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Preoperative skeletal muscle index and visceral-to-subcutaneous fat area ratio are associated with long-term outcomes of elderly gastric cancer patients after gastrectomy

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Abstract

Purpose

Sarcopenia is a risk factor of severe surgical complications, short-term outcomes, and long-term outcomes for patients with gastric cancer. Several computed tomography (CT) measurements have been performed to diagnose sarcopenia. However, the optimal CT measurements for determining long-term outcomes have not been revealed.

Methods

A retrospective review of gastric cancer patients with clinical stage I, II, or III who underwent gastrectomy at age 75 years or more at Shizuoka General Hospital from 2007 to 2015 was performed. Using preoperative CT, skeletal muscle index (SMI), total psoas area, intramuscular adipose tissue content in multifidus muscle, morphologic change of psoas muscle, and visceral-to-subcutaneous adipose tissue area ratio (VSR) were measured in the third lumbar section. A Cox regression analysis was used to explore prognostic factors for overall survival.

Results

A total of 257 patients were reviewed. There were 171, 53, and 33 patients with clinical stages I, II, and III, respectively. A multivariate analysis indicated that, in addition to age, performance status, clinical stage, and types of resection, which are known prognostic factors, SMI and VSR are prognostic factors (p = 0.016, 0.046, respectively). The prognostic score, which was the frequency of positive SMI and VSR values within the cutoff, also indicates overall survival. The five-year OS rates of patients with prognostic scores of 0, 1, and 2 were 90.9%, 62.3%, and 52%, respectively (p < 0.001).

Conclusion

Preoperative SMI and VSR were prognostic factors for the overall survival of elderly patients with gastric cancer after gastrectomy.

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References

  1. Rosenberg IH (1989) Summary comments: epidemiological and methodological problems in determining nutritional status of older persons. Am J Clin Nutr. 50:1231

    Article  Google Scholar 

  2. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y et al (2019) Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 48:16–31

    Article  Google Scholar 

  3. Bray F, Ferlay J, Soerjomataram I, Siegel RL et al (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 68:394–424

    Article  Google Scholar 

  4. Japanese Gastric Cancer Association (2020) Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer

  5. Simonsen C, de Heer P, Bjerre ED, Suetta C et al (2018) Sarcopenia and postoperative complication risk in gastrointestinal surgical oncology: a meta-analysis. Ann Surg. 268:58–69

    Article  Google Scholar 

  6. Zhuang CL, Huang DD, Pang WY, Zhou CJ et al (2016) Sarcopenia is an independent predictor of severe postoperative complications and long-term survival after radical gastrectomy for gastric cancer: analysis from a large-scale cohort. Medicine (Baltimore). 95:e3164

    Article  Google Scholar 

  7. Sakurai K, Kubo N, Tamura T, Toyokawa T et al (2017) Adverse effects of low preoperative skeletal muscle mass in patients undergoing gastrectomy for gastric cancer. Ann Surg Oncol. 24:2712–2719

    Article  Google Scholar 

  8. Fukuda Y, Yamamoto K, Hirao M, Nishikawa K et al (2016) Sarcopenia is associated with severe postoperative complications in elderly gastric cancer patients undergoing gastrectomy. Gastric Cancer. 19:986–993

    Article  Google Scholar 

  9. Peng PD, van Vledder MG, Tsai S, de Jong MC et al (2011) Sarcopenia negatively impacts short-term outcomes in patients undergoing hepatic resection for colorectal liver metastasis. HPB (Oxford). 13:439–446

    Article  Google Scholar 

  10. Kitajima Y, Hyogo H, Sumida Y, Eguchi Y et al (2013) Severity of non-alcoholic steatohepatitis is associated with substitution of adipose tissue in skeletal muscle. J Gastroenterol Hepatol. 28:1507–1514

    Article  Google Scholar 

  11. Hanaoka M, Yasuno M, Ishiguro M, Yamauchi S et al (2017) Morphologic change of the psoas muscle as a surrogate marker of sarcopenia and predictor of complications after colorectal cancer surgery. Int J Colorectal Dis. 32:847–856

    Article  Google Scholar 

  12. Moon HG, Ju YT, Jeong CY, Jung EJ et al (2008) Visceral obesity may affect oncologic outcome in patients with colorectal cancer. Ann Surg Oncol. 15:1918–1922

    Article  Google Scholar 

  13. Quan H, Li B, Couris CM, Fushimi K et al (2011) Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol. 173:676–682

    Article  Google Scholar 

  14. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 240:205–213

    Article  Google Scholar 

  15. Sobin LH, Gospodarowicz MK (2009) Wittekind C. TNM classification of malignant tumours, 7th edn. Wiley-Blackwell, New York

    Google Scholar 

  16. Japanese Gastric Cancer Association (2017) Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. 20:1–19

    Article  Google Scholar 

  17. Liu Z, Feng F, Guo M, Liu S et al (2017) Distal gastrectomy versus total gastrectomy for distal gastric cancer. Medicine (Baltimore). 96:e6003

    Article  Google Scholar 

  18. Shachar SS, Williams GR, Muss HB, Nishijima TF (2016) Prognostic value of sarcopenia in adults with solid tumours: A meta-analysis and systematic review. Eur J Cancer. 57:58–67

    Article  Google Scholar 

  19. Nishigori T, Tsunoda S, Obama K, Hisamori S et al (2018) Optimal cutoff values of skeletal muscle index to define sarcopenia for prediction of survival in patients with advanced gastric cancer. Ann Surg Oncol. 25:3596–3603

