Sarcopenia as prognostic factor in patients with gastric cancer: Preliminary results

Introduction:

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, 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 methods:

Retrospective study, conducted in two hospitals (Universitätsklinikum Frankfurt and Krankenhaus Nordwest) 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. For this, 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.

Results:

Figure 1 shows the CONSORT flow chart. 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. In 35 patients (42.2%), perioperative chemotherapy was performed as planned without major interruption or dose reduction. Dose reductions were necessary in 21 patients (25.3%), 27 patients (32.5%) terminated the chemotherapy early. 61 patients (73.5%) had a Clavien-Dindo-Score of 0 – 2, 22 patients (26.5%) of 3 – 5, indicating major surgical complications including death. 39 patients (47%) showed signs of sarcopenia, 44 patients (53%) revealed a normal nutritional status before starting perioperative chemotherapy.

Conclusion:

Sarcopenia is present in a large proportion of patients with locally advanced gastric or GEJ cancer. Influences on tolerability of chemotherapy, surgical complications and survival remain to be analyzed.

Fig. 1: CONSORT flow diagram