Risk factors of sarcopenia in patients with esophageal squamous cell carcinoma

doi:10.21203/rs.3.rs-5048041/v1

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Risk factors of sarcopenia in patients with esophageal squamous cell carcinoma

https://doi.org/10.21203/rs.3.rs-5048041/v1

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Background: Esophageal squamous cell carcinoma（ESCC） is a common malignant tumor of the digestive tract, which seriously threatens human life and health. This study aimed to explore the correlation between sarcopenia in patients with ESCC and tumor clinical stage, characteristics, adverse reactions after chemotherapy and peripheral blood inflammatory indexes. Moreover, the correlation between appendicular skeletal mass index (ASMI) and the patient-generated subjective global assessment (PG-SGA) for the assessment of patient nutritional status were also be analyzed.

Methods: The clinical data of 225 patients with advanced ESCC in Hebei General Hospital from January 2019 to February 2022 were collected. Pearson analysis was carried out to analyze the correlation between ASMI and PG-SGA score.

Results: Among the 225 patients, the incidence of sarcopenia was 43.11% ( 97 of 225 patients) . The sarcopenia group was significantly older and the incidence of grade Ⅲ / Ⅳ adverse reactions after chemotherapy was higher; In addition, the sarcopenia group showed lower BMI, but higher PG - SGA score and NLR (neutrophil-to-lymphocyte ratio, NLR) (P<0.05). Univariate analysis and multivariate analysis showed that age, PG-SGA score, grade Ⅲ / Ⅳ adverse reaction after chemotherapy, and NLR were independent risk factors for sarcopenia (P< 0.05). There was a significant negative correlation between ASMI and PG - SGA score (r=-0.27,P<0.001) .

Conclusion: Advanced age, the occurrence of adverse reactions after chemotherapy and the systemic inflammatory state of patients are closely related to the occurrence of sarcopenia in advanced ESCC. ASMI and PG-SGA, have a significant correlation in the evaluation of nutritional status of patients.

esophageal squamous cell carcinoma

appendicular skeletal mass index

sarcopenia

Sarcopenia refers to a syndrome caused by the persistent loss of skeletal muscle mass, strength and function. The main clinical manifestations are reduced skeletal muscle strength and skeletal muscle quality. Sarcopenia has been widely reported to impair the physical function and survival of the elderly (1), and its relationship with prognosis has been reported in various tumors (2-4). Cancer patients suffer from increased protein catabolism, inflammatory response, and metabolic abnormalities. Cancer patients are more likely to develop sarcopenia due to increased protein catabolism, inflammation, metabolic abnormalities, insufficient food intake, frequent chemotherapy, gastrointestinal diversion and other reasons, and studies consistently show that its occurrence is closely related to tumor cachexia(5-7).

In recent years, reports show that C-reactive protein (CRP)/albumin ratio, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and prognostic nutritional index（PNI） and other inflammatory indicators can be used to predict tumor prognosis (8,9). However, the relationship between the occurrence of sarcopenia and inflammatory markers in patients with ESCC remains unclear. At the same time, there is currently a lack of comparative the two assessment methods those are the appendicular skeletal mass index (AS-MI) and the patient-generated subjective global assessment (PG-SGA). In view of the fact that PG-SGA assessment is subjective and complex, ASMI is relatively objective and easy to obtain. ASMI can make relatively accurate judgments on patients' nutritional status, which will greatly reduce the complexity of clinical work. Therefore, for advanced ESCC patients, this study explored the correlation between sarcopenia, adverse reactions to chemotherapy, and inflammatory indicators. The correlation between ASMI and PG-SGA was analyzed.

2.1 Study design and participants

A retrospective cohort study was implemented within Hebei general hospital, Shijiazhuang, China. From January 2019 to February 2022. A total of 225 cases were included, including 169 males and 56 females; Age ranges from 25 to 80 years old. Inclusion criteria: ①esophageal squamous cell carcinoma confirmed by histopathology, all grade IV Stage; ②There are no contraindications to chemotherapy, and at least 2 cycles of standard chemotherapy can be accepted; ③Aged between 18 and 90 years old, no communication difficulties, and cooperative with the investigation; ④No infection or other inflammatory diseases; ⑤no history of other cancers; ⑥no heart, liver, kidney and other important organ dysfunction. Exclusion criteria: pregnancy or breastfeeding. All patients were clinically staged in accordance with the eighth edition of the TNM classification. Data for this study were collected from electronic medical records. The study followed the Declaration of Helsinki guidelines and was authorized through the Ethics Committee of Hebei general hospital. All included ESCC patients received individualized drug treatment by physicians and follow the National Comprehensive Cancer Network (NCCN) anti-tumor treatment guidelines. Patients received 5-fluorouracil (5-FU)-based drugs Based on chemotherapy regimens, including single 5-FU regimen, oxaliplatin combined with 5-FU regimen, paclitaxel combined with 5-FU regimen, cisplatin combined with fluorouracil regimen or paclitaxel combined with cisplatin regimen. The choice is mainly based on the patient’s nutritional status, age and other factors.

