Body Composition Changes in Gastric Cancer Patients during Preoperative FLOT Therapy: Preliminary Results of an Italian Cohort Study

Abstract

Background: The impact of the new chemotherapy, fluorouracil plus leucovorin, oxaliplatin, and docetaxel (FLOT) on body composition in gastric cancer (GC) patients remains unknown. We assessed body composition changes of GC patients receiving the FLOT regimen and their impact on treatment outcomes. Methods: Preoperative pre- and post-FLOT computed tomography (CT) scans of advanced GC patients were studied. Lumbar skeletal muscle index (SMI) and adipose indices were calculated before and after FLOT. Results: A total of 26 patients were identified between April 2019 and January 2020. Nineteen patients were sarcopenic at diagnosis. The mean BMI decreased (from 24.4 ± 3.7 to 22.6 ± 3.1; p < 0.0001) as well as the SMI (from 48.74 ± 9.76 to 46.52 ± 9.98; p = 0.009) and visceral adipose index (VAI) (from 49.04 ± 31.06 to 41.99 ± 23.91; p = 0.004) during preoperative FLOT therapy. BMI, SMI, and VAI variations were not associated with toxicity, Response Evaluation Criteria in Solid Tumors (RECIST), response, delay and completion of perioperative FLOT chemotherapy, and the execution of gastrectomy; a decrease of SMI ≥ 5% was associated with a higher Mandard tumor regression grade (p = 0.01). Conclusions: Almost three-quarters (73.1%) of GC patients were sarcopenic at diagnosis. Preoperative FLOT was associated with a further reduction in SMI, BMI, and VAI. These changes were not associated with short-term outcomes.

Body composition and immunonutritional status in patients treated with pressurized intraperitoneal aerosol chemotherapy (PIPAC) for gastrointestinal peritoneal metastases: a prospective single-center analysis

“…This study is affected by several limitations: i) the sample size needs to be increased to confirm our findings; ii) since changes in body composition during chemotherapy administration are frequently reported [ 45 ], [ 46 ], [ 47 ], further longitudinal analysis is planned to investigate the impact of repeated PIPAC cycles; iii) GI primary tumors may differently condition nutritional status of PM patients.…”

Body composition dynamics and impact on clinical outcome in gastric and gastro-esophageal junction cancer patients undergoing perioperative chemotherapy with the FLOT protocol

“…Although the number of patients included in our single center-cohort exceeded the number of patients in the abovementioned analyses (Mirkin et al 2017;Rinninella et al 2021), the sample size (n = 46) as well as the number of events (disease recurrence/death: n = 14) are a limitation of this study. Furthermore, the follow-up period (median: 32 months) was shorter in comparison to the FLOT4 study (43 months), therefore, the impact of body composition parameters and dynamics on clinical outcome has to be interpreted with caution.…”

Impact of Low Skeletal Muscle Mass on Complications and Survival for Gastric Cancer: A Propensity Score Matching Analysis

“…Several clinical studies have reported that LSMM might be an unfavorable factor for the short-time outcomes and prognosis ( 19 – 22 ), but some existing have shown contrasting results ( 23 – 26 ). Katsunobu et al ( 23 ) have shown that there is no relationship between preoperative LSMM and postoperative complications.…”