Increasing adipose burden in young men with metastatic testicular cancer following front-line cytotoxic chemotherapy.

525 Background: Exposure to cytotoxic chemotherapy (CC) has been observed to be associated with significant changes in body composition, namely marked lean muscle mass losses, with implications for treatment-related toxicity and oncologic outcomes. However, prior studies predominately include elderly patients who, a priori, are at risk for sarcopenia or severe skeletal muscle deficiency. To date, the impact of CC on body composition in young men with testicular cancer remains undefined. Methods: A retrospective analysis of 19 patients with metastatic testicular cancer treated with CC was performed (2015-17). Lumbar skeletal muscle index (SMI), visceral (VAI), subcutaneous (SCAI), and intramuscular adipose (IMAI) indices (cm2/m2), as well as fat-free mass (FFM, kg) and fat mass (FM, kg) were calculated using cross-sectional soft tissue area measurements on pre- and post-CC computed tomography (CT) axial scans and compared using paired Wilcoxon Signed Rank Tests. Results: Median age was 29 years. According to the NHANES FMI-based classification, 5 (26.3%), 9 (47.4%), 4 (21.1%), and 1 (5.3%) patients had normal, excess, class I, and class II obesity, respectively. Median pre- and post-CC BMI was 27.7 vs. 29.6 kg/m2(p = 0.03). Median pre- and post-CC SMI, VAI, SAI, and IAI were 63.5 vs 57.8 (p = 0.14), 19.9 vs 30.8 (p = 0.01), 47.9 vs 58.2 (p = 0.03), and 3.0 vs 5.2 (p = 0.002), respectively. Median muscle density pre- and post-CC were 47.0 vs 43.6 HU (p = 0.002). Pre- and post-chemotherapy FFM were 21.5 vs 19.5 kg, representing an overall median loss of 2.8%, (IQR -10.1, +4.7; Range -49.5 - +16.3; p = 0.14). Conversely, pre- and post-CC FM were 6.6 vs 7.5 kg, representing an overall median gain of 13.3% (IQR -3.3, +17.0; -24.9 - +50; p = 0.01). Median time between imaging assessments was 121 days. Specific median measures of adiposity each increased significantly, such that VIA increased by 29% (p = 0.01), SCAI increased by 39.7% (p = 0.03), and IMIA increased by 39.7% (p = 0.002). Conclusions: While lean muscularity remained stable, we observed significant increases in total body adipose mass with decreased muscle density in this consecutive case series of testicular cancer patients following CC.

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The impact of sarcopenia on toxicity and pharmacokinetics of 5-fluorouracil (5FU) in colorectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.633 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 633-633 ◽

Cited By ~ 2

Author(s):

Grant Richard Williams ◽

Allison Mary Deal ◽

Shlomit S. Shachar ◽

Christine Marie Walko ◽

Jai Narendra Patel ◽

...

Keyword(s):

Colorectal Cancer ◽

Skeletal Muscle ◽

Body Composition ◽

Secondary Analysis ◽

Cytotoxic Agents ◽

Composition Analysis ◽

Muscle Area ◽

Skeletal Muscle Index ◽

Grade 3 ◽

The Impact

633 Background: Great heterogeneity exists in the ability of adults with cancer to tolerate treatment. Variability in body composition may affect rates of metabolism of cytotoxic agents and contribute to the variable chemotherapy toxicity observed. The goal of this study was to explore the impact of body composition, in particular sarcopenia, on the pharmacokinetics of 5-fluorouracil (5FU) in a cohort of patients receiving FOLFOX +/- bevacizumab for colorectal cancer. Methods: We performed a secondary analysis of a completed multicenter trial that investigated pharmacokinetic-guided 5FU in patients receiving mFOLFOX6 +/- bevacizumab [Patel et al. The Oncologist 2014]. Computed Tomography (CT) images that were performed as part of routine care were used to for body composition analysis. Skeletal muscle area (SMA) and density (SMD) were analyzed from CT scan L3 lumbar segments using radiological software. SMA and height (m2) were used to calculate skeletal muscle index (SMI = SMA/m2). Skeletal Muscle Gauge (SMG) was created by multiplying SMI x SMD. Differences were compared using two group t-tests and fisher’s exact tests. Results: Of the 70 patients from the original study, 25 had available CT imaging. The mean age was 59, 52% female, 80% Caucasian, and 92% with either stage III or IV disease. Eleven patients (44%) had grade 3/4 toxicity, and 12 patients were identified as sarcopenic (48%) [per Martin et al. JCO 2013]. Sarcopenic patients had numerically higher first cycle 5FU AUCs compared to non-sarcopenic patients (19.3 vs. 17.3 AUC, p= 0.43) and higher grade 3/4 toxicities (50 vs 38.5%, p= 0.70). Patients with low SMG ( < 1475 AU) had higher grade 3/4 toxicities (62 vs 25%, p= 0.11) and higher hematologic toxicities (46 v 8%, p= 0.07). Conclusions: CRC patients with sarcopenia had numerically higher first cycle AUCs of 5FU and a higher incidence of severe toxicities; however, this was not statistically significant, possibly due to limited sample size. SMG, an integrated muscle measure, was more highly correlated with toxicity outcomes than either SMI or SMD alone. Further research exploring the role of body composition in pharmacokinetics is needed with a focus on alternative dosing strategies in sarcopenic patients.