2.2 Research methods

Patients received PG-SGA nutritional status score within 24 hours after admission.0~3points were divided into no or mild malnutrition, 4~8 points were considered moderate malnutrition, and≥9 is considered severe malnutrition. A clinical nutrition testing analyzer (AiNST-CNDS20) was used to measure the skeletal muscle index of the limbs and body mass index (BMI) [10].Clinical information was collected, including age, gender, tumor type, degree of differentiation, and Hematological indicators such as hemoglobin (HB), platelet count (PLT), albumin (ALB), prealbumin(PAB),D-dimer, and peripheral blood inflammation-related indicators including white blood cell (WBC), procalcitonin (PCT), interleukin-6 (IL-6) , CRP, NLR and PLR. Among them, NLR and PLR were divided according to the median of relevant indicators of all patients, and the boundary values of other indicators were divided according to clinical practice and the normal value of laboratory detection boundary values.

2.3 Criteria for the determination of sarcopenia

According to the 2019 Asia Working Group for Sarcopenia (AWGS) expert consensus recommendation(10), ASMI was used as the evaluation index for sarcopenia. According to the bioelectrical impedance analysis (Bioimpedance analysis (BIA) results: men<7.0kg/m² and women<5.7kg/m², patients were divided into two groups: sarcopenia group and non-sarcopenia group. ASMI=Appendicular skeletal muscle mass index(kg)/ height(m²).

2.3 Statistical analysis

SPSS 23.0 statistical software was used for data processing. Measurement data that conformed to normal distribution after normality test were expressed as (x ±s), and independent sample t test was used for comparison between groups. Non-normally distributed measurement data were described by the median (interquartile range), that is, M (P25, P75), and the rank sum test is used to conduct two sets of samples. Categorical variables were compared using the χ2 test or Fisher's exact probability method. For the indicators with significant correlation in the single-factor analysis results, logistic regression analysis was further used to perform multi-factor analysis. The correlation between the two indicators PG-SGA and ASMI was adopted Pearson correlation analysis. The inspection standard was P<0.05.

3.1 The clinical characteristics of the sarcopenia group and the non-sarcopenia group

Table 1 presents the clinical data of a total of 225 patients with advanced ESCC, 97 cases (42.8%) had sarcopenia. Compared with the non-sarcopenia group, the sarcopenia group patients were older [67.0 (60.3, 70.0) years old vs 63. 0 (53.0, 69.0) years old, P = 0. 014] and had a higher incidence of grade III/IV adverse reactions(P<0.001). BMI [(17.90 ± 2.37) kg/m² vs.(20.64±3.13) kg/m²,P<0.001], ASMI [(6.30±0.59) vs (7.48±0.84 ), P<0.001 ] were lower in sarcopenia.PG-SGA score [(11. 06±3. 18)vs(7.56±4.82) , P <0.001] 、NLR[4.72 (3.02,7.59) vs2.65 (1.75,4. 28), P<0.001]were higher in sarcopenia. Gender, tumor differentiation, WBC, HB, PLT, ALB, PAB, TB, D-dimer, IL-6, CRP, PLR were no significant difference between the two groups(P>0.05),as shown in table 1 and 3.

TABLE 1 The clinical characteristics of the sarcopenia group and the non-sarcopenia group

3.2 Grade III/IV adverse reactions after chemotherapy

The incidence of all grade Ⅲ / Ⅳ adverse events was significantly higher in the sarcopenia group than in the non-sarcopenia group(P<0. 001). The incidence of grade Ⅲ / Ⅳ gastrointestinal toxicity in the sarcopenia group was significantly higher than the non-sarcopenia group (P = 0. 002). There was no significant difference in the incidence of neutropenia, anemia and thrombocytopenia (P>0.05), see Table 2.

