Underestimated Value of Sarcopenia in Gastric Cancer Surgery

Surgery remains the only potentially curative option for gastric cancer, although it is related to high postoperative morbidity and mortality rate. Approximately every second gastric cancer patient is diagnosed with sarcopenia, which is a significant risk factor for postoperative complications and poor long-term outcomes. However, sarcopenia is underestimated in routine clinical practice, since it remains the interest of clinical trials. Sarcopenia diagnostic criteria are not fully standardized, but it consists of tests for muscle strength, quantity and quality. They include grip strength, chair stand test, computed tomography, magnetic resonance imaging, ultrasound, bioelectrical impedance analysis and densitometry tests. Regarding the growing evidence for sarcopenia impact on surgical gastric cancer treatment results, it is a high probability that sarcopenia assessment will come to routine clinical practice. Although, until then there is a need for further clinical trials to standardize the diagnostic and to find effective treatment strategies.

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Effect of position and exercise on measurement of muscle quantity and quality: towards a standardised pragmatic protocol for clinical practice

BMC Sports Science Medicine and Rehabilitation ◽

10.1186/s13102-020-00227-3 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Carly Welch ◽

Zeinab Majid ◽

Isabelle Andrews ◽

Zaki Hassan-Smith ◽

Vicky Kamwa ◽

...

Keyword(s):

Clinical Practice ◽

Skeletal Muscle Mass ◽

Rectus Femoris ◽

Bioelectrical Impedance ◽

Impedance Analysis ◽

Upper Body ◽

Fat Percentage ◽

Non Invasive ◽

Vastus Intermedius ◽

Total Body

Abstract Background Ultrasonography is an emerging non-invasive bedside tool for muscle quantity/quality assessment; Bioelectrical Impedance Analysis (BIA) is an alternative non-invasive bedside measure of body composition, recommended for evaluation of sarcopenia in clinical practice. We set out to assess impact of position and exercise upon measures towards protocol standardisation. Methods Healthy volunteers aged 18–35 were recruited. Bilateral Anterior Thigh Thickness (BATT; rectus femoris and vastus intermedius), BATT: Subcutaneous Ratio (BATT:SCR), and rectus femoris echogenicity were measured using ultrasound and BIA was performed; 1) lying with upper body at 45° (Reclined), 2) lying fully supine at 180o (Supine), 3) sat in a chair with upper body at 90o (Sitting), and 4) after exercise Reclined. Variability of Skeletal Muscle Mass (SMM) by two different equations from BIA (SMM-Janssen, SMM-Sergi), phase angle, fat percentage, and total body (TBW), extracellular (ECW), and intracellular water (ICW) were assessed. Results Forty-four participants (52% female; mean 25.7 years-old (SD 5.0)) were recruited. BATT increased from Reclined to Sitting (+ 1.45 cm, 1.27–1.63), and after exercise (+ 0.51, 0.29–0.73). Echogenicity reduced from Reclined to Sitting (− 2.1, − 3.9 – -0.26). SMM-Sergi declined from Reclined to Supine (− 0.65 kg, − 1.08 – − 0.23) and after exercise (− 0.70 kg, − 1.27 – -0.14). ECW increased from Reclined to Sitting (+ 1.19 L, 0.04–2.35). There were no other statistically significant changes. Conclusion Standardisation of protocols is especially important for assessment of muscle quantity by ultrasonography; BIA measurements may also vary dependent on the equations used. Where possible, participants should be rested prior to muscle ultrasonography and BIA, and flexion of the knees should be avoided.

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Undifferentiated-type predominant mixed-type early gastric cancer is a significant risk factor for requiring additional surgeries after endoscopic submucosal dissection

Scientific Reports ◽

10.1038/s41598-020-63781-3 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Yusuke Horiuchi ◽

Junko Fujisaki ◽

Noriko Yamamoto ◽

Naoki Ishizuka ◽

Akiyoshi Ishiyama ◽

...

Keyword(s):

Gastric Cancer ◽

Risk Factor ◽

Early Gastric Cancer ◽

Endoscopic Submucosal Dissection ◽

Mixed Type ◽

Significant Risk ◽

Significant Risk Factor ◽

Submucosal Dissection ◽

Undifferentiated Type

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Validity of bioelectrical impedance analysis to assess nutritional status in patients with gastric cancer during radiotherapy

World Chinese Journal of Digestology ◽

10.11569/wcjd.v23.i22.3597 ◽

2015 ◽

Vol 23 (22) ◽

pp. 3597

Author(s):

Hui-Ping Ding

Keyword(s):

Gastric Cancer ◽

Nutritional Status ◽

Bioelectrical Impedance Analysis ◽

Bioelectrical Impedance ◽

Impedance Analysis

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Comparison of visceral fat area measured by CT and bioelectrical impedance analysis in Chinese patients with gastric cancer: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2019-036335 ◽

2020 ◽

Vol 10 (7) ◽

pp. e036335

Author(s):

Bo Gao ◽

Yu Liu ◽

Chao Ding ◽

Shunli Liu ◽

Xiaotian Chen ◽

...

