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Aliyev A, Kok JHH, Ahmadov E, Samadov E, Babazade I, Mammadov E, Asgarova P, Adilli A, Ibrahimli A. Impact of Body Composition on Dose Modifications and Prognosis in Locally Advanced Gastric Cancer Patients Undergoing Neoadjuvant Chemotherapy. J Gastrointest Surg 2025:102087. [PMID: 40381835 DOI: 10.1016/j.gassur.2025.102087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2025] [Revised: 05/07/2025] [Accepted: 05/09/2025] [Indexed: 05/20/2025]
Abstract
BACKGROUND Despite advances in treatment, locally advanced GC continues to be associated with poor prognosis. Body composition, specifically the distribution of skeletal muscle and adipose tissue, has emerged as a key factor influencing cancer prognosis, yet its impact on neoadjuvant chemotherapy (NACT) dose modifications and long-term survival in GC remains unclear. The primary aim of this study was to assess the relationship between body composition and dose delay/reduction during preoperative NACT in locally advanced gastric cancer patients. The secondary aim was to evaluate the impact of body composition on overall and disease-free survival. METHODS This retrospective study included 97 patients with locally advanced gastric adenocarcinoma treated with NACT at Liv Bona Dea Hospital, Baku, Azerbaijan, between 2018 and 2024. Body composition parameters-skeletal muscle index (SMI), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT)-were analyzed using pre- and post-NACT CT imaging. Dose delay and reduction were defined as treatment delays of ≥5 days and dose reductions of ≥10% due to chemotherapy-related side effects. Survival outcomes were assessed using Kaplan-Meier analysis. RESULTS Of the 97 patients (mean age: 63), 33% experienced dose delays and 15% had dose reductions. Multivariate analysis revealed that lower pre-NACT VAT measurements were associated with both dose delay (p=0.01, OR=7.31) and dose reduction (p=0.01, OR=8.87). No significant correlation was found between body composition parameters and overall survival (OS) or disease-free survival (DFS). However, neural (p=0.013, HR=1.88) and venous invasion (p=0.03, HR=1.43) were independent predictors of poor OS, while poor histological grade (p=0.008, HR=2.01) and neural invasion (p=0.039, HR=1.61) independently predicted poor DFS. In addition, VAT loss during the NACT period increased the length of stay after operation in this cohort (p=0.004). CONCLUSION This study is the first to demonstrate that lower pre-NACT VAT is a significant predictor of dose reduction and delay in locally advanced gastric cancer patients. While body composition did not predict survival outcomes, tumor histological grade and invasion factors were significant for prognosis. These findings suggest that monitoring body composition, particularly VAT, could aid in optimizing chemotherapy dosing and improving treatment outcomes for GC patients undergoing NACT. Further prospective studies are needed to validate these results.
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Affiliation(s)
- Altay Aliyev
- Liv Bona Dea Hospital, Department of Oncology, Baku, Azerbaijan.
| | - Johnn Henry Herrera Kok
- Complejo Asistencial Universitario de Palencia, Department of General and Digestive Surgery.
| | - Eldar Ahmadov
- Liv Bona Dea Hospital, Department of General Surgery, Baku, Azerbaijan.
| | - Elgun Samadov
- Liv Bona Dea Hospital, Department of General Surgery, Baku, Azerbaijan.
| | - Iqbal Babazade
- Liv Bona Dea Hospital, Department of Oncology, Baku, Azerbaijan.
| | - Elkhan Mammadov
- Liv Bona Dea Hospital, Department of Pathology, Baku, Azerbaijan.
| | - Parvana Asgarova
- Liv Bona Dea Hospital, Department of General Surgery, Baku, Azerbaijan.
| | - Adila Adilli
- Liv Bona Dea Hospital, Department of Radiology, Baku, Azerbaijan.
| | - Arturan Ibrahimli
- Cleveland Clinic, Surgical Subspecialties Institute, Cleveland, Ohio, USA.
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Zhan C, Bu J, Li S, Huang X, Quan Z. Postoperative skeletal muscle loss as a prognostic indicator of clinical outcomes in patients with gastric cancer: a systematic review and meta-analysis. J Gastrointest Surg 2025; 29:101898. [PMID: 39608746 DOI: 10.1016/j.gassur.2024.101898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2024] [Revised: 11/06/2024] [Accepted: 11/23/2024] [Indexed: 11/30/2024]
Abstract
BACKGROUND A decrease in skeletal muscle mass is frequently observed during the perioperative period in patients with gastric cancer (GC) and is strongly associated with postoperative complications and poor long-term survival outcomes. Relevant research indicates that a certain proportion of patients with GC experience skeletal muscle mass loss after surgery. Therefore, a systematic review and meta-analysis was conducted to assess postoperative skeletal muscle loss as a prognostic marker for clinical outcomes in patients with GC. METHODS PubMed, Web of Science, and Embase were used to systematically screen and retrieve relevant studies according to strictly established inclusion and exclusion criteria. Further analysis of the effect of postoperative skeletal muscle loss on long-term survival metrics (including overall survival [OS], recurrence-free survival [RFS], disease-free survival [DFS], and disease-specific survival [DSS]) in patients with GC was performed. RESULTS' From 10 studies and 11 related publications, more than 3764 patients with GC were identified. Severe postoperative skeletal muscle loss occurred in 25.7% of patients with GC and was significantly correlated with poorer OS (hazard ratio [HR], 2.27; 95% CI, 1.58-3.25; P <.00001), RFS (HR, 2.96; 95% CI, 1.47-5.97; P =.002), DFS (HR, 2.41; 95% CI, 1.17-4.97; P =.02), and DSS (HR, 4.12; 95% CI, 2.44-6.94; P <.00001). When postoperative skeletal muscle loss advanced to sarcopenia, patients had worse OS as well (HR, 2.22; 95% CI, 1.49-3.30; P <.0001). CONCLUSION Patients who undergo radical surgery for GC often experience skeletal muscle mass loss, and significant skeletal muscle mass loss is associated with poorer survival outcomes. Identifying patients with significant skeletal muscle mass loss during follow-up and promptly providing tailored interventions, such as nutritional and exercise support, are essential.
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Affiliation(s)
- Chenyang Zhan
- Department of General Surgery, Chengdu Second People's Hospital, Chengdu, China; School of Clinical Medicine, Chengdu Medical College, Chengdu, China
| | - Jun Bu
- Department of General Surgery, Chengdu Second People's Hospital, Chengdu, China.
| | - Sheng Li
- Department of General Surgery, Chengdu Second People's Hospital, Chengdu, China; School of Clinical Medicine, Chengdu Medical College, Chengdu, China
| | - Xiujin Huang
- Department of General Surgery, Chengdu Second People's Hospital, Chengdu, China; School of Clinical Medicine, North Sichuan Medical University, Nanchong, China
| | - Zongjie Quan
- Department of General Surgery, Chengdu Second People's Hospital, Chengdu, China; School of Clinical Medicine, North Sichuan Medical University, Nanchong, China
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Xu L, Zhang S, Cao C. The impact of the muscle mass-to-fat ratio on the prognosis of patients undergoing pancreaticoduodenectomy for pancreatic cancer. Kaohsiung J Med Sci 2025; 41:e12928. [PMID: 39717925 PMCID: PMC11827537 DOI: 10.1002/kjm2.12928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Revised: 11/17/2024] [Accepted: 12/11/2024] [Indexed: 12/25/2024] Open
Abstract
To evaluate the relationship between the muscle mass-to-fat ratio (MMFR) at the third lumbar spine (L3) and overall survival (OS) as well as related complications after pancreaticoduodenectomy (PD) for pancreatic cancer. Patients who underwent PD for pancreatic cancer between March 2017 and May 2023 at the Second Affiliated Hospital of Soochow University were included. Muscle mass and fat content at the L3 were measured by computed tomography. The specific formula that was used to calculate the MMFR was total abdominal muscle area/(subcutaneous adipose tissue area + visceral adipose tissue area), and the optimal cutoff values of the MMFR based on receiver operating characteristic curves were 0.688 for males and 0.382 for females. Patient characteristics were collected, and multivariate analyses were used to evaluate the impact of the MMFR on prognosis. Kaplan-Meier survival curves and log-rank tests were used to compare OS between the high-MMFR and low-MMFR groups. On the basis of the optimal cutoff values, 191 patients were divided into two groups, with 91 patients in the low-MMFR group and 100 patients in the high-MMFR group. The incidence of POPF was significantly greater in the low-MMFR group than in the high-MMFR group. According to multivariate analysis, the MMFR was an independent factor associated with POPF and OS. Patients with low MMFRs had significantly shorter OS and a greater POPF incidence than did those with high MMFRs. The MMFR is an independent predictor of POPF and affects the OS of patients undergoing PD for pancreatic cancer.
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Affiliation(s)
- Long‐Jie Xu
- Department of General SurgeryThe Second Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Sheng‐Qiang Zhang
- Department of General SurgeryThe Second Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Chun Cao
- Department of General SurgeryThe Second Affiliated Hospital of Soochow UniversitySuzhouChina
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Liu R, Zhou J, Chen X, Zhang J, Chen Q, Liu X, Yao K. Diagnostic and Therapeutic Advances of RNAs in Precision Medicine of Gastrointestinal Tumors. Biomedicines 2024; 13:47. [PMID: 39857631 PMCID: PMC11762367 DOI: 10.3390/biomedicines13010047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2024] [Revised: 12/01/2024] [Accepted: 12/10/2024] [Indexed: 01/27/2025] Open
Abstract
Gastrointestinal tumors present a significant challenge for precision medicine due to their complexity, necessitating the development of more specific diagnostic tools and therapeutic agents. Recent advances have positioned coding and non-coding RNAs as emerging biomarkers for these malignancies, detectable by liquid biopsies, and as innovative therapeutic agents. Many RNA-based therapeutics, such as small interfering RNA (siRNA) and antisense oligonucleotides (ASO), have entered clinical trials or are available on the market. This review provides a narrative examination of the diagnostic and therapeutic potential of RNA in gastrointestinal cancers, with an emphasis on its application in precision medicine. This review discusses the current challenges, such as drug resistance and tumor metastasis, and highlights how RNA molecules can be leveraged for targeted detection and treatment. Additionally, this review categorizes specific diagnostic biomarkers and RNA therapeutic targets based on tissue type, offering a comprehensive analysis of their role in advancing precision medicine for gastrointestinal tumors.
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Affiliation(s)
- Runhan Liu
- Department of Gastrointestinal Surgery, Huaihe Hospital of Henan University, Kaifeng 475000, China
- School of Clinical Medicine, Henan University, Kaifeng 475004, China
- School of Biomedical Engineering, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Jiaxin Zhou
- School of Life Sciences, Henan University, Kaifeng 475004, China
- School of Pharmacy, Henan University, Kaifeng 475004, China
| | - Xiaochen Chen
- School of Life Sciences, Henan University, Kaifeng 475004, China
| | - Jie Zhang
- School of Life Sciences, Henan University, Kaifeng 475004, China
- School of Pharmacy, Henan University, Kaifeng 475004, China
| | - Qunzhi Chen
- School of Life Sciences, Henan University, Kaifeng 475004, China
| | - Xiaoming Liu
- Department of Gastrointestinal Surgery, Huaihe Hospital of Henan University, Kaifeng 475000, China
- School of Clinical Medicine, Henan University, Kaifeng 475004, China
| | - Kunhou Yao
- Department of Gastrointestinal Surgery, Huaihe Hospital of Henan University, Kaifeng 475000, China
- School of Clinical Medicine, Henan University, Kaifeng 475004, China
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Hu Q, Kudo K, Yukaya T, Hasuda H, Nakanishi R, Nakanoko T, Ando K, Ota M, Kimura Y, Koga T, Kusumoto T, Oki E, Yoshizumi T. Clinical Impact of Skeletal Muscle Mass and Nutritional Status in Patients with Recurrent or Advanced Gastric Cancer Treated with Nivolumab. Oncology 2024; 103:192-200. [PMID: 39265563 DOI: 10.1159/000540840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 08/01/2024] [Indexed: 09/14/2024]
Abstract
INTRODUCTION This study aimed to evaluate the clinical impact of skeletal muscle mass and nutritional status in gastric cancer patients treated with nivolumab monotherapy as late-line treatment. METHODS We conducted a multi-institutional retrospective study of 90 gastric cancer patients who previously received anti-PD-1 therapy (nivolumab). On computed tomography images captured before nivolumab induction, the skeletal muscle index (SMI, cm2/m2) was defined as the erector muscle area (cm2) divided by the height (m) squared. Patients were divided into two groups: those with SMI-high (n = 45) and those with SMI-low (n = 45). Prognostic nutritional index (PNI) was also calculated before nivolumab induction. The associations of SMI and PNI with response rate (RR), progression-free survival (PFS), overall survival (OS), disease control rate (DCR), and safety were analyzed. RESULTS The cutoff values for SMI were determined as 13.45 for males and 10.41 for females. SMI-high was significantly associated with a higher RR (odds ratio = 12.36, p = 0.02) and DCR (odds ratio = 2.97, p = 0.02). Although not significant, PNI-high also tended to be associated with a higher RR. Multivariate analysis showed that SMI-high was independently associated with a higher RR and higher DCR in gastric cancer. Moreover, prognostic analyses revealed that SMI-high (log-rank test p = 0.008) and PNI-high (log-rank test p = 0.0008) were significantly associated with longer OS since nivolumab induction. SMI-high was also associated with longer PFS (log-rank test p = 0.03). There were no significant differences in immune-related adverse event between SMI-low and SMI-high. CONCLUSION SMI and PNI were associated with nivolumab efficacy in gastric cancer patients. Management of skeletal muscle loss and nutritional status in gastric cancer patients who will receive nivolumab would be beneficial to enhance survival outcomes.
