scholarly journals Preoperative nutritional risk index and postoperative one-year skeletal muscle loss can predict the prognosis of patients with gastric cancer: a registry based study

2020 ◽  
Author(s):  
Kyung Won Kim ◽  
Koeun Lee ◽  
Jung-Bok Lee ◽  
Taeyong Park ◽  
Seungwoo Khang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Skeletal Muscle ◽  
Overall Survival ◽  
Regression Analysis ◽  
Risk Index ◽  
Nutritional Risk ◽  
Muscle Loss ◽  
Skeletal Muscle Index ◽  
Nutritional Risk Index ◽  
Skeletal Muscle Loss

Abstract Background: Patients with gastric cancer have increased nutritional risk and experience a significant skeletal muscle loss after surgery. We aimed to determine whether muscle loss during the first postoperative year and nutritional status are indicators for predicting prognosis. Methods: From a gastric cancer registry, a total of 958 patients who received curative gastrectomy followed by chemotherapy for stage 2 and 3 gastric cancer and survived longer than 1 year were investigated. Clinical and laboratory data were collected. Skeletal muscle index (SMI) was assessed based on the muscle area at the L3 level on abdominal computed tomography. Results: Preoperative nutritional risk index (NRI) and postoperative decrement of SMI (dSMI) were significantly associated with overall survival (hazards ratio: 0.972 [95% CI: 0.958-0.986] and 1.058 [95% CI: 1.033-1.085], respectively) in a multivariate Cox regression analysis. Recurrence, tumor stage, comorbidity, and the preoperative muscle and subcutaneous fat area were also significant prognostic indicators. Kaplan-Meier analyses exhibited that patients with higher NRI had a significantly longer survival than those with lower NRI (3-year overall survival: 84.6% vs. 72.9%, P < 0.001). In addition, a significantly better prognosis was observed in a patient group with less decrease of SMI (3-year overall survival: 85.6% vs. 74.5%, P = 0.009). A logistic regression analysis demonstrated that the performance of preoperative NRI and dSMI in mortality prediction was quite significant (AUC: 0.63, P < 0.001) and the combination of clinical factors enhanced the predictive accuracy to the AUC of 0.90 (P < 0.001). This prognostic relevance of NRI and dSMI was maintained in patients experiencing tumor recurrence. Conclusions: Skeletal muscle loss during the first postoperative year and preoperative NRI are predictors of overall survival in stage 2 or 3 gastric cancer patients regardless of relapse. Our results support the potential importance of exercise and nutritional support along with standard treatment.

scholarly journals Preoperative nutritional risk index and postoperative one-year skeletal muscle loss can predict the prognosis of patients with gastric adenocarcinoma: a registry-based study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kyung Won Kim ◽  
Koeun Lee ◽  
Jung-Bok Lee ◽  
Taeyong Park ◽  
Seungwoo Khang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Skeletal Muscle ◽  
Overall Survival ◽  
Regression Analysis ◽  
Risk Index ◽  
Nutritional Risk ◽  
Muscle Loss ◽  
Nutritional Risk Index ◽  
Skeletal Muscle Loss ◽  
Gastric Cancer Patients

Abstract Background Patients with gastric cancer have an increased nutritional risk and experience a significant skeletal muscle loss after surgery. We aimed to determine whether muscle loss during the first postoperative year and preoperative nutritional status are indicators for predicting prognosis. Methods From a gastric cancer registry, a total of 958 patients who received curative gastrectomy followed by chemotherapy for stage 2 and 3 gastric cancer and survived longer than 1 year were investigated. Clinical and laboratory data were collected. Skeletal muscle index (SMI) was assessed based on the muscle area at the L3 level on abdominal computed tomography. Results Preoperative nutritional risk index (NRI) and postoperative decrement of SMI (dSMI) were significantly associated with overall survival (hazards ratio: 0.976 [95% CI: 0.962–0.991] and 1.060 [95% CI: 1.035–1.085], respectively) in a multivariate Cox regression analysis. Recurrence, tumor stage, comorbidity index were also significant prognostic indicators. Kaplan-Meier analyses exhibited that patients with higher NRI had a significantly longer survival than those with lower NRI (5-year overall survival: 75.8% vs. 63.0%, P <  0.001). In addition, a significantly better prognosis was observed in a patient group with less decrease of SMI (5-year overall survival: 75.7% vs. 66.2%, P = 0.009). A logistic regression analysis demonstrated that the performance of preoperative NRI and dSMI in mortality prediction was quite significant (AUC: 0.63, P <  0.001) and the combination of clinical factors enhanced the predictive accuracy to the AUC of 0.90 (P <  0.001). This prognostic relevance of NRI and dSMI was maintained in patients experiencing tumor recurrence and highlighted in those with stage 3 gastric adenocarcinoma. Conclusions Preoperative NRI is a predictor of overall survival in stage 2 or 3 gastric cancer patients and skeletal muscle loss during the first postoperative year was significantly associated with the prognosis regardless of relapse in stage 3 tumors. These factors could be valuable adjuncts for accurate prediction of prognosis in gastric cancer patients.

