Cardiopulmonary exercise testing has greater prognostic value than sarcopenia in oesophago‐gastric cancer patients undergoing neoadjuvant therapy and surgical resection

Background Sarcopenia (low skeletal muscle mass), myosteatosis (low skeletal muscle radiation‐attenuation) and fitness are independently associated with postoperative outcomes in oesophago‐gastric cancer. This study aimed to investigate (1) the effect of neoadjuvant therapy (NAT) on sarcopenia, myosteatosis and cardiopulmonary exercise testing (CPET), (2) the relationship between these parameters, and (3) their association with postoperative morbidity and survival. Methods Body composition analysis used single slice computed tomography (CT) images from chest (superior to aortic arch) and abdominal CT scans (third lumbar vertebrae). Oxygen uptake at anaerobic threshold (VO2 at AT) and at peak exercise (VO2 Peak) were measured using CPET. Measurements were performed before and after NAT and an adjusted regression model assessed their association. Results Of the 184 patients recruited, 100 underwent surgical resection. Following NAT skeletal muscle mass, radiation‐attenuation and fitness reduced significantly (p