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P7 THE IMPACT OF PREHABILITATION ON PARAMETERS OF BODY COMPOSITION IN PATIENTS UNDERGOING MULTIMODAL THERAPY FOR OESOPHAGO-GASTRIC (OG) CANCER

Diseases of the Esophagus ◽

10.1093/dote/doz092.07 ◽

2019 ◽

Vol 32 (Supplement_2) ◽

Author(s):

Doganay Emre ◽

R Boshier Piers ◽

J Halliday Laura ◽

Thomas Rob ◽

E Low Donald ◽

...

Keyword(s):

Skeletal Muscle ◽

Body Composition ◽

Neoadjuvant Therapy ◽

Physical Performance ◽

Skeletal Muscle Index ◽

Significant Difference ◽

Axial Ct ◽

Gastric Cancer Patients ◽

Subcutaneous Adipose ◽

The Impact

Abstract Aims This study characterises changes in body composition and physical performance during neoadjuvant therapy in the context of prehabilitation before oesophago-gastric resection. Background & Methods Neoadjuvant therapy has deleterious effects on functional capacity and may lead to a decline in physical fitness and skeletal muscle mass. This is a retrospective review of oesophago-gastric cancer patients undergoing prehabilitation. Assessment of body composition (skeletal muscle, visceral and subcutaneous adipose tissue) was performed from L3 axial CT images acquired at the time of diagnosis and after neoadjuvant therapy. Results 42 patients (33M, 65.7±11.1) met the inclusion criteria. Patients body weight (81.8±21.3 kg vs. 81.3±21 kg, p=0.668) and BMI (27.9±7.2 kg/m2 vs. 27.8±7.0 kg/m2, p=0.648) did not change significantly between the study time points. There was no significant difference between estimated lean body mass (39.2±13.2 vs. 38.3±10.1; 95%CI -2.5 to 4.3 p=0.592) and fat mass (30.6±15.4 vs. 28.6±14.0; 95%CI -1.7 to 5.7, p=0.284). Skeletal muscle index significantly decreased (46.5±9.9 to 43.1±9.8; 95%CI 2.1 to 4.6, p<0.001). Patients who were adherent to the prehabilitation programme had a significantly higher skeletal muscle index compared to noncompliant patients (47.4±10.4 vs. 40.2±8.9; 95%CI 1.5 to 13.5, p=0.016). Patients who achieved a higher MET-minutes were less likely to be sarcopenic (F(1,40 = 6.1, p = 0.018)).There was no decline in physical performance (Median IQR; VO2max ml kg−1min−1) during neoadjuvant therapy (17.5 [14-19.3] vs. 17.5 [13.3-19.3]; p=0.164). Conclusion this is the first study to report variations in parameters of body composition in patients undergoing a prehabilitation programme. Findings suggest that prehabilitation may be a useful adjunct in limiting the extent of sarcopenia and patient deconditioning during neoadjuvant therapy.

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Predictive Value of Skeletal Muscle Mass in Recurrent/Metastatic Head and Neck Squamous Cell Carcinoma Patients Treated With Immune Checkpoint Inhibitors

Frontiers in Oncology ◽

10.3389/fonc.2021.699668 ◽

2021 ◽

Vol 11 ◽

Author(s):

Lorena Arribas ◽

Maria Plana ◽

Miren Taberna ◽

Maria Sospedra ◽

Noelia Vilariño ◽

...

