Impact of skeletal muscle mass in patients with unresectable gastric cancer who received palliative first-line chemotherapy based on 5-fluorouracil

Abstract Background The mortality rate of patients with unresectable gastric cancer (UGC) has decreased with the development of chemotherapies and surgical techniques. However, the survival rate remains low. We retrospectively examined the prognostic significance of the pretreatment skeletal muscle mass index (SMI) and nutritional and inflammatory factors in patients with UGC. Methods This study included 83 patients diagnosed with UGC at Tottori University Hospital who received palliative chemotherapy based on 5-fluorouracil. Pretreatment computed tomography (CT) measured overall skeletal muscle mass (SMM) and cross-sectional SMM at the third lumbar vertebra (L3). We focused on the neutrophil-to-lymphocyte ratio (NLR), C-reactive protein-to-albumin ratio (CAR), prognostic nutritional index (PNI), and platelet-to-lymphocyte ratio (PLR) as nutritional and inflammatory factors. Results Receiver operating characteristic curve analysis was performed for median survival time (MST) after palliative chemotherapy. SMIs for males and females (43.9 cm2/m2 and 34.7 cm2/m2, respectively) were the cutoff values, and patients were divided into high (SMIHigh; n = 41) and low SMI groups (SMILow; n = 42). Body mass index (BMI) was significantly higher in patients in the SMIHigh group than in the SMILow group (p < 0.001). The number of patients who received third-line chemotherapy was significantly higher in the SMIHigh group than in the SMILow group (p = 0.037). The MST was significantly higher in the SMIHigh group than in the SMILow group (17.3 vs. 13.8 months; p = 0.008). The incidence of grade 3 or 4 side effects was significantly higher in patients with SMILow UGC (p = 0.028). NLR was significantly higher in patients with SMILow than it was in those with SMIHigh. (p = 0.047). In the univariate analysis, performance status, SMI, histological type, lines of chemotherapy, and NLR were prognostic indicators. The multivariate analysis identified SMI (p = 0.037), NLR (p = 0.002), and lines of chemotherapy (p < 0.001) as independent prognostic factors. Conclusions The SMILow group had significantly more grade 3 or 4 side effects, were related to high NLR, and had a significantly worse prognosis than the SMIHigh group. Trial registration Retrospectively registerd.

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Impact of skeletal muscle mass in patients with recurrent gastric cancer

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02283-6 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Tomoyuki Matsunaga ◽

Hiroaki Satio ◽

Wataru Miyauchi ◽

Yuji Shishido ◽

Kozo Miyatani ◽

...

Keyword(s):

Gastric Cancer ◽

Skeletal Muscle ◽

Side Effects ◽

Muscle Mass ◽

Skeletal Muscle Mass ◽

Univariate Analysis ◽

Lumbar Vertebra ◽

Histological Type ◽

Recurrent Gastric Cancer ◽

Grade 3

Abstract Background We retrospectively examined the relationship among skeletal muscle mass index (SMI), prognosis, and chemotherapy side effects in patients with recurrent gastric cancer (RGC). Methods Sixty-seven patients who developed recurrence after undergoing curative gastrectomy for gastric cancer at Tottori University Hospital and received palliative chemotherapy were included in this study. Pretreatment computed tomography was performed to measure the skeletal muscle mass (SMM) and cross-sectional SMM at the third lumbar vertebra. We focused on haematologic toxicity (neutropenia, thrombocytopenia, and anaemia), febrile neutropenia, and gastrointestinal toxicity (diarrhoea, vomiting, and stomatitis) as the side effects of chemotherapy. Results Median SMIs for males and females (43.9 and 34.7 cm2/m2, respectively) were used as cutoff values. The patients were classified into high (SMIHigh; n = 34) and low SMI groups (SMILow; n = 33). The SMILow group included more patients treated with monotherapy (P = 0.016) compared with the SMIHigh group, had a significantly lower number of chemotherapy lines (P = 0.049), and had a significantly higher incidence of grade 3 or 4 side effects (P = 0.010). The median survival rate was significantly higher in the SMIHigh group (17.8 vs 15.8 months; P = 0.034). In the univariate analysis, body mass index, SMI, histological type, and prognostic nutritional index were identified as prognostic indicators. The multivariate analysis identified SMI (P = 0.037) and histological type (P = 0.028) as independent prognostic factors. Conclusion The incidence of grade 3 or 4 side effects was significantly higher in patients with SMILow RGC. SMI was a useful prognostic marker of RGC.

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Depletion of skeletal muscle mass adversely affects long-term outcomes for men undergoing gastrectomy for gastric cancer

PLoS ONE ◽

10.1371/journal.pone.0256365 ◽

2021 ◽

Vol 16 (8) ◽

pp. e0256365

Author(s):

Katsunobu Sakurai ◽

Naoshi Kubo ◽

Yutaka Tamamori ◽

Naoki Aomatsu ◽

Takafumi Nishii ◽

...