TABLE 2 Comparison of adverse reactions after two cycles of chemotherapy

3.3 Univariate and multivariate logistic regression analysis of the sarcopenia

Univariate analysis was performed for indicators that were considered likely to be associated with sarcopenia in patients with advanced ESCC. After univariate analysis, age, BMI, PG-SGA score, grade Ⅲ / Ⅳ adverse reactions and NLR were risk factors for sarcopenia.In logistic multivariate regression analysis, the results showed that age, PG-SGA score, grade III/IV adverse reactions, and NLR were independent risk factors for the occurrence of sarcopenia (P<0.05), see Table 3, Table 4.

Table 3 Univariate analysis of the occurrence of sarcopenia in patients with ESCC

TABLE4 Multivariate analysis of the occurrence of sarcopenia in patients with ESCC

3.4 Correlation analysis between ASMI and PG-SGA scores

A scatter plot was drawn for this group of data, and it was found that there is a linear correlation between ASMI and PG-SGA scores. Further Pearson correlation analysis was performed and it was found that ASMI and PG-SGA had a negative correlation ( r = - 0.27, P <0.001), see Figure 1.

The European Working Group on Sarcopenia in Older People (EWGSOP2) updated the definition and diagnostic criteria of sarcopenia in 2018 (11). Sarcopenia is a progressive, systemic skeletal muscle disease that increases the risk of adverse outcomes such as falls, fractures, physical disability, and death. Studies have shown that the incidence of ESCC combined with sarcopenia is as high as 28.8% in elderly people over 65 years old, which is much higher than the incidence of sarcopenia (12,13). In this study, patients in the sarcopenia group were older, and univariate and multivariate Logistic regression analysis showed that age was an independent risk factor for sarcopenia (P<0.05). The reason may be that ESCC mostly occurs in middle-aged and elderly people, and muscle mass and strength will decrease with age. In addition, it is also prone to malnutrition, cancer cachexia, and multiple underlying diseases(14). Therefore, elderly patients with ESCC are more likely to develop sarcopenia and need to be paid attention by clinicians.

Studies have shown that sarcopenia is associated with an increased risk of dose-limiting toxicity(15,16). In this study, the incidence of grade Ⅲ/Ⅳ adverse events in the sarcopenia group was significantly higher than that in the non-sarcopenia group. Platinum drugs, which are widely used in chemotherapy for advanced gastric cancer, are mainly distributed in fat-free tissues such as kidney, liver, and pancreas. Patients with sarcopenia have lower BMI and body fat content, which suggests that these patients are more likely to suffer chemotherapy-related toxicity when receiving platinum chemotherapy(17). Because the dose of chemotherapy is calculated based on the patient's height and weight, and changes in body composition are usually ignored, patients with sarcopenia usually receive relatively high doses of chemotherapy drugs while their lean tissue is relatively low, which may lead to a high risk of toxicity (18,19). In this study, the grade Ⅲ / Ⅳ adverse reactions in patients with sarcopenia after chemotherapy were significantly higher than those in patients with non-sarcopenia, which may be related to the main chemotherapy drugs of patients are 5-FU and platinum. The dose of chemotherapy drugs was adjusted without dynamic follow-up of skeletal muscle mass, which caused patients to be more prone to serious adverse reactions after chemotherapy.

The results of this study also suggest that inflammatory status is closely related to the occurrence of sarcopenia. NLR in the sarcopenia group is higher than that in the non-sarcopenia group. In univariate and multivariate Logistic regression analysis, NLR was an independent risk factor for sarcopenia. High NLR reflects the decrease of peripheral lymphocyte count or the increase of peripheral neutrophil count, and the relative decrease of lymphocyte count. The breakdown of the balance of lymphocyte count leads to immune tolerance and immune escape, and the decline of anti-tumor ability of the body, which provides conditions for tumor metastasis and invasion(20-22). It has been reported that low preoperative lymphocyte count is associated with poor survival in a variety of tumors (23). Neutrophils, which are involved in innate immunity, are an important part of various inflammatory responses and play a dual role in tumor development and metastasis. The high number of neutrophils is associated with poor prognosis and prognosis (24). Literature reports have shown that NLR is associated with sarcopenia in colorectal cancer and lung cancer, and a high NLR can independently predict a shorter overall survival (25-27). It is suggested that when a high NLR is observed in clinical practice, we should pay attention to the occurrence of sarcopenia as soon as possible and actively take corresponding intervention measures.