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Affiliation(s)
- Qingjiang Hu
- Department of Surgery and Science, Kyushu University Hospital, Fukuoka, Japan,
| | - Kensuke Kudo
- Department of Gastroenterological Surgery and Clinical Research Institute Cancer Research Division, National Kyushu Medical Center, Fukuoka, Japan
| | | | - Hirofumi Hasuda
- Department of Surgery and Science, Kyushu University Hospital, Fukuoka, Japan
| | - Ryota Nakanishi
- Department of Surgery and Science, Kyushu University Hospital, Fukuoka, Japan
| | - Tomonori Nakanoko
- Department of Surgery and Science, Kyushu University Hospital, Fukuoka, Japan
| | - Koji Ando
- Department of Surgery and Science, Kyushu University Hospital, Fukuoka, Japan
| | - Mitsuhiko Ota
- Department of Surgery and Science, Kyushu University Hospital, Fukuoka, Japan
| | - Yasue Kimura
- Department of Surgery and Science, Kyushu University Hospital, Fukuoka, Japan
| | - Tadashi Koga
- Department of Surgery, ASO Iizuka Hospital, Iizuka, Japan
| | - Tetsuya Kusumoto
- Department of Gastroenterological Surgery and Clinical Research Institute Cancer Research Division, National Kyushu Medical Center, Fukuoka, Japan
| | - Eiji Oki
- Department of Surgery and Science, Kyushu University Hospital, Fukuoka, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Kyushu University Hospital, Fukuoka, Japan
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Yang YN, Wang LS, Dang YQ, Ji G. Evaluating the efficacy of immunotherapy in gastric cancer: Insights from immune checkpoint inhibitors. World J Gastroenterol 2024; 30:3726-3729. [PMID: 39221068 PMCID: PMC11362881 DOI: 10.3748/wjg.v30.i32.3726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 08/06/2024] [Accepted: 08/09/2024] [Indexed: 08/26/2024] Open
Abstract
The emergence of immunotherapy, particularly immune checkpoint inhibitors (ICIs), represents a groundbreaking approach to treating gastric cancer (GC). However, the prognosis of GC patients receiving ICI treatment is influenced by various factors. This manuscript identified sarcopenia and myosteatosis as inde-pendent prognostic factors impacting the outcomes of GC patients treated with ICIs. Additionally, this study introduced a visual predictive model to estimate the prognosis of GC patients. If confirmed by further studies, this observation could provide valuable insights to propel the advancement of personalized clinical medicine and the integration of precision medicine practices.
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Affiliation(s)
- Yu-Nuo Yang
- Institute of Digestive Diseases, Longhua Hospital, China-Canada Center of Research for Digestive Diseases, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Li-Sheng Wang
- Department of Biochemistry, University of Ottawa, Ottawa K1H 8M5, ON, Canada
| | - Yan-Qi Dang
- Institute of Digestive Diseases, Longhua Hospital, China-Canada Center of Research for Digestive Diseases, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Guang Ji
- Institute of Digestive Diseases, Longhua Hospital, China-Canada Center of Research for Digestive Diseases, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
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Cai WT, Zeng XY, Huang YS, Chen WS, Chen XJ, Xie XH. The clinical outcome of minor changes in serum creatinine for patients after curative gastrectomy: a prospective study. Front Oncol 2024; 14:1416888. [PMID: 39234398 PMCID: PMC11371684 DOI: 10.3389/fonc.2024.1416888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 07/29/2024] [Indexed: 09/06/2024] Open
Abstract
Introduction Patients with renal insufficiency are more prone to postoperative complications (PCs). Studies have shown that minor changes in serum creatinine (SCr), immediately post-surgery, can aid in assessing patients' renal function. This study aimed to explore the relationship between the changes in SCr and PCs in patients with gastric cancer (GC). Materials and methods We prospectively collected data regarding the SCr of 530 GC patients, within 2 weeks before surgery and within 24 hours after surgery in our hospital (2014-2016). The patients were divided into three groups according to the level of SCr change after surgery: reduced (<10%), normal (10%), and elevated (>10%) creatinine groups. Univariate and multivariate logistic analysis were performed to evaluate its correlation with short-term PCs in the patients. The R language was used to construct a nomogram. Results 83, 217, and 230 patients were assigned to the elevated, reduced, and normal SCr groups, respectively. Multivariate analysis showed that the reduced and elevated SCr groups were independently associated with the occurrence of PCs and severe postoperative complications (SPCs), respectively. Additionally, postsurgical SCr change, age, hypoalbuminemia, total gastrectomy, combined resection, and laparoscopy, were independently related to PCs. Combining the above influential factors, the predictive model can distinguish patients with PCs more reliably (c-index is 0.715). Conclusion Post-surgery, reduced SCr is a protective factor for PCs, while elevated serum creatinine is an independent risk factor for SPCs. Our nomogram can identify GC patients with high risks of PCs.
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Affiliation(s)
- Wen-Tao Cai
- Department of Traumatic Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiu-Ya Zeng
- Acupuncture Massage & Physical Therapy, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yun-Shi Huang
- Department of Traumatic Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wei-Sheng Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiang-Jian Chen
- Department of Traumatic Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xian-Hai Xie
- Department of Traumatic Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
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Ding P, Wu J, Wu H, Li T, Yang J, Yang L, Guo H, Tian Y, Yang P, Meng L, Zhao Q. Myosteatosis predicts postoperative complications and long-term survival in robotic gastrectomy for gastric cancer: A propensity score analysis. Eur J Clin Invest 2024; 54:e14201. [PMID: 38533747 DOI: 10.1111/eci.14201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Robotic gastrectomy is increasingly utilized for gastric cancer, but high morbidity remains a concern. Myosteatosis or low skeletal muscle density reflecting fatty infiltration, associates with complications after other cancer surgeries but has not been evaluated for robotic gastrectomy. METHODS This retrospective study analysed 381 patients undergoing robotic gastrectomy for gastric cancer from September 2019 to October 2022. Myosteatosis was quantified on preoperative computed tomography (CT) images at lumbar 3 (L3). Propensity score matching addressed potential confounding between myosteatosis and non-myosteatosis groups. Outcomes were postoperative complications, 30 days mortality, 30 days readmissions and survival. RESULTS Myosteatosis was present in 33.6% of patients. Myosteatosis associated with increased overall (47.7% vs. 26.5%, p < 0.001) and severe complications (12.4% vs. 4.9%, p < 0.001). After matching, myosteatosis remained associated with increased overall complications, major complications, intensive care unit (ICU) transfer and readmission (all p < 0.05). Myosteatosis independently predicted overall [odds ratio (OR) = 2.86, 95% confidence interval (CI): 1.57-5.20, p = 0.001] and severe complications (OR = 4.81, 95% CI: 1.51-15.27, p = 0.008). Myosteatosis also associated with reduced overall (85.0% vs. 93.2%, p = 0.015) and disease-free survival (80.3% vs. 88.4%, p=0.029). On multivariate analysis, myosteatosis independently predicted poorer survival [hazard ratio (HR) = 2.83, 95% CI: 1.32-6.08, p=0.012] and disease-free survival (HR = 1.83, 95% CI: 1.01-3.30, p=0.032). CONCLUSION Preoperative CT-defined myosteatosis independently predicts increased postoperative complications and reduced long-term survival after robotic gastrectomy for gastric cancer. Assessing myosteatosis on staging CT could optimize preoperative risk stratification.
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Affiliation(s)
- Pingan Ding
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, China
- Big data analysis and mining application for precise diagnosis and treatment of gastric cancer Hebei Provincial Engineering Research Center, Shijiazhuang, China
| | - Jiaxiang Wu
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, China
- Big data analysis and mining application for precise diagnosis and treatment of gastric cancer Hebei Provincial Engineering Research Center, Shijiazhuang, China
| | - Haotian Wu
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, China
- Big data analysis and mining application for precise diagnosis and treatment of gastric cancer Hebei Provincial Engineering Research Center, Shijiazhuang, China
| | - Tongkun Li
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, China
- Big data analysis and mining application for precise diagnosis and treatment of gastric cancer Hebei Provincial Engineering Research Center, Shijiazhuang, China
| | - Jiaxuan Yang
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, China
- Big data analysis and mining application for precise diagnosis and treatment of gastric cancer Hebei Provincial Engineering Research Center, Shijiazhuang, China
| | - Li Yang
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, China
- Big data analysis and mining application for precise diagnosis and treatment of gastric cancer Hebei Provincial Engineering Research Center, Shijiazhuang, China
- The Department of CT/MRI, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Honghai Guo
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, China
- Big data analysis and mining application for precise diagnosis and treatment of gastric cancer Hebei Provincial Engineering Research Center, Shijiazhuang, China
| | - Yuan Tian
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, China
- Big data analysis and mining application for precise diagnosis and treatment of gastric cancer Hebei Provincial Engineering Research Center, Shijiazhuang, China
| | - Peigang Yang
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, China
- Big data analysis and mining application for precise diagnosis and treatment of gastric cancer Hebei Provincial Engineering Research Center, Shijiazhuang, China
| | - Lingjiao Meng
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, China
- Big data analysis and mining application for precise diagnosis and treatment of gastric cancer Hebei Provincial Engineering Research Center, Shijiazhuang, China
- Research Center of the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qun Zhao
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, China
- Big data analysis and mining application for precise diagnosis and treatment of gastric cancer Hebei Provincial Engineering Research Center, Shijiazhuang, China
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Dogan O, Sahinli H, Duzkopru Y, Akdag T, Kocanoglu A. Is sarcopenia effective on survival in patients with metastatic gastric cancer? World J Gastrointest Oncol 2024; 16:1861-1868. [PMID: 38764843 PMCID: PMC11099424 DOI: 10.4251/wjgo.v16.i5.1861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/16/2024] [Accepted: 03/05/2024] [Indexed: 05/09/2024] Open
Abstract
BACKGROUND Sarcopenia is a progressively diminishing state characterized by the reduction of muscle mass and density, which is frequently observed in malignancies of solid organs. AIM To assess how sarcopenia affects the overall survival of individuals who have been diagnosed with metastatic gastric cancer. METHODS The study retrospectively included individuals who had been diagnosed with metastatic gastric cancer between January 2008 and December 2020. Sarcopenia was identified through the calculation of the average Hounsfield units (HUAC) using computed tomography (CT) images taken at the time of diagnosis in patients. RESULTS A total of 118 patients with metastatic gastric cancer were evaluated. Sarcopenia was detected in 29 patients (24.6%). The median survival of all patients was 8 (1-43) mo. The median survival of patients with sarcopenia was 2 mo, while it was 10 mo for those without sarcopenia (P < 0.001). A significant relationship was found between sarcopenia and survival. CONCLUSION Sarcopenia has been observed to impact survival outcomes in various types of solid tumor cancers. Sarcopenic patients can be identified in a short time, easily and inexpensively, by HUAC measurements from CT images used for diagnosis, and survival could be promoted with nutritional support.
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Affiliation(s)
- Ozlem Dogan
- Department of Medical Oncology, Adıyaman University Training and Research Hospital, Adiyaman 02100, Turkey
| | - Hayriye Sahinli
- Department of Medical Oncology, Ankara Etlik City Hospital, Ankara 06170, Turkey
| | - Yakup Duzkopru
- Department of Medical Oncology, Ankara Etlik City Hospital, Ankara 06170, Turkey
| | - Tuba Akdag
- Department of Radiology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara 06000, Turkey
| | - Abdulkadir Kocanoglu
- Department of Medical Oncology, Ankara Ataturk Sanatoryum Training and Research Hospital, Ankara 06170, Turkey
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Aringhieri G, Di Salle G, Catanese S, Vivaldi C, Salani F, Vitali S, Caccese M, Vasile E, Genovesi V, Fornaro L, Tintori R, Balducci F, Cappelli C, Cioni D, Masi G, Neri E. Abdominal Visceral-to-Subcutaneous Fat Volume Ratio Predicts Survival and Response to First-Line Palliative Chemotherapy in Patients with Advanced Gastric Cancer. Cancers (Basel) 2023; 15:5391. [PMID: 38001651 PMCID: PMC10670010 DOI: 10.3390/cancers15225391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/22/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
Prognosis in advanced gastric cancer (aGC) is predicted by clinical factors, such as stage, performance status, metastasis location, and the neutrophil-to-lymphocyte ratio. However, the role of body composition and sarcopenia in aGC survival remains debated. This study aimed to evaluate how abdominal visceral and subcutaneous fat volumes, psoas muscle volume, and the visceral-to-subcutaneous (VF/SF) volume ratio impact overall survival (OS) and progression-free survival (PFS) in aGC patients receiving first-line palliative chemotherapy. We retrospectively examined CT scans of 65 aGC patients, quantifying body composition parameters (BCPs) in 2D and 3D. Normalized 3D BCP volumes were determined, and the VF/SF ratio was computed. Survival outcomes were analyzed using the Cox Proportional Hazard model between the upper and lower halves of the distribution. Additionally, response to first-line chemotherapy was compared using the χ2 test. Patients with a higher VF/SF ratio (N = 33) exhibited significantly poorer OS (p = 0.02) and PFS (p < 0.005) and had a less favorable response to first-line chemotherapy (p = 0.033), with a lower Disease Control Rate (p = 0.016). Notably, absolute BCP measures and sarcopenia did not predict survival. In conclusion, radiologically assessed VF/SF volume ratio emerged as a robust and independent predictor of both survival and treatment response in aGC patients.
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Affiliation(s)
- Giacomo Aringhieri
- Academic Radiology, Department of Translational Research, University of Pisa, Via Roma 67, 56126 Pisa, Italy; (G.A.); (R.T.); (D.C.); (E.N.)
- Italian Society of Medical and Interventional Radiology, SIRM Foundation, Via della Signora 2, 20122 Milano, Italy
| | - Gianfranco Di Salle
- Academic Radiology, Department of Translational Research, University of Pisa, Via Roma 67, 56126 Pisa, Italy; (G.A.); (R.T.); (D.C.); (E.N.)
| | - Silvia Catanese
- Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (S.C.); (C.V.); (F.B.); (G.M.)
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy; (F.S.); (M.C.); (E.V.); (V.G.); (L.F.); (C.C.)
| | - Caterina Vivaldi
- Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (S.C.); (C.V.); (F.B.); (G.M.)
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy; (F.S.); (M.C.); (E.V.); (V.G.); (L.F.); (C.C.)
| | - Francesca Salani
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy; (F.S.); (M.C.); (E.V.); (V.G.); (L.F.); (C.C.)