Keyword(s):

Skeletal Muscle ◽

Squamous Cell Carcinoma ◽

Body Composition ◽

Cell Carcinoma ◽

Head And Neck ◽

Muscle Mass ◽

Squamous Cell ◽

Neck Squamous Cell Carcinoma ◽

Skeletal Muscle Index ◽

The Impact

BackgroundReduced muscle mass has been associated with increased treatment complications in several tumor types. We evaluated the impact of skeletal muscle index (SMI) on prognosis and immune-related adverse events (IrAEs) in a cohort of recurrent/metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) treated with immune checkpoints inhibitors (ICI).MethodsA single-institutional, retrospective study was performed including 61 consecutive patients of R/M HNSCC diagnosed between July 2015 and December 2018. SMI was quantified using a CT scan at L3 to evaluate body composition. Median baseline SMI was used to dichotomize patients in low and high SMI. Kaplan-Meier estimations were used to detect overall survival (OS) and progression-free survival (PFS). Toxicity was recorded using Common Terminology Criteria for Adverse Event v4.3.ResultsPatients were 52 men (85.2%) with mean of age 57.7 years (SD 9.62), mainly oral cavity (n = 21; 34.4%). Low SMI was an independent factor for OS in the univariate (HR, 2.06; 95% CI, 1.14–3.73, p = 0.017) and multivariate Cox analyses (HR, 2.99; 95% CI, 1.29–6.94; p = 0.011). PFS was also reduced in patients with low SMI (PFS HR, 1.84; 95% CI, 1.08–3.12; p = 0.025). IrAEs occurred in 29 (47.5%) patients. There was no association between low SMI and IrAEs at any grade (OR, 0.56; 95% CI, 0.20–1.54; p = 0.261). However, grades 3 to 4 IrAEs were developed in seven patients of whom three had low SMI.ConclusionsLow SMI before ICI treatment in R/M HNSCC patients had a negative impact on OS and PFS. Further prospective research is needed to confirm the role of body composition as a predictive biomarker in ICI treatment.

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Low Skeletal Muscle Index And Myosteatosis As Predictors of Mortality In Critically Ill Surgical Patients

10.21203/rs.3.rs-681091/v2 ◽

2021 ◽

Author(s):

Marco Giani ◽

Emanuele Rezoagli ◽

Alice Grassi ◽

Marco Porta ◽

Luca Riva ◽

...

Keyword(s):

Skeletal Muscle ◽

Body Composition ◽

Prolonged Mechanical Ventilation ◽

Adverse Outcomes ◽

Surgical Patients ◽

Rank Test ◽

Specific Patient ◽

Skeletal Muscle Index ◽

Increased Risk ◽

The Impact

Abstract BackgroundLow muscle mass and other specific body composition indexes, assessed by computed tomography (CT), are associated with adverse outcomes after elective surgery, such as an increased risk of postoperative complications and higher mortality. However, limited information is available about the role of these indexes on short- and long-term outcomes in surgical patients admitted to the intensive care unit (ICU). The aim of the study was to assess the association of body composition indexes with 90-days mortality in this specific patient cohort.MethodsWe performed a retrospective study including adult surgical patients admitted to the ICU between 2014 and 2018 who underwent a CT scan at the time of admission. Total Muscle Area (TMA), Total Fat Area (TFA), Visceral fat area (VFA) and Intramuscular fat area (IMFA) were measured. Skeletal Muscle Index (TMA/m2), MyoSteatosis (IMFA/TMA), Sarcopenic Obesity (VFA/TMA) were then calculated. We analyzed the impact of these indexes on mortality.Results204 patients were included. Overall 90-day mortality was 28%. Log rank test and cox multivariate analysis on 90-day mortality showed a significant association of low SMI and myosteatosis with 90-days mortality. Myosteatosis was also significantly associated with prolonged mechanical ventilation and increased ICU length of stay.ConclusionsSpecific body composition indexes may predict mortality in surgical patients admitted to the ICU. Low skeletal muscle index and myosteatosis were independently associated with increased 90-day mortality.

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Low Skeletal Muscle Index and Myosteatosis as Predictors of Mortality in Critically Ill Surgical Patients

10.21203/rs.3.rs-681091/v1 ◽

2021 ◽

Author(s):

Marco Giani ◽

Emanuele Rezoagli ◽

Alice Grassi ◽

Marco Porta ◽

Luca Riva ◽

...

