Computed Tomography–Quantified Body Composition Predicts Short-Term Outcomes After Gastrectomy in Gastric Cancer

Abstract

Background Malnutrition is a common and critical problem that influences outcome in cancer patients. Body composition reflects a patient’s metabolic profile and physiologic reserves, which might be the true determinant of prognosis. In the present study, which aimed to identify valuable new prognostic indicators, we investigated the association between computed tomography–quantified body composition and short-term outcomes after gastrectomy for gastric cancer.MethodsSkeletal muscle index, mean muscle attenuation, and ratio of visceral-to-subcutaneous adipose tissue area (vsr) were calculated from preoperative computed tomography images. Low skeletal muscle index, low mean muscle attenuation, and high vsr were respectively termed “sarcopenia,” “myosteatosis,” and “visceral obesity.” The association of body composition with postoperative complications and serum markers of nutrition and inflammation after radical gastrectomy were analyzed.ResultsThe overall complication rate was significantly higher in the sarcopenia (62.5% vs. 27.3%, p = 0.001) and myosteatosis groups (38.2% vs. 4%, p = 0.002). Patients with visceral obesity had a higher incidence of inflammatory complications (20.3% vs. 6.5%, p = 0.01). Multivariate logistic regression analysis demonstrated that sarcopenia (p = 0.013), myosteatosis (p = 0.017), and low serum retinol-binding protein (p = 0.019) were independent risk factors for overall complications. Compared with control subjects, patients with sarcopenia had lower postoperative levels of serum retinol-binding protein (p = 0.007), and patients with visceral obesity had higher levels of C-reactive protein (p = 0.026).Conclusions Sarcopenia, myosteatosis, and visceral obesity were significantly associated with increased rates of postoperative complications and affected the postoperative nutrition and inflammation status of patients with gastric cancer.

The Predictive Value of Low Muscle Mass as Measured on CT Scans for Postoperative Complications and Mortality in Gastric Cancer Patients: A Systematic Review and Meta-Analysis

“…After title and abstract and full text screening, 15 studies were eligible for inclusion, reporting on 4887 patients ( Figure 1). The association between low muscle mass and postoperative complications was reported in 12 studies [12,13,[23][24][25][26][27][28][29][30][31][32] of which 9 studies reported data on severe postoperative complications (Clavien-Dindo grade ≥III) [12,[23][24][25][26][27][28]31,32]. Overall mortality was reported as an outcome measure in 9 studies [24][25][26]28,31,[33][34][35], and 5 studies reported on disease-specific mortality [28,31,[33][34][35].…”

“…Most studies were retrospective cohort studies (67%) [12,13,[24][25][26][27][28]31,33,34], although 5 were prospective in nature (33%) [23,29,30,32,35]. The majority of the studies included more men than women, with a percentage of male patients varying from 35% to 84%.…”

“…In all studies, CT-based assessment of muscle mass was performed in patients prior to surgery [12,13,[23][24][25][26][27][28][29][30][31][32][33][34][35]. Thirteen studies (87%) calculated the total two-dimensional skeletal muscle area at the level of the third lumbar vertebra [12,[23][24][25][27][28][29][30][31][32][33][34][35]. The areas of interest were determined either automatically, or by one or multiple observers.…”

“…The areas of interest were determined either automatically, or by one or multiple observers. Several normalization techniques of the skeletal muscle area were applied, of which the normalization to the squared height of the patient was the most common (93%) [12,13,23,24,[26][27][28][29][30][31][32][33][34][35]. In two studies, only the muscle area of the psoas muscle on the third lumbar level was measured, which was normalized to the squared height [13,26].…”

“…Only one study normalized the skeletal muscle area to the total body surface area [25]. Subsequently, patients were frequently categorized in low muscle mass versus normal muscle mass, as based on literature-based [12,13,23,24,27,29,30,32,33] or data-dependent cutoff values [25,26,28,31,34,35]. All cutoff values were sex-specific, and two studies used different muscle mass cutoff values for obese and nonobese patients (body mass index <25 kg/m 2 and ≥25 kg/m 2 ) [12,24].…”