- Translational Medicine PhD Course, Institute of Life Sciences, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Saverio Vitali
- Diagnostic and Interventional Radiology, University Hospital of Cisanello, Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy;
| | - Miriam Caccese
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy; (F.S.); (M.C.); (E.V.); (V.G.); (L.F.); (C.C.)
| | - Enrico Vasile
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy; (F.S.); (M.C.); (E.V.); (V.G.); (L.F.); (C.C.)
| | - Virginia Genovesi
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy; (F.S.); (M.C.); (E.V.); (V.G.); (L.F.); (C.C.)
| | - Lorenzo Fornaro
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy; (F.S.); (M.C.); (E.V.); (V.G.); (L.F.); (C.C.)
| | - Rachele Tintori
- Academic Radiology, Department of Translational Research, University of Pisa, Via Roma 67, 56126 Pisa, Italy; (G.A.); (R.T.); (D.C.); (E.N.)
| | - Francesco Balducci
- Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (S.C.); (C.V.); (F.B.); (G.M.)
| | - Carla Cappelli
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy; (F.S.); (M.C.); (E.V.); (V.G.); (L.F.); (C.C.)
| | - Dania Cioni
- Academic Radiology, Department of Translational Research, University of Pisa, Via Roma 67, 56126 Pisa, Italy; (G.A.); (R.T.); (D.C.); (E.N.)
- Italian Society of Medical and Interventional Radiology, SIRM Foundation, Via della Signora 2, 20122 Milano, Italy
| | - Gianluca Masi
- Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (S.C.); (C.V.); (F.B.); (G.M.)
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy; (F.S.); (M.C.); (E.V.); (V.G.); (L.F.); (C.C.)
| | - Emanuele Neri
- Academic Radiology, Department of Translational Research, University of Pisa, Via Roma 67, 56126 Pisa, Italy; (G.A.); (R.T.); (D.C.); (E.N.)
- Italian Society of Medical and Interventional Radiology, SIRM Foundation, Via della Signora 2, 20122 Milano, Italy
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11
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Xie K, He D, Zhao T, Liu T, Tang M. Gastric Cancer with Sarcopenia: an Area Worth Focusing On. Curr Treat Options Oncol 2023; 24:1305-1327. [PMID: 37464229 DOI: 10.1007/s11864-023-01122-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 07/20/2023]
Abstract
OPINION STATEMENT Gastric cancer (GC) is the fifth most common cancer and the third leading cause of cancer death worldwide, which seriously endangers human health. A number of studies have shown that sarcopenia occurs more frequently in patients with gastric cancer than in the general population and can significantly affect the disease status and survival of patients, which is of great significance in predicting the prognosis of gastric cancer. Patients with gastric cancer may suffer sarcopenia no matter before or after surgery, and the pathogenesis is complex. Abnormal nutrient metabolism and reduced exercise are the leading causes. In addition, surgical treatment and chemotherapy for gastric cancer might participate in the physiological and pathological mechanism of sarcopenia. Generally speaking, exercise and nutritional therapy are the main prevention and treatment methods for sarcopenia. But more prospective evidence is needed to establish reasonable interventions, and other drug treatments are in their infancy. For the diagnostic criteria of sarcopenia, the cut-off values of the skeletal muscle mass index obtained from CT images vary widely and need to be standardized and unified. We also need to explore simple predictors to facilitate sarcopenia risk assessment. More research is needed to formulate more appropriate treatments for gastric cancer patients with sarcopenia.
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Affiliation(s)
- Kaiqiang Xie
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- The Hunan Institute of Pharmacy Practice and Clinical Research, Changsha, 410008, China
- Institute of Hospital Pharmacy, Central South University, Changsha, 410008, China
| | - Danling He
- Xiangya School of Pharmaceutical Sciences, Central South University, Changsha, 410008, China
| | - Tingyu Zhao
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- The Hunan Institute of Pharmacy Practice and Clinical Research, Changsha, 410008, China
- Institute of Hospital Pharmacy, Central South University, Changsha, 410008, China
| | - Ting Liu
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- The Hunan Institute of Pharmacy Practice and Clinical Research, Changsha, 410008, China
- Institute of Hospital Pharmacy, Central South University, Changsha, 410008, China
| | - Mimi Tang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
- The Hunan Institute of Pharmacy Practice and Clinical Research, Changsha, 410008, China.
- Institute of Hospital Pharmacy, Central South University, Changsha, 410008, China.
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12
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Li G, He L, Sun H. Nutritional risk index predicts the prognosis of gastric cancer patients with pyloric stenosis who received preoperative parenteral nutrition. Oncol Lett 2023; 26:401. [PMID: 37600343 PMCID: PMC10433704 DOI: 10.3892/ol.2023.13988] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/03/2023] [Indexed: 08/22/2023] Open
Abstract
Patients with gastric cancer with pyloric stenosis frequently have poor nutritional status and preoperative parenteral nutrition has been a common treatment strategy. The present study aimed to explore the predictive ability of the nutritional risk index (NRI) regarding the prognosis of patients with gastric cancer and pyloric stenosis who received preoperative parenteral nutrition. A total of 194 patients with gastric cancer with pyloric stenosis who received preoperative parenteral nutrition at Tthe Second People's Hospital of Neijiang (Neijiang, China) between January 2016 and December 2021 were included. At the same time, 221 patients with gastric cancer without pyloric stenosis who received surgery during the same period were also collected and the clinicopathological characteristics of the patients were compared. The optimal cut-off value of the NRI was determined from the receiver operating characteristic curve and prognostic factors were identified by survival analysis. Finally, a nomogram was constructed to predict the survival probability of patients with gastric cancer. The results indicated that patients with pyloric stenosis exhibited a wide range of unfavorable pathological characteristics and blood parameters. In addition, their overall survival (OS) was significantly worse (P<0.001). Among the patients with pyloric stenosis, there were 120 patients (61.9%) with an NRI <93.42 and 74 patients (38.1%) with NRI ≥93.42. Furthermore, patients with an NRI <93.42 had poorer OS (34.37 months vs. not reached, P=0.004). Of note, age, tumor size, radical resection, NRI and TNM stage were determined to be independent prognostic factors for OS. The C-index of the nomogram was 0.760 (95%CI: 0.688-0.832). In conclusion, the NRI was indicated to be an accurate score reflecting the nutritional status of patients, which was able to predict the clinical outcomes of patients with gastric cancer with pyloric stricture who received preoperative parenteral nutrition. Patients with a low NRI had shorter survival times.
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Affiliation(s)
- Guomiao Li
- Cancer Center, The Second People's Hospital of Neijiang, Neijiang, Sichuan 641000, P.R. China
| | - Lijuan He
- Department of Health Management Center, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Hao Sun
- Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
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13
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Funk-Debleds P, Rossi J, Bernard L, Galan A, Kepenekian V, Glehen O, Chambrier C. Post-operative weight loss affects 3-year survival in patients with gastric adenocarcinoma after gastrectomy and hyperthermic intraperitoneal chemotherapy. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106895. [PMID: 37012111 DOI: 10.1016/j.ejso.2023.03.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 02/09/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION Patients with advanced gastric adenocarcinoma are at high risk of malnutrition. Some patients benefit from total gastrectomy associated with hyperthermic intraperitoneal chemotherapy (HIPEC) with or without cytoreduction surgery (CR) as a curative strategy. The aim of this study was to describe pre- and post-operative nutritional assessments and their impact on survival in these patients. MATERIALS AND METHODS All patients with advanced gastric adenocarcinoma treated with gastrectomy and HIPEC with or without CR at Lyon University Hospital were retrospectively included from April 2012 to August 2017. Carcinologic data, history of weight, anthropometric measures, nutritional biological markers and CT-scan body composition were collected. RESULTS 54 patients were included. Malnutrition affected 48.1% before and 64.8% after surgery, and severe malnutrition respectively 11.1% and 20.3%. Pre-operative sarcopenia diagnosed by CT scan was found in 40.7% of the patients while 81.1% of the sarcopenic patients had a normal or high body mass index. A loss of ⩾ 20% of usual weight on discharge was a pejorative factor of survival at 3 years of follow-up (p = 0.0470). Only 14.8% of the patients continued artificial nutrition following discharge but artificial nutrition was resumed in 30.4% of the patients within 4 months after discharge owing to weight loss. CONCLUSIONS Patients with advanced gastric adenocarcinoma undergoing gastrectomy and HIPEC with or without CR are at high risk of malnutrition. Post-operative weight loss has a pejorative impact on outcome. These patients should be systematically screened for malnutrition with early interventionist nutritional care and close nutritional follow-up.
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Affiliation(s)
- Pamela Funk-Debleds
- Département de Soins de Support, Centre de Lutte Contre le Cancer Léon Bérard, Lyon, France.
| | - Julien Rossi
- Département de Radiologie, Hospices Civils de Lyon, Hôpital Lyon-Sud, Pierre Bénite, France
| | - Lorraine Bernard
- Service de Biostatistique et Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France; Université de Lyon, F-69000, Lyon, France; Université Lyon 1, F-69100, Villeurbanne, France; 4 CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, F-69100, Villeurbanne, France
| | - Alexandre Galan
- Département de Radiologie, Hospices Civils de Lyon, Hôpital Lyon-Sud, Pierre Bénite, France
| | - Vahan Kepenekian
- Département de Chirurgie Viscérale, Hospices Civils de Lyon, Hôpital Lyon-Sud, Pierre Bénite, France
| | - Olivier Glehen
- Département de Chirurgie Viscérale, Hospices Civils de Lyon, Hôpital Lyon-Sud, Pierre Bénite, France; Equipe Accueil CICLY, Université Lyon 1, Lyon, France
| | - Cécile Chambrier
- Unité de Nutrition Clinique Intensive, Hospices Civil de Lyon, Hôpital Lyon-Sud, Pierre Bénite, France
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14
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Miao X, Ding L, Lu J, Zhu H, Zhao K, Xu X, Zhu S, Chen L, Hu J, Xu Q. Preoperative low handgrip strength (HGS) with HGS asymmetry is associated with adverse outcomes among older adults with gastric cancer. J Geriatr Oncol 2023; 14:101583. [PMID: 37429105 DOI: 10.1016/j.jgo.2023.101583] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 06/16/2023] [Accepted: 06/30/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION This study aimed to explore the associations of low hand grip strength (HGS), HGS asymmetry, their combinations, and frailty on hospital readmissions, total complications, and prolonged length of stay (PLOS) among older adults with gastric cancer. MATERIALS AND METHODS This study included 342 patients with gastric cancer aged ≥60 years who were scheduled to undergo radical surgery. The Tilburg Frailty Indicator (TFI) was used to collect information on frailty. HGS was measured twice for each hand using an electronic handgrip dynamometer. The highest HGS readings on each hand were used for calculating the HGS asymmetry ratio: non-dominant HGS (kg)/dominant HGS (kg). The Fine and Gray proportional subdistribution hazard model and the logistic regression model were used for the analyses, with covariates adjusted. RESULTS Low HGS (subdistribution hazard ratios [SHR] = 2.10, 95% confidence interval [CI] = 1.05-3.93, P = 0.036) and low HGS with HGS asymmetry (SHR = 3.95, 95% CI = 1.50-10.36, P = 0.005) were significantly associated with hospital readmissions. Frailty was associated with total complications (odds ratio [OR] = 2.87, 95% CI = 1.61-5.13, P < 0.001) and PLOS (OR = 1.98, 95% CI = 1.19-3.29, P < 0.001). Low HGS, HGS asymmetry, and their combinations were not significantly associated with total complications and PLOS. DISCUSSION Preoperative low HGS and low HGS with HGS asymmetry were associated with hospital readmissions, while frailty was associated with total complications and PLOS among older adults with gastric cancer. In the future, more rigorously designed studies are needed to verify our results further to improve preoperative clinical assessment and frailty evaluation among older adults with gastric cancer.
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Affiliation(s)
- Xueyi Miao
- School of Nursing, Nanjing Medical University, Nanjing 211166, China
| | - Lingyu Ding
- Department of Colorectal Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Jinling Lu
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Hanfei Zhu
- School of Nursing, Nanjing Medical University, Nanjing 211166, China
| | - Kang Zhao
- School of Nursing, Nanjing Medical University, Nanjing 211166, China
| | - Xinyi Xu
- Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Shuqin Zhu
- School of Nursing, Nanjing Medical University, Nanjing 211166, China
| | - Li Chen
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Jieman Hu
- School of Nursing, Nanjing Medical University, Nanjing 211166, China
| | - Qin Xu
- School of Nursing, Nanjing Medical University, Nanjing 211166, China.
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15
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Zhou D, Liu Y, Zhang L, Lu M, Gao X, Li G, Xiang X, Xu H, Li G, Sun Z, Wei W, Yi K, Zuo J, Wu Y, Qian J, Zhou J, Duan K, Wu Y, Tian Z, Jiang C, Wang X. Effects of oral immunonutritional supplement on 3-year disease-free survival in gastric cancer patients with pathological stage III after total gastrectomy (CRUCIAL): study protocol of a multicentre, randomised clinical trial. BMJ Open 2023; 13:e067990. [PMID: 37041057 PMCID: PMC10106032 DOI: 10.1136/bmjopen-2022-067990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
INTRODUCTION The nutritional status of patients with gastric cancer (GC) after total gastrectomy continues to deteriorate and lasts a long time after discharge, which is an independent risk factor for mortality. Recent guidelines have recommended appropriate nutritional support after discharge for cancer surgery patients with malnutrition or nutritional risk. The evidence on the efficacy of oral immunonutritional supplement (INS) and its effect on long-term disease-free survival (DFS) in patients with GC is limited. This study was designed to test the hypothesis that oral INS compared to diet alone may improve 3-year DFS of GC patients with pathological stage III after total gastrectomy (Nutrition Risk Screening 2002 score ≥3 at discharge). METHODS AND ANALYSIS This is a pragmatic, open-label, multicentre, randomised controlled study. 696 eligible GC patients with pathological stage III after total gastrectomy will be randomised in a 1:1 ratio to oral INS group or normal diet group for 6 months. The primary endpoint is 3-year DFS after discharge. The following secondary endpoints will be evaluated: 3-year overall survival; unplanned readmission rate at 3 and 6 months after discharge; quality of life, body mass index and haematological index at 3, 6 and 12 months after discharge; incidence of sarcopenia at 6 and 12 months after discharge; and the tolerance to chemotherapy. The adverse events of oral INS will also be evaluated during the intervention. ETHICS AND DISSEMINATION This study was approved by the ethics committee of Jinling Hospital, Nanjing University (number 2021NZKY-069-01). The present study may validate the effectiveness of oral immunonutritional therapy in improving 3-year DFS for GC patients with pathological stage III after total gastrectomy for the first time. The results of this trial will be disseminated in peer-reviewed journals and at scientific conferences. TRIAL REGISTRATION NUMBER NCT05253716.