Keyword(s):

Skeletal Muscle ◽

Body Composition ◽

Prolonged Mechanical Ventilation ◽

Adverse Outcomes ◽

Surgical Patients ◽

Rank Test ◽

Specific Patient ◽

Skeletal Muscle Index ◽

Increased Risk ◽

The Impact

Abstract Background Low muscle mass and other specific body composition indexes, assessed by computed tomography (CT), are associated with adverse outcomes after elective surgery, such as an increased risk of postoperative complications and higher mortality. However, limited information is available about the role of these indexes on short- and long-term outcomes in surgical patients admitted to the intensive care unit (ICU). The aim of the study was to assess the association of body composition indexes with 90-days mortality in this specific patient cohort. Methods We performed a retrospective study including adult surgical patients admitted to the ICU between 2014 and 2018 who underwent a CT scan at the time of admission. Total Muscle Area (TMA), Total Fat Area (TFA), Visceral fat area (VFA) and Intramuscular fat area (IMFA) were measured. Skeletal Muscle Index (TMA/m2), MyoSteatosis (IMFA/TMA), Sarcopenic Obesity (VFA/TMA) were then calculated. We analyzed the impact of these indexes on mortality. Results 204 patients were included. Overall 90-day mortality was 28%. Log rank test and cox multivariate analysis on 90-day mortality showed a significant association of low SMI and myosteatosis with 90-days mortality. Myosteatosis was also significantly associated with prolonged mechanical ventilation and increased ICU length of stay. Conclusions Specific body composition indexes may predict mortality in surgical patients admitted to the ICU. Low skeletal muscle index and myosteatosis were independently associated with increased 90-day mortality.

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Impact of body composition on outcomes from anti-programmed death-1 (PD-1) treatment.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.9516 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 9516-9516 ◽

Cited By ~ 3

Author(s):

Arissa Young ◽

Henry T. Quach ◽

Elizabeth J. Davis ◽

Javid Moslehi ◽

Grant R. Williams ◽

...

Keyword(s):

Skeletal Muscle ◽

Body Composition ◽

Adipose Tissue ◽

Favorable Effect ◽

High Fat ◽

Muscle Area ◽

Skeletal Muscle Index ◽

Pre Treatment ◽

Skeletal Muscle Area ◽

The Impact

9516 Background: Obesity is associated with improved outcomes in melanoma patients (pts) treated with PD-1, whereas low muscle mass, known as sarcopenia, has been associated with poor outcomes in many cancers. We sought to assess the impact of body composition on PD-1 outcomes. Methods: We analyzed pre-treatment CT scans at the L3 slice using Slice-o-matic software (Tomovision V. 5.0) to determine skeletal muscle, visceral adipose, and subcutaneous adipose tissue parameters for 104 pts with metastatic melanoma who received PD-1 monotherapy. We assessed sarcopenia using skeletal muscle index (SMI=skeletal muscle area/m2). We also quantified total adipose tissue index (TATI), and skeletal muscle gauge (SMG = SMI x skeletal muscle density [SMD]). We stratified pts into high/low groups using previously published cutoffs and assessed toxicity (tox), progression-free and overall survival (PFS/OS), and response rate (RR) by group. Results: Sarcopenia (low SMI) was negatively associated with any tox (39% vs. 60%, p=0.04) but not OS, PFS, or RR. Adiposity (TATI) was not associated with outcomes. By contrast, SMG was significantly associated with OS (median 35.5 vs. 16.0m, p=0.01 for high vs. low SMG). Interestingly, when incorporating TATI with SMG, we found that high SMG/high TATI pts (high muscle/high fat) have superior clinical outcomes (Table). Notably, low SMG/high TATI pts (low muscle/high fat) had seemingly the worst outcomes. Conclusions: We found that high SMG, a measure incorporating muscle area and density, was associated with improved OS in PD1 treated pts. Further, pts with high adiposity and high SMG had superior outcomes, potentially identifying the population responsible for the favorable effect of obesity in these pts. Validation and combination treated cohorts will be presented. [Table: see text]

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Hypoalbuminemia Reflects Nutritional Risk, Body Composition and Systemic Inflammation and Is Independently Associated with Survival in Patients with Colorectal Cancer

Cancers ◽

10.3390/cancers12071986 ◽

2020 ◽

Vol 12 (7) ◽

pp. 1986 ◽

Cited By ~ 1

Author(s):

Arwa S. Almasaudi ◽

Ross D. Dolan ◽

Christine A. Edwards ◽

Donald C. McMillan

Keyword(s):