    Article  Google Scholar 

  20. Voron T, Tselikas L, Pietrasz D, Pigneur F et al (2015) Sarcopenia impacts on short- and long-term results of hepatectomy for hepatocellular carcinoma. Ann Surg. 261:1173–1183

    Article  Google Scholar 

  21. Malietzis G, Currie AC, Athanasiou T, Johns N et al (2016) Influence of body composition profile on outcomes following colorectal cancer surgery. Br J Surg. 103:572–580

    Article  CAS  Google Scholar 

  22. Tamandl D, Paireder M, Asari R, Baltzer PA et al (2016) Markers of sarcopenia quantified by computed tomography predict adverse long-term outcome in patients with resected oesophageal or gastro-oesophageal junction cancer. Eur Radiol. 26:1359–1367

    Article  Google Scholar 

  23. Cooper AB, Slack R, Fogelman D, Holmes HM et al (2015) Characterization of anthropometric changes that occur during neoadjuvant therapy for potentially resectable pancreatic cancer. Ann Surg Oncol. 22:2416–2423

    Article  Google Scholar 

  24. Harada K, Ida S, Baba Y, Ishimoto T et al (2016) Prognostic and clinical impact of sarcopenia in esophageal squamous cell carcinoma. Dis Esophagus. 29:627–633

    Article  CAS  Google Scholar 

  25. Rollins KE, Tewari N, Ackner A, Awwad A et al (2016) The impact of sarcopenia and myosteatosis on outcomes of unresectable pancreatic cancer or distal cholangiocarcinoma. Clin Nutr. 35:1103–1109

    Article  Google Scholar 

  26. Chaston TB, Dixon JB (2008) Factors associated with percent change in visceral versus subcutaneous abdominal fat during weight loss: findings from a systematic review. Int J Obes (Lond). 32:619–628

    Article  CAS  Google Scholar 

  27. Gonzalez MC, Pastore CA, Orlandi SP, Heymsfield SB (2014) Obesity paradox in cancer: new insights provided by body composition. Am J Clin Nutr. 99:999–1005

    Article  CAS  Google Scholar 

  28. Martin L, Birdsell L, Macdonald N, Reiman T et al (2013) Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol. 31:1539–1547

    Article  Google Scholar 

  29. Kuwada K, Kuroda S, Kikuchi S, Yoshida R et al (2018) Sarcopenia and comorbidity in gastric cancer surgery as a useful combined factor to predict eventual death from other causes. Ann Surg Oncol. 25:1160–1166

    Article  Google Scholar 

  30. Hu CL, Jin XH, Yuan ZD, Xiong SW et al (2019) Prognostic significance of preoperative skeletal muscle status in patients with gastric cancer after radical gastrectomy. Asia Pac J Clin Nutr. 28:442–449

    PubMed  Google Scholar 

  31. Imamura H, Nishikawa K, Kishi K, Inoue K et al (2016) Effects of an oral elemental nutritional supplement on post-gastrectomy body weight loss in gastric cancer patients: a randomized controlled clinical trial. Ann Surg Oncol. 23:2928–2935

    Article  Google Scholar 

  32. Nakashima Y, Saeki H, Nakanishi R, Sugiyama M et al (2018) Assessment of sarcopenia as a predictor of poor outcomes after esophagectomy in elderly patients with esophageal cancer. Ann Surg. 267:1100–1104

    Article  Google Scholar 

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Funding

This study was supported by the Medical Research Scholarship of the Shizuoka Prefectural Hospital Organization.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-ku, Shizuoka, 420-8527, Japan

    Yusuke Taki, Shinsuke Sato, Kazuya Higashizono, Erina Nagai, Masato Nishida, Masaya Watanabe, Ko Ohata, Hideyuki Kanemoto & Noriyuki Oba

  2. Division of Statistical Analysis in Research Support Center, Shizuoka General Hospital, Shizuoka, Japan

    Eiji Nakatani

Authors
  1. Yusuke Taki
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  2. Shinsuke Sato
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  3. Eiji Nakatani
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  4. Kazuya Higashizono
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  5. Erina Nagai
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  6. Masato Nishida
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  7. Masaya Watanabe
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  8. Ko Ohata
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  9. Hideyuki Kanemoto
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  10. Noriyuki Oba
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Contributions

Study conception and design: Yusuke Taki and Shinsuke Sato. Acquisition of data: Yusuke Taki. Analysis and interpretation of data: Yusuke Taki, Shinsuke Sato, and Eiji Nakatani. Drafting of manuscript: Yusuke Taki. Critical revision of manuscript: Shinsuke Sato, Eiji Nakatani, Kazuya Higashizono, Erina Nagai, Masato Nishida, Masaya Watanabe, Ko Ohata, Hideyuki Kanemoto, and Noriyuki Oba.

Corresponding author

Correspondence to Yusuke Taki.

Ethics declarations

Ethics approval and consent to participate

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The content of this research was disclosed on the hospital’s website, and patients had the opportunity to reject it. The Institutional Review Board of Shizuoka General Hospital approved this study and has determined that individual patient consent is not required due to its retrospective nature. Patients’ data were anonymized and de-identified before analysis.

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The authors declare no competing interests.

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Taki, Y., Sato, S., Nakatani, E. et al. Preoperative skeletal muscle index and visceral-to-subcutaneous fat area ratio are associated with long-term outcomes of elderly gastric cancer patients after gastrectomy. Langenbecks Arch Surg 406, 463–471 (2021). https://doi.org/10.1007/s00423-021-02092-1

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  • DOI: https://doi.org/10.1007/s00423-021-02092-1

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