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Affiliation(s)
- Da Zhou
- Research Institute of General Surgery, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Yuxiu Liu
- Data and Statistics Division of Department of Critical Care Medicine, Nanjing Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Li Zhang
- Research Institute of General Surgery, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Mengjie Lu
- China Hospital Development Institute, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuejin Gao
- Research Institute of General Surgery, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Guoli Li
- Research Institute of General Surgery, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Xiaosong Xiang
- Research Institute of General Surgery, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Hao Xu
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Gang Li
- Department of General Surgery, Jiangsu Cancer Hospital, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zhiping Sun
- Department of Clinical Nutrition, Affiliated Second Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Wei Wei
- Department of General Surgery, Affiliated Second Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Kui Yi
- Department of Gastroenteropancreatic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Junbo Zuo
- Department of General Surgery, Zhenjiang First People's Hospital, Zhenjiang, Jiangsu, China
| | - Yugang Wu
- Department of General Surgery, The Third Affiliated Hospital of Soochow University and The First People's Hospital of Changzhou, Changzhou, Jiangsu, China
| | - Jun Qian
- Department of General Surgery, ChangZhou Second Hospital, the affiliated Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Jian Zhou
- Department of General Surgery, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Kaipeng Duan
- Department of General Surgery, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yong Wu
- Department of General Surgery, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhiqiang Tian
- Department of General Surgery, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Chao Jiang
- Department of General Surgery, Yixing People's Hospital, Yixing, Jiangsu, China
| | - Xinying Wang
- Research Institute of General Surgery, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
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16
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Yi X, Zhou G, Fu Y, Wu J, Chen C, Zai H, He Q, Pang P, Zhou H, Gong G, Lei T, Tan F, Liu H, Li B, Chen BT. CT-based assessment of sarcopenia for differentiating wild-type from mutant-type gastrointestinal stromal tumor. Sci Rep 2023; 13:3216. [PMID: 36828845 PMCID: PMC9958176 DOI: 10.1038/s41598-022-27213-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 12/28/2022] [Indexed: 02/26/2023] Open
Abstract
Non-invasive prediction for KIT/PDGFRA status in GIST is a challenging problem. This study aims to evaluate whether CT based sarcopenia could differentiate KIT/PDGFRA wild-type gastrointestinal stromal tumor (wt-GIST) from the mutant-type GIST (mu-GIST), and to evaluate genetic features of GIST. A total of 174 patients with GIST (wt-GIST = 52) were retrospectively identified between January 2011 to October 2019. A sarcopenia nomogram was constructed by multivariate logistic regression. The performance of the nomogram was evaluated by discrimination, calibration curve, and decision curve. Genomic data was obtained from our own specimens and also from the open databases cBioPortal. Data was analyzed by R version 3.6.1 and clusterProfiler ( http://cbioportal.org/msk-impact ). There were significantly higher incidence (75.0% vs. 48.4%) and more severe sarcopenia in patients with wt-GIST than in patients with mu-GIST. Multivariate logistic regression analysis showed that sarcopenia score (fitted based on age, gender and skeletal muscle index), and muscle fat index were independent predictors for higher risk of wt-GIST (P < 0.05 for both the training and validation cohorts). Our sarcopenia nomogram achieved a promising efficiency with an AUC of 0.879 for the training cohort, and 0.9099 for the validation cohort with a satisfying consistency in the calibration curve. Favorable clinical usefulness was observed using decision curve analysis. The additional gene sequencing analysis based on both our data and the external data demonstrated aberrant signal pathways being closely associated with sarcopenia in the wt-GIST. Our study supported the use of CT-based assessment of sarcopenia in differentiating the wt-GIST from the mu-GIST preoperatively.
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Affiliation(s)
- Xiaoping Yi
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
- National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Central South University, Changsha, 410008, People's Republic of China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, 410008, Hunan, People's Republic of China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, 410008, Hunan, People's Republic of China
| | - Gaofeng Zhou
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Yan Fu
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Jinchun Wu
- Department of Oncology, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Changyong Chen
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Hongyan Zai
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Qiongzhi He
- Geneplus-Beijing Institute, Beijing, People's Republic of China
| | - Peipei Pang
- GE Healthcare, Hangzhou, 310000, People's Republic of China
| | - Haiyan Zhou
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Guanghui Gong
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Tianxiang Lei
- Department of General Surgery, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Fengbo Tan
- Department of General Surgery, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Heli Liu
- Department of General Surgery, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.
| | - Bin Li
- Department of Oncology, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.
| | - Bihong T Chen
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA, 91010, USA
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17
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Sugiyama K, Shiraishi K, Motohashi T, Onoda S, Sato M, Kato K, Uda H, Hattori M, Suenaga M, Hirashima N, Shimada M, Kataoka M, Kitagawa C. The Impact of Nutritional Support on Survival Outcomes in Patients with Advanced Gastric Adenocarcinoma Treated with Chemotherapy. Nutr Cancer 2023; 75:867-875. [PMID: 36591915 DOI: 10.1080/01635581.2022.2162090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Malnutrition and cachexia occur commonly in patients with advanced gastric cancer (AGC). This study elucidated the effect of nutritional support (NS) on survival outcomes among patients with AGC undergoing chemotherapy. We retrospectively evaluated new AGC cases at our institute between January 2015 and January 2021. Inclusion criteria were unresectable or recurrent chemotherapy-treated gastric adenocarcinoma, ECOG performance status (PS) 0-2, and adequate organ function. Time to treatment failure (TTF) and overall survival (OS) were evaluated, and univariate and multivariate analyses identified prognostic factors. A total of 103 eligible patients were separated into groups: 69 patients (67%) into NS and 34 (33%) into routine care (RC). The median follow-up time was 11.0 mo, (0.5-92). NS was offered to patients with poorer PS (p = 0.03), Glasgow prognostic score (GPS) positivity (p = 0.001), and high neutrophil-to-lymphocyte ratios (cut-off ≤ 3, p = 0.02). Median OS and TTF in the RC and NS groups were 11.6 and 10.4 mo, (p = 0.99) and 4.2 and 5.5 mo, (p = 0.07), respectively. Multivariate analyses identified NS (hazard ratio [HR] = 0.53, p = 0.01) and GPS positivity for TTF, and low body mass index (HR = 2.03, p = 0.007) and GPS positivity (HR = 2.25, p = 0.001) for OS as significant prognostic factors. Thus, NS with chemotherapy is a potentially effective intervention for AGC.
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Affiliation(s)
- Keiji Sugiyama
- Department of Medical Oncology, Nationial Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Kazuhiro Shiraishi
- Department of Medical Oncology, Nationial Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Takuya Motohashi
- Department of Nutrition Service, National Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Shinpei Onoda
- Department of Nutrition Service, National Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Mariko Sato
- Department of Medical Oncology, Nationial Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Kyoko Kato
- Department of Medical Oncology, Nationial Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Hiroaki Uda
- Department of Surgery, National Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Masashi Hattori
- Department of Surgery, National Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Masaya Suenaga
- Department of Surgery, National Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Noboru Hirashima
- Department of Gastroenterology, National Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Masaaki Shimada
- Department of Gastroenterology, National Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Masato Kataoka
- Department of Surgery, National Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Chiyoe Kitagawa
- Department of Medical Oncology, Nationial Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan
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18
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Bechtold ML, Brown PM, Escuro A, Grenda B, Johnston T, Kozeniecki M, Limketkai BN, Nelson KK, Powers J, Ronan A, Schober N, Strang BJ, Swartz C, Turner J, Tweel L, Walker R, Epp L, Malone A. When is enteral nutrition indicated? JPEN J Parenter Enteral Nutr 2022; 46:1470-1496. [PMID: 35838308 DOI: 10.1002/jpen.2364] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 11/07/2022]
Abstract
Enteral nutrition (EN) is a vital component of nutrition around the world. EN allows for delivery of nutrients to those who cannot maintain adequate nutrition by oral intake alone. Common questions regarding EN are when to initiate and in what scenarios it is safe. The answers to these questions are often complex and require an evidence-based approach. The Board of Directors of the American Society for Parenteral and Enteral Nutrition (ASPEN) established an Enteral Nutrition Committtee to address the important questions surrounding the indications for EN. Consensus recommendations were established based on eight extremely clinically relevant questions regarding EN indications as deemed by the Enteral Nutrition Committee. These consensus recommendations may act as a guide for clinicians and stakeholders on difficult questions pertaining to indications for EN. This paper was approved by the ASPEN Board of Directors.
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Affiliation(s)
| | | | | | - Brandee Grenda
- Morrison Healthcare at Atrium Health Navicant, Charlotte, North Carolina, USA
| | - Theresa Johnston
- Nutrition Support Team, Christiana Care Health System, Newark, Delaware, USA
| | | | | | | | - Jan Powers
- Nursing Research and Professional Practice, Parkview Health System, Fort Wayne, Indiana, USA
| | - Andrea Ronan
- Fanconi Anemia Research Fund, Eugene, Oregon, USA
| | - Nathan Schober
- Cancer Treatment Centers of America - Atlanta, Newnan, Georgia, USA
| | | | - Cristina Swartz
- Northwestern Medicine Delnor Cancer Center, Chicago, Illinois, USA
| | - Justine Turner
- Department of Pediatrics, Division of Gastroenterology and Nutrition, University of Alberta, Edmonton, Canada
| | | | - Renee Walker
- Michael E. DeBakey Veteran Affairs Medical Center, Houston, Texas, USA
| | - Lisa Epp
- Mayo Clinic, Rochester, Minnesota, USA
| | - Ainsley Malone
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
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19
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Brzeszczynski F, Brzeszczynska J, Duckworth AD, Murray IR, Simpson AHRW, Hamilton DF. The effect of sarcopenia on outcomes following orthopaedic surgery : a systematic review. Bone Joint J 2022; 104-B:321-330. [PMID: 35227092 DOI: 10.1302/0301-620x.104b3.bjj-2021-1052.r1] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIMS Sarcopenia is characterized by a generalized progressive loss of skeletal muscle mass, strength, and physical performance. This systematic review primarily evaluated the effects of sarcopenia on postoperative functional recovery and mortality in patients undergoing orthopaedic surgery, and secondarily assessed the methods used to diagnose and define sarcopenia in the orthopaedic literature. METHODS A systematic search was conducted in MEDLINE, EMBASE, and Google Scholar databases according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Studies involving sarcopenic patients who underwent defined orthopaedic surgery and recorded postoperative outcomes were included. The quality of the criteria by which a diagnosis of sarcopenia was made was evaluated. The quality of the publication was assessed using Newcastle-Ottawa Scale. RESULTS A total of 365 studies were identified and screened, 26 full-texts were reviewed, and 19 studies were included in the review. A total of 3,009 patients were included, of whom 2,146 (71%) were female and 863 (29%) were male. The mean age of the patients was 75.1 years (SD 7.1). Five studies included patients who underwent spinal surgery, 13 included hip or knee surgery, and one involved patients who underwent fixation of a distal radial fixation. The mean follow-up was 1.9 years (SD 1.9; 5 days to 5.6 years). There was wide heterogeneity in the measurement tools which were used and the parameters for the diagnosis of sarcopenia in the studies. Sarcopenia was associated with at least one deleterious effect on surgical outcomes in all 19 studies. The postoperative rate of mortality was reported in 11 studies (57.9%) and sarcopenia was associated with poorer survival in 73% (8/11) of these. The outcome was most commonly assessed using the Barthel Index (4/19), and sarcopenic patients recorded lower scores in 75% (3/4) of these. Sarcopenia was defined using the gold-standard three parameters (muscle strength, muscle quantity or quality, and muscle function) in four studies (21%), using two parameters in another four (21%) and one in the remaining 11 (58%). The methodological quality of the studies was moderate to high. CONCLUSION There is much heterogeneity in the reporting of the parameters which are used for the diagnosis of sarcopenia, and evaluating the outcome of orthopaedic surgery in sarcopenic patients. However, what data exist suggest that sarcopenia impairs recovery and increases postoperative mortality, especially in patients undergoing emergency surgery. Further research is required to develop processes that allow the accurate diagnosis of sarcopenia in orthopaedics, which may facilitate targeted pre- and postoperative interventions that would improve outcomes. Cite this article: Bone Joint J 2022;104-B(3):321-330.
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Affiliation(s)
- Filip Brzeszczynski
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Joanna Brzeszczynska
- Institute of Biomedical and Environmental Health Research, University of the West of Scotland, Paisley, UK.,Department of Molecular Biophysics, University of Lodz, Lodz, Poland
| | - Andrew D Duckworth
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK.,Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Iain R Murray
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - A Hamish R W Simpson
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK.,Department of Orthopaedics and Trauma, University of Edinburgh, Edinburgh, UK
| | - David F Hamilton
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
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20
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Kim HJ, Lee ES, Kim BJ, Kim WS, Park JY, Kim JG, Park JM, Kim JW, Chi KC, Kang H. Risk factors and clinical outcomes of postgastrectomy sarcopenia newly developed after curative resection for gastric cancer. Medicine (Baltimore) 2022; 101:e28699. [PMID: 35147091 PMCID: PMC8830859 DOI: 10.1097/md.0000000000028699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 01/10/2022] [Indexed: 01/04/2023] Open
Abstract
This study aimed to investigate the risk factors and clinical impact of newly developed sarcopenia after surgical resection on the prognosis of patients undergoing curative gastrectomy for gastric cancer (GC).The clinicopathological data of 573 consecutive patients with GC who underwent curative gastrectomy were reviewed. Their skeletal muscle mass and abdominal fat volume were measured using abdominal computed tomography.Forty six of them (8.0%) were diagnosed with preoperative sarcopenia. Among the 527 patients without sarcopenia, 57 (10.8%) were diagnosed with postgastrectomy sarcopenia newly developed 1 year after curative gastrectomy. Female sex, weight loss, proximal location of the tumor and differentiated tumor were significant risk factors of postgastectomy sarcopenia newly developed after curative gastrectomy. There was a significant difference in the 5-year overall survival among the preoperative sarcopenic, nonsarcopenic, and postgastrectomy sarcopenic groups (P = .017). Especially, there was a significant difference between nonsarcopenic and postgastrectomy sarcopenic groups (P = .009). However, there was no significant difference in the 5-year disease-free survival among the groups (P = .49).Since newly developed sarcopenia after surgical resection had an influence on the overall survival, patients with high sarcopenia risks after curative gastrectomy may require early nutritional support.
