Ireland.
| | - Noel E Donlon
- Department of Surgery, Trinity College Dublin, and the Trinity St. James's Cancer Institute Dublin, Dublin, Ireland
| | - Jessie A Elliott
- Department of Surgery, Trinity College Dublin, and the Trinity St. James's Cancer Institute Dublin, Dublin, Ireland
| | - Brendan Moran
- Department of Surgery, Trinity College Dublin, and the Trinity St. James's Cancer Institute Dublin, Dublin, Ireland
| | - Hugo Temperley
- Department of Surgery, Trinity College Dublin, and the Trinity St. James's Cancer Institute Dublin, Dublin, Ireland
| | - Tim S Nugent
- Department of Surgery, Trinity College Dublin, and the Trinity St. James's Cancer Institute Dublin, Dublin, Ireland
| | - Maria Davern
- Department of Surgery, Trinity College Dublin, and the Trinity St. James's Cancer Institute Dublin, Dublin, Ireland
| | - Sinead King
- Department of Surgery, Trinity College Dublin, and the Trinity St. James's Cancer Institute Dublin, Dublin, Ireland
| | - Melissa Conroy
- Department of Surgery, Trinity College Dublin, and the Trinity St. James's Cancer Institute Dublin, Dublin, Ireland
| | - Joanne Lysaght
- Department of Surgery, Trinity College Dublin, and the Trinity St. James's Cancer Institute Dublin, Dublin, Ireland
| | - Narayanasamy Ravi
- Department of Surgery, Trinity College Dublin, and the Trinity St. James's Cancer Institute Dublin, Dublin, Ireland
| | - Carmel Ryan
- Department of Pathology, St. James's Hospital and Trinity College Dublin, Dublin, Ireland
| | - Stephen Finn
- Department of Pathology, St. James's Hospital and Trinity College Dublin, Dublin, Ireland
| | - Suzanne Norris
- Hepatology Department, Department of Medicine, St. James's Hospital and Trinity College Dublin, Dublin, Ireland
| | - Clare L Donohoe
- Department of Surgery, Trinity College Dublin, and the Trinity St. James's Cancer Institute Dublin, Dublin, Ireland
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Kotti A, Holmqvist A, Woisetschläger M, Sun XF. Computed tomography-measured body composition and survival in rectal cancer patients: a Swedish cohort study. Cancer Metab 2022; 10:19. [PMID: 36419131 PMCID: PMC9686115 DOI: 10.1186/s40170-022-00297-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 11/07/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The association between body composition and survival in rectal cancer patients is still unclear. Therefore, we aimed to evaluate the impact of computed tomography (CT)-measured body composition on survival in rectal cancer patients, stratifying our analyses by sex, tumour location, tumour stage and radiotherapy. METHODS This retrospective cohort study included 173 patients with rectal adenocarcinoma. CT colonography scans at the time of diagnosis were used to assess the skeletal muscle index (SMI) and the visceral adipose tissue area (VAT). The patients were divided into a low or high SMI group and a low or high VAT group according to previously defined cutoff values. Endpoints included cancer-specific survival (CSS) and overall survival (OS). RESULTS In all patients, low SMI was associated with worse CSS (HR, 2.63; 95% CI, 1.35-5.12; P = 0.004) and OS (HR, 3.57; 95% CI, 2.01-6.34; P < 0.001) compared to high SMI. The differences remained significant after adjusting for potential confounders (CSS: adjusted HR, 2.28; 95% CI, 1.13-4.58; P = 0.021; OS: adjusted HR, 3.17; 95% CI, 1.73-5.82; P < 0.001). Low SMI was still related to a poor prognosis after stratifying by sex, tumour location, stage and radiotherapy (P < 0.05). High VAT was associated with better CSS (HR, 0.31; 95% CI, 0.11-0.84; P = 0.022) and OS (HR, 0.40; 95% CI, 0.17-0.97; P = 0.044) compared to low VAT among men with rectal cancer ≤ 10 cm from the anal verge. High VAT was associated with worse CSS (HR, 4.15; 95% CI, 1.10-15.66; P = 0.036) in women with rectal cancer ≤ 10 cm from the anal verge. CONCLUSIONS Low SMI was associated with worse survival. High VAT predicted better survival in men but worse survival in women. The results suggest that CT-measured body composition is a useful tool for evaluating the prognosis of rectal cancer patients and demonstrate the need to include the sex and the tumour location in the analyses.