Keyword(s):

Gastric Cancer ◽

Bioelectrical Impedance Analysis ◽

Visceral Obesity ◽

Bioelectrical Impedance ◽

Impedance Analysis ◽

Cross Sectional Study ◽

Sectional Study ◽

Limits Of Agreement ◽

Visceral Fat Area ◽

Cross Sectional

ObjectivesBioelectrical impedance analysis (BIA) is a simple and inexpensive method to estimate body composition. However, the accuracy of BIA is unknown. We aimed to assess the accuracy of BIA in estimating visceral fat area (VFA) in patients with gastric cancer.Study designThis was a cross-sectional study comparing the accuracy of BIA in estimating VFA with the gold standard method measured by CT. VFA was measured in enrolled patients both by CT and BIA. VFA by CT at umbilical level ≥100 cm2 was considered as visceral obesity. Reliability between the two methods was assessed by intraclass correlation coefficient (ICC) and consistency was assessed by Bland-Altman method (95% limits of agreement). The area under the receiver operating characteristic curve (AUROC) was used to assess the performance of BIA in diagnosing visceral obesity.SettingThe study was conducted in China.ParticipantsFrom 1 January 2017 to 1 December 2018, a total of 157 patients diagnosed with gastric cancer were enrolled.ResultsOverall, VFA by CT and BIA in patients was 84.39±46.43 cm2 and 71.94±22.44 cm2, respectively. VFA estimated by BIA was positively correlated with VFA measured by CT using Pearson’s test (r=0.650, p<0.001). Overall, ICC for the two methods was 0.675. The mean bias between the two measurements was 12.45±36.13 cm2. The 95% limits of agreement ranged from −58.36 cm2 to 83.26 cm2. The cut-off value for diagnosing visceral obesity by BIA was 81 cm2 (AUROC: 0.822, p<0.001, 95% CI 0.758 to 0.887).ConclusionsVFA measured by BIA showed satisfactory reliability with that measured by CT. However, the absolute values of the two methods were not interchangeable. The cut-off value for VFA by BIA in diagnosing visceral obesity was 81 cm2 for patients with gastric cancer in the Chinese population.

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Non-fasting bioelectrical impedance analysis in cystic fibrosis: Implications for clinical practice and research

Journal of Cystic Fibrosis ◽

10.1016/j.jcf.2019.05.018 ◽

2020 ◽

Vol 19 (1) ◽

pp. 153-158 ◽

Cited By ~ 2

Author(s):

F.M. Hollander-Kraaijeveld ◽

Y. Lindeman ◽

N.M. de Roos ◽

M. Burghard ◽

E.A. van de Graaf ◽

...

Keyword(s):

Cystic Fibrosis ◽

Clinical Practice ◽

Bioelectrical Impedance Analysis ◽

Bioelectrical Impedance ◽

Impedance Analysis

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Bioelectrical Impedance Analysis for Prediction of Early Complications after Gastrectomy in Elderly Patients with Gastric Cancer: the Phase Angle Measured Using Bioelectrical Impedance Analysis

Journal of Gastric Cancer ◽

10.5230/jgc.2019.19.e22 ◽

2019 ◽

Vol 19 (3) ◽

pp. 278 ◽

Cited By ~ 4

Author(s):

Byunghyuk Yu ◽

Ki Bum Park ◽

Ji Yeon Park ◽

Seung Soo Lee ◽

Oh Kyoung Kwon ◽

...

Keyword(s):

Gastric Cancer ◽

Elderly Patients ◽

Phase Angle ◽

Bioelectrical Impedance Analysis ◽

Bioelectrical Impedance ◽

Impedance Analysis ◽

Early Complications

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Accuracy of endoscopic ultrasound staging of gastric cancer in routine clinical practice in Singapore

Chinese Journal of Digestive Diseases ◽

10.1111/j.1443-9573.2006.00270.x ◽

2006 ◽

Vol 7 (4) ◽

pp. 191-196 ◽

Cited By ~ 12

Author(s):

Tiing Leong ANG ◽

Tay Meng NG ◽

Kwong Ming FOCK ◽

Eng Kiong TEO

Keyword(s):

Gastric Cancer ◽

Clinical Practice ◽

Endoscopic Ultrasound ◽

Routine Clinical Practice ◽

Staging Of Gastric Cancer

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A review of the patterns of docetaxel use for hormone refractory prostate cancer (HRPC) at the Princess Margaret Hospital

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e16161 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e16161-e16161

Author(s):

S. N. Chin ◽

L. Wang ◽

A. Lau ◽

M. Moore ◽

S. S. Sridhar

Keyword(s):

