Associations between sarcopenia and peripheral inflammatory, nutritional factors, and prognosis in patients with gastric cancer_Chinese Journal of Evidence-Based Medicine

Authors：

PU Lin , YIN Yiqiong , WEN Yue , LAI Li ,  CHEN Yi , YAN Youtong

Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

CHEN Yi, Email: toddychan@163.com

Keywords：

Gastric cancer; Sarcopenia; Overall survival

DOI：

10.7507/1672-2531.202204053

Video：

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Objective To investigate the relevance among sarcopenia, peripheral inflammatory, and nutritional factors, as well as the impact of sarcopenia on the prognosis of gastric cancer. Methods A total of 174 patients with gastric cancer in Department of Gastrointestinal Surgery in West China Hospital of Sichuan University from July 2016 to December 2020 were retrospectively included. The skeletal muscle index (SMI) of the third lumbar vertebra level was calculated using CT images, and male patients with SMI<52.4 cm²/m² and female patients with SMI<38.5 cm²/m² were considered sarcopenia. The key clinicopathological features of patients were collected for prognostic analysis. Results Among the 174 patients with gastric cancer, 73 patients (41.95%) were diagnosed with sarcopenia. Compared with those of non-sarcopenia, the patients who were diagnosed with sarcopenia showed a significantly elder age and lower body mass index (BMI). In addition, males demonstrated a significantly higher rate of sarcopenia. Further, patients with sarcopenia showed a significant increasing in the incidence of postoperative pulmonary infections and length of hospitalization than patients without sarcopenia. The two groups showed significant differences in type 2 diabetes, peripheral C-reaction protein (CRP), interleukin-6 (IL-6), albumin, prealbumin, and hemoglobin. Overall, the multivariate analysis and Kaplan-Meier survival curves indicated that sarcopenic patients had a significantly lower survival rate than the non-sarcopenia patients. Conclusion Sarcopenia is closely related to higher levels of inflammation, malnutrition, and poor prognosis in patients with gastric cancer. Therefore, we should diagnose sarcopenia patients as early as possible, and give nutritional support to the patients.

Citation： PU Lin, YIN Yiqiong, WEN Yue, LAI Li, CHEN Yi, YAN Youtong. Associations between sarcopenia and peripheral inflammatory, nutritional factors, and prognosis in patients with gastric cancer. Chinese Journal of Evidence-Based Medicine, 2023, 23(1): 2-6. doi: 10.7507/1672-2531.202204053 Copy

