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Annals of Surgical Oncology

, Volume 25, Issue 6, pp 1625–1632 | Cite as

Long-Term Outcomes of Gastric Cancer Patients with Preoperative Sarcopenia

  • Taiichi Kawamura
  • Rie Makuuchi
  • Masanori Tokunaga
  • Yutaka Tanizawa
  • Etsuro Bando
  • Hiroshi Yasui
  • Takashi Aoyama
  • Toshimi Inano
  • Masanori Terashima
Gastrointestinal Oncology

Abstract

Background

There are few reports of long-term outcomes of gastric cancer patients with sarcopenia. The purpose of this study was to assess the impact of sarcopenia on long-term outcomes in gastric cancer patients who underwent curative resection.

Methods

A total of 951 patients aged 65 years or older who underwent R0 resection for gastric cancer were investigated. Sarcopenia was defined as a decreased arm muscle area < 38.05 cm2 in men and < 27.87 cm2 in women combined with a decline in grip strength to < 26 kgf in men and < 18 kgf in women.

Results

Of 951 patients, 111 (11.7%) were diagnosed with sarcopenia. Reduced surgery was performed significantly more frequently in patients with sarcopenia (p = 0.006). The incidence of eligible patients who received adjuvant chemotherapy was significantly lower in patients with sarcopenia than in those without sarcopenia (p = 0.030). Mortality due to gastric cancer and aging-associated multiple organ failure rates without obvious diseases were higher in patients with sarcopenia (p = 0.036 and p < 0.001, respectively). Overall survival (OS) and cause-specific survival (CSS) were significantly worse in patients with sarcopenia (p < 0.001 and p = 0.005, respectively). Multivariate analysis for OS and CSS revealed that sarcopenia was an independent prognostic factor in gastric cancer patients (p < 0.001 and p = 0.043, respectively).

Conclusions

Sarcopenia is related to poor survival in gastric cancer patients and appears to be a significant negative prognostic factor in patients with gastric cancer who underwent curative resection.

Notes

Funding

The authors have no financial disclosures.

