Sarcopenia as a prognostic factor for survival in patients with locally advanced gastroesophageal adenocarcinoma

English version

Autoři: Christine Koch ^aff001; Cornelius Reitz ^aff001; Teresa Schreckenbach ^aff002; Katrin Eichler ^aff003; Natalie Filmann ^aff004; Salah-Eddin Al-Batran ^aff005; Thorsten Götze ^aff005; Stefan Zeuzem ^aff001; Wolf Otto Bechstein ^aff002; Thomas Kraus ^aff006; Jörg Bojunga ^aff001; Markus Düx ^aff007; Jörg Trojan ^aff001; Irina Blumenstein ^aff001
Působiště autorů: Department of Gastroenterology, Hepatology, Endocrinology and Nutrition, University Hospital, Goethe University, Frankfurt am Main, Germany ^aff001; Department of General and Visceral Surgery, University Hospital, Goethe University, Frankfurt am Main, Germany ^aff002; Institute for Diagnostic and Interventional Radiology, University Hospital, Goethe University, Frankfurt am Main, Germany ^aff003; Institute for Biostatistics and Mathematical Modelling, Goethe University, Frankfurt am Main, Germany ^aff004; Institute for Clinical Research, (IKF), Hospital Nordwest, Frankfurt am Main, Germany ^aff005; Central Institute for Radiology and Neuroradiology, Nordwest Hospital, Frankfurt am Main, Germany ^aff006; Department of General and Viseral Surgery, Hospital Nordwest, Frankfurt am Main, Germany ^aff007
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0223613

Souhrn

Background and aims

Patients with gastric cancer often show signs of malnutrition. We sought to evaluate the influence of sarcopenia in patients with locally advanced, not metastasized, gastric or gastro-esophageal junction (GEJ) cancer undergoing curative treatment (perioperative chemotherapy and surgery) on morbidity and mortality in order to identify patients in need for nutritional intervention.

Patients and methods

Two-centre study, conducted in the Frankfurt University Clinic and Krankenhaus Nordwest (Frankfurt) as part of the University Cancer Center Frankfurt (UCT). 47/83 patients were treated in the FLOT trial (NCT01216644). Patients´ charts were reviewed for clinical data. Two consecutive CT scans were retrospectively analyzed to determine the degree of sarcopenia. Survival was calculated using the Kaplan-Meier method, multivariate analysis was performed using the Cox regression.

Results

60 patients (72.3%) were male and 23 (27.7%) female. 45 patients (54.2%) had GEJ type 1–3 and 38 (45.8%) gastric tumors, respectively. Sarcopenic patients were significantly older than non-sarcopenic patients (mean age 65.1 years vs. 59.5 years, p = 0.042), terminated the chemotherapy significantly earlier (50% vs. 22.6%, p = 0.037) and showed higher Clavien-Dindo scores, indicating more severe perioperative complications (score ≥3 43.3 vs. 17.0%, p = 0.019). Sarcopenic patients had a significantly shorter survival than non-sarcopenic patients (139.6 ± 19.5 [95% CI, 101.3–177.9] vs. 206.7 ± 13.8 [95% CI, 179.5–233.8] weeks, p = 0.004). Multivariate Cox regression analysis showed that, besides UICC stage, sarcopenia significantly influenced survival.

Conclusion

Sarcopenia is present in a large proportion of patients with locally advanced gastric or GEJ cancer and significantly influences tolerability of chemotherapy, surgical complications and survival.

Klíčová slova:

Cancer treatment – Surgical and invasive medical procedures – Sarcopenia – Digestive system procedures – Gastric cancer – Cancer chemotherapy – Regression analysis – Surgical oncology

Zdroje

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