1.	Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing, 2019, 48(1): 16-31.
2.	Cruz-Jentoft AJ, Sayer AA. Sarcopenia. Lancet, 2019, 393(10191): 2636-2646.
3.	Anker SD, Morley JE, von Haehling S. Welcome to the ICD-10 code for sarcopenia. J Cachexia Sarcopenia Muscle, 2016, 7(5): 512-514.
4.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
5.	Smyth EC, Nilsson M, Grabsch HI, et al. Gastric cancer. Lancet, 2020, 396(10251): 635-648.
6.	Dunne RF, Loh KP, Williams GR, et al. Cachexia and sarcopenia in older adults with cancer: a comprehensive review. Cancers (Basel), 2019, 11(12): 1861.
7.	Xia L, Zhao R, Wan Q, et al. Sarcopenia and adverse health-related outcomes: an umbrella review of meta-analyses of observational studies. Cancer Med, 2020, 9(21): 7964-7978.
8.	Pamoukdjian F, Bouillet T, Lévy V, et al. Prevalence and predictive value of pre-therapeutic sarcopenia in cancer patients: a systematic review. Clin Nutr, 2018, 37(4): 1101-1113.
9.	Schneider M, Hübner M, Becce F, et al. Sarcopenia and major complications in patients undergoing oncologic colon surgery. J Cachexia Sarcopenia Muscle, 2021, 12(6): 1757-1763.
10.	Trejo-Avila M, Bozada-Gutiérrez K, Valenzuela-Salazar C, et al. Sarcopenia predicts worse postoperative outcomes and decreased survival rates in patients with colorectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis, 2021, 36(6): 1077-1096.
11.	Simonsen C, de Heer P, Bjerre ED, et al. Sarcopenia and postoperative complication risk in gastrointestinal surgical oncology: a meta-analysis. Ann Surg, 2018, 268(1): 58-69.
12.	Catanese S, Aringhieri G, Vivaldi C, et al. Role of baseline computed-tomography-evaluated body composition in predicting outcome and toxicity from first-line therapy in advanced gastric cancer patients. J Clin Med, 2021, 10(5): 1079.
13.	Rinninella E, Cintoni M, Raoul P, et al. Muscle mass, assessed at diagnosis by L3-CT scan as a prognostic marker of clinical outcomes in patients with gastric cancer: a systematic review and meta-analysis. Clin Nutr, 2020, 39(7): 2045-2054.
14.	Kamarajah SK, Bundred J, Tan BHL. Body composition assessment and sarcopenia in patients with gastric cancer: a systematic review and meta-analysis. Gastric Cancer, 2019, 22(1): 10-22.
15.	Guerri S, Mercatelli D, Aparisi Gómez MP, et al. Quantitative imaging techniques for the assessment of osteoporosis and sarcopenia. Quant Imaging Med Surg, 2018, 8(1): 60-85.
16.	Hacker UT, Hasenclever D, Linder N, et al. Prognostic role of body composition parameters in gastric/gastroesophageal junction cancer patients from the EXPAND trial. J Cachexia Sarcopenia Muscle, 2020, 11(1): 135-144.
17.	Kim YY, Lee J, Jeong WK, et al. Prognostic significance of sarcopenia in microsatellite-stable gastric cancer patients treated with programmed death-1 inhibitors. Gastric Cancer, 2021, 24(2): 457-466.
18.	Oke SM, Rye B, Malietzis G, et al. Survival and CT defined sarcopenia in patients with intestinal failure on home parenteral support. Clin Nutr, 2020, 39(3): 829-836.
19.	Prado CM, Lieffers JR, McCargar LJ, et al. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol, 2008, 9(7): 629-635.
20.	Mishra A, Bigam KD, Extermann M, et al. Sarcopenia and low muscle radiodensity associate with impaired FEV1 in allogeneic haematopoietic stem cell transplant recipients. J Cachexia Sarcopenia Muscle, 2020, 11(6): 1570-1579.
21.	Fehrenbach U, Wuensch T, Gabriel P, et al. CT Body composition of sarcopenia and sarcopenic obesity: predictors of postoperative complications and survival in patients with locally advanced esophageal adenocarcinoma. Cancers (Basel), 2021, 13(12): 2921.
22.	Cohen S, Nathan JA, Goldberg AL. Muscle wasting in disease: molecular mechanisms and promising therapies. Nat Rev Drug Discov, 2015, 14(1): 58-74.
23.	Gheller BJ, Riddle ES, Lem MR, et al. Understanding age-related changes in skeletal muscle metabolism: differences between females and males. Annu Rev Nutr, 2016, 36: 129-156.
24.	Biolo G, Cederholm T, Muscaritoli M. Muscle contractile and metabolic dysfunction is a common feature of sarcopenia of aging and chronic diseases: from sarcopenic obesity to cachexia. Clin Nutr, 2014, 33(5): 737-748.
25.	Palmela C, Velho S, Agostinho L, et al. Body composition as a prognostic factor of neoadjuvant chemotherapy toxicity and outcome in patients with locally advanced gastric cancer. J Gastric Cancer, 2017, 17(1): 74-87.
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): 333-338.
27.	Ten Haaf DSM, Eijsvogels TMH, Bongers CCWG, et al. Protein supplementation improves lean body mass in physically active older adults: a randomized placebo-controlled trial. J Cachexia Sarcopenia Muscle, 2019, 10(2): 298-310.
28.	Smith GI, Julliand S, Reeds DN, et al. Fish oil-derived n-3 PUFA therapy increases muscle mass and function in healthy older adults. Am J Clin Nutr, 2015, 102(1): 115-122.
29.	Liao CD, Tsauo JY, Wu YT, et al. Effects of protein supplementation combined with resistance exercise on body composition and physical function in older adults: a systematic review and meta-analysis. Am J Clin Nutr, 2017, 106(4): 1078-1091.
30.	Antoniak AE, Greig CA. The effect of combined resistance exercise training and vitamin D3 supplementation on musculoskeletal health and function in older adults: a systematic review and meta-analysis. BMJ Open, 2017, 7(7): e014619.
31.	Velho S, Moço S, Ferreira A, et al. Dietary patterns and their relationships to sarcopenia in Portuguese patients with gastrointestinal cancer: An exploratory study. Nutrition, 2019, 63-64: 193-199.
32.	Bear DE, Langan A, Dimidi E, et al. β-Hydroxy-β-methylbutyrate and its impact on skeletal muscle mass and physical function in clinical practice: a systematic review and meta-analysis. Am J Clin Nutr, 2019, 109(4): 1119-1132.

1. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing, 2019, 48(1): 16-31.
2. Cruz-Jentoft AJ, Sayer AA. Sarcopenia. Lancet, 2019, 393(10191): 2636-2646.
3. Anker SD, Morley JE, von Haehling S. Welcome to the ICD-10 code for sarcopenia. J Cachexia Sarcopenia Muscle, 2016, 7(5): 512-514.
4. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
5. Smyth EC, Nilsson M, Grabsch HI, et al. Gastric cancer. Lancet, 2020, 396(10251): 635-648.
6. Dunne RF, Loh KP, Williams GR, et al. Cachexia and sarcopenia in older adults with cancer: a comprehensive review. Cancers (Basel), 2019, 11(12): 1861.
7. Xia L, Zhao R, Wan Q, et al. Sarcopenia and adverse health-related outcomes: an umbrella review of meta-analyses of observational studies. Cancer Med, 2020, 9(21): 7964-7978.
8. Pamoukdjian F, Bouillet T, Lévy V, et al. Prevalence and predictive value of pre-therapeutic sarcopenia in cancer patients: a systematic review. Clin Nutr, 2018, 37(4): 1101-1113.
9. Schneider M, Hübner M, Becce F, et al. Sarcopenia and major complications in patients undergoing oncologic colon surgery. J Cachexia Sarcopenia Muscle, 2021, 12(6): 1757-1763.
10. Trejo-Avila M, Bozada-Gutiérrez K, Valenzuela-Salazar C, et al. Sarcopenia predicts worse postoperative outcomes and decreased survival rates in patients with colorectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis, 2021, 36(6): 1077-1096.
11. Simonsen C, de Heer P, Bjerre ED, et al. Sarcopenia and postoperative complication risk in gastrointestinal surgical oncology: a meta-analysis. Ann Surg, 2018, 268(1): 58-69.
12. Catanese S, Aringhieri G, Vivaldi C, et al. Role of baseline computed-tomography-evaluated body composition in predicting outcome and toxicity from first-line therapy in advanced gastric cancer patients. J Clin Med, 2021, 10(5): 1079.
13. Rinninella E, Cintoni M, Raoul P, et al. Muscle mass, assessed at diagnosis by L3-CT scan as a prognostic marker of clinical outcomes in patients with gastric cancer: a systematic review and meta-analysis. Clin Nutr, 2020, 39(7): 2045-2054.
14. Kamarajah SK, Bundred J, Tan BHL. Body composition assessment and sarcopenia in patients with gastric cancer: a systematic review and meta-analysis. Gastric Cancer, 2019, 22(1): 10-22.
15. Guerri S, Mercatelli D, Aparisi Gómez MP, et al. Quantitative imaging techniques for the assessment of osteoporosis and sarcopenia. Quant Imaging Med Surg, 2018, 8(1): 60-85.
16. Hacker UT, Hasenclever D, Linder N, et al. Prognostic role of body composition parameters in gastric/gastroesophageal junction cancer patients from the EXPAND trial. J Cachexia Sarcopenia Muscle, 2020, 11(1): 135-144.
17. Kim YY, Lee J, Jeong WK, et al. Prognostic significance of sarcopenia in microsatellite-stable gastric cancer patients treated with programmed death-1 inhibitors. Gastric Cancer, 2021, 24(2): 457-466.
18. Oke SM, Rye B, Malietzis G, et al. Survival and CT defined sarcopenia in patients with intestinal failure on home parenteral support. Clin Nutr, 2020, 39(3): 829-836.