Inflammatory factors will promote muscle atrophy, ultimately stimulating protein catabolism and inhibiting muscle synthesis. High levels of inflammatory factors are negatively correlated with muscle strength and quality (28,29).Research results generally suggest that CRP levels in patients with sarcopenia are significantly higher than those in the control group(30,31). In this study, peripheral blood CRP and IL-6 in patients with sarcopenia were higher than those in the control group, but the difference was not statistically significant,which may be related to the small sample size. Moreover, due to the inherent limitations of retrospective studies, data such as TNF-α, IL-8 and IL-10 were not collected in this study, and larger scale clinical trials are needed to explore in the future.

In this study, 83. 5%(81 cases) of the sarcopenia group had severe malnutrition, suggesting that sarcopenia was closely related to malnutrition. Correlation analysis showed that ASMI was negatively correlated with PG-SGA score (P<0.001), indicating that patients with lower ASMI had higher PG-SGA scores, and similar findings were observed in patients with cirrhosis(32,33). These results suggest that there is consistency between muscle measurement and PG-SGA in the assessment of nutrition. Since PG-SGA assessment is subjective and complex to operate (34), and some patients cannot cooperate to complete it, ASMI is relatively objective and easy to obtain. If only ASMI can be used to judge the nutritional status of patients relatively accurately in clinical work, which can reduce the work burden to some extent.

In order to make nutritional assessment more objective and convenient, muscle measurement may replace PG-SGA in the future, but further tests of multiple indicators are still needed.

This study is a single-center retrospective clinical study on the risk factors of sarcopenia in patients with advanced ESCC. It is preliminarily found that age, high PG-SGA score, grade Ⅲ / Ⅳ adverse reactions after chemotherapy, and NLR are independent risk factors for sarcopenia in patients with ESCC.

Ethics statement

The study was performed the Declaration of Helsinki guidelines and was approved by the Ethics Committee of Hebei General Hospital. The patients/participants provided their written informed consent to participate in this study.

Funding

Medical Research Project of Hebei Province (20240624).

Declaration of competing interest

The authors declare they have no competing interests.