Muscle wasting, visceral and subcutaneous adiposity, inflammation, nutritional deficiencies, and metastatic esophageal cancer (MEC) prognosis.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e14595-e14595
Author(s):  
Jaspreet K Bajwa ◽  
Aline Fusco Fares ◽  
George Dong ◽  
Daniel Vilarim Araujo ◽  
Katrina Hueniken ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
De Novo ◽  
Risk Index ◽  
Intraclass Correlation ◽  
Nutritional Risk ◽  
Nutritional Deficiencies ◽  
Continuous Variables ◽  
Skeletal Muscle Index ◽  
Nutritional Risk Index ◽  
Subcutaneous Adiposity

e14595 Background: MEC, associated with fatigue and dysphagia, leads to loss of skeletal muscle mass, malnutrition, subcutaneous and visceral adiposity. Cancer inflammation mobilizes muscle and adipose tissue, potentially leading to cachexia and sarcopenia. Supportive management depends on understanding the cancer frailty determinants that lead to poor outcomes. Methods: We retrospectively identified de novo MEC patients pts treated in Toronto, Canada (2007-2014). Body composition including visceral (VA) and subcutaneous adiposity (SA) at L3 level were assessed with baseline CT scans using SliceOMatic software by two outcome-blinded radiologists (Intraclass correlation, 0.92-1.00). Sarcopenia was assessed using Skeletal Muscle Index (SMI) with cut-offs defined either by optimized-stratification (OpS) or gender-dependent consensus cutoffs (GdC). Cox proportional hazard models generated adjusted hazard ratios (aHR). Results: Of 101 patients, 82% were male; 96% Caucasian; median age at diagnosis 61y (29-88); mean body mass index (BMI) 25.4; 69%/31% adeno/squamous cell carcinoma; median overall and progression free survival were: 6.4 (OS) and 3.9 mos (PFS). Median follow-up time was 5.6 mos. SMI-OpS and SMI-GdC were correlated (Rho = 0.67). Nutritional risk index, BMI, neutrophil-to-lymphocyte and neutrophil-to-platelet ratios were not associated with outcome (p > 0.20, each comparison). However, univariable analyses identified serum albumin, LDH, and either SMI-OpS or SMI-GdC as being associated with OS. In multivariable models, sarcopenia was associated with worse OS (SMI-OpS aHR = 1.93 (1.0-3.7) p = 0.046; SMI-GdC aHR = 2.30 (1.3-4.1) p = 0.004), and worse PFS (SMI-OpS aHR = 2.16 (1.2-4.0) p = 0.01; SMI-GdC aHR = 1.66 (1.0-2.9) p = 0.07)). In 55 pts receiving chemotherapy at diagnosis, less VA (p = 0.01) and SA (p = 0.02), as continuous variables, were associated with worse OS. Conclusions: Though no associations were found between nutritional deficiencies or inflammatory markers and prognosis, there was approximately a two-fold worse prognosis in the presence of sarcopenia, and associations with loss of adiposity. (JB/AFF/DR/MM contributed equally).

scholarly journals Baseline Sarcopenia and Skeletal Muscle Loss During Chemotherapy Affect Survival Outcomes in Metastatic Gastric Cancer

2018 ◽  
Vol 38 (10) ◽  
pp. 5859-5866 ◽  
Author(s):  
KEIJI SUGIYAMA ◽  
YUKIYA NARITA ◽  
SEIICHIRO MITANI ◽  
KAZUNORI HONDA ◽  
TOSHIKI MASUISHI ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Skeletal Muscle ◽  
Metastatic Gastric Cancer ◽  
Survival Outcomes ◽  
Muscle Loss ◽  
Skeletal Muscle Loss

Change in body composition and survival in patients with pancreatic cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15716-e15716
Author(s):  
Mridula Krishnan ◽  
Lei Yu ◽  
Aneesha Dasgupta ◽  
Nicholas J Mullen ◽  
Ferdinand Osayande ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Pancreatic Cancer ◽  
Overall Survival ◽  
Rank Test ◽  
Survival Outcomes ◽  
Muscle Loss ◽  
Skeletal Muscle Index ◽  
Risk Of Death ◽  
Resection Status ◽  
Baseline Characteristics

