A Novel Prognostic Scoring System Based on Preoperative Sarcopenia Predicts the Long-Term Outcome for Patients After R0 Resection for Gastric Cancer: Experiences of a High-Volume Center

Zheng, Zhifang; Lü, Jun; Zheng, Chao‐Hui; Li, Ping; Xie, Jian‐Wei; Wang, Jia-Bin; Ji, Lin; Chen, Qi‐Yue; Ma, Lin; Huang, Chang‐Ming

doi:10.1245/s10434-017-5813-7

Cited by 61 publications

(84 citation statements)

References 31 publications

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“…Some of the previous studies, all recruiting patients from Asian populations, suggested an increased risk of death among patients with sarcopenia and GC with hazard ratio (HR) of 1.6‐2.7 . Detailed data from Western countries are not available, but in a mixed population of patients with various gastrointestinal malignancies, including 65 GCs, SMI of sarcopenia did not influence survival .…”

Section: Discussionmentioning

confidence: 95%

“…Another important element for the clinical application of SMI as a predictive and prognostic biomarker is related to the cut‐off values used to define sarcopenia. Values used previously to identify GC patients with impaired postoperative outcomes ranged from 32 to 52.4 for males and 28.6 to 41 for women. However, these studies used various statistical approaches to estimate the optimum cut‐off points, predominantly the most significant P values discriminating survival, or they used values adopted from other studies .…”

Section: Discussionmentioning

confidence: 99%

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Prognostic and predictive implications of sarcopenia in Western patients undergoing gastric resections for carcinoma of the stomach

Sierżęga

Chrzan

Wiktorowicz

et al. 2019

Journal of Surgical Oncology

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Introduction Sarcopenia is highly prevalent in patients with gastrointestinal malignancies, including gastric cancer, but there is a lack of adequate data from Western populations. Methods Computed tomography scans of 138 Caucasian patients subject to stomach resections due to gastric adenocarcinoma between 2012 and 2015 were reviewed to evaluate the impact of sarcopenia. The definition of sarcopenia was based on the lumbar skeletal muscle index (SMI) using cut‐off values formulated by the international consensus definitions of sarcopenia (SMI <52.4 cm2/m2 for men and <38.5 cm2/m2 for women). Results Sixty (43%) of 138 patients were sarcopenic. Sarcopenia was associated with postoperative morbidity (43% vs 23%; P = .011), major postoperative complications (Clavien‐Dindo ≥3a; 36% vs 21%; P = .035), and reoperations (23% vs 9%; P = .020). Patients with sarcopenia also had prolonged postoperative hospital stay (8.0 vs 6.5 days; P = .010). The overall median survival of patients with sarcopenia was significantly lower than those with normal skeletal muscles (11.0 vs 36.7 months; P = .005) and sarcopenia remained an independent prognostic factor with an odds ratio of 1.94 (95% confidence interval, 1.08 to 3.48; P = .026). Conclusion Sarcopenia, defined by SMI, is associated with an increased risk of postoperative morbidity and impaired long‐term survival.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Prognostic and predictive implications of sarcopenia in Western patients undergoing gastric resections for carcinoma of the stomach

Sierżęga

Chrzan

Wiktorowicz

et al. 2019

Journal of Surgical Oncology

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“…So far, the cutpoint of sarcopenia has not been uniform worldwide . In Western countries, most cutpoints for L3 SMI appear in the upper 30 cm 2 /m 2 in women and 40 cm 2 /m 2 and low 50 cm 2 /m 2 in men, which are higher than that of Eastern countries researched . If the Western definitions are applied, the prevalence of sarcopenia in our study is about 90.7%.…”

Section: Discussionmentioning

confidence: 51%

“…Single‐slice muscle area at the third lumbar vertebra strongly correlated with the whole‐body volume of muscle tissue and has been extensively used in oncology settings . Based on our previous reports , the optimal cutoff levels for SMI were calculated by the X‐tile software (Yale University, New Haven, CT) . In the current study, preoperative sarcopenia was defined as follows: for men, an SMI less than 36.4 cm 2 /m 2 ; for women, an SMI less than 28.4 cm 2 /m 2 .…”

Section: Subjects Materials and Methodsmentioning

confidence: 99%

“…Recently, there have been accumulating studies that have proven that sarcopenia and systemic inflammation are closely associated with a poor prognosis from malignant tumors . Sarcopenia, a syndrome characterized by the progressive and generalized loss of skeletal muscle mass and strength, is associated with a poor surgical outcome . Systemic inflammation has been reported to play a critical role in the pathogenesis and progression of cancer .…”