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Affiliation(s)
- Hye Jin Kim
- Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Eun Sun Lee
- Department of Radiology, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Beom Jin Kim
- Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Won-Seok Kim
- Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Jae Yong Park
- Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Jae Gyu Kim
- Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Joong-Min Park
- Department of Surgery, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Jong Won Kim
- Department of Surgery, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Kyong-Choun Chi
- Department of Surgery, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Hyung Kang
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Korea
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21
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Billroth II anastomosis maintains SMI and BMI better than Roux-en-Y anastomosis following totally laparoscopic distal gastrectomy: a propensity score-matched study. Langenbecks Arch Surg 2022; 407:1441-1450. [DOI: 10.1007/s00423-022-02459-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 01/27/2022] [Indexed: 11/26/2022]
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22
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Metzger GA, Carsel A, Sebastião YV, Deans KJ, Minneci PC. Does sarcopenia affect outcomes in pediatric surgical patients? A scoping review. J Pediatr Surg 2021; 56:2099-2106. [PMID: 33500162 DOI: 10.1016/j.jpedsurg.2021.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/06/2020] [Accepted: 01/08/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Adults with sarcopenia have a greater risk of postoperative complications, a higher rate of ICU admission, and an increased length of hospital stay. Few studies have explored the prevalence or importance of sarcopenia in the pediatric population. This study reviews the published literature on sarcopenia in the pediatric population, including pediatric surgery. METHODS Original studies related to sarcopenia in children were identified using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines and the PubMed database. RESULTS A total of 390 articles were screened, with 28 meeting inclusion criteria. Twenty (71%) studies provided a means to define abnormal and 18 studies (64%) showed that a specific disease process could impact lean muscle mass in children. Only 4 (14%) studies associated the change in muscle mass with an outcome. Two studies investigated sarcopenia and outcomes in the pediatric surgical patient and demonstrated associations with worse outcomes. CONCLUSION Despite studies showing an association between sarcopenia and negative outcomes in the adult surgical population, there remains a paucity of evidence regarding the impact of sarcopenia on the pediatric population. Future studies are needed to ascertain the relationship between muscle mass and outcomes in pediatric surgical patients.
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Affiliation(s)
- Gregory A Metzger
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, 611 East Livingston Avenue, Columbus, OH, 43205, United States
| | - Alex Carsel
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, 611 East Livingston Avenue, Columbus, OH, 43205, United States
| | - Yuri V Sebastião
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, 611 East Livingston Avenue, Columbus, OH, 43205, United States
| | - Katherine J Deans
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, 611 East Livingston Avenue, Columbus, OH, 43205, United States; Department of Pediatric Surgery, Nationwide Children's Hospital, 611 East Livingston Avenue, Columbus, OH 43205, United States
| | - Peter C Minneci
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, 611 East Livingston Avenue, Columbus, OH, 43205, United States; Department of Pediatric Surgery, Nationwide Children's Hospital, 611 East Livingston Avenue, Columbus, OH 43205, United States.
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23
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Mulazzani GE, Corti F, Della Valle S, Di Bartolomeo M. Nutritional Support Indications in Gastroesophageal Cancer Patients: From Perioperative to Palliative Systemic Therapy. A Comprehensive Review of the Last Decade. Nutrients 2021; 13:nu13082766. [PMID: 34444926 PMCID: PMC8400027 DOI: 10.3390/nu13082766] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/04/2021] [Accepted: 08/10/2021] [Indexed: 02/07/2023] Open
Abstract
Gastric cancer treatments are rapidly evolving, leading to significant survival benefit. Recent evidence provided by clinical trials strongly encouraged the use of perioperative chemotherapy as standard treatment for the localized disease, whereas in the advanced disease setting, molecular characterization has improved patients’ selection for tailored therapeutic approaches, including molecular targeted therapy and immunotherapy. The role of nutritional therapy is widely recognized, with oncologic treatment’s tolerance and response being better in well-nourished patients. In this review, literature data on strategies or nutritional interventions will be critically examined, with particular regard to different treatment phases (perioperative, metastatic, and palliative settings), with the aim to draw practical indications for an adequate nutritional support of gastric cancer patients and provide an insight on future directions in nutritional strategies. We extensively analyzed the last 10 years of literature, in order to provide evidence that may fit current clinical practice both in terms of nutritional interventions and oncological treatment. Overall, 137 works were selected: 34 Randomized Clinical Trials (RCTs), 12 meta-analysis, 9 reviews, and the most relevant prospective, retrospective and cross-sectional studies in this setting. Eleven ongoing trials have been selected from clinicaltrial.gov as representative of current research. One limitation of our work lies in the heterogeneity of the described studies, in terms of sample size, study procedures, and both nutritional and clinical outcomes. Indeed, to date, there are no specific evidence-based guidelines in this fields, therefore we proposed a clinical algorithm with the aim to indicate an appropriate nutritional strategy for gastric cancer patients.
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Affiliation(s)
- Giulia E.G. Mulazzani
- Clinical Nutrition Unit, Department of Critical and Supportive Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy; (G.E.G.M.); (S.D.V.)
| | - Francesca Corti
- Gastrointestinal Medical Oncology, Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy;
| | - Serena Della Valle
- Clinical Nutrition Unit, Department of Critical and Supportive Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy; (G.E.G.M.); (S.D.V.)
| | - Maria Di Bartolomeo
- Gastrointestinal Medical Oncology, Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy;
- Correspondence: ; Tel.: +39-02-2390-2882
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24
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Aprile G, Basile D, Giaretta R, Schiavo G, La Verde N, Corradi E, Monge T, Agustoni F, Stragliotto S. The Clinical Value of Nutritional Care before and during Active Cancer Treatment. Nutrients 2021; 13:nu13041196. [PMID: 33916385 PMCID: PMC8065908 DOI: 10.3390/nu13041196] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 12/18/2022] Open
Abstract
Malnutrition and muscle wasting are frequently reported in cancer patients, either linked to the tumor itself or caused by oncologic therapies. Understanding the value of nutritional care during cancer treatment remains crucial. In fact, cancer-associated sarcopenia plays a key role in determining higher rates of morbidity, mortality, treatment-induced toxicities, prolonged hospitalizations and reduced adherence to anticancer treatment, worsening quality of life and survival. Planning baseline screening to intercept nutritional troubles earlier, organizing timely reassessments, and providing adequate counselling and dietary support, healthcare professional may positively interfere with this process and improve patients' overall outcomes during the whole disease course. Several screening tools have been proposed for this purpose. Nutritional Risk Screening (NRS), Mini Nutritional Assessment (MNA), Patient Generated Subjective Global Assessment (PG-SGA) are the most common studied. Interestingly, second-level tools including skeletal muscle index (SMI) and bioelectric impedance analysis (BIA) provide a more precise assessment of body composition, even if they are more complex. However, nutritional assessment is not currently used in clinical practice and procedures must be standardized in order to improve the efficacy of standard chemotherapy, targeted agents or even checkpoint inhibitors that is potentially linked with the patients' nutritional status. In the present review, we will discuss about malnutrition and the importance of an early nutritional assessment during chemotherapy and treatment with novel checkpoint inhibitors, in order to prevent treatment-induced toxicities and to improve survival outcomes.
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Affiliation(s)
- Giuseppe Aprile
- Department of Oncology, AULSS8 Berica, 36100 Vicenza, Italy; (D.B.); (R.G.)
- Correspondence: ; Tel.: +39-0444753906
| | - Debora Basile
- Department of Oncology, AULSS8 Berica, 36100 Vicenza, Italy; (D.B.); (R.G.)
| | - Renato Giaretta
- Department of Oncology, AULSS8 Berica, 36100 Vicenza, Italy; (D.B.); (R.G.)
| | - Gessica Schiavo
- Clinical Nutritional Unit, AULSS8 Berica, 36100 Vicenza, Italy;
| | - Nicla La Verde
- Department of Oncology, PO Sacco, ASST Fatebenefratelli Sacco, 20131 Milano, Italy;
| | - Ettore Corradi
- Clinical Nutritional Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy;
| | - Taira Monge
- Clinical Nutrition, S. Giovanni Battista Hospital, 10126 Torino, Italy;
| | - Francesco Agustoni
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Silvia Stragliotto
- Department of Oncology, Istituto Oncologico Veneto—IRCCS, 31033 Padova, Italy;
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25
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Fornaro L, Spallanzani A, de Vita F, D’Ugo D, Falcone A, Lorenzon L, Tirino G, Cascinu S, on behalf of GAIN (GAstric Cancer Italian Network). Beyond the Guidelines: The Grey Zones of the Management of Gastric Cancer. Consensus Statements from the Gastric Cancer Italian Network (GAIN). Cancers (Basel) 2021; 13:1304. [PMID: 33804024 PMCID: PMC8001719 DOI: 10.3390/cancers13061304] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/19/2021] [Accepted: 03/11/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Management of gastric and gastroesophageal junction (GEJ) adenocarcinoma remains challenging, because of the heterogeneity in tumor biology within the upper gastrointestinal tract. Daily clinical practice is full of grey areas regarding the complexity of diagnostic, staging, and therapeutic procedures. The aim of this paper is to provide a guide for clinicians facing challenging situations in routine practice, taking a multidisciplinary consensus approach based on available literature. METHODS The GAIN (GAstric cancer Italian Network) group was established with the aims of reviewing literature evidence, discussing key issues in prevention, diagnosis, and management of gastric and GEJ adenocarcinoma, and offering a summary of statements. A Delphi consensus method was used to obtain opinions from the expert panel of specialists. RESULTS Forty-nine clinical questions were identified in six areas of interest: role of multidisciplinary team; risk factors; diagnosis; management of early gastric cancer and multimodal approach to localized gastric cancer; treatment of elderly patients with locally advanced resectable disease; and treatment of locally advanced and metastatic cancer. CONCLUSIONS The statements presented may guide clinicians in practical management of this disease.
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Affiliation(s)
- Lorenzo Fornaro
- Department of Translational Medicine, Division of Medical Oncology, AOU Pisana, 56126 Pisa, Italy;
| | - Andrea Spallanzani
- Department of Oncology and Hematology, University Hospital of Modena, 41125 Modena, Italy;
| | - Ferdinando de Vita
- Department of Precision Medicine, Division of Medical Oncology, School of Medicine, University of Campania ‘Luigi Vanvitelli’, 81100 Caserta, Italy; (F.d.V.); (G.T.)
| | - Domenico D’Ugo
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, 00168 Rome, Italy; (D.D.); (L.L.)
| | - Alfredo Falcone
- Department of Translational Medicine, Division of Medical Oncology, University of Pisa, 56126 Pisa, Italy;
| | - Laura Lorenzon
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, 00168 Rome, Italy; (D.D.); (L.L.)
| | - Giuseppe Tirino
- Department of Precision Medicine, Division of Medical Oncology, School of Medicine, University of Campania ‘Luigi Vanvitelli’, 81100 Caserta, Italy; (F.d.V.); (G.T.)
| | - Stefano Cascinu
- Medical Oncology, Università Vita-Salute San Raffaele, 20132 Milan, Italy
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26
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Zhang Y, Li Z, Jiang L, Xue Z, Ma Z, Kang W, Ye X, Liu Y, Jin Z, Yu J. Marked loss of adipose tissue during neoadjuvant therapy as a predictor for poor prognosis in patients with gastric cancer: A retrospective cohort study. J Hum Nutr Diet 2021; 34:585-594. [PMID: 33491826 DOI: 10.1111/jhn.12861] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/07/2020] [Accepted: 12/22/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The influence of body composition changes during neoadjuvant treatment (NT) on long-term survival in patients with gastric cancer (GC) undergoing radical gastrectomy remains unclear. The present study aimed to explore the association between changes in body composition during NT and survival in patients with GC. METHODS GC patients treated with NT and radical gastrectomy between 2015 and 2018 were included in this retrospective study. Skeletal muscle mass, visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were measured by computer tomography before and after NT. Body composition changes during NT were compared with Kaplan-Meier curves. Univariate and multivariate regression analyses were applied to determine the predictors of overall survival (OS) and disease-free survival (DFS). RESULTS In total, 157 GC patients were studied. A marked loss of adipose tissue was associated with poor nutritional status. The median follow-up time for all patients was 25 months. Patients with marked VAT loss (≥ 35.7%) during NT had significantly shorter OS (p = 0.028) and DFS (p = 0.03). Similarly, poorer OS (p = 0.033) and DFS (p = 0.003) were observed in patients with marked SAT loss (≥ 30.1%) during NT. Changes in skeletal muscle mass and body weight during NT were not associated with survival. Marked VAT loss accompanied by marked SAT loss was an independent predictor of OS (hazards ratio = 2.447; p = 0.045) and DFS (hazards ratio = 2.674; p = 0.018). CONCLUSIONS Patients with locally advanced GC have a worse survival when they experienced marked loss of adipose tissue during NT.
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Affiliation(s)
- Yingjing Zhang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zijian Li
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Jiang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhigang Xue
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhiqiang Ma
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weiming Kang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Ye
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuqin Liu
- Cell Culture Centre, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianchun Yu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Zhang Y, Li Z, Jiang L, Xue Z, Ma Z, Kang W, Ye X, Liu Y, Jin Z, Yu J. Impact of body composition on clinical outcomes in people with gastric cancer undergoing radical gastrectomy after neoadjuvant treatment. Nutrition 2021; 85:111135. [PMID: 33556785 DOI: 10.1016/j.nut.2020.111135] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/07/2020] [Accepted: 12/14/2020] [Indexed: 01/27/2023]
Abstract
OBJECTIVES The influence of body composition on clinical outcomes in individuals with gastric cancer (GC) undergoing radical gastrectomy after neoadjuvant treatment (NT) remains unclear. The purpose of this retrospective study was to investigate the association between body composition before NT or after NT and clinical outcomes in individuals with GC receiving multimodal treatments. METHODS This retrospective study included individuals with GC who received NT followed by radical gastrectomy between January 2016 and December 2018. Skeletal muscle, visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) were measured by cross-sectional areas at the level of third lumbar vertebra based on single-slice computed tomography scan prior to NT and prior to the surgical operation. Sarcopenia, high VAT, and high SAT were defined using cutoff points of skeletal muscle index, visceral fat area, and subcutaneous fat area. Univariate and multivariate analyses were performed to evaluate risk factors of NT-related adverse events, postoperative complications and predictors of long-term survival. RESULTS A total of 110 individuals with GC were enrolled in this study. Sarcopenia was present in 62.7% of them before NT and in 56.4% after NT. Sarcopenia before NT was associated with more NT-related adverse events (odds ratio, 2.901; 95% confidence interval [CI], 1.205-6.983; P = 0.018). High VAT after NT (≥106 cm2) was associated with an increasing incidence of postoperative complications (odds ratio, 4.261; 95% CI, 1.332-13.632; P = 0.015). No body-composition parameter was relevant to tumor pathologic response to NT. As for long-term survival, poor overall survival was associated with both low VAT before NT (<120 cm2; hazard ratio [HR], 2.542; 95% CI, 1.111-5.817; P = 0.027) and low SAT after NT (<99.5 cm2; HR, 2.743; 95% CI, 1.248-6.027; P = 0.012). Similarly, shorter disease-free survival was associated with low VAT before NT (<120 cm2; HR, 2.502; 95% CI, 1.222-5.124; P = 0.012) and low VAT after NT (<106 cm2; HR, 2.505; 95% CI, 1.172-5.358; P = 0.018). CONCLUSIONS Body composition measured by computed tomography could predict NT-related adverse events, postoperative complications, and long-term survival in multimodal treatments for GC. More meaningfully, adipose-tissue status has significant prognostic value for individuals with advanced GC.