Jia R, Zhang Y, Wang Z, Hu B, Wang Z, Qiao H. Association between lipid metabolism and periodontitis in obese patients: a cross-sectional study. BMC Endocr Disord. 2023 May 25;23(1):119. https://doi.org/10.1186/s12902-023-01366-7.
Kuwada K, Kuroda S, Kikuchi S, Yoshida R, Nishizaki M, Kagawa S, Fujiwara T. Clinical Impact of Sarcopenia on Gastric Cancer. Anticancer Res. 2019 May;39(5):2241-2249. https://doi.org/10.21873/anticanres.13340.
Hijikata N, Ishikawa A, Matsuda S, Kawakami M, Muraoka K, Ando M, etal. Effect of Postoperative Oral Intake Status on Sarcopenia Six Months After Esophageal Cancer Surgery. Dysphagia. 2023 Feb;38(1):340-350. https://doi.org/10.1007/s00455-022-10471-z.
Ushitani Y, Shimada Y, Yamada Y, Kudo Y, Yamada T, Tanaka T, Ohira T, Ikeda N. ASO Visual Abstract: Clinical Impact of Sarcopenia 1 Year after Surgery in Patients with Early-Stage Non-small Cell Lung Cancer. Ann Surg Oncol. 2022 Oct;29(11):6934-6935. https://doi.org/ 10.1245/s10434-022-12068-0.
Choi MH, Yoon SB. Sarcopenia in pancreatic cancer: Effect on patient outcomes. World J Gastrointest Oncol. 2022 Dec 15;14(12):2302-2312. https://doi.org/10.4251/wjgo.v14.i12.2302..
Fujimoto Y, Maeda D, Kagiyama N, Sunayama T, Dotare T, etal. Prevalence and prognostic impact of the coexistence of cachexia and sarcopenia in older patients with heart failure. Int J Cardiol. 2023 Jun 15;381:45-51. https://doi.org/10.1016/j.ijcard.2023.03.035.
Nakai M, Morikawa K, Hosoda S, Yoshida S, Kubo A, Tokuchi Y, etal. Pre-sarcopenia and Mac-2 binding protein glycosylation isomer as predictors of recurrence and prognosis of early-stage hepatocellular carcinoma. World J Hepatol. 2022 Jul 27;14(7):1480-1494. https://doi.org/ 10.4254/wjh.v14.i7.1480.
Ida S , Takahashi H , Kawabata-Iwakawa R ,et al.Tissue-resident memory T cells correlate with the inflammatory tumor microenvironment and improved prognosis in head and neck squamous cell carcinoma[J].Oral Oncology, 2021, 122:105508. https://doi.org/10.1016/j.oraloncology.2021.105508.
Chen H, Liu CT, Hong CQ, Chu LY, Huang XY, Wei LF, etal. Nomogram based on nutritional and inflammatory indicators for survival prediction of small cell carcinoma of the esophagus. Nutrition. 2021 Apr;84:111086. https://doi.org/10.1016/j.nut.2020.111086.
Chen LK, Woo J, Assantachai P, Auyeung TW, Chou MY, Iijima K, etal. Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. J Am Med Dir Assoc. 2020 Mar;21(3):300-307.e2. https://doi.org/10.1016/j.jamda.2019.12.012.
Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, etal; Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019 Jul 1;48(4):601. https://doi.org/10.1093/ageing/afz046.
Harada K, Ida S, Baba Y, Ishimoto T, Kosumi K, Tokunaga R, etal. Prognostic and clinical impact of sarcopenia in esophageal squamous cell carcinoma. Dis Esophagus. 2016 Aug;29(6):627-33. https://doi.org/10.1111/dote.12381.
Nakashima Y, Saeki H, Nakanishi R, Sugiyama M, Kurashige J, Oki E, Maehara Y. Assessment of Sarcopenia as a Predictor of Poor Outcomes After Esophagectomy in Elderly Patients With Esophageal Cancer. Ann Surg. 2018 Jun;267(6):1100-1104. https://doi.org/10.1097/SLA.0000000000002252.
Sugawara K, Yagi K, Uemura Y, Okumura Y, Nishida M, Aikou S,etal. Associations of Systemic Inflammation and Sarcopenia With Survival of Esophageal Carcinoma Patients. Ann Thorac Surg. 2020 Aug;110(2):374-382. https://doi.org/10.1016/j.athoracsur.2020.03.013.
Wendrich AW, Swartz JE, Bril SI, Wegner I, de Graeff A, Smid EJ, etal. Low skeletal muscle mass is a predictive factor for chemotherapy dose-limiting toxicity in patients with locally advanced head and neck cancer. Oral Oncol. 2017 Aug;71:26-33. https://doi.org/10.1016/j.oraloncology.2017.05.012.
Heidelberger V, Goldwasser F, Kramkimel N, Jouinot A, Huillard O, Boudou-Rouquette P, etal. Sarcopenic overweight is associated with early acute limiting toxicity of anti-PD1 checkpoint inhibitors in melanoma patients. Invest New Drugs. 2017 Aug;35(4):436-441. https://doi.org/10.1007/s10637-017-0464-x.
Yang YR, Shi CS, Chang SW, Wu YY, Su YL, Lin GP, Kuan FC. The impact of sarcopenia on overall survival in patients with pan-RAS wild-type colorectal liver metastasis receiving hepatectomy. Sci Rep. 2023 Apr 27;13(1):6911. https://doi.org/10.1038/s41598-023-33439-x.
Suto H, Inui Y, Okamura A. Predicting Chemotherapy-Related Adverse Events in Elderly Cancer Patients with Prior Anticancer Therapy. Curr Oncol. 2022 Mar 23;29(4):2185-2192. https://doi.org/10.3390/curroncol29040177.