Colorectal Cancer ◽

Skeletal Muscle ◽

Body Composition ◽

Inflammatory Response ◽

Systemic Inflammation ◽

Systemic Inflammatory Response ◽

Nutritional Risk ◽

Skeletal Muscle Index ◽

Muscle Density ◽

Subcutaneous Adiposity

It has long been recognized that albumin has prognostic value in patients with cancer. However, although the Global Leadership Initiative on Malnutrition GLIM criteria (based on five diagnostic criteria, three phenotypic criteria and two etiologic criteria) recognize inflammation as an important etiologic factor in malnutrition, there are limited data regarding the association between albumin, nutritional risk, body composition and systemic inflammation, and whether albumin is associated with mortality independent of these parameters. The aim of this study was to examine the relationship between albumin, nutritional risk, body composition, systemic inflammation, and outcomes in patients with colorectal cancer (CRC). A retrospective cohort study (n = 795) was carried out in which patients were divided into normal and hypoalbuminaemic groups (albumin < 35 g/L) in the presence and absence of a systemic inflammatory response C-reactive protein (CRP > 10 and <10 mg/L, respectively). Post-operative complications, severity of complications and mortality were considered as outcome measures. Categorical variables were analyzed using Chi-square test χ2 or linear-by-linear association. Survival data were analyzed using univariate and multivariate Cox regression. In the presence of a systemic inflammatory response, hypoalbuminemia was directly associated with Malnutrition Universal Screening Tool MUST (p < 0.001) and inversely associated with Body Mass Index BMI (p < 0.001), subcutaneous adiposity (p < 0.01), visceral obesity (p < 0.01), skeletal muscle index (p < 0.001) and skeletal muscle density (p < 0.001). There was no significant association between hypoalbuminemia and either the presence of complications or their severity. In the absence of a systemic inflammatory response (n = 589), hypoalbuminemia was directly associated with MUST (p < 0.05) and inversely associated with BMI (p < 0.01), subcutaneous adiposity (p < 0.05), visceral adiposity (p < 0.05), skeletal muscle index (p < 0.01) and skeletal muscle density (p < 0.001). Hypoalbuminemia was, independently of inflammatory markers, associated with poorer cancer-specific and overall survival (both p < 0.001). The results suggest that hypoalbuminemia in patients with CRC reflects both increased nutritional risk and greater systemic inflammatory response and was independently associated with poorer survival in patients with CRC.

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Deep Learning-Based Body Composition Analysis Predicts Outcome in Melanoma Patients Treated with Immune Checkpoint Inhibitors

Diagnostics ◽

10.3390/diagnostics11122314 ◽

2021 ◽

Vol 11 (12) ◽

pp. 2314

Author(s):

Anton Faron ◽

Nikola S. Opheys ◽

Sebastian Nowak ◽

Alois M. Sprinkart ◽

Alexander Isaak ◽

...

Keyword(s):

Skeletal Muscle ◽

Body Composition ◽

Adipose Tissue ◽

Deep Learning ◽

Immune Checkpoint ◽

Composition Analysis ◽

Skeletal Muscle Index ◽

Checkpoint Inhibitor Therapy ◽

Tissue Compartments ◽

The Impact

Previous studies suggest an impact of body composition on outcome in melanoma patients. We aimed to determine the prognostic value of CT-based body composition assessment in patients receiving immune checkpoint inhibitor therapy for treatment of metastatic disease using a deep learning approach. One hundred seven patients with staging CT examinations prior to initiation of checkpoint inhibition between January 2013 and August 2019 were retrospectively evaluated. Using an automated deep learning-based body composition analysis pipeline, parameters for estimation of skeletal muscle mass (skeletal muscle index, SMI) and adipose tissue compartments (visceral adipose tissue index, VAI; subcutaneous adipose tissue index, SAI) were derived from staging CT. The cohort was binarized according to gender-specific median cut-off values. Patients below the median were defined as having low SMI, VAI, or SAI, respectively. The impact on outcome was assessed using the Kaplan–Meier method with log-rank tests. A multivariable logistic regression model was built to test the impact of body composition parameters on 3-year mortality. Patients with low SMI displayed significantly increased 1-year (25% versus 9%, p = 0.035), 2-year (32% versus 13%, p = 0.017), and 3-year mortality (38% versus 19%, p = 0.016). No significant differences with regard to adipose tissue compartments were observed (3-year mortality: VAI, p = 0.448; SAI, p = 0.731). On multivariable analysis, low SMI (hazard ratio (HR), 2.245; 95% confidence interval (CI), 1.005–5.017; p = 0.049), neutrophil-to-lymphocyte ratio (HR, 1.170; 95% CI, 1.076–1.273; p < 0.001), and Karnofsky index (HR, 0.965; 95% CI, 0.945–0.985; p = 0.001) remained as significant predictors of 3-year mortality. Lowered skeletal muscle index as an indicator of sarcopenia was associated with worse outcome in patients with metastatic melanoma receiving immune checkpoint inhibitor therapy.

