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

Nutrients ◽  
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.

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

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.

scholarly journals Naples Prognostic Score Predicts Tumor Regression Grade in Resectable Gastric Cancer Treated with Preoperative Chemotherapy

Cancers ◽  
2021 ◽  
Vol 13 (18) ◽  
pp. 4676
Author(s):  
Eva Lieto ◽  
Annamaria Auricchio ◽  
Giuseppe Tirino ◽  
Luca Pompella ◽  
Iacopo Panarese ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Cancer Patients ◽  
Preoperative Chemotherapy ◽  
Multimodal Treatment ◽  
Tumor Regression ◽  
Prognostic Score ◽  
Tumor Regression Grade ◽  
Term Survival ◽  
Gastric Cancer Patients ◽  
Regression Grade

Despite recent progresses, locally advanced gastric cancer remains a daunting challenge to embrace. Perioperative chemotherapy and D2-gastrectomy depict multimodal treatment of gastric cancer in Europe, shows better results than curative surgery alone in terms of downstaging, micrometastases elimination, and improved long-term survival. Unfortunately, preoperative chemotherapy is useless in about 50% of cases of non-responder patients, in which no effect is registered. Tumor regression grade (TRG) is directly related to chemotherapy effectiveness, but its understanding is achieved only after surgical operation; accordingly, preoperative chemotherapy is given indiscriminately. Conversely, Naples Prognostic Score (NPS), related to patient immune-nutritional status and easily obtained before taking any therapeutic decision, appeared an independent prognostic variable of TRG. NPS was calculated in 59 consecutive surgically treated gastric cancer patients after neoadjuvant FLOT4-based chemotherapy. 42.2% of positive responses were observed: all normal NPS and half mild/moderate NPS showed significant responses to chemotherapy with TRG 1–3; while only 20% of the worst NPS showed some related benefits. Evaluation of NPS in gastric cancer patients undergoing multimodal treatment may be useful both in selecting patients who will benefit from preoperative chemotherapy and for changing immune-nutritional conditions in order to improve patient’s reaction against the tumor.

Effects of a planned preoperative exercise program on body composition in early gastric cancer patients with metabolic syndrome.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 206-206
Author(s):  
Taiichi Kawabe ◽  
Haruhiko Cho ◽  
Kenki Segami ◽  
Shigeya Hayashi ◽  
Yousuke Makuuchi ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Skeletal Muscle ◽  
Body Composition ◽  
Energy Expenditure ◽  
Visceral Fat ◽  
Exercise Program ◽  
Skeletal Muscle Index ◽  
Preoperative Exercise ◽  
Gastric Cancer Patients ◽  
Fat Volume

206 Background: Visceral fat obesity and skeletal muscle depletion were reported to be both risk factors for complications in abdominal cancers surgery. Preoperative exercise may reduce morbidity by modifying body composition. Methods: We conducted an exploratory study attached to a prospective study (AEGES) to examine the effects of a 4-weeks exercise in stage I gastric cancer patients with metabolic syndrome. The AEGES enrolled 50 patients between 2007 and 2013, of which 18 were assigned to the exercise arm. The exercise program consisted of aerobic training 3-7 days a week, resistance training once or twice a week, and stretching. The expected energy expenditure of exercise was set at 30 kcal/kg/week. The total energy expenditure was measured using a calorie counter. After completion of the exercise, the patients received CT and endoscopy for re-staging, then underwent curative gastrectomy. Total skeletal muscle cross-sectional area (cm2) was evaluated on the average of two adjacent axial images at L3. Muscle area was expressed as lumber skeletal muscle index (cm2/m2). Total visceral fat volume was evaluated at the level of umbilicus. The changes of parameters before and after the exercise were assessed by paired Wilcoxon sign test. Results: A total of 15 patients with evaluable CT image were examined. Body weight, body mass index, and abdominal circumference were significantly decreased (-1.5 kg, -0.52 kg/m2, and -3.3 cm, respectively). The median skeletal muscle index was 48.06 cm2/m2 before and 46.85 cm2/m2 after the exercise, which was not statistically significant (p=0.41), while the median visceral fat volume was 205.2 cm2 before and 169.0 cm2 after the exercise, which was statistically significant (p=0.001). There was a weak correlation between total energy expenditure and amount of skeletal muscle index change (r=0.22 by Spearman’s correlation and p=0.427). No patient demonstrated progression of clinical cancer stage during 4 weeks. Conclusions: Preoperative exercise for 4 weeks could significantly modify body composition without progression of gastric cancer. More intensive or personalized exercise would be required to increase skeletal muscle.

scholarly journals Impact of Palliative Gastrectomy in Patients with Incurable Gastric Cancer

Medicina ◽  
2021 ◽  
Vol 57 (3) ◽  
pp. 198
Author(s):  
Ji Yeon Park ◽  
Byunghyuk Yu ◽  
Ki Bum Park ◽  
Oh Kyoung Kwon ◽  
Seung Soo Lee ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Cancer Patients ◽  
Tumor Resection ◽  
Palliative Resection ◽  
Primary Tumors ◽  
Palliative Intent ◽  
Palliative Gastrectomy ◽  
Gastric Cancer Patients ◽  
The Impact

