Loss of skeletal muscle mass after curative gastrectomy is a poor prognostic factor

Park

J cachexia sarcopenia muscle

et al. 2021

Background Preoperative sarcopenia is associated with a poor long‐term prognosis in patients with gastric cancer (GC). Most GC patients rapidly lose muscle mass after gastrectomy. This retrospective cohort study analysed the effect of postoperative muscle loss and surgery‐induced sarcopenia on the long‐term outcomes of patients with GC. Methods Preoperative and postoperative 1 year abdominal computed tomography scans were available for 1801 GC patients who underwent curative gastrectomy between January 2009 and December 2013 at Seoul National University Bundang Hospital. The patients were categorized into normal, presarcopenia, and sarcopenia groups according to the skeletal muscle index (SMI) measured on computed tomography scans. Patients who were not sarcopenic prior to gastrectomy but became sarcopenic after surgery were defined as the surgery‐induced sarcopenia group. Results There were 1227 men and 574 women included in the study. The mean age of the patients was 59.5 ± 12.3 years. Multivariable Cox‐regression analyses showed that preoperative SMI was not associated with overall survival (OS). However, postoperative sarcopenia was associated with significantly worse OS only in men [hazard ratio (HR), 1.75; 95% confidence interval (CI), 1.08–2.85]. SMI loss was an independent risk factor for OS in the entire cohort and in men (HR, 1.01; 95% CI, 1.00–1.02, for the entire cohort; HR, 1.02; 95% CI, 1.01–1.04, for men). The surgery‐induced sarcopenia group was associated with significantly higher mortality (HR, 1.84; 95% CI, 1.16–2.90, for the cohort; HR, 2.73; 95% CI, 1.54–4.82, for men), although SMI loss and surgery‐induced sarcopenia were not risk factors in women. Similar results were obtained for relapse‐free survival. Conclusions Postoperative muscle mass loss and surgery‐induced sarcopenia are prognostic factors for survival in patients with GC. Impact of postoperative muscle mass loss and surgery‐induced sarcopenia on survival outcomes is dependent on the sex.

Section: Discussionmentioning

confidence: 99%

Prognostic significance of surgery‐induced sarcopenia in the survival of gastric cancer patients: a sex‐specific analysis

Park

J cachexia sarcopenia muscle

et al. 2021

“…Second, we assessed only preoperative sarcopenia. Kugimiya et al [ 37 ] reported that postoperative loss of skeletal muscle mass was an independent predictor of a poor prognosis. Thus, further investigations are needed to determine the relationship between postoperative sarcopenia and prognosis.…”

Section: Discussionmentioning

confidence: 99%

Body mass index and skeletal muscle index are useful prognostic factors for overall survival after gastrectomy for gastric cancer

et al. 2020

Among patients undergoing gastrectomy for gastric cancer, the impact of anthropometric indices on surgical outcomes is not well-established. The aim of this study was to evaluate the prognostic significance of the skeletal muscle index (SMI) and body mass index (BMI) on overall survival (OS) in patients with gastric cancer. A total of 305 patients who underwent curative gastrectomy for gastric adenocarcinoma between January 2005 and March 2008 were enrolled. Patients were classified into groups based on the SMI and BMI. The SMI was measured by preoperative abdominal computed tomography (CT). The SMI groups were classified based on gender-specific cut-off values obtained by means of optimum stratification. BMI groups were divided according to the World Health Organization definition of obesity for Asians. The mean SMI was 58.2 cm2/m2 and the mean BMI was 23.2 kg/m2. One hundred fifteen (37.7%) patients had sarcopenia based on the diagnostic cut-off values (56.2 cm2/m2 for men and 53.6 cm2/m2 for women). Apart from gender, there were no significant differences in patient characteristics or surgical outcomes between the SMI groups. In the underweight group, tumor (T) stage, tumor-node-metastasis (TNM) stage, number of retrieved lymph nodes, D2 dissection, and hospital stay were significantly increased compared with the overweight/obese group. High and low BMI, and low SMI, were independent prognostic factors for OS (hazard ratio [HR] = 2.355, 1.736, and 1.607, respectively; P = .009, .023, and .033, respectively). SMI and BMI did not impact perioperative morbidity in patients undergoing gastrectomy for gastric cancer. Both SMI and BMI are useful prognostic factors for OS in gastric cancer patients after gastrectomy.

“…Some authors emphasize the postoperative development of sarcopenia, when comparing pre- and postoperative body composition, as a prognostic factor for poorer overall survival [21,31,32]. We did not perform longitudinal analyses.…”

Section: Discussionmentioning

confidence: 99%

Sarcopenia as a prognostic factor for survival in patients with locally advanced gastroesophageal adenocarcinoma

et al. 2019

Background and aimsPatients with gastric cancer often show signs of malnutrition. We sought to evaluate the influence of sarcopenia in patients with locally advanced, not metastasized, gastric or gastro-esophageal junction (GEJ) cancer undergoing curative treatment (perioperative chemotherapy and surgery) on morbidity and mortality in order to identify patients in need for nutritional intervention.Patients and methodsTwo-centre study, conducted in the Frankfurt University Clinic and Krankenhaus Nordwest (Frankfurt) as part of the University Cancer Center Frankfurt (UCT). 47/83 patients were treated in the FLOT trial (NCT01216644). Patients´ charts were reviewed for clinical data. Two consecutive CT scans were retrospectively analyzed to determine the degree of sarcopenia. Survival was calculated using the Kaplan-Meier method, multivariate analysis was performed using the Cox regression.Results60 patients (72.3%) were male and 23 (27.7%) female. 45 patients (54.2%) had GEJ type 1–3 and 38 (45.8%) gastric tumors, respectively. Sarcopenic patients were significantly older than non-sarcopenic patients (mean age 65.1 years vs. 59.5 years, p = 0.042), terminated the chemotherapy significantly earlier (50% vs. 22.6%, p = 0.037) and showed higher Clavien-Dindo scores, indicating more severe perioperative complications (score ≥3 43.3 vs. 17.0%, p = 0.019). Sarcopenic patients had a significantly shorter survival than non-sarcopenic patients (139.6 ± 19.5 [95% CI, 101.3–177.9] vs. 206.7 ± 13.8 [95% CI, 179.5–233.8] weeks, p = 0.004). Multivariate Cox regression analysis showed that, besides UICC stage, sarcopenia significantly influenced survival.ConclusionSarcopenia is present in a large proportion of patients with locally advanced gastric or GEJ cancer and significantly influences tolerability of chemotherapy, surgical complications and survival.