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Role of the Appendicular Skeletal Muscle Index for Predicting the Recurrence-Free Survival of Head and Neck Cancer

Diagnostics ◽

10.3390/diagnostics11020309 ◽

2021 ◽

Vol 11 (2) ◽

pp. 309

Author(s):

Kun-Yun Yeh ◽

Hang Huong Ling ◽

Shu-Hang Ng ◽

Cheng-Hsu Wang ◽

Pei-Hung Chang ◽

...

Keyword(s):

Skeletal Muscle ◽

Body Composition ◽

Head And Neck Cancer ◽

Mass Loss ◽

Lean Mass ◽

Recurrence Free Survival ◽

Skeletal Muscle Index ◽

Free Survival ◽

Prognostic Predictor ◽

Appendicular Skeletal Muscle

Background: This study investigates whether the appendicular skeletal muscle index (ASMI) was an independent prognostic predictor for patients with locally advanced head and neck cancer (LAHNC) receiving concurrent chemoradiotherapy (CCRT) and whether there were any differences in lean mass loss in different body regions during CCRT. Methods: In this prospective study, we analyzed the clinicopathological variables and the total body composition data before and after treatment. The factors associated with the 2-year recurrence-free survival rate (RFSR) were analyzed via logistic regression analysis. Results: A total of 98 patients were eligible for analysis. The body weight, body mass index, and all parameters of body composition significantly decreased after CCRT. The pretreatment ASMI was the only independent prognostic factor for predicting the 2-year RFSR (hazard ratio, 0.235; 95% confidence interval, 0.062–0.885; p = 0.030). There was at least 5% reduction in total lean and fat mass (p < 0.001); however, the highest lean mass loss was observed in the arms (9.5%), followed by the legs (7.2%), hips (7.1%), waist (4.7%), and trunk (3.6%). Conclusions: The pretreatment ASMI was the only independent prognostic predictor for the 2-year RFSR of LAHNC patients undergoing CCRT. Asynchronous loss of lean mass may be observed in different body parts after CCRT.

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Body Composition Changes in Gastric Cancer Patients during Preoperative FLOT Therapy: Preliminary Results of an Italian Cohort Study

Nutrients ◽

10.3390/nu13030960 ◽

2021 ◽

Vol 13 (3) ◽

pp. 960

Author(s):

Emanuele Rinninella ◽

Antonia Strippoli ◽

Marco Cintoni ◽

Pauline Raoul ◽

Raffaella Vivolo ◽

...

Keyword(s):

Gastric Cancer ◽

Body Composition ◽

Tumor Regression ◽

Evaluation Criteria ◽

Tumor Regression Grade ◽

Skeletal Muscle Index ◽

Before And After ◽

Gastric Cancer Patients ◽

The Impact ◽

Composition Changes

Background: The impact of the new chemotherapy, fluorouracil plus leucovorin, oxaliplatin, and docetaxel (FLOT) on body composition in gastric cancer (GC) patients remains unknown. We assessed body composition changes of GC patients receiving the FLOT regimen and their impact on treatment outcomes. Methods: Preoperative pre- and post-FLOT computed tomography (CT) scans of advanced GC patients were studied. Lumbar skeletal muscle index (SMI) and adipose indices were calculated before and after FLOT. Results: A total of 26 patients were identified between April 2019 and January 2020. Nineteen patients were sarcopenic at diagnosis. The mean BMI decreased (from 24.4 ± 3.7 to 22.6 ± 3.1; p < 0.0001) as well as the SMI (from 48.74 ± 9.76 to 46.52 ± 9.98; p = 0.009) and visceral adipose index (VAI) (from 49.04 ± 31.06 to 41.99 ± 23.91; p = 0.004) during preoperative FLOT therapy. BMI, SMI, and VAI variations were not associated with toxicity, Response Evaluation Criteria in Solid Tumors (RECIST), response, delay and completion of perioperative FLOT chemotherapy, and the execution of gastrectomy; a decrease of SMI ≥ 5% was associated with a higher Mandard tumor regression grade (p = 0.01). Conclusions: Almost three-quarters (73.1%) of GC patients were sarcopenic at diagnosis. Preoperative FLOT was associated with a further reduction in SMI, BMI, and VAI. These changes were not associated with short-term outcomes.

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