Keyword(s):

Gastric Cancer ◽

Skeletal Muscle ◽

Muscle Mass ◽

Skeletal Muscle Mass ◽

Independent Predictor ◽

Major Complication ◽

Cancer Specific Survival ◽

Skeletal Muscle Index ◽

Lumbar Vertebral Body ◽

Grade 3

Background Although low skeletal muscle mass has an adverse impact on the treatment outcomes of cancer patients, whether the relationship between preoperative skeletal muscle mass and gastrectomy outcomes in gastric cancer (GC) differs between men and women is unclear. The study aimed to clarify this relationship based on gender. Methods Between January 2007 and December 2015, 1054 patients who underwent gastrectomy for GC at Osaka City General Hospital were enrolled in this study. We evaluated sarcopenia by the skeletal muscle index (SMI), which was measured by computed tomography (CT) using areas of muscle in the third lumbar vertebral body (L3). Male and female patients were each divided into two groups (low skeletal muscle and high skeletal muscle). Results The SMI emerged as an independent predictor of 5-year overall survival (OS) in male GC patients (Hazard ratio 2.51; 95% confidence interval (CI) 1.73–3.63, p < 0.001) based on multivariate analysis. However, this index was not an independent predictive determinant of 5-year cancer-specific survival (CSS). The SMI was not an independent predictor of either OS or CSS in female GC patients. The incidence of leakage and major complication (Clavien Dindo grade ≧ 3) did not differ significantly across groups. Conclusions Preoperative skeletal muscle mass is a valuable prognostic predictor of OS in male GC patients.

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CHANGES OF SKELETAL MUSCLE MASS DURING PALLIATIVE CHEMOTHERAPY IN OLDER PATIENTS WITH ADVANCED GASTRIC CANCER

Journal of Geriatric Oncology ◽

10.1016/s1879-4068(19)31245-7 ◽

2019 ◽

Vol 10 (6) ◽

pp. S76

Author(s):

I. Hwang ◽

S. Park ◽

J. Choi

Keyword(s):

Gastric Cancer ◽

Skeletal Muscle ◽

Advanced Gastric Cancer ◽

Muscle Mass ◽

Older Patients ◽

Skeletal Muscle Mass ◽

Palliative Chemotherapy

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Loss of skeletal muscle mass during palliative chemotherapy is a poor prognostic factor in patients with advanced gastric cancer

Annals of Oncology ◽

10.1093/annonc/mdz265.027 ◽

2019 ◽

Vol 30 ◽

pp. v727

Author(s):

I.G. Hwang ◽

S.E. Park ◽

S.-C. Lee ◽

J.H. Choi

Keyword(s):

Gastric Cancer ◽

Skeletal Muscle ◽

Prognostic Factor ◽

Advanced Gastric Cancer ◽

Muscle Mass ◽

Skeletal Muscle Mass ◽

Palliative Chemotherapy ◽

Poor Prognostic Factor

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Loss of skeletal muscle mass during palliative chemotherapy is a poor prognostic factor in patients with advanced gastric cancer

Scientific Reports ◽

10.1038/s41598-020-74765-8 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Song Ee Park ◽

Jin Hwa Choi ◽

Jae Yong Park ◽

Beom Jin Kim ◽

Jae Gyu Kim ◽

...

Keyword(s):

Gastric Cancer ◽

Skeletal Muscle ◽

Body Weight ◽

Prognostic Factor ◽

Muscle Mass ◽

Skeletal Muscle Mass ◽

Palliative Chemotherapy ◽

Chemotherapy Response ◽

First Line ◽

Poor Prognostic Factor

Abstract Cancer causes muscle mass loss, which is associated with a poor prognosis. Chemotherapy may also reduce muscle mass. We investigated skeletal muscle mass change during palliative chemotherapy for advanced gastric cancer (AGC) and its association with treatment outcomes. We retrospectively reviewed 111 consecutive AGC patients who underwent first-line palliative chemotherapy. Skeletal muscle area was measured before and after chemotherapy at the third lumbar vertebra level using computed tomography scans. We compared skeletal muscle index (SMI), body mass index (BMI), and body weight changes to chemotherapy response and survival. The 80 male and 31 female patients’ median age was 65 (range 31–87) years, and 46.8% had sarcopenia at baseline. Median pre-chemotherapy to post-chemotherapy SMI, BMI, and body weight decreases were − 4.5 cm2/m2 (− 11.3%) (P < 0.001); − 0.7 kg/m2 (− 3.2%) (P < 0.001); and − 2.0 kg (− 3.5%) (P < 0.001), respectively. Median SMI decreases for patients with objective response, stable disease, and disease progression were − 4.0 cm2/m2 (range − 20.1 ~ 9.5); − 4.5 cm2/m2 (range − 19.8 ~ 0.8); and − 3.8 cm2/m2 (range: − 17.6 ~ 0.1), respectively. Response to chemotherapy was not associated with SMI decrease (P = 0.463). In multivariable analysis, sarcopenia at baseline (HR 1.681; 95% CI 1.083–2.609, P = 0.021), decreased SMI (HR 1.620; 95% CI 1.041–2.520; P = 0.032) were significant poor prognostic factors for survival. Skeletal muscle mass decreased significantly during chemotherapy in AGC patients, but was not associated with chemotherapy response. Decreased SMI was a poor prognostic factor in AGC patients during first-line palliative chemotherapy.

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