References

  1. 1.
    Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39(4):412–23.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Brown JC, Harhay MO, Harhay MN. Sarcopenia and mortality among a population-based sample of community-dwelling older adults. J Cachexia Sarcopenia Muscle. 2015;7(3):290–98.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Hirani V, Blyth F, Naganathan V, et al. Sarcopenia is associated with incident disability, institutionalization, and mortality in community-dwelling older men: the concord health and ageing in men project. J Am Med Dir Assoc. 2015;16(7):607–13.CrossRefPubMedGoogle Scholar
  4. 4.
    Yuki A, Shimokata H. Sarcopenia among Japanese elderly. Igakunoayumi. 2014;248(9):649–54.Google Scholar
  5. 5.
    Tamandl D, Paireder M, Asari R, Baltzer PA, Schoppmann SF, Ba-Ssalamah A. Markers of sarcopenia quantified by computed tomography predict adverse long-term outcome in patients with resected oesophageal or gastro-oesophageal junction cancer. Eur Radiol. 2016;26(5):1359–67.CrossRefPubMedGoogle Scholar
  6. 6.
    Miyamoto Y, Baba Y, Sakamoto Y, et al. Sarcopenia is a negative prognostic factor after curative resection of colorectal Cancer. Ann Surg Oncol. 2015;22(8):2663–68.CrossRefPubMedGoogle Scholar
  7. 7.
    Okumura S, Kaido T, Hamaguchi Y, et al. Impact of the preoperative quantity and quality of skeletal muscle on outcomes after resection of extrahepatic biliary malignancies. Surgery. 2016;159(3):821–33.CrossRefPubMedGoogle Scholar
  8. 8.
    Levolger S, van Vledder MG, Muslem R, et al. Sarcopenia impairs survival in patients with potentially curable hepatocellular carcinoma. J Surg Oncol. 2015;112(2):208–13.CrossRefPubMedGoogle Scholar
  9. 9.
    Zhuang CL, Huang DD, Pang WY, et al. Sarcopenia is an independent predictor of severe postoperative complications and long-term survival after radical gastrectomy for gastric cancer: analysis from a large-scale cohort. Medicine. 2016;95(13):e3164.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Kudou K, Saeki H, Nakashima Y, et al. Prognostic significance of sarcopenia in patients with esophagogastric junction cancer or upper gastric cancer. Ann Surg Oncol. 2017 July;24(7):1804–1810.  https://doi.org/10.1245/s10434-017-5811-9. Epub 2017 Feb 21.CrossRefPubMedGoogle Scholar
  11. 11.
    Tegels JJ, van Vugt JL, Reisinger KW, et al. Sarcopenia is highly prevalent in patients undergoing surgery for gastric cancer but not associated with worse outcomes. J Surg Oncol. 2015;112(4):403–407.CrossRefPubMedGoogle Scholar
  12. 12.
    Wang SL, Zhuang CL, Huang DD, et al. Sarcopenia adversely impacts postoperative clinical outcomes following gastrectomy in patients with gastric cancer: a prospective study. Ann Surg Oncology. 2016;23(2):556–64.CrossRefGoogle Scholar
  13. 13.
    Shen Y, Hao Q, Zhou J, Dong B. The impact of frailty and sarcopenia on postoperative outcomes in older patients undergoing gastrectomy surgery: a systematic review and meta-analysis. BMC Geriatr. 2017;17(1):188.  https://doi.org/10.1186/s12877-017-0569-2.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Fukuda Y, Yamamoto K, Hirao M, et al. Sarcopenia is associated with severe postoperative complications in elderly gastric cancer patients undergoing gastrectomy. Gastric Cancer. 2015; 19(3):986–93.CrossRefPubMedGoogle Scholar
  15. 15.
    Zhou CJ, Zhang FM, Zhang FY, et al. Sarcopenia: a new predictor of postoperative complications for elderly gastric cancer patients who underwent radical gastrectomy. J Surg Res. 2017;211:137–46.  https://doi.org/10.1016/j.jss.2016.12.014. Epub 2016 Dec 22.CrossRefGoogle Scholar
  16. 16.
    Chen LK, Liu LK, Woo J, et al. Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc. 2014;15(2):95–101.CrossRefPubMedGoogle Scholar
  17. 17.
    Frisancho AR. Triceps skin fold and upper arm muscle size norms for assessment of nutrition status. Am J Clin Nutr. 1974;27(10):1052–58.PubMedGoogle Scholar
  18. 18.
    Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14(2):113–23.CrossRefGoogle Scholar
  19. 19.
    Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14(2):101–12.Google Scholar
  20. 20.
    Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003;22(4):415–21.CrossRefGoogle Scholar
  21. 21.
    Onodera T, Goseki N, Kosaki G. [Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients]. Nihon Geka Gakkai Zasshi. 1984;85(9):1001–1005.PubMedGoogle Scholar
  22. 22.
    Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96.CrossRefPubMedGoogle Scholar
  23. 23.
    NCI Common Terminology Criteria for Adverse Effects (CTCAE) Version 4. Available at: https://evs.nci.nih.gov/ftp1/CTCAE/About.html. Accessed 13 Nov 2016.
  24. 24.
    Sakuramoto S, Sasako M, Yamaguchi T, et al. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med. 2007;357(18):1810–20.CrossRefPubMedGoogle Scholar
  25. 25.
    Molina Garrido MJ, Guillen Ponce C, Fernandez Félix BM, et al. [Detection and evaluation of the role of sarcopenia in elderly patients with cancer treated with chemotherapy. ONCOSARCO project]. Rev Esp Geriatr Gerontol. 2016;  https://doi.org/10.1016/j.regg.2016.02.003.PubMedGoogle Scholar
  26. 26.
    Tan BH, Brammer K, Randhawa N, et al. Sarcopenia is associated with toxicity in patients undergoing neo-adjuvant chemotherapy for oesophago-gastric cancer. Eur J Surg Oncol. 2015;41(3):333–38.CrossRefPubMedGoogle Scholar
  27. 27.
    Mirkin KA, Luke FE, Gangi A, et al. Sarcopenia related to neoadjuvant chemotherapy and perioperative outcomes in resected gastric cancer: a multi-institutional analysis. J Gastrointest Oncol. 2017;8(3):589–95.  https://doi.org/10.21037/jgo.2017.03.02.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    McLeay SC, Morrish GA, Kirkpatrick CM, Green B. The relationship between drug clearance and body size: systematic review and meta-analysis of the literature published from 2000 to 2007. Clin Pharmacokinet. 2012;51(5):319–30.CrossRefPubMedGoogle Scholar
  29. 29.
    Dalamaga M. Interplay of adipokines and myokines in cancer pathophysiology: emerging therapeutic implications. World J Exp Med. 2013;3(3):26–33.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Rolland Y, Lauwers-Cances V, Cournot M, et al. Sarcopenia, calf circumference, and physical function of elderly women: a cross-sectional study. Am Geriatr Soc. 2003;51(8):1120–11204.CrossRefGoogle Scholar
  31. 31.
    Landi F, Cruz-Jentoft AJ, Liperoti R, et al. Sarcopenia and mortality risk in frail older persons aged 80 years and older: results from ilSIRENTE study. Age Ageing. 2013;42(2):203–209.CrossRefPubMedGoogle Scholar
  32. 32.
    Kim M, Shinkai S, Murayama H, Mori S. Comparison of segmental multifrequency bioelectrical impedance analysis with dual-energy x-ray absorptiometry for the assessment of body composition in a community-dwelling older population. Geriatr Gerontol Int. 2015;15(8):1013–22.CrossRefPubMedGoogle Scholar
  33. 33.
    Reiss J, Iglseder B, Kreutzer M, et al. Case finding for sarcopenia in geriatric inpatients: performance of bioimpedance analysis in comparison to dual x-ray absorptiometry. BMC Geriatr. 2016;16:52.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Malafarina V, Uriz-Otano F, Iniesta R, Gil-Guerrero L. Effectiveness of nutritional supplementation on muscle mass in treatment of sarcopenia in old age: a systematic review. Am Med Dir Assoc. 2013;14(1):10–17.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Taiichi Kawamura
    • 1
  • Rie Makuuchi
    • 1
  • Masanori Tokunaga
    • 1
  • Yutaka Tanizawa
    • 1
  • Etsuro Bando
    • 1
  • Hiroshi Yasui
    • 2
  • Takashi Aoyama
    • 3
  • Toshimi Inano
    • 3
  • Masanori Terashima
    • 1
  1. 1.Division of Gastric SurgeryShizuoka Cancer CenterShizuokaJapan
  2. 2.Division of Gastrointestinal OncologyShizuoka Cancer CenterShizuokaJapan
  3. 3.Dietary DepartmentShizuoka Cancer CenterShizuokaJapan

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