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Affiliation(s)
- Angeliki Kotti
- grid.5640.70000 0001 2162 9922Department of Radiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 85 Linköping, Sweden ,grid.5640.70000 0001 2162 9922Department of Biomedical and Clinical Sciences, Linköping University, SE-581 83 Linköping, Sweden
| | - Annica Holmqvist
- grid.5640.70000 0001 2162 9922Department of Oncology, and Department of Biomedical and Clinical Sciences, Linköping University, SE-581 85 Linköping, Sweden
| | - Mischa Woisetschläger
- grid.5640.70000 0001 2162 9922Department of Radiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 85 Linköping, Sweden ,grid.5640.70000 0001 2162 9922Centre for Medical Image Science and Visualization (CMIV), Linköping University, SE-581 85 Linköping, Sweden
| | - Xiao-Feng Sun
- grid.5640.70000 0001 2162 9922Department of Biomedical and Clinical Sciences, Linköping University, SE-581 83 Linköping, Sweden
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Sasso JGRJ, de Moura DTH, Proença IM, Junior ESDM, Ribeiro IB, Sánchez-Luna SA, Cheng S, Bestetti AM, Kum AST, Bernardo WM, de Moura EGH. Anti-reflux versus conventional self-expanding metal stents in the palliation of esophageal cancer: A systematic review and meta-analysis. Endosc Int Open 2022; 10:E1406-E1416. [PMID: 36262514 PMCID: PMC9576338 DOI: 10.1055/a-1894-0914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/05/2022] [Indexed: 11/09/2022] Open
Abstract
Background and study aims Self-expanding metal stents (SEMS) are an effective palliative endoscopic therapy to reduce dysphagia in esophageal cancer. Gastroesophageal reflux disease (GERD) is a relatively common complaint after non-valved conventional SEMS placement. Therefore, valved self-expanding metal stents (SEMS-V) were designed to reduce the rate of GERD symptoms. We aimed to perform a systematic review and meta-analysis comparing the two stents. Material and methods This was a systematic review and meta-analysis including only randomized clinical trials (RCT) comparing the outcomes between SEMS-V and non-valved self-expanding metal stents (SEMS-NV) following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Data were analyzed with Review Manager Software. Quality of evidence was evaluated using Grading of Recommendations Assessment, Development, and Evaluation guidelines. Results Ten randomized clinical trials including a total of 467 patients, 234 in the SEMS-V group and 233 in the SEMS-NV group, were included. There were no statistically significant differences regarding GERD qualitative analysis (RD -0.17; 95 % CI -0.67, 0.33; P = 0.5) and quantitative analysis (SMD -0.22; 95 % CI -0.53, 0.08; P = 0.15) technical success (RD -0.03; 95 % CI -0.07, 0.01; P = 0.16), dysphagia improvement (RD -0.07; 95 % CI -0.19, 0.06; P = 0.30), and adverse events (RD 0.07; 95 % CI -0.07, 0.20; P = 0.32). Conclusions Both SEMS-V and SEMS-NV are safe and effective in the palliation of esophageal cancer with similar rates of GERD, dysphagia relief, technical success, adverse events, stent migration, stent obstruction, bleeding, and improvement of the quality of life.
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Affiliation(s)
- João Guilherme Ribeiro Jordão Sasso
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Diogo Turiani Hourneaux de Moura
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Igor Mendonça Proença
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Epifânio Silvino do Monte Junior
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Igor Braga Ribeiro
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Sergio A. Sánchez-Luna
- Basil I. Hirschowitz Endoscopic Center of Excellence, Division of Gastroenterology and Hepatology, Department of Internal Medicine, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, United States
| | - Spencer Cheng
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Alexandre Moraes Bestetti
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Angelo So Taa Kum
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Wanderley Marques Bernardo
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Eduardo Guimarães Hourneaux de Moura
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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Role of Obesity, Physical Exercise, Adipose Tissue-Skeletal Muscle Crosstalk and Molecular Advances in Barrett's Esophagus and Esophageal Adenocarcinoma. Int J Mol Sci 2022; 23:ijms23073942. [PMID: 35409299 PMCID: PMC8999972 DOI: 10.3390/ijms23073942] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 02/07/2023] Open
Abstract
Both obesity and esophageal adenocarcinoma (EAC) rates have increased sharply in the United States and Western Europe in recent years. EAC is a classic example of obesity-related cancer where the risk of EAC increases with increasing body mass index. Pathologically altered visceral fat in obesity appears to play a key role in this process. Visceral obesity may promote EAC by directly affecting gastroesophageal reflux disease and Barrett’s esophagus (BE), as well as a less reflux-dependent effect, including the release of pro-inflammatory adipokines and insulin resistance. Deregulation of adipokine production, such as the shift to an increased amount of leptin relative to “protective” adiponectin, has been implicated in the pathogenesis of BE and EAC. This review discusses not only the epidemiology and pathophysiology of obesity in BE and EAC, but also molecular alterations at the level of mRNA and proteins associated with these esophageal pathologies and the potential role of adipokines and myokines in these disorders. Particular attention is given to discussing the possible crosstalk of adipokines and myokines during exercise. It is concluded that lifestyle interventions to increase regular physical activity could be helpful as a promising strategy for preventing the development of BE and EAC.
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