366. sarcopenia decided from lower psoas muscle index is strongly poor prognostic factor for elderly esophageal cancer patients

Abstract Background Elderly esophageal cancer patients undergoing esophagectomy are increasing. Although esophageal cancer patients suffering sarcopenia are already well known to have poor prognosis, the impact of sarcopenia for each age group may differ, since older patients have a higher frequency of primary sarcopenia than younger patients. Methods To clarify the relationship between sarcopenia and surgical outcomes in elderly esophageal cancer patients, we measured the psoas muscle index (PMI) in 103 elderly esophageal cancer patients aged 75 years or older who underwent radical esophagectomy from 2007 to 2021. The patients were then classified into two groups, sarcopenia group and non-sarcopenia group, using the 25th percentile of PMI as a cut-off value, and the relationship with outcomes of surgery and neoadjuvant chemotherapy (NAC) was examined. Results The 103 patients included 83 males and 20 females. The sarcopenia group had significantly lower BMI, but there was no correlation with oncological factors such as tumor depth or lymph node metastasis. NAC (FP) was performed in 39 patients and there was no clear correlation between completion, efficacy, or adverse events and sarcopenia. Thoracoscopic esophagectomy was performed in 93 patients, and there was no clear correlation between short-term surgical outcomes and sarcopenia. However, the 5-year overall survival and 5-year disease free survival were significantly lower in the sarcopenia group, resulted sarcopenia was an independent poor prognostic factor. Conclusion In elderly esophageal cancer patients over 75-year-old who underwent radical esophagectomy, sarcopenia does not significantly affect short-term surgical outcomes, and NAC is possibly able to administer as in the non-sarcopenia group. However, the indication of surgery to sarcopenic patients should be carefully decided because they have worse long-term prognosis than non-sarcopenic patients.