J Gastric Cancer.  2018 Sep;18(3):242-252. 10.5230/jgc.2018.18.e25.

Sarcopenia and Post-Operative Morbidity and Mortality in Patients with Gastric Cancer

• O'Brien S
• Twomey M
• Moloney F
• Kavanagh R
• Carey BW
• Power D
• Maher MM
• O'Connor O
• Ó'Súilleabháin C

• KMID: 2420784
• DOI: http://doi.org/10.5230/jgc.2018.18.e25

Abstract

PURPOSE
Surgical resection for gastric adenocarcinoma is associated with significant post-operative morbidity and mortality. The aim of this study was to assess the prognostic significance of sarcopenia in patients undergoing resection for gastric adenocarcinoma with respect to post-operative morbidity and survival.
MATERIALS AND METHODS
A retrospective analysis was conducted on a cohort of consecutive patients who underwent surgical resection for gastric adenocarcinoma between 2008 and 2014. Patient demographics, radiological parameters, and pathological data were collected. OsiriX software (Pixmeo) was used to measure skeletal muscle area, which was normalized for height to calculate skeletal muscle index.
RESULTS
A total of 56 patients (41 male, 15 female; mean age, 68.4 ± 11.9 years) met the inclusion criteria. Of these, 36% (20 of 56) of the patients were sarcopenic pre-operatively. Both sarcopenic and non-sarcopenic patient groups were equally matched with the exception of weight and body mass index (P=0.036 and 0.001, respectively). Sarcopenia was associated with a decreased overall survival (log-rank P=0.003) and was an adverse prognostic predictor of overall survival in multivariate analysis (hazard ratio, 10.915; P=0.001). Sarcopenia was a predictor of serious in-hospital complications in multivariate analysis (odds ratio, 3.508; P=0.042).
CONCLUSIONS
In patients undergoing curative resection for gastric cancer, there was a statistically significant association between sarcopenia and both decreased overall survival and serious post-operative complications. The measurement and reporting of skeletal muscle index on pre-operative computed tomography should be considered.

Keyword

Sarcopenia; Stomach neoplasms; Prognosis; Morbidity; Tomography, X-ray computed

MeSH Terms

Adenocarcinoma
Body Mass Index
Cohort Studies
Demography
Female
Humans
Male
Mortality*
Multivariate Analysis
Muscle, Skeletal
Prognosis
Retrospective Studies
Sarcopenia*
Stomach Neoplasms*
Tomography, X-Ray Computed

Figure

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  Fig. 1 Axial CT scan of a 77-year-old sarcopenic male with a skeletal muscle index of 41.58 cm2/m2. The total skeletal muscle area (indicated in purple) was measured on a CT slice at the level of L3. CT = computed tomography.

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  Fig. 2 Kaplan-Meier analysis for RFS indicated that there was no statistically significant difference in RFS between sarcopenic and non-sarcopenic patients (P=0.084, log-rank test). RFS = recurrence-free survival.

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  Fig. 3 Kaplan-Meier analysis for OS indicated a statistically significant difference in OS between non-sarcopenic and sarcopenic patients (P=0.003, log-rank test). OS = overall survival.

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