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Sarcopenia as an independent prognostic factor for survival and perioperative complications in patients with gastric cancer
13 August 2018 (online)
Patients with cancer often show signs of malnutrition, which might influence morbidity and mortality while undergoing chemotherapy or surgical treatment. The tolerability of perioperative chemotherapy in patients with gastric cancer is often limited.
Aim of the study:
To evaluate the influence of sarcopenia in patients with locally advanced gastric or gastro-esophageal junction (GEJ) cancer undergoing curative treatment on morbidity and mortality.
Patients and methods:
Retrospective study, conducted in two hospitals as part of the University Cancer Center Frankfurt (UCT). A large proportion of the patients were treated in the FLOT trial (NCT01216644). Patients' charts were reviewed for the following items: age, sex, tumor type, histology, TNM stage, treatment, Clavien-Dindo-Score, BMI, survival data. Two consecutive CT scans were retrospectively analyzed to determine the degree of sarcopenia. Mean total muscle area (TMA) was measured at L3 and set in relation to body height, resulting in the skeletal muscle index, SMI. SMI = TMA [cm2]/height [m]2. Definition of Sarcopenia: male patients: BMI< 25: SMI< 43 cm2/m2; BMI≥25: SMI< 53 cm2/m2; female patients: SMI< 41 cm2/m2. Statistics included Kaplan-Meier method and Cox regression.
60 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 = 0.041), 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 = 0.009). Sarcopenic patients had a significantly shorter survival than non-sarcopenic patients (139.6 [95% CI, 101.3 – 177.9] vs. 206.7 [95% CI, 179.5 – 233.8] weeks, p = 0.004). Cox regression analysis did not reveal factors influencing survival other than sarcopenia.
Sarcopenia is present in a large proportion of patients with locally advanced gastric or GEJ cancer and is an independent prognostic factor for survival. Besides, it significantly influences tolerability of chemotherapy and surgical complications.