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Affiliation(s)
- Yingjing Zhang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zijian Li
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Jiang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhigang Xue
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhiqiang Ma
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weiming Kang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Ye
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuqin Liu
- Cell Culture Centre, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Jianchun Yu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Hossain M, Yu D, Bikdeli B, Yu S. Sarcopenia and Adverse Post-Surgical Outcomes in Geriatric Patients: A Scoping Review. J Frailty Aging 2021; 10:63-69. [PMID: 33331624 DOI: 10.14283/jfa.2020.27] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Sarcopenia is associated with adverse outcomes in cancer, chemotherapy, solid organ transplants, intensive care and medical patients. It has also been proven to increase perioperative mortality, hospital length of stay and complications in patients of various age groups. However, a limited number of studies have examined the association of post-surgical outcomes and sarcopenia inclusively in patients aged 65 years and older. OBJECTIVE This scoping review aimed to examine the relationship between adverse post-surgical outcomes and sarcopenia in patients aged 65 years and older. METHODOLOGY EMBASE and Medline databases were searched for sarcopenia, perioperative period and post-surgical outcomes. The articles were screened based on exclusion and inclusion criteria and were reviewed systematically as per the Joanna Briggs Institute (JBI) Methodology for Scoping Reviews. RESULTS After duplicates removal and application of the inclusion and exclusion criteria, eight articles were included for this study from a total of nine hundred initially identified articles. All studies defined sarcopenia as low muscle mass but did not include physical function or muscle strength as the parameter of sarcopenia. Low muscle mass was associated with higher mortality in emergency surgeries, reduced long term survival in open elective surgeries, and increased length of hospital stay in endoscopic surgeries. CONCLUSION The current review suggests that low muscle mass is associated with higher mortality and various adverse post-surgical outcomes in the elderly. It remains to be determined if applying the definition of sarcopenia as per the international consensus/guidelines will affect the association of adverse post-surgical outcomes and sarcopenia.
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Affiliation(s)
- M Hossain
- Monowar Hossain, Aged and Extended Care Services, The Queen Elizabeth Hospital. Central Adelaide Local Health Network, South Australia,
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29
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Kouzu K, Tsujimoto H, Sugasawa H, Ishibashi Y, Itazaki Y, Tsuchiya S, Kishi Y, Ueno H. Impact of postoperative reduced skeletal muscle on prognosis after recurrence in gastric cancer. Mol Clin Oncol 2020; 14:3. [PMID: 33235731 PMCID: PMC7678615 DOI: 10.3892/mco.2020.2165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 08/21/2020] [Indexed: 02/06/2023] Open
Abstract
Little is known about the association between sarcopenia development after gastrectomy and gastric cancer prognosis after recurrence. The present study retrospectively examined the effects of decreased psoas muscle index (PMI) on post-recurrence prognosis after gastrectomy. A total of 67 patients with gastric cancer recurrence were included in the present study. PMI at pre-operation and recurrence were calculated, and 25 patients whose PMI reduction rate value was lower than the cutoff values (male=0.766 and female=0.704) were classified into the sarcopenia group and 42 patients into the non-sarcopenia group. There were no significant differences between the groups regarding age, sex, pathological stage, and nutrition and inflammation indices at the time of recurrence. Post-recurrence overall survival (OS) was significantly shorter in the sarcopenia group compared with the non-sarcopenia group (P<0.001). The post-recurrence survival rate was significantly worse in the sarcopenia group compared with the non-sarcopenia group (P<0.001). In multivariate analysis, sarcopenia (HR=5.04) and the total courses of chemotherapy after recurrence (HR=3.88) were independent unfavorable prognostic factors. In conclusion, sarcopenia and fewer total courses of post-recurrence chemotherapy were poor prognostic factors after gastric cancer recurrence. To improve prognosis, preventing sarcopenia development after gastrectomy is required.
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Affiliation(s)
- Keita Kouzu
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-0042, Japan
| | - Hironori Tsujimoto
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-0042, Japan
| | - Hidekazu Sugasawa
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-0042, Japan
| | - Yusuke Ishibashi
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-0042, Japan
| | - Yujiro Itazaki
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-0042, Japan
| | - Satoshi Tsuchiya
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-0042, Japan
| | - Yoji Kishi
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-0042, Japan
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-0042, Japan
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30
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Association between skeletal muscle loss and the response to nivolumab immunotherapy in advanced gastric cancer patients. Int J Clin Oncol 2020; 26:523-531. [PMID: 33226523 DOI: 10.1007/s10147-020-01833-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 11/02/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Skeletal muscle loss is a hallmark of malignancies, including advanced gastric cancer (GC). Although programmed death (PD)-1 inhibitors, including nivolumab, have promising anti-cancer effects, there is limited information regarding markers that can predict these therapeutic effects, which include PD-ligand 1 (PD-L1) expression and the tumor mutation burden. Therefore, we evaluated whether the baseline psoas muscle mass index (PMI, a surrogate for skeletal muscle mass) could predict the response of GC to nivolumab treatment, based on progression-free survival (PFS), the objective response rate, and the disease control rate. METHODS This retrospective study evaluated 31 Japanese patients who received nivolumab for advanced GC and underwent imaging analysis between November 2017 and November 2019. The computed tomography results were used to estimate the psoas major muscle mass. Sex-specific cut-off values were used for the PMI, with low PMI values defined as < 3.6 cm2/m2 for male patients and < 2.9 cm2/m2 for female patients. RESULTS The median PFS interval was 2.3 months for the patients with stage IV GC. Nine patients (29%) had a low baseline PMI, and these patients had significantly shorter median PFS than the group with a non-low baseline PMI (0.5 months vs. 2.4 months, P = 0.004). CONCLUSIONS As a surrogate marker for skeletal muscle loss, the PMI may be useful for predicting the response to nivolumab among patients with advanced GC.
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31
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Soares JDP, Howell SL, Teixeira FJ, Pimentel GD. Dietary Amino Acids and Immunonutrition Supplementation in Cancer-Induced Skeletal Muscle Mass Depletion: A Mini-Review. Curr Pharm Des 2020; 26:970-978. [PMID: 32067606 DOI: 10.2174/1381612826666200218100420] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 01/08/2020] [Indexed: 01/12/2023]
Abstract
Cancer patients display systemic inflammation, which leads to an increase in protein catabolism, thus promoting the release of free amino acids to further support metabolism and remodelling of muscle proteins. Inflammation associated with tumor growth leads to malnutrition, a factor that increases the risk of developing cachexia. With cancer-induced cachexia, nutritional interventions have gained traction as a preventative method to manage this condition. Currently, cancer consensus recommendations suggest a protein intake above 1.0 g/kg.day-1 up to 2.0 g/k.day-1 for cancer patients, although an ideal amount for some amino acids in isolation has yet to be determined. Due to controversy in the literature regarding the benefits of the biochemical mechanisms of various muscle mass supplements, such as L-leucine (including whey protein and BCAA), β-hydroxy-beta-methyl butyrate (HMβ), arginine, glutamine and creatine, several studies have carefully examined their effects. L-leucine and its derivatives appear to regulate protein synthesis by direct or indirect activation of the mTORC1 pool of kinases, further promoting muscle protein balance. Arginine and glutamine may act by reducing inflammation and infection progression, thus promoting improvements in food intake. Creatine exerts anabolic activity, acting as an immediate energy substrate to support muscle contraction further increasing lean mass, mainly due to greater water uptake by the muscle. In this narrative review, we highlighted the main findings regarding protein consumption and amino acids to mitigate cancer-induced skeletal muscle depletion.
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Affiliation(s)
- Jéssika D P Soares
- Laboratorio de Investigacao em Nutricao Clinica e Esportiva (Labince), Faculdade de Nutricao, Universidade Federal de Goias, Goiania, Brazil
| | - Scott L Howell
- School of Health Sciences, Faculty Health Science, Trident University International, Cypress, CA 90630, United States
| | - Filipe J Teixeira
- CBIOS (Research Center for Biosciences & Health Technologies), Universidade Lusófona de Humanidades e Tecnologias, Campo Grande 376, 1749-024 Lisboa, Portugal
| | - Gustavo D Pimentel
- Laboratorio de Investigacao em Nutricao Clinica e Esportiva (Labince), Faculdade de Nutricao, Universidade Federal de Goias, Goiania, Brazil
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32
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Yu JI, Choi C, Lee J, Kang WK, Park SH, Kim ST, Hong JY, Kim S, Sohn TS, Lee JH, An JY, Choi MG, Bae JM, Kim KM, Han H, Kim K, Nam H, Lim DH. Effect of baseline sarcopenia on adjuvant treatment for D2 dissected gastric cancer: Analysis of the ARTIST phase III trial. Radiother Oncol 2020; 152:19-25. [PMID: 32739319 DOI: 10.1016/j.radonc.2020.07.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/20/2020] [Accepted: 07/27/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE This study evaluated the clinical significance of preoperative sarcopenia according to adjuvant concurrent chemo-radiotherapy (XP-RT) or chemotherapy alone (XP) in the D2 dissected gastric cancer patient cohort of the ARTIST trial. MATERIALS AND METHODS Skeletal muscles at the L3 vertebra level from preoperative computed tomography images among the ARTIST trial participants were measured using validated in-house software. Skeletal muscle index (SMI) was defined as the measured skeletal muscle area divided by the square of the height, and sarcopenia was defined according to the Korean-specific cutoff, i.e. L3 SMI ≤ 49 cm2/m2 for men and ≤31 cm2/m2 for women. RESULTS Among the 440 patients in whom we were able to evaluate L3 SMI, 75 (17.0%) met the definition for preoperative sarcopenia. No differences in treatment-related toxicities or treatment compliance were observed according to the presence of preoperative sarcopenia in either treatment arm. In the subgroup of patients without preoperative sarcopenia, recurrence was significantly lower in the XP-RT arm than that in the XP arm (p = 0.02). Recurrence-free survival (RFS) was also significantly higher in the XP-RT arm (p = 0.02, hazard ratio 0.633, 95% confidence interval 0.433-0.926) in this subgroup. In the multivariate analysis, and after adjusting for significant prognostic factors, the superior outcome of XP-RT arm regarding RFS was maintained in the subgroup of the patients without preoperative sarcopenia. CONCLUSIONS Superior clinical outcomes of adjuvant XP-RT over XP were only observed in patients without preoperative sarcopenia.
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Affiliation(s)
- Jeong Il Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Changhoon Choi
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeeyun Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won Ki Kang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Se Hoon Park
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung Tae Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung Yong Hong
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Sung Sohn
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jun Ho Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Yeong An
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Min Gew Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Moon Bae
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyoung-Mee Kim
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Heewon Han
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Kyunga Kim
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Heerim Nam
- Department of Radiation Oncology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Do Hoon Lim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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33
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Sarcopenia: looking to muscle mass to better manage pancreatic cancer patients. Curr Opin Support Palliat Care 2020; 13:279-285. [PMID: 31361630 DOI: 10.1097/spc.0000000000000455] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Overall survival of patients with pancreatic cancer is strongly conditioned by tumor biology and the incidence of malnutrition and metabolic disorders. In this landscape, the assessment of body composition is crucial to properly manage the clinical implications of muscle wasting. The pathogenesis of this condition is the result of a complex interplay between cancer and the host. In particular, sarcopenia is induced by an inadequate nutritional intake, hormonal abnormalities, inflammation and imbalance between anabolic and catabolic pathways. RECENT FINDINGS Recent evidences have highlighted the role of sarcopenia in cancer patients, revealing a prognostic impact on morbidity, mortality and survival. SUMMARY The occurrence of sarcopenia could amplify chemotherapy-induced toxicities, prolong hospitalizations and reduce adherence to anticancer treatment, worsening quality of life and survival. Although considerable efforts have been made to develop treatment strategies, no effective interventions have been identified so far. Nevertheless, if promptly and adequately supported, pancreatic cancer might benefit from adopted dietary intervention to avoid further loss of lean mass.
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Liu X, Xue Z, Yu J, Li Z, Ma Z, Kang W, Ye X, Jiang L. Risk Factors for Postoperative Infectious Complications in Elderly Patients with Gastric Cancer. Cancer Manag Res 2020; 12:4391-4398. [PMID: 32606934 PMCID: PMC7293399 DOI: 10.2147/cmar.s253649] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/16/2020] [Indexed: 12/24/2022] Open
Abstract
Background Elderly patients with gastric cancer (GC) are at increased risk of infectious complications following gastrectomy. A limited set of risk factors has been identified to predict complications in these patients. To improve the safety of gastrectomy in this population, we investigated the incidence of infectious complications and associated clinicopathologic, nutritional and surgical risk factors in a cohort of elderly patients with GC. Methods Elderly GC patients (≥70 years) who underwent gastrectomy between January 2013 and December 2017 in Peking Union Medical College Hospital were included in the study. Clinicopathologic data were collected retrospectively. Severity of complications was classified using the Clavien–Dindo system. Infectious complications were assessed based on clinical diagnosis of health care-associated infection as defined by the US Centers for Disease Control and Prevention. Multivariate logistic regression analyses were performed to determine the risk factors for infectious complications. Results Three hundred thirty-one consecutive patients were included, with a median age of 74 years (range 70–88). The rate of surgical morbidity was 37.5% and the mortality rate was 1.2%. The incidence of infectious complications was 19.6%, with the most common infectious complication being pulmonary infection (11.5%). Preoperative weight loss ≥5% (odds ratio [OR] = 2.21; 95% CI, 1.15–4.28; p = 0.018), Charlson comorbidity index score ≥3 (OR = 2.83; 95% CI, 1.30–6.16; p = 0.009) and preoperative hsCRP level ≥10 mg/L (OR = 2.48; 95% CI, 1.14–5.38; p = 0.022) were independently associated with infectious complications. Conclusion Preoperative weight loss, elevated hsCRP level and comorbidity burden can be used to predict postoperative infectious complications in elderly GC patients. It is recommended to pay more attention to the treatment of elderly GC patients with these risk factors.