e15716 Background: The incidence of pancreatic ductal adenocarcinoma (PDAC) is on the rise and continues to have a poor overall survival despite aggressive available treatment strategies. Sarcopenia is prevalent in PDAC patients and is likely caused by both disease and treatment. We hypothesized that ongoing muscle loss during treatment with chemotherapy would be associated with shorter progression-free survival (PFS) and overall survival (OS). Methods: We measured skeletal muscle index at L3 vertebra on baseline follow-up scans in patients with PDAC treated with chemotherapy at our institution. Patients were categorized by percent SMI lost over an 8-week period (<10%, 10-20%, ≥20% loss). We compared PFS and OS between the groups. Results: We included 162 patients with stage I-IV pancreatic cancer. Baseline characteristics are listed in the Table. SMI loss was associated with shortened PFS and OS (p=0.009, p=0.032 respectively) via log-rank test for trend. Even after adjusting for confounders (age, gender, resection status, stage, baseline sarcopenia, treatment and therapy), the relative risk of death (2.0; 95% CI=1.10-3.64, p=0.023), and progression (1.83; 95% CI =1.08-3.10, p =0.024) were higher in those who lost ≥20% SMI. There was no significant association between BMI change or fat change with the survival outcomes. Conclusions: The loss of skeletal muscle during the first 8 weeks of chemotherapy is associated with shortened survival outcomes and is independent of stage and resection status in patients receiving chemotherapy for PDAC. Future studies should seek to understand mechanisms of muscle loss by both tumor and chemotherapy to improve survival in patients with PDAC. Baseline characteristics. [Table: see text]

Skeletal muscle loss under chemotherapy and its association with survival and systemic treatment toxicity in metastatic colorectal cancer: An AGEO prospective multicenter study.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 4025-4025 ◽  
Author(s):  
Claire Gallois ◽  
Camille Bourillon ◽  
Edouard Auclin ◽  
Pascal Artru ◽  
Astrid Lievre ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Skeletal Muscle ◽  
Multivariate Analysis ◽  
Metastatic Colorectal Cancer ◽  
Survival Outcomes ◽  
Muscle Loss ◽  
Skeletal Muscle Index ◽  
Nutritional Factors ◽  
Multicenter Observational Study ◽  
Skeletal Muscle Loss

4025 Background: We showed in a previous work that “Patient Generated-Subjective Global Assessment” (PG-SGA) was independently associated with survival and treatment toxicities in non-pretreated metastatic colorectal cancer (mCRC) patients. We have evaluated here if muscle mass in these patients can provide useful additional information for clinical practice. The objective of the present work was to evaluate the association between baseline sarcopenia, and the variation of the Skeletal Muscle Index (SMI) under treatment with survival and chemotherapy-related toxicities in our population of non-pretreated mCRC patients. Methods: This prospective multicenter observational study enrolled non-pretreated mCRC patients. Measurement of SMI was performed on routine CT scan at day 0 (D0) and day 60 (D60). PG-SGA score and other nutritional factors were collected at D0. Progression-free survival (PFS) and overall survival (OS) were calculated from treatment start. Treatment related toxicities were registered according to the NCI CTCAE v4.0. Results: 149 patients were included in eight French centers from 7/2013 to 11/2016. Sarcopenia at baseline was not significantly associated with survival outcomes or chemotherapy-related toxicities. The best cut-point value of SMI variation (between D0 and D60) for OS prediction obtained with a log-rank maximisation method was -14%. The decrease in SMI > 14%, with a median follow-up of 23 months, was significantly associated with shorter PFS (6 vs 9 mo; HR 1.8, 95%CI 1.1-3.1, p = 0.02) and OS (8.5 vs 26 mo; HR 2.4, 95%CI 1.3-4.4, p = 0.004), independently of hypoalbuminemia and malnutrition defined by PG-SGA, in multivariate analysis. 40% of patients with a SMI decrease > 14%, and 22% of patients with a SMI increase or stable or decrease < 14% developed grade ≥ 2 clinical toxicities (OR 3.0, 95%CI 1.2-7.7, p = 0.02), but the difference was not statistically significant in multivariate analysis (OR 2.3. 95%CI 0.8-6.7, p = 0.1). Conclusions: To our knowledge, this study is the first study assessing the association of skeletal muscle loss with survival and treatment toxicities in patients with mCRC prospectively. In our population of non pre-treated mCRC patients, baseline sarcopenia was not associated with poor survival outcomes, but the decrease in SMI > 14% during the first two months of treatment was significantly associated with decreased PFS and OS, independently of other prognostic and nutritional factors.