Section: Introductionmentioning

confidence: 99%

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Prognostic Value and Association of Sarcopenia and Systemic Inflammation for Patients with Gastric Cancer Following Radical Gastrectomy

Lin

Xie

et al. 2019

The Oncologist

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Objective The aim of this study was to investigate the prognostic value of preoperative sarcopenia and systemic inflammation for patients with resectable gastric cancer (GC) and develop a novel and powerful prognostic score based on these factors. Materials and Methods Patients with GC who underwent radical gastrectomy between December 2009 and December 2013 were included. A multivariate Cox regression analysis was performed to identify the prognostic factors. A novel prognostic score (SLMR) was developed based on preoperative sarcopenia and the lymphocyte‐monocyte ratio (LMR), and its prognostic value was evaluated. Results In total, 1,167 patients with resectable GC were included in the study. On multivariate analysis, preoperative sarcopenia and the LMR were shown to be independent prognostic factors (both p < .001). A low LMR was an independent predictor from sarcopenia (p < .001). Based on preoperative sarcopenia and the LMR, we established the SLMR. An elevated SLMR was associated with older age, higher ASA scores, larger tumor size, advanced stages, and vascular invasion (all p < .05). Multivariate analysis revealed that the SLMR was a significant independent predictor (p < .001). We incorporated the SLMR into a prognostic model that included tumor size and TNM stage and generated a nomogram, which accurately predicted 3‐ and 5‐year survival for GC patients. Conclusion Preoperative systemic inflammation is significantly associated with sarcopenia. The LMR combined with sarcopenia could enhance prognostication for patients with GC who underwent radical gastrectomy. Implications for Practice Increasing evidence shows that sarcopenia and systemic inflammation are closely associated with the prognosis of malignant tumors, and it is essential for clinicians to understand the relationship and combined prognostic effects of these factors for gastric cancer (GC). Based on a large data set, this study found that preoperative systemic inflammation was significantly associated with sarcopenia in GC, and combining these two predictors could effectively predict the prognosis and complement the prognostic value of the TNM staging system. These findings may lead to the development of new therapeutic avenues to improve cancer outcomes.

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Preoperative skeletal muscle index vs the controlling nutritional status score: Which is a better objective predictor of long‐term survival for gastric cancer patients after radical gastrectomy?

et al. 2018

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Skeletal muscle index (SMI) and the controlling nutritional status (CONUT) score are useful for evaluating nutritional status, which is closely associated with cancer prognosis. This study compared the prognostic value of these indicators in patients with gastric cancer (GC) after radical gastrectomy (RG). We retrospectively enrolled 532 patients between 2010 and 2011. SMI was measured via CT images to determine low SMI. The CONUT score was calculated based on serum albumin, total lymphocyte count, and cholesterol. Patients were grouped according to SMI and the CONUT score based on previous research. Spearman's correlation coefficient, the Kaplan‐Meier method, and Cox regression were used. There was no significant correlation between SMI and the CONUT score. Five‐year overall survival (OS) and recurrence‐free survival (RFS) in patients with low SMI were significantly worse than those in patients with high SMI (P < .001). The normal nutrition group had better OS and RFS than did the light and moderate or severe malnutrition groups (P < .05), but the OS and RFS were not significantly different between the light and moderate or severe malnutrition groups (P = .726). Univariate analysis showed that SMI and the CONUT score were associated with OS and RFS, but only SMI remained prognostic in multivariate analysis. Preoperative SMI based on CT images is a more objective predictor than the CONUT score of long‐term survival in GC after RG, but this finding must be confirmed by prospective trials.

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A Novel Prognostic Scoring System Based on Preoperative Sarcopenia Predicts the Long-Term Outcome for Patients After R0 Resection for Gastric Cancer: Experiences of a High-Volume Center

Abstract: The prognostic scoring system combining sarcopenia with the cT and cN system can accurately predict 3-year OS and RFS rates after radical gastrectomy for GC.

Cited by 61 publications

References 31 publications

Prognostic and predictive implications of sarcopenia in Western patients undergoing gastric resections for carcinoma of the stomach

Prognostic and predictive implications of sarcopenia in Western patients undergoing gastric resections for carcinoma of the stomach

Prognostic Value and Association of Sarcopenia and Systemic Inflammation for Patients with Gastric Cancer Following Radical Gastrectomy

Preoperative skeletal muscle index vs the controlling nutritional status score: Which is a better objective predictor of long‐term survival for gastric cancer patients after radical gastrectomy?

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