Gallois C, Bourillon C, Auclin E, Artru P, Lièvre A, Lecomte T, etal. Skeletal muscle loss during chemotherapy and its association with survival and systemic treatment toxicity in metastatic colorectal cancer: An AGEO prospective multicenter study. Clin Res Hepatol Gastroenterol. 2021 Nov;45(6):101603. https://doi.org/10.1016/j.clinre.2020.101603.
Yenmis G, Yaprak Sarac E, Besli N, Soydas T, Tastan C, Dilek Kancagi D, etal. Anti-cancer effect of metformin on the metastasis and invasion of primary breast cancer cells through mediating NF-kB activity. Acta Histochem. 2021 May;123(4):151709. https://doi.org/10.1016/j.acthis.2021.151709.
Hajizadeh F, Aghebati Maleki L, Alexander M, Mikhailova MV, Masjedi A, etal. Tumor-associated neutrophils as new players in immunosuppressive process of the tumor microenvironment in breast cancer. Life Sci. 2021 Jan 1;264:118699. https://doi.org/10.1016/j.lfs.2020.118699.
Germain C, Gnjatic S, Dieu-Nosjean MC. Tertiary Lymphoid Structure-Associated B Cells are Key Players in Anti-Tumor Immunity. Front Immunol. 2015 Feb 23;6:67. https://doi.org/10.3389/fimmu.2015.00067.
Rho SY, Hwang HK, Chong JU, Yoon DS, Lee WJ, Kang CM. Association of preoperative total lymphocyte count with prognosis in resected left-sided pancreatic cancer. ANZ J Surg. 2019 May;89(5):503-508. https://doi.org/10.1111/ans.15030.
Zheng Z, Xu Y, Shi Y, Shao C. Neutrophils in the tumor microenvironment and their functional modulation by mesenchymal stromal cells. Cell Immunol. 2022 Sep;379:104576. https://doi.org/10.1016/j.cellimm.2022.104576.
Diem S, Schmid S, Krapf M, Flatz L, Born D, Jochum W, etal. Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to-Lymphocyte ratio (PLR) as prognostic markers in patients with non-small cell lung cancer (NSCLC) treated with nivolumab. Lung Cancer. 2017 Sep;111:176-181. https://doi.org/10.1016/j.lungcan.2017.07.024.
Maeda K, Shibutani M, Otani H, Nagahara H, Ikeya T, Iseki Y, etal. Inflammation-based factors and prognosis in patients with colorectal cancer. World J Gastrointest Oncol. 2015 Aug 15;7(8):111-7. https://doi.org/10.4251/wjgo.v7.i8.111.
Go SI, Park MJ, Song HN, Kang MH, Park HJ, Jeon KN, etal. Sarcopenia and inflammation are independent predictors of survival in male patients newly diagnosed with small cell lung cancer. Support Care Cancer. 2016 May;24(5):2075-2084. https://doi.org/10.1007/s00520-015-2997-x.
Ribeiro JC, Duarte JG, Gomes GAO, Costa-Guarisco LP, de Jesus ITM, Nascimento CMC, etal. Associations between inflammatory markers and muscle strength in older adults according to the presence or absence of obesity. Exp Gerontol. 2021 Aug;151:111409. https://doi.org/10.1016/j.exger.2021.111409.
Paoli A, Cenci L, Pompei P, Sahin N, Bianco A, Neri M, etal. Effects of Two Months of Very Low Carbohydrate Ketogenic Diet on Body Composition, Muscle Strength, Muscle Area, and Blood Parameters in Competitive Natural Body Builders. Nutrients. 2021 Jan 26;13(2):374. https://doi.org/10.3390/nu13020374.
He N, Zhang Y, Zhang Y, Feng B, Zheng Z, Ye H. Circulating miR-29b decrease in response to sarcopenia in patients with cardiovascular risk factors in older Chinese. Front Cardiovasc Med. 2022 Dec 20;9:1094388. https://doi.org/10.3389/fcvm.2022.1094388.
Lee WJ, Peng LN, Loh CH, Chen LK. Sex-different associations between serum homocysteine, high-sensitivity C-reactive protein and sarcopenia: Results from I-Lan Longitudinal Aging Study. Exp Gerontol. 2020 Apr;132:110832. https://doi.org/10.1016/j.exger.2020.110832.
Tantai X, Liu Y, Yeo YH, Praktiknjo M, Mauro E, Hamaguchi Y, etal. Effect of sarcopenia on survival in patients with cirrhosis: A meta-analysis. J Hepatol. 2022 Mar;76(3):588-599. https://doi.org/10.1016/j.jhep.2021.11.006.
Artru F, Labreuche J, Louvet A. TIPSS and reversal of sarcopenia, and TIPSS is a promising therapy for sarcopenia in cirrhosis-Authors' reply. Aliment Pharmacol Ther. 2021 Jan;53(1):211-212. https://doi.org/10.1111/apt.16152.
Jager-Wittenaar H, Ottery FD. Assessing nutritional status in cancer: role of the Patient-Generated Subjective Global Assessment. Curr Opin Clin Nutr Metab Care. 2017 Sep;20(5):322-329. https://doi.org/10.1097/MCO.0000000000000389.

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Risk factors of sarcopenia in patients with esophageal squamous cell carcinoma

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Abstract

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1 Introduction

2 Materials and Methods

3 Results

4 Discussion

5 Conclusion and clinical implications

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