Prognostic significance of sarcopenia in metastatic esophageal squamous cell carcinoma.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 4068-4068
Author(s):  
Kirsty Taylor ◽  
Osvaldo Espin-Garcia ◽  
Tina Romagnuolo ◽  
Frances Allison ◽  
Lucy Xiaolu Ma ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Squamous Cell ◽  
Risk Index ◽  
Univariate Analysis ◽  
Cell Cancer ◽  
Prognostic Significance ◽  
Skeletal Muscle Index ◽  
Significant Difference ◽  
Nutritional Risk Index ◽  
Ecog Ps

4068 Background: Sarcopenia is defined as low skeletal muscle mass and represents a quantifiable marker of frailty. Disease related symptoms of anorexia, nausea and dysphagia, in addition to reduced physical activity contribute to muscle wasting in metastatic esophageal squamous cell cancer (MESCC) patients. This study set out to evaluate the prognostic utility of sarcopenia and its association with nutritional indices. Methods: MESCC patients (pts) with available abdominal CT imaging, attending Princess Margaret Cancer Centre between 2011 and 2016, were identified from the institutional database. Skeletal muscle index (SMI), normalized by height, was calculated at the third lumbar (L3) vertebra using SliceOMatic software. SMI cutoffs for sarcopenia were 34.4cm2/m2 in females and 45.4cm2/m2 in males based on previously established consensus. Nutritional risk index (NRI) was calculated using weight and albumin with malnutrition defined as < 97.5. Results: Of the 58 pts analyzed, 26 presented with de novo MESCC, median age was 64 (range 48-85), 30 pts were ECOG PS ≤1 and 45% received systemic therapy. 93% of pts experienced weight loss > 5% in the 3 months preceding diagnosis and median BMI was 20.4 (range 16.3-34.9). Twenty-four (41%) pts were sarcopenic (SP) with differences in BMI and NRI (p < 0.05) compared to non-sarcopenic (NSP) pts. Median BMI in SP pts was 18.9 (16.3-25.6), 46% had a BMI < 18.5 and none were obese (BMI ≥ 30). By NRI, 58% of SP pts were malnourished. Males comprised 71% of SP pts (p = 0.03) but no difference from NSP MESCC pts was identified with age, race, ECOG PS or smoking status with univariate analysis. Median overall survival (OS) was 6 months; 4.2 in SP pts and 6.2 in NSP pts. Significant difference was identified with NRI (p = .0.009) but not sarcopenia (p = 0.247) or BMI (p = 0.393). With a multi-variate Cox model for NRI and sarcopenia, including age, sex, race, and ECOG PS, only ECOG PS was a significant predictor of mortality, HR for 2-3 vs 0-1 of 5.4 (2.5-11.9) p < 0.001. Conclusions: Sarcopenia at diagnosis was not associated with OS. NRI was superior to BMI alone with respect to discriminating pt outcomes, however ECOG PS was the only measure significantly associated with survival.

170 SKELETAL MUSCLE LOSS DURING NEOADJUVANT CHEMOTHERAPY IS A PREDICTOR OF MAJOR POSTOPERATIVE COMPLICATIONS IN PATIENTS WITH ESOPHAGUS CANCER

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Kazuya Higashizono ◽  
Shinsuke Sato ◽  
Erina Nagai ◽  
Yusuke Taki ◽  
Masato Nishida ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Esophageal Cancer ◽  
Postoperative Complications ◽  
Neoadjuvant Chemotherapy ◽  
Surgical Stress ◽  
Univariate Analysis ◽  
Muscle Loss ◽  
Cross Sectional ◽  
Skeletal Muscle Index ◽  
Skeletal Muscle Loss

Abstract   It is known that various factors, including surgical stress, nutritional deficits and sarcopenia, affect the incidence of postoperative complications. The aim of this study is to identify the predictors of major complications (Clavien-Dindo ≥II) after esophageal resection following neoadjuvant chemotherapy (NAC). Methods Forty-nine patients with esophageal cancer undergoing NAC and surgery between January 2017 and December 2019 were identified from our surgery database and retrospectively analyzed. Onodera prognostic nutritional index (PNI) was used as the indicator of nutritional status. For the evaluation of skeletal muscle mass, computed tomography imaging of the total cross-sectional muscle tissue measured at the third lumbar level defined the skeletal muscle index (SMI). Images were collected before and after NAC. Univariate and multivariate logistic regression analyses were used to assess the association between various predictors and major postoperative complications. Results Of the Forty-nine patients, 20 patients (40.8%) had major complication after surgery. Of the 20 patients, 5 had pneumonia and 4 had anastomotic leakage. Nine patients (18.3%) complete planned dose of NAC. SMI reduction was observed in 42 patients (85.7%) during NAC. According to univariate analysis, SMI reduction during NAC, and PNI before chemotherapy were significantly associated with major postoperative complications (P = 0.032, P = 0.035, respectively). According to multivariate analysis, SMI reduction during NAC is an independent predictor for the incidence of major postoperative complications (P = 0.0034). Conclusion Skeletal muscle loss during neoadjuvant chemotherapy can be an useful predictor of major postoperative complications in patients with esophageal cancer.

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