Clinical Trial ◽

Clinical Trials ◽

Clinical Practice ◽

Median Duration ◽

Response Rates ◽

Routine Clinical Practice ◽

Phase Iii ◽

Line Treatment ◽

Second Line ◽

First Line

e16161 Background: Docetaxel is standard of care for the treatment of HRPC, based on two large randomized clinical trials. The aim of this study was to determine if docetaxel use and effectiveness in routine clinical practice was similar to that seen in the TAX 327 randomized phase III clinical trial. Methods: A retrospective chart review was undertaken to assess patterns of docetaxel use for HRPC at our institution for the 2-year period since its approval for the first-line treatment of HRPC in 2005. Results: Eighty-eight patients, median age 71 and baseline PSA 107, received docetaxel in the first line setting. Main reasons for initiating docetaxel were rising PSA (90%) and progressive symptoms (71%). Eighteen percent of patients received docetaxel for rising PSA alone. A median of 7 cycles was administered. PSA response rates were 61%, time to response 1.5 months, and response duration 6.8 months. Disease progression was the most common reason for treatment discontinuation (36%). Main toxicities were fatigue (32%) and neuropathy (22%). Kaplan Meier survival analysis showed median duration of survival was 15.9 months (95% CI 12.4–20.5) from first drug use. 1-year survival was 0.63 (95% CI 0.52–0.72). Post-docetaxel, 36 patients received second-line treatment, mostly with mitoxantrone (89%). Second-line response rates were 22%, and median duration of response was 4 months. Conclusions: In routine clinical practice, docetaxel is a well-tolerated regimen for the treatment of HRPC. Response rates and toxicity profiles were comparable to the randomized trials. However, compared with the TAX 327 clinical trial, survival was slightly shorter than expected (15.9 vs. 18.9 months), possibly due to inclusion of patients with poorer performance status and comorbidities, who may be excluded from clinical trials. Second-line response rates were also comparable with previous reports. No significant financial relationships to disclose.

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Incidence and risk factors of thromboembolism (TE) in advanced gastric cancer (AGC) receiving chemotherapy: A prospective observational study (NCT01047618).

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.3_suppl.31 ◽

2014 ◽

Vol 32 (3_suppl) ◽

pp. 31-31

Author(s):

Baek-Yeol Ryoo ◽

Min-Hee Ryu ◽

Sook Ryun Park ◽

Myoung Joo Kang ◽

Kwon-Oh Park ◽

...

Keyword(s):

Gastric Cancer ◽

Risk Factor ◽

Incidence Rate ◽

Univariate Analysis ◽

Significant Risk ◽

Significant Risk Factor ◽

Limited Information ◽

Vein Thrombosis ◽

Gastric Cancer Patients ◽

D Dimer

31 Background: The incidence of TE in gastric cancer patients (pts) is known to be high. But because the previous reports were retrospectively analyzed in heterogeneous population, they give us only limited information. We therefore conducted a prospective study to investigate the incidence of TE and prognostic factors related with TE in AGC pts receiving chemotherapy. Methods: We checked D-dimer and coagulation battery at the start of chemotherapy and every 3 months thereafter. If there developed symptoms or signs of TE, or if D-dimer elevated 5 μg/mL or more we checked imaging studies to detect TE. The chemotherapy regimen mainly included fluoropyrimidine plus platinum-based for 1st-line, taxane-based for 2nd-line, and irinotecan-based for 3rd-line chemotherapy. Results: Between Nov 2009 and Apr 2012, 241 pts were analyzed. They received median 9 (range 1 - 42) cycles of chemotherapy. During the median observational duration of 16.7 months, 32 events (13.3%, 95% CI; 8.9 - 17.7%) of TE were detected. The types of TE were as follows; deep vein thrombosis (DVT) only in 18 (56.3%), pulmonary embolism (PE) only in 4 (12.5%), DVT and PE in 5 (15.6%), cerebral infarction in 4 (12.5%), and intra-abdominal arterial thrombosis 1 (3.1%) pts. The 1-year and 2-year cumulative incidences of TE were 15.0% (95% CI, 9.6 - 20.0%) and 20.0% (95% CI, 12.1 - 26.9%), respectively. The incidence rate of TE was 14.1 (95% CI, 9.6 - 19.9) events/100 person-years. In univariate analysis, the previous gastrectomy history, baseline CA72-4 level and baseline D-dimer level were statistically significant risk factor related with TE development. But in multivariate analysis, baseline D-dimer level was the only independent risk factor associated with TE development (Hazard ratio 2.46 [95% CI, 1.08 - 5.63], P= 0.033). Among 32 pts with baseline D-dimer 5.0 μg/mL or higher, 8 pts (25.0%) developed TE, while for pts whose baseline D-dimer was lower than 5.0 μg/mL, 24 out of 209 pts (11.5%) developed TE. Conclusions: The incidence rate of TE in AGC pts receiving chemotherapy was 14.1 (95% CI, 9.6 - 19.9) events/100 person-years. D-dimer was an important prognostic factor related with TE development. Clinical trial information: NCT01047618.

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