19. Prado CM, Lieffers JR, McCargar LJ, et al. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol, 2008, 9(7): 629-635.
20. Mishra A, Bigam KD, Extermann M, et al. Sarcopenia and low muscle radiodensity associate with impaired FEV1 in allogeneic haematopoietic stem cell transplant recipients. J Cachexia Sarcopenia Muscle, 2020, 11(6): 1570-1579.
21. Fehrenbach U, Wuensch T, Gabriel P, et al. CT Body composition of sarcopenia and sarcopenic obesity: predictors of postoperative complications and survival in patients with locally advanced esophageal adenocarcinoma. Cancers (Basel), 2021, 13(12): 2921.
22. Cohen S, Nathan JA, Goldberg AL. Muscle wasting in disease: molecular mechanisms and promising therapies. Nat Rev Drug Discov, 2015, 14(1): 58-74.
23. Gheller BJ, Riddle ES, Lem MR, et al. Understanding age-related changes in skeletal muscle metabolism: differences between females and males. Annu Rev Nutr, 2016, 36: 129-156.
24. Biolo G, Cederholm T, Muscaritoli M. Muscle contractile and metabolic dysfunction is a common feature of sarcopenia of aging and chronic diseases: from sarcopenic obesity to cachexia. Clin Nutr, 2014, 33(5): 737-748.
25. Palmela C, Velho S, Agostinho L, et al. Body composition as a prognostic factor of neoadjuvant chemotherapy toxicity and outcome in patients with locally advanced gastric cancer. J Gastric Cancer, 2017, 17(1): 74-87.
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): 333-338.
27. Ten Haaf DSM, Eijsvogels TMH, Bongers CCWG, et al. Protein supplementation improves lean body mass in physically active older adults: a randomized placebo-controlled trial. J Cachexia Sarcopenia Muscle, 2019, 10(2): 298-310.
28. Smith GI, Julliand S, Reeds DN, et al. Fish oil-derived n-3 PUFA therapy increases muscle mass and function in healthy older adults. Am J Clin Nutr, 2015, 102(1): 115-122.
29. Liao CD, Tsauo JY, Wu YT, et al. Effects of protein supplementation combined with resistance exercise on body composition and physical function in older adults: a systematic review and meta-analysis. Am J Clin Nutr, 2017, 106(4): 1078-1091.
30. Antoniak AE, Greig CA. The effect of combined resistance exercise training and vitamin D3 supplementation on musculoskeletal health and function in older adults: a systematic review and meta-analysis. BMJ Open, 2017, 7(7): e014619.
31. Velho S, Moço S, Ferreira A, et al. Dietary patterns and their relationships to sarcopenia in Portuguese patients with gastrointestinal cancer: An exploratory study. Nutrition, 2019, 63-64: 193-199.
32. Bear DE, Langan A, Dimidi E, et al. β-Hydroxy-β-methylbutyrate and its impact on skeletal muscle mass and physical function in clinical practice: a systematic review and meta-analysis. Am J Clin Nutr, 2019, 109(4): 1119-1132.

Chinese Journal of Evidence-Based Medicine

Associations between sarcopenia and peripheral inflammatory, nutritional factors, and prognosis in patients with gastric cancer

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