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Affiliation(s)
- Xiao Liu
- Department of Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Zhigang Xue
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Jianchun Yu
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Zijian Li
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Zhiqiang Ma
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Weiming Kang
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Xin Ye
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Lin Jiang
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
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35
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Nishigori T, Obama K, Sakai Y. Assessment of body composition and impact of sarcopenia and sarcopenic obesity in patients with gastric cancer. Transl Gastroenterol Hepatol 2020; 5:22. [PMID: 32258526 DOI: 10.21037/tgh.2019.10.13] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 10/21/2019] [Indexed: 12/16/2022] Open
Abstract
Malnutrition is a critical problem in patients with gastric cancer (GC); however, no universally accepted marker that is convenient for clinical use has been defined. Recently, body composition has attracted considerable attention as a means to assess nutrition status in patients with cancer. The clinical role of skeletal muscle mass has also been increasingly recognized. In patients with GC, sarcopenia, which is the loss of skeletal muscle mass, was found to be significantly associated with increased post-surgical complications including hospital stay, healthcare costs, and poor survival. In addition, sarcopenic obesity, which combines the health risks of obesity and sarcopenia, is recognized as a strong risk factor for poor short- and long-term outcomes following gastrectomy. The mechanism linking sarcopenia to worse postoperative outcomes remains unclear; however, skeletal muscle has been found to act as an endocrine organ that produces substances affecting the immune system. In addition, sarcopenia was reported to be associated with toxicity and termination of chemotherapy. Patients with sarcopenia may be unable to react appropriately to the stress of gastrectomy and perioperative chemotherapy. To improve the short- and long-term outcomes of patients with GC and sarcopenia, adequate energy and protein intake are necessary during resistance training. In the present study, we performed a literature review and presented a method to evaluate body composition, the relationship between skeletal muscle mass and GC, and perioperative nutrition and exercise therapy for patients with sarcopenia.
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Affiliation(s)
- Tatsuto Nishigori
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazutaka Obama
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshiharu Sakai
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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36
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Feng W, Huang M, Zhao X, Chen S, Wang C, Chang J, Guo W, Chen Z, Zhu H, Zhu X. Severe loss of visceral fat and skeletal muscle after chemotherapy predicts poor prognosis in metastatic gastric cancer patients without gastrectomy. J Cancer 2020; 11:3310-3317. [PMID: 32231736 PMCID: PMC7097939 DOI: 10.7150/jca.37270] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 02/02/2020] [Indexed: 12/14/2022] Open
Abstract
Background: The influence of body composition parameters in cancer prognosis attracted researchers' attention. This study investigated the role of visceral fat and skeletal muscle in the prognosis and efficacy of chemotherapy in metastatic gastric cancer (MGC). Methods: This study included MGC patients without gastrectomy treated with EOF regimen (epirubicin, oxaliplatin and fluorouracil), who participated in a Phase II clinical trial (NCT00767377) with available PACS image data. The visceral fat area (VFA) and skeletal muscle area (SMA) were measured using standard computed tomography (CT). Results: A total of 46 patients were enrolled in the study. Patients with low baseline VFA and SMA had significantly shorter PFS and OS. In addition, the loss of VFA and SMA also predicts significantly shorter PFS and OS. A prognostic index that included two risk factors, severe loss of VFA and SMA, was used to categorize the patients into two groups: good-risk group (0 risk factors), poor-risk group (1 or 2 risk factors). Compared with the good-risk group, the poor-risk group displayed a 3.562-fold-increased risk of progression [hazard ratio (HR) 3.652, 95 % CI 1.653-7.678; P =0.001] and 2.859-fold-increased risk of death [hazard ratio (HR) 2.859, 95 % CI 1.271-6.434; P =0.011]. Conclusion: Low baseline VFA and SMA, as well as the severe loss of VFA and SMA predict poor prognosis for MGC patients treated by EOF regimen. In patients with severe loss of VFA and/or SMA after 2-cycle chemotherapy, the decision of subsequent chemotherapy should be made after deliberate consideration.
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Affiliation(s)
- Wanjing Feng
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, 270 Dong' An Road, Shanghai200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, 130 Dong' An Road, Shanghai 200032, People's Republic of China
| | - Mingzhu Huang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, 270 Dong' An Road, Shanghai200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, 130 Dong' An Road, Shanghai 200032, People's Republic of China
| | - Xiaoying Zhao
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, 270 Dong' An Road, Shanghai200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, 130 Dong' An Road, Shanghai 200032, People's Republic of China
| | - Siyuan Chen
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, 270 Dong' An Road, Shanghai200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, 130 Dong' An Road, Shanghai 200032, People's Republic of China
| | - Chenchen Wang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, 270 Dong' An Road, Shanghai200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, 130 Dong' An Road, Shanghai 200032, People's Republic of China
| | - Jinjia Chang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, 270 Dong' An Road, Shanghai200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, 130 Dong' An Road, Shanghai 200032, People's Republic of China
| | - Weijian Guo
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, 270 Dong' An Road, Shanghai200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, 130 Dong' An Road, Shanghai 200032, People's Republic of China
| | - Zhiyu Chen
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, 270 Dong' An Road, Shanghai200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, 130 Dong' An Road, Shanghai 200032, People's Republic of China
| | - Hui Zhu
- Department of Oncology, Shanghai Medical College, Fudan University, 130 Dong' An Road, Shanghai 200032, People's Republic of China.,Department of Radiology, Fudan University Shanghai Cancer Center, 270 Dong' An Road, Shanghai200032, People's Republic of China
| | - Xiaodong Zhu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, 270 Dong' An Road, Shanghai200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, 130 Dong' An Road, Shanghai 200032, People's Republic of China
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37
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Caccialanza R, Cereda E, Klersy C, Brugnatelli S, Borioli V, Ferrari A, Caraccia M, Lobascio F, Pagani A, Delfanti S, Aprile G, Reni M, Rimassa L, Melisi D, Cascinu S, Battistini L, Candiloro F, Pedrazzoli P. Early intravenous administration of nutritional support (IVANS) in metastatic gastric cancer patients at nutritional risk, undergoing first-line chemotherapy: study protocol of a pragmatic, randomized, multicenter, clinical trial. Ther Adv Med Oncol 2020; 12:1758835919890281. [PMID: 32127922 PMCID: PMC7036492 DOI: 10.1177/1758835919890281] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/29/2019] [Indexed: 12/15/2022] Open
Abstract
Background Malnutrition is common in cancer patients, particularly in those affected by gastrointestinal malignancies, and negatively affects treatment tolerance, survival, functional status, and quality of life (QoL). Nutritional support, including supplemental parenteral nutrition (SPN), has been recommended at the earliest opportunity in malnourished cancer patients. The limited available evidence on the efficacy of SPN in gastrointestinal cancer patients is positive, particularly with regards to QoL, body composition, and energy intake, but the evidence on survival is still scanty. Furthermore, studies regarding the early administration of SPN in combination with nutritional counseling from the beginning of first-line chemotherapy (CT) are lacking. We hypothesize that early systematic SPN in combination with nutritional counseling (NC), compared with NC alone, can benefit patients with previously untreated metastatic gastric cancer at nutritional risk undergoing first-line CT. Methods The aim of this pragmatic, multicenter, randomized (1:1), parallel-group, open-label, controlled clinical trial is to evaluate the efficacy in terms of survival, weight maintenance, body composition, QoL and feasibility of cancer therapy of early systematic SNP. This is in combination with NC, compared with NC alone, in treatment-naïve metastatic gastric cancer patients at nutritional risk undergoing first-line CT. Discussion Malnutrition in oncology remains an overlooked problem. Although the importance of SPN in gastrointestinal cancer patients has been acknowledged, no studies have yet evaluated the efficacy of early SPN in metastatic gastric patients undergoing CT. The present study, which guarantees the early provision of nutritional assessment and support to all the enrolled patients in accordance with the recent guidelines and recommendations, could represent one of the first proofs of the clinical effectiveness of early intensive nutritional support in cancer patients undergoing CT. This study could stimulate further large randomized trials in different cancer types, potentially resulting in the improvement of supportive care quality. Trial registration This study is registered on ClinicalTrials.gov: NCT03949907.
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Affiliation(s)
- Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, Pavia 27100, Italy
| | - Emanuele Cereda
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Catherine Klersy
- Biometry and Clinical Epidemiology Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Silvia Brugnatelli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valeria Borioli
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandra Ferrari
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marilisa Caraccia
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Federica Lobascio
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Anna Pagani
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sara Delfanti
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| | - Michele Reni
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Clinical and Research Center IRCCS, Rozzano (Milan), Italy
| | - Davide Melisi
- Digestive Molecular Clinical Oncology Research Unit, Section of Medical Oncology, Department of Medicine, University of Verona, Verona, Italy
| | - Stefano Cascinu
- Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Luca Battistini
- Neuroimmunology Unit, IRCCS Santa Lucia Foundation, Rome, Italy
| | | | - Paolo Pedrazzoli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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38
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Babic A, Rosenthal MH, Bamlet WR, Takahashi N, Sugimoto M, Danai LV, Morales-Oyarvide V, Khalaf N, Dunne RF, Brais LK, Welch MW, Zellers CL, Dennis C, Rifai N, Prado CM, Caan B, Sundaresan TK, Meyerhardt JA, Kulke MH, Clish CB, Ng K, Vander Heiden MG, Petersen GM, Wolpin BM. Postdiagnosis Loss of Skeletal Muscle, but Not Adipose Tissue, Is Associated with Shorter Survival of Patients with Advanced Pancreatic Cancer. Cancer Epidemiol Biomarkers Prev 2019; 28:2062-2069. [PMID: 31533940 DOI: 10.1158/1055-9965.epi-19-0370] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/29/2019] [Accepted: 08/27/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Pancreatic cancer is associated with development of cachexia, a wasting syndrome thought to limit survival. Few studies have longitudinally quantified peripheral tissues or identified biomarkers predictive of future tissue wasting. METHODS Adipose and muscle tissue were measured by computed tomography (CT) at diagnosis and 50 to 120 days later in 164 patients with advanced pancreatic cancer. Tissue changes and survival were evaluated by Cox proportional hazards regression. Baseline levels of circulating markers were examined in relation to future tissue wasting. RESULTS Compared with patients in the bottom quartile of muscle change per 30 days (average gain of 0.8 ± 2.0 cm2), those in the top quartile (average loss of 12.9 ± 4.9 cm2) had a hazard ratio (HR) for death of 2.01 [95% confidence interval (CI), 1.12-3.62]. Patients in the top quartile of muscle attenuation change (average decrease of 4.9 ± 2.4 Hounsfield units) had an HR of 2.19 (95% CI, 1.18-4.04) compared with those in the bottom quartile (average increase of 2.4 ± 1.6 Hounsfield units). Changes in adipose tissue were not associated with survival. Higher plasma branched chain amino acids (BCAA; P = 0.004) and lower monocyte chemoattractant protein-1 (MCP-1; P = 0.005) at diagnosis were associated with greater future muscle loss. CONCLUSIONS In patients with advanced pancreatic cancer, muscle loss and decrease in muscle density in 2 to 4 months after diagnosis were associated with reduced survival. BCAAs and MCP-1 levels at diagnosis were associated with subsequent muscle loss. IMPACT BCAAs and MCP-1 levels at diagnosis could identify a high-risk group for future tissue wasting.
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Affiliation(s)
- Ana Babic
- Dana-Farber Cancer Institute, Boston, Massachusetts.
| | - Michael H Rosenthal
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | | | - Laura V Danai
- Department of Biochemistry and Molecular Biology, University of Massachusetts Amherst, Amherst, Massachusetts
| | | | - Natalia Khalaf
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts
| | - Richard F Dunne
- Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, New York
| | | | | | | | - Courtney Dennis
- Broad Institute of MIT and Harvard University, Cambridge, Massachusetts
| | - Nader Rifai
- Department of Pathology, Boston Children's Hospital, Boston, Massachusetts
| | - Carla M Prado
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Canada
| | - Bette Caan
- Kaiser Permanente Division of Research, Oakland, California
| | | | | | - Matthew H Kulke
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Boston University and Boston Medical Center, Section of Hematology/Oncology, Boston, Massachusetts
| | - Clary B Clish
- Broad Institute of MIT and Harvard University, Cambridge, Massachusetts
| | - Kimmie Ng
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Matthew G Vander Heiden
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Koch Institute for Integrative Cancer Research and Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts
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Sierzega M, Chrzan R, Wiktorowicz M, Kolodziejczyk P, Richter P. Prognostic and predictive implications of sarcopenia in Western patients undergoing gastric resections for carcinoma of the stomach. J Surg Oncol 2019; 120:473-482. [PMID: 31124178 DOI: 10.1002/jso.25509] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/03/2019] [Accepted: 05/06/2019] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Sarcopenia is highly prevalent in patients with gastrointestinal malignancies, including gastric cancer, but there is a lack of adequate data from Western populations. METHODS Computed tomography scans of 138 Caucasian patients subject to stomach resections due to gastric adenocarcinoma between 2012 and 2015 were reviewed to evaluate the impact of sarcopenia. The definition of sarcopenia was based on the lumbar skeletal muscle index (SMI) using cut-off values formulated by the international consensus definitions of sarcopenia (SMI <52.4 cm2 /m2 for men and <38.5 cm2 /m2 for women). RESULTS Sixty (43%) of 138 patients were sarcopenic. Sarcopenia was associated with postoperative morbidity (43% vs 23%; P = .011), major postoperative complications (Clavien-Dindo ≥3a; 36% vs 21%; P = .035), and reoperations (23% vs 9%; P = .020). Patients with sarcopenia also had prolonged postoperative hospital stay (8.0 vs 6.5 days; P = .010). The overall median survival of patients with sarcopenia was significantly lower than those with normal skeletal muscles (11.0 vs 36.7 months; P = .005) and sarcopenia remained an independent prognostic factor with an odds ratio of 1.94 (95% confidence interval, 1.08 to 3.48; P = .026). CONCLUSION Sarcopenia, defined by SMI, is associated with an increased risk of postoperative morbidity and impaired long-term survival.
