Body Composition as a Prognostic Factor of Neoadjuvant Chemotherapy Toxicity and Outcome in Patients with Locally Advanced Gastric Cancer

Carolina Palmela; Sónia Velho; Lisa Agostinho; Francisco Branco; Marta Santos; Maria Pia Costa Santos; Maria Helena Oliveira; João Strecht; Rui Maio; Marília Cravo; Vickie E. Baracos

doi:https://doi.org/10.5230/jgc.2017.17.e8

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자료유형: 학술저널

저자정보: Carolina Palmela (Hospital Beatriz Ângelo) Sónia Velho (Hospital Beatriz Ângelo) Lisa Agostinho (Hospital Beatriz Ângelo) Francisco Branco (Hospital Beatriz Ângelo) Marta Santos (Hospital Beatriz Ângelo) Maria Pia Costa Santos (Hospital Beatriz Ângelo) Maria Helena Oliveira (Hospital Beatriz Ângelo) João Strecht (Hospital Beatriz Ângelo) Rui Maio (Hospital Beatriz Ângelo) Marília Cravo (Hospital Beatriz Ângelo) Vickie E. Baracos (University of Alberta)

저널정보: 대한위암학회 Journal of Gastric Cancer Journal of Gastric Cancer 제17권 제1호

발행연도: 2017.3

수록면: 74 - 87 (14page)

DOI: https://doi.org/10.5230/jgc.2017.17.e8

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Purpose: Neoadjuvant chemotherapy has been shown to improve survival in locally advanced gastric cancer, but it is associated with significant toxicity. Sarcopenia and sarcopenic obesity have been studied in several types of cancers and have been reported to be associated with higher chemotherapy toxicity and morbi-mortality. The aim of this study was to assess the prevalence of sarcopenia/sarcopenic obesity in patients with gastric cancer, as well as its association with chemotherapy toxicity and long-term outcomes. Materials and Methods: A retrospective analysis was performed using an academic cancer center patient cohort diagnosed with locally advanced gastric cancer between January 2012 and December 2014 and treated with neoadjuvant chemotherapy. We analyzed body composition (skeletal muscle and visceral fat index) in axial computed tomography images. Results: A total of 48 patients met the inclusion criteria. The mean age was 68±10 years, and 33 patients (69%) were men. Dose-limiting toxicity was observed in 22 patients (46%), and treatment was terminated early owing to toxicity in 17 patients (35%). Median follow-up was 17 months. Sarcopenia and sarcopenic obesity were found at diagnosis in 23% and 10% of patients, respectively. We observed an association between termination of chemotherapy and both sarcopenia (P=0.069) and sarcopenic obesity (P=0.004). On multivariate analysis, the odds of treatment termination were higher in patients with sarcopenia (odds ratio=4.23; P=0.050). Patients with sarcopenic obesity showed lower overall survival (median survival of 6 months [95% confidence interval {CI}=3.9?8.5] vs. 25 months [95% CI=20.2?38.2]; log-rank test P=0.000). Conclusions: Sarcopenia and sarcopenic obesity were associated with early termination of neoadjuvant chemotherapy in patients with gastric cancer; additionally, sarcopenic obesity was associated with poor survival.

#Stomach neoplasms #Body composition #Sarcopenia #Neoadjuvant therapy #Prognosis

참고문헌 (42)

참고문헌 신청

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Fox JG / 2007 / Inflammation, atrophy, and gastric cancer / J Clin Invest 117:60~69

Cunningham D / 2006 / Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer / N Engl J Med 355:11~20

Tan BH / 2015 / Sarcopenia is associated with toxicity in patients undergoing neo-adjuvant chemotherapy for oesophago-gastric cancer / Eur J Surg Oncol 41:333~338

Prado CM / 2008 / Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts : a population-based study / Lancet Oncol 9:629~635

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