Strong impact of sarcopenia as a risk factor of survival in resected gastric cancer patients: first Italian report of a Bicentric study

Abstract

Gastric cancer (GC) accounts for 4% of all cancers in Europe. Sarcopenia is a complex syndrome characterized by a loss of muscle mass and function associated with age, often present in neoplastic patients. Recently, several studies have shown a significant association between sarcopenia and poor prognosis in various pathological conditions. The current observational retrospective study investigates the association between sarcopenia and overall survival (OS) and recurrence-free survival (RFS) in patients with GC undergoing up-front surgery with curative intent. Resected GC patients' clinical records and CT images were retrospectively assessed. The preoperative CT calculation of the skeletal muscle index (SMI) at L3 level allowed us to categorize patients as sarcopenic or not. Kaplan-Meyer and univariate and multivariate Cox regression analyses were performed to determine the difference in survival and presence of independent prognostic factors. Fifty-five patients, 28 male and 27 female, out of 298 studied for gastric cancer were enrolled in the current study from two cancer referral centers in Italy. The preoperative CT calculation of the SMI at L3 level allowed us to identify 39 patients with and 16 without sarcopenia. A statistically significant difference between the sarcopenic and non-sarcopenic groups was observed in both OS and RFS (p < 0.023; p < 0.006). Moreover, sarcopenia was strongly correlated to a higher risk of recurrence in univariate and multivariate analysis (p < 0.02). Sarcopenia can be considered a critical risk factor for survival in patients with resectable GC treated with up-front surgery. Identifying sarcopenic patients at the time of diagnosis would direct selection of patients who could benefit from early nutritional and/or physical treatments able to increase their muscle mass and possibly improve the prognosis. More extensive multicenter studies are needed to address this issue.

Prognostic role of pretreatment skeletal muscle index in gastric cancer patients: A meta-analysis

“…Only 13 included studies involving 5,803 patients explored the predictive role of pretreatment SMI for DFS ( 22 , 23 , 26 , 32 , 34 – 37 , 40 , 41 , 47 , 49 ). The pooled results indicated that lower pretreatment SMI was related with worse DFS (HR = 1.39, 95% CI: 1.13–1.69, p < 0.001; I 2 = 58.5%, p = 0.004) ( Figure 3 ).…”

Prognostic factors in gastric cancer patients: a 10-year mono-institutional experience

“…Two Japanese studies showed that impaired fasting blood glucose and high haemoglobin A1c are associated with an increased risk of developing GC in HP-positive individuals ( 14 , 15 ). Lately, results from studies on sarcopenia and obese sarcopenia have strengthened the assumptions that a strong relationship exists between tissue and body composition and GC ( 16 ).…”

Chest CT-Derived Muscle Analysis in COVID-19 Patients

“…'Marbling', or fat infiltration into muscle, lowers muscle quality and work performance. Studies to understand the pathogenesis of SO observed certain patterns of age-related changes in body muscle and fat composition [7].…”