Background and Objectives: The prognosis of metastatic or unresectable gastric cancer is dismal, and the benefits of the palliative resection of primary tumors with noncurative intent remain controversial. This study aimed to evaluate the impact of palliative gastrectomy (PG) on overall survival in gastric cancer patients. Materials and Methods: One hundred forty-eight gastric cancer patients who underwent PG or a nonresection (NR) procedure between January 2011 and 2017 were retrospectively reviewed to select and analyze clinicopathological factors that affected prognosis. Results: Fifty-five patients underwent primary tumor resection with palliative intent, and 93 underwent NR procedures owing to the presence of metastatic or unresectable disease. The PG group was younger and more female dominant. In the PG group, R1 and R2 resection were performed in two patients (3.6%) and 53 patients (96.4%), respectively. The PG group had a significantly longer median overall survival than the NR group (28.4 vs. 7.7 months, p < 0.001). Multivariate analyses revealed that the overall survival was significantly better after palliative resection (hazard ratio (HR), 0.169; 95% confidence interval (CI), 0.088–0.324; p < 0.001) in patients with American Society of Anesthesiologists Physical Status (ASA) scores ≤1 (HR, 0.506; 95% CI, 0.291–0.878; p = 0.015) and those who received postoperative chemotherapy (HR, 0.487; 95% CI, 0.296–0.799; p = 0.004). Among the patients undergoing palliative resection, the presence of <15 positive lymph nodes was the only significant predictor of better overall survival (HR, 0.329; 95% CI, 0.121–0.895; p = 0.030). Conclusions: PG might lead to the prolonged survival of certain patients with incurable gastric cancer, particularly those with less-extensive lymph-node metastasis.

scholarly journals Clinical and Oncological Value of Preoperative BMI in Gastric Cancer Patients: A Single Center Experience

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Costantino Voglino ◽  
Giulio Di Mare ◽  
Francesco Ferrara ◽  
Lorenzo De Franco ◽  
Franco Roviello ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Cancer Patients ◽  
Blood Proteins ◽  
Term Survival ◽  
Long Term Survival ◽  
Single Center Experience ◽  
Group B ◽  
Gastric Cancer Patients ◽  
The Impact

Introduction. The impact of preoperative BMI on surgical outcomes and long-term survival of gastric cancer patients was investigated in various reports with contrasting results.Materials & Methods. A total of 378 patients who underwent a surgical resection for primary gastric cancer between 1994 and 2011 were retrospectively studied. Patients were stratified according to BMI into a normal group (<25, group A), an overweight group (25–30, group B), and an obesity group (≥30, group C). These 3 groups were compared according to clinical-pathological characteristics, surgical treatment, and long-term survival.Results. No significant correlations between BMI and TNM (2010), UICC stage (2010), Lauren’s histological type, surgical results, lymph node dissection, and postoperative morbidity and mortality were observed. Factors related to higher BMI were male genderP<0.05, diabetesP<0.001, and serum blood proteinsP<0.01. A trend to fewer lymph nodes retrieved during gastrectomy with lymphadenectomy in overweight patients (B and C groups) was observed, although not statistically significant. There was no difference in overall survival or disease-specific survival between the three groups.Conclusion. According to our data, BMI should not be considered a significant predictor of postoperative complications or long-term result in gastric cancer patients.

scholarly journals The Impact of COVID-19 on Gastric Cancer Surgery: A Single-Center Retrospective Study

2020 ◽  
Author(s):  
Yu-xuan Li ◽  
Chang-zheng He ◽  
Yi-chen Liu ◽  
Peng-yue Zhao ◽  
Xiao-lei Xu ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Waiting Time ◽  
World Health ◽  
Abdominal Ct ◽  
Surgical Strategies ◽  
Patients With Cancer ◽  
Global Pandemic ◽  
Health Organization ◽  
Gastric Cancer Patients ◽  
The Impact

Abstract Background: The coronavirus disease 2019 (COVID-19) has been declared a global pandemic by the World Health Organization. Patients with cancer are more likely to incur poor clinical outcomes. Due to the prevailing pandemic, we propose some surgical strategies for gastric cancer patients. Methods: The ‘COVID-19’ period was defined as occurring between 2020-01-20 and 2020-03-20. The enrolled patients were divided into two groups, pre-COVID-19 group (PCG) and COVID-19 group (CG). A total of 109 patients with gastric cancer were enrolled in this study. Results: The waiting time before admission increased by 4 days in the CG (PCG: 4.5 [IQR: 2, 7.8] vs. CG: 8.0 [IQR: 2,20]; p=0.006). More patients had performed chest CT scans besides abdominal CT before admission during the COVID-19 period (PCG: 22 [32%] vs. CG: 30 [73%], p=0.001). After admission during the COVID period, the waiting time before surgery was longer (PCG: 3[IQR: 2,5] vs. CG: 7[IQR: 5,9]; p<0.001), more laparoscopic surgeries were performed (PCG: 51[75%] vs. CG: 38[92%], p=0.021), and hospital stay period after surgery was longer (7[IQR: 6,8] vs.9[IQR:7,11]; p<0.001). In addition, the total cost of hospitalization increased during this period, (PCG: 9.22[IQR:7.82,10.97] vs. CG: 10.42[IQR:8.99,12.57]; p=0.006). Conclusion: This study provides an opportunity for our surgical colleagues to reflect on their own services and any contingency plans they may have to tackle the COVID-19 crisis.

The Impact Of Health Insurance Coverage On Outcomes For U.S. Gastric Cancer Patients

2011 ◽  
Vol 165 (2) ◽  
pp. 338
Author(s):  
J.K. Smith ◽  
S. Ng ◽  
J.S. Hill ◽  
T.P. McDade ◽  
S.A. Shah ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Health Insurance ◽  
Cancer Patients ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Gastric Cancer Patients ◽  
The Impact
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