Impact of skeletal muscle mass in patients with recurrent gastric cancer

Abstract

Background We retrospectively examined the relationship among skeletal muscle mass index (SMI), prognosis, and chemotherapy side effects in patients with recurrent gastric cancer (RGC). Methods Sixty-seven patients who developed recurrence after undergoing curative gastrectomy for gastric cancer at Tottori University Hospital and received palliative chemotherapy were included in this study. Pretreatment computed tomography was performed to measure the skeletal muscle mass (SMM) and cross-sectional SMM at the third lumbar vertebra. We focused on haematologic toxicity (neutropenia, thrombocytopenia, and anaemia), febrile neutropenia, and gastrointestinal toxicity (diarrhoea, vomiting, and stomatitis) as the side effects of chemotherapy. Results Median SMIs for males and females (43.9 and 34.7 cm2/m2, respectively) were used as cutoff values. The patients were classified into high (SMIHigh; n = 34) and low SMI groups (SMILow; n = 33). The SMILow group included more patients treated with monotherapy (P = 0.016) compared with the SMIHigh group, had a significantly lower number of chemotherapy lines (P = 0.049), and had a significantly higher incidence of grade 3 or 4 side effects (P = 0.010). The median survival rate was significantly higher in the SMIHigh group (17.8 vs 15.8 months; P = 0.034). In the univariate analysis, body mass index, SMI, histological type, and prognostic nutritional index were identified as prognostic indicators. The multivariate analysis identified SMI (P = 0.037) and histological type (P = 0.028) as independent prognostic factors. Conclusion The incidence of grade 3 or 4 side effects was significantly higher in patients with SMILow RGC. SMI was a useful prognostic marker of RGC.

Impact of Preoperative Skeletal Muscle Mass on the Outcomes and Recurrence After Total Gastrectomy in Patients With Gastric Cancer

“…To the best of our knowledge, only a few published studies suggest greater risk for recurrence in patients with low muscle mass before gastric surgery for gastric cancer. 23,24 Skeletal muscle in nonobese individuals is the largest human organ and has been identified as a secretory organ. 25 Bioactive proteins or myokines secreted from skeletal muscle cells influence the onset and course of disease through their endocrine function, as they interplay with weight regulation, innate and adaptive immune system, insulin sensitivity, altered pharmacokinetics of anticancer drugs, protein status, and tumor growth.…”

“…We defined a poor outcome as death at the end of follow-up period. To the best of our knowledge, only a few published studies suggest greater risk for recurrence in patients with low muscle mass before gastric surgery for gastric cancer 23,24…”

Geriatric nutritional risk index as a prognostic factor in patients with recurrent pancreatic cancer

“…Sarcopenia is considered to be debilitating disorders of skeletal muscle and there is a closely relationship between sarcopenia and prognosis in patients with cancer. Loss of Skeletal muscle mass leads to patients with advanced cancer poor prognosis and several reports said that sarcopenia defined by SMI was a useful prognostic factor in advanced cancers [ 30 – 32 ]. Sarcopenia is featured by the absence of inflammation [ 33 ].…”

A novel nomogram based on cardia invasion and chemotherapy to predict postoperative overall survival of gastric cancer patients

“…This may have sacrificed some precision but simplified the model. Finally, some novel biomarkers were reported to be useful in predicting prognosis of GC, such as differential gene expression, which will be tested in future studies [ 32 – 35 ].…”