Marked Loss of Muscle, Visceral Fat, or Subcutaneous Fat After Gastrectomy Predicts Poor Survival in Advanced Gastric Cancer: Single-Center Study from the CLASSIC Trial

Park, Hyung Soon; Kim, Hyo Song; Beom, Seung‐Hoon; Rha, Sun Young; Chung, Hyun Cheol; Kim, Jee Hung; Chun, Youngsub; Lee, Si Won; Choe, Eun Ah; Heo, Su Jin; Noh, Sung Hoon; Hyung, Woo Jin; Cheong, Jae‐Ho; Kim, Wook; Son, Taeil; Lim, Joon Seok; Baek, Song Ee; Jung, Minkyu

doi:10.1245/s10434-018-6624-1

Cited by 79 publications

(69 citation statements)

References 25 publications

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“…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

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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“…Our study, as a large-scale research, demonstrated that progressive muscle loss during the rst year after gastrectomy is also a signi cant indicator of worse prognosis. Indeed, in a recent study based on a randomized multicenter trial, a marked loss in muscle or subcutaneous/visceral fat at 6 months after surgery could predict poor prognosis in patients with stage 2/3 gastric cancer 21 . Although the study had a small number of population including patients not receiving adjuvant treatment, their results also demonstrated the prognostic importance of progressive muscle loss after gastric cancer surgery.…”

Section: Discussionmentioning

confidence: 99%

Preoperative nutritional risk index and postoperative one-year skeletal muscle loss can predict the prognosis of patients with gastric cancer: a registry based study

Kim

Lee

et al. 2020

Preprint

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Background: Patients with gastric cancer have increased nutritional risk and experience a significant skeletal muscle loss after surgery. We aimed to determine whether muscle loss during the first postoperative year and nutritional status are indicators for predicting prognosis. Methods: From a gastric cancer registry, a total of 958 patients who received curative gastrectomy followed by chemotherapy for stage 2 and 3 gastric cancer and survived longer than 1 year were investigated. Clinical and laboratory data were collected. Skeletal muscle index (SMI) was assessed based on the muscle area at the L3 level on abdominal computed tomography. Results: Preoperative nutritional risk index (NRI) and postoperative decrement of SMI (dSMI) were significantly associated with overall survival (hazards ratio: 0.972 [95% CI: 0.958-0.986] and 1.058 [95% CI: 1.033-1.085], respectively) in a multivariate Cox regression analysis. Recurrence, tumor stage, comorbidity, and the preoperative muscle and subcutaneous fat area were also significant prognostic indicators. Kaplan-Meier analyses exhibited that patients with higher NRI had a significantly longer survival than those with lower NRI (3-year overall survival: 84.6% vs. 72.9%, P < 0.001). In addition, a significantly better prognosis was observed in a patient group with less decrease of SMI (3-year overall survival: 85.6% vs. 74.5%, P = 0.009). A logistic regression analysis demonstrated that the performance of preoperative NRI and dSMI in mortality prediction was quite significant (AUC: 0.63, P < 0.001) and the combination of clinical factors enhanced the predictive accuracy to the AUC of 0.90 (P < 0.001). This prognostic relevance of NRI and dSMI was maintained in patients experiencing tumor recurrence. Conclusions: Skeletal muscle loss during the first postoperative year and preoperative NRI are predictors of overall survival in stage 2 or 3 gastric cancer patients regardless of relapse. Our results support the potential importance of exercise and nutritional support along with standard treatment.

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“…Sarcopenia is a well-known independent predictor of short- and long-term postsurgical outcome in GC [ 21 , 102 ], associated to higher postsurgical complication rate (i.e., infection rate), longer hospitalization, more frequent need of mechanical ventilation, and a greater number of hospital readmissions, ultimately leading to poor DFS and OS. Likewise, sarcopenia is associated with toxicity in GC patients undergoing perioperative systemic treatment for early stage of disease [ 22 , 23 , 103 ] or multiple lines of therapy in the metastatic setting [ 35 ], leading to early discontinuation of treatment, reduced efficacy of antineoplastic agents, and poor prognosis.…”

Section: Sarcopenia Cachexia Malnutrition and Supportive Carementioning

confidence: 99%

“…Furthermore, a growing amount of evidence highlighted the importance of the best supportive care (BSC), especially in such cancer patients at high risk of malnutrition, loss of body composition parameters, and sarcopenia, with detrimental effects on safety and outcome of both systemic and surgical treatments [ 21 , 22 , 23 ].…”

Section: Introductionmentioning

confidence: 99%

Multimodality Treatment in Metastatic Gastric Cancer: From Past to Next Future

Parisi

Porzio

Ficorella

2020

Cancers

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Gastric cancer (GC) still remains an incurable disease in almost two-thirds of the cases. However, a deeper knowledge of its biology in the last few years has revealed potential biomarkers suitable for tailored treatment with targeted agents. This aspect, together with the improvement in early supportive care and a wiser use of the available cytotoxic drugs across multiple lines of treatment, has resulted in incremental and progressive survival benefits. Furthermore, slowly but surely, targeted therapies and immune checkpoint inhibitors are revising the therapeutic scenario even in metastatic GC and especially in particular subgroups. Moreover, important study results regarding the possible role of an integrated approach combining systemic, surgical, and locoregional treatment in carefully selected oligometastatic GC patients are awaited. This review summarizes the state-of-the-art and the major ongoing trials involving a multimodal treatment of metastatic GC.

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Marked Loss of Muscle, Visceral Fat, or Subcutaneous Fat After Gastrectomy Predicts Poor Survival in Advanced Gastric Cancer: Single-Center Study from the CLASSIC Trial

Abstract: Marked loss in body composition parameters significantly predicted shorter DFS and OS among patients with GC who underwent gastrectomy. Postoperative nutrition and active healthcare interventions could improve the prognosis of these GC patients.

Cited by 79 publications

References 25 publications

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

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

Preoperative nutritional risk index and postoperative one-year skeletal muscle loss can predict the prognosis of patients with gastric cancer: a registry based study

Multimodality Treatment in Metastatic Gastric Cancer: From Past to Next Future

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