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Affiliation(s)
- Marek Sierzega
- First Department of Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Robert Chrzan
- Department of Radiology, Jagiellonian University Medical College, Krakow, Poland
| | - Milosz Wiktorowicz
- First Department of Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Piotr Kolodziejczyk
- First Department of Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Piotr Richter
- First Department of Surgery, Jagiellonian University Medical College, Krakow, Poland
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40
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Basile D, Parnofiello A, Vitale MG, Cortiula F, Gerratana L, Fanotto V, Lisanti C, Pelizzari G, Ongaro E, Bartoletti M, Garattini SK, Andreotti VJ, Bacco A, Iacono D, Bonotto M, Casagrande M, Ermacora P, Puglisi F, Pella N, Fasola G, Aprile G, Cardellino GG. The IMPACT study: early loss of skeletal muscle mass in advanced pancreatic cancer patients. J Cachexia Sarcopenia Muscle 2019; 10:368-377. [PMID: 30719874 PMCID: PMC6463465 DOI: 10.1002/jcsm.12368] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/03/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pancreatic cancer (PC) patients have multiple risk factors for sarcopenia and loss of skeletal muscle mass (LSMM), which may cause greater treatment toxicities, reduced response to cancer therapy, prolonged hospitalization, impaired quality of life, and worse prognosis. METHODS This is a retrospective study on advanced PC patients treated at the Department of Oncology of Udine, Italy, from January 2012 to November 2017. Among 162 patients who received chemotherapy, 94 consecutive patients with an available computed tomography (CT) scan were retrospectively analyzed. The primary objective of our study was to explore if an early LSMM ≥ 10% (measured at first radiological evaluation and compared with baseline) and/or baseline sarcopenia may impact prognosis. Baseline sarcopenia was defined according to Prado's criteria. Skeletal muscle area was measured as cross-sectional areas (cm2 ) using CT scan data through the Picture archiving and communication system (PACS) image system. RESULTS In the whole cohort, 48% of patients were ≤70 years old, and 50% had metastatic disease. At baseline, 73% of patients had sarcopenia, and 16% presented a visceral fat area ≥ 44 cm2 /m2 . Overall, 21% experienced an early LSMM ≥ 10%. Approximately 33% of sarcopenic patients at baseline and ~35% of patients with early LSMM ≥ 10% had a body mass index > 25 kg/m2 . Of note, 71% of patients were evaluated by a nutritionist, and 56% received a dietary supplementation (oral and/or parenteral). After a median follow-up of 30.44 months, median overall survival (OS) was 11.28 months, whereas median progression-free survival (PFS) was 5.72 months. By multivariate analysis, early LSMM ≥ 10% was significantly associated with worse OS [hazard ratio (HR): 2.16; 95% confidence interval (CI) 1.23-3.78; P = 0.007] and PFS (HR: 2.31; 95% CI 1.30-4.09; P = 0.004). Moreover, an exploratory analysis showed that inflammatory indexes, such as neutrophil-lymphocyte ratio variation, impact early LSMM ≥ 10% (odds ratio 1.31, 95% CI 1.06-1.61, P = 0.010). CONCLUSIONS Early LSMM ≥ 10% has a negative prognostic role in advanced PC patients. Further prospective investigations are needed to confirm these preliminary data.
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Affiliation(s)
- Debora Basile
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Annamaria Parnofiello
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Maria Grazia Vitale
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Francesco Cortiula
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Lorenzo Gerratana
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Valentina Fanotto
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Camilla Lisanti
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Giacomo Pelizzari
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Elena Ongaro
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Michele Bartoletti
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Silvio Ken Garattini
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Victoria Josephine Andreotti
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Anna Bacco
- Department of Endocrinology, University Hospital of Udine, Udine, UD, Italy
| | - Donatella Iacono
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Marta Bonotto
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | | | - Paola Ermacora
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Fabio Puglisi
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, PN, Italy
| | - Nicoletta Pella
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Gianpiero Fasola
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, ULSS8 Berica, East District, Vicenza, VI, Italy
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41
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Park HS, Lee JB, Jung M. ASO Author Reflections: Prognostic Impact of Body Composition Change After Gastrectomy for Advanced Gastric Cancer. Ann Surg Oncol 2018; 25:765-766. [PMID: 30421047 DOI: 10.1245/s10434-018-7017-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Hyung Soon Park
- Division of Medical Oncology, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Jii Bum Lee
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Minkyu Jung
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-gu, Seoul, 03722, Korea.
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42
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Zheng Z, Lu J, Xie J, Wang J, Lin J, Chen Q, Cao L, Lin M, Tu R, Zheng C, Huang C, Li P. Preoperative skeletal muscle index vs the controlling nutritional status score: Which is a better objective predictor of long-term survival for gastric cancer patients after radical gastrectomy? Cancer Med 2018; 7:3537-3547. [PMID: 29953752 PMCID: PMC6089186 DOI: 10.1002/cam4.1548] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/13/2018] [Accepted: 04/18/2018] [Indexed: 12/21/2022] Open
Abstract
Skeletal muscle index (SMI) and the controlling nutritional status (CONUT) score are useful for evaluating nutritional status, which is closely associated with cancer prognosis. This study compared the prognostic value of these indicators in patients with gastric cancer (GC) after radical gastrectomy (RG). We retrospectively enrolled 532 patients between 2010 and 2011. SMI was measured via CT images to determine low SMI. The CONUT score was calculated based on serum albumin, total lymphocyte count, and cholesterol. Patients were grouped according to SMI and the CONUT score based on previous research. Spearman's correlation coefficient, the Kaplan-Meier method, and Cox regression were used. There was no significant correlation between SMI and the CONUT score. Five-year overall survival (OS) and recurrence-free survival (RFS) in patients with low SMI were significantly worse than those in patients with high SMI (P < .001). The normal nutrition group had better OS and RFS than did the light and moderate or severe malnutrition groups (P < .05), but the OS and RFS were not significantly different between the light and moderate or severe malnutrition groups (P = .726). Univariate analysis showed that SMI and the CONUT score were associated with OS and RFS, but only SMI remained prognostic in multivariate analysis. Preoperative SMI based on CT images is a more objective predictor than the CONUT score of long-term survival in GC after RG, but this finding must be confirmed by prospective trials.
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Affiliation(s)
- Zhi‐Fang Zheng
- Department of Gastric SurgeryFujian Medical University Union HospitalFuzhouChina
- Department of General SurgeryFujian Medical University Union HospitalFuzhouChina
| | - Jun Lu
- Department of Gastric SurgeryFujian Medical University Union HospitalFuzhouChina
- Department of General SurgeryFujian Medical University Union HospitalFuzhouChina
| | - Jian‐Wei Xie
- Department of Gastric SurgeryFujian Medical University Union HospitalFuzhouChina
- Department of General SurgeryFujian Medical University Union HospitalFuzhouChina
| | - Jia‐Bin Wang
- Department of Gastric SurgeryFujian Medical University Union HospitalFuzhouChina
- Department of General SurgeryFujian Medical University Union HospitalFuzhouChina
- Key Laboratory of Ministry of Education of Gastrointestinal CancerFujian Medical UniversityFuzhouChina
- Fujian Key Laboratory of Tumor MicrobiologyFujian Medical UniversityFuzhouChina
| | - Jian‐Xian Lin
- Department of Gastric SurgeryFujian Medical University Union HospitalFuzhouChina
- Department of General SurgeryFujian Medical University Union HospitalFuzhouChina
- Key Laboratory of Ministry of Education of Gastrointestinal CancerFujian Medical UniversityFuzhouChina
- Fujian Key Laboratory of Tumor MicrobiologyFujian Medical UniversityFuzhouChina
| | - Qi‐Yue Chen
- Department of Gastric SurgeryFujian Medical University Union HospitalFuzhouChina
- Department of General SurgeryFujian Medical University Union HospitalFuzhouChina
| | - Long‐Long Cao
- Department of Gastric SurgeryFujian Medical University Union HospitalFuzhouChina
- Department of General SurgeryFujian Medical University Union HospitalFuzhouChina
| | - Mi Lin
- Department of Gastric SurgeryFujian Medical University Union HospitalFuzhouChina
- Department of General SurgeryFujian Medical University Union HospitalFuzhouChina
| | - Ru‐Hong Tu
- Department of Gastric SurgeryFujian Medical University Union HospitalFuzhouChina
- Department of General SurgeryFujian Medical University Union HospitalFuzhouChina
| | - Chao‐Hui Zheng
- Department of Gastric SurgeryFujian Medical University Union HospitalFuzhouChina
- Department of General SurgeryFujian Medical University Union HospitalFuzhouChina
- Key Laboratory of Ministry of Education of Gastrointestinal CancerFujian Medical UniversityFuzhouChina
- Fujian Key Laboratory of Tumor MicrobiologyFujian Medical UniversityFuzhouChina
| | - Chang‐Ming Huang
- Department of Gastric SurgeryFujian Medical University Union HospitalFuzhouChina
- Department of General SurgeryFujian Medical University Union HospitalFuzhouChina
- Key Laboratory of Ministry of Education of Gastrointestinal CancerFujian Medical UniversityFuzhouChina
- Fujian Key Laboratory of Tumor MicrobiologyFujian Medical UniversityFuzhouChina
| | - Ping Li
- Department of Gastric SurgeryFujian Medical University Union HospitalFuzhouChina
- Department of General SurgeryFujian Medical University Union HospitalFuzhouChina
- Key Laboratory of Ministry of Education of Gastrointestinal CancerFujian Medical UniversityFuzhouChina
- Fujian Key Laboratory of Tumor MicrobiologyFujian Medical UniversityFuzhouChina
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Baldessari C, Gelsomino F, Spallanzani A, Pugliese G, Reggiani Bonetti L, Bettelli S, Cascinu S. Beyond the Beyond: A Case of an Extraordinary Response to Multiple Lines of Therapy in a de novo Metastatic HER2-Negative Gastric Cancer Patient. Gastrointest Tumors 2018; 5:14-20. [PMID: 30574477 DOI: 10.1159/000488983] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 03/29/2018] [Indexed: 12/14/2022] Open
Abstract
Background Gastric cancer is the fourth cause of cancer-related death in Europe and the prognosis of these patients remains dismal. It has been demonstrated that chemotherapy improved survival compared with best supportive care and recently, subsequent lines of therapy, also with new drugs, obtained positive results. Summary We present the case of a patient diagnosed with a de novo metastatic gastric cancer who experienced an extraordinary long response to multiple lines of chemotherapy (FOLFOX6, paclitaxel plus ramucirumab, FOLFIRI, rechallenge with FOLFOX6). Key Message Gastric cancer therapy should be considered as the result of a strategy based on the patient's condition, and tolerance and response to various therapies. The emerging evidence of the role of subsequent lines of therapy, along with the recognition of the pivotal role of nutritional support and the availability of new drugs, should help clinicians in the management of patients with gastric cancer. Practical Implications We propose a practical therapeutic algorithm in order to help clinicians who deal with patients with gastric cancer.
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Affiliation(s)
- Cinzia Baldessari
- Department of Oncology and Haematology, Università di Modena e Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Fabio Gelsomino
- Department of Oncology and Haematology, Università di Modena e Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Andrea Spallanzani
- Department of Oncology and Haematology, Università di Modena e Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Giuseppe Pugliese
- Department of Oncology and Haematology, Università di Modena e Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Luca Reggiani Bonetti
- Department of Diagnostic Medicine and Public Health, Section of Pathology, Università di Modena e Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Stefania Bettelli
- Department of Diagnostic Medicine and Public Health, Section of Pathology, Università di Modena e Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Stefano Cascinu
- Department of Oncology and Haematology, Università di Modena e Reggio Emilia, Policlinico di Modena, Modena, Italy
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44
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Park HS, Kim HS, Beom SH, Rha SY, Chung HC, Kim JH, Chun YJ, Lee SW, Choe EA, Heo SJ, Noh SH, Hyung WJ, Cheong JH, Kim HI, Son T, Lim JS, Baek SE, Jung M. 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. Ann Surg Oncol 2018; 25:3222-3230. [PMID: 30051367 DOI: 10.1245/s10434-018-6624-1] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is increasing interest in the influence of body composition on oncological outcomes. We evaluated the role of skeletal muscle and fat among patients with gastric cancer (GC) who underwent gastrectomy with or without adjuvant chemotherapy, as well as those changes' associations with survival outcomes. METHODS The present study evaluated 136 patients with GC who were enrolled in the CLASSIC Trial at Yonsei Cancer Center. Baseline body compositions including skeletal muscle area, Hounsfield units (HU), visceral fat area, and subcutaneous fat area were measured by preoperative computed tomography (CT). CT before and after the gastrectomy were used to determine the 6-month relative changes in body composition parameters. Continuous variables were dichotomized according to the best cutoff values by Contal and O'Quigley method. RESULTS Seventy-three patients (53.7%) underwent surgery alone, and 63 patients (46.3%) underwent surgery followed by adjuvant chemotherapy. The baseline body composition parameters were not associated with disease-free survival (DFS) or overall survival (OS). Except for the HU, the marked loss of muscle, visceral fat, or subcutaneous fat significantly predicted shorter DFS and OS. Patients with a marked loss in at least one significant body composition parameter had significantly shorter DFS (hazard ratio 2.9, 95% confidence interval 1.7-4.8, P < 0.001) and OS (hazard ratio 2.9, 95% confidence interval 1.7-5.0, P < 0.001). CONCLUSIONS 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.
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Affiliation(s)
- Hyung Soon Park
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.,Division of Medical Oncology, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Hyo Song Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Hoon Beom
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Sun Young Rha
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Cheol Chung
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jee Hung Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - You Jin Chun
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Si Won Lee
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Eun-Ah Choe
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Su Jin Heo
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Hoon Noh
- Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jae-Ho Cheong
- Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Hyoung-Il Kim
- Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Taeil Son
- Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Seok Lim
- Division of Abdominal Imaging, Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Song-Ee Baek
- Division of Abdominal Imaging, Department of Radiology, Yonsei University College of Medicine, Seoul, Korea.
| | - Minkyu Jung
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
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