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Marked Loss of Muscle, Visceral Fat, or Subcutaneous Fat After Gastrectomy Predicts Poor Survival in Advanced Gastric Cancer: Single-Center Study from the CLASSIC Trial

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

There is increasing interest in the influence of body composition on oncological outcomes. We evaluated the role of skeletal muscle and fat among patients with gastric cancer (GC) who underwent gastrectomy with or without adjuvant chemotherapy, as well as those changes’ associations with survival outcomes.

Methods

The present study evaluated 136 patients with GC who were enrolled in the CLASSIC Trial at Yonsei Cancer Center. Baseline body compositions including skeletal muscle area, Hounsfield units (HU), visceral fat area, and subcutaneous fat area were measured by preoperative computed tomography (CT). CT before and after the gastrectomy were used to determine the 6-month relative changes in body composition parameters. Continuous variables were dichotomized according to the best cutoff values by Contal and O’Quigley method.

Results

Seventy-three patients (53.7%) underwent surgery alone, and 63 patients (46.3%) underwent surgery followed by adjuvant chemotherapy. The baseline body composition parameters were not associated with disease-free survival (DFS) or overall survival (OS). Except for the HU, the marked loss of muscle, visceral fat, or subcutaneous fat significantly predicted shorter DFS and OS. Patients with a marked loss in at least one significant body composition parameter had significantly shorter DFS (hazard ratio 2.9, 95% confidence interval 1.7–4.8, P < 0.001) and OS (hazard ratio 2.9, 95% confidence interval 1.7–5.0, P < 0.001).

Conclusions

Marked loss in body composition parameters significantly predicted shorter DFS and OS among patients with GC who underwent gastrectomy. Postoperative nutrition and active healthcare interventions could improve the prognosis of these GC patients.

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Funding

This study was supported by a 2014 faculty research Grant from the Yonsei University College of Medicine (6-2014-0177 to M Jung).

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Authors and Affiliations

Authors

Corresponding authors

Correspondence to Song-Ee Baek MD or Minkyu Jung MD, PhD.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Human and animal Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The protocol was reviewed and approved by the local Institutional Review Board (IRB Approval No. 2017-2283-001).

Informed consent

The institutional IRB decided to waive the informed consent of this study because it was an observation study using retrospectively collected data.

Electronic supplementary material

Below is the link to the electronic supplementary material.

10434_2018_6624_MOESM1_ESM.tif

Measurements of muscle mass, Hounsfield units (HU), visceral fat, and subcutaneous fat at lumbar vertebra 3 (L3) level using computed tomography (CT) scan. (a) Measured axial CT image which was selected by reference images with (b) 3D reconstruction image, (c) coronal image and (d) sagittal image. (e) Measurements of muscle area and HU (blue area). (f) Visceral (green area) and subcutaneous (blue area) fat area measurements

10434_2018_6624_MOESM2_ESM.tif

Correlations between each body composition factor. The correlations are shown for (a) 6-month relative muscle change and 6-month relative visceral fat change, (b) 6-month relative muscle change and 6 month relative subcutaneous fat change, and (c) 6 month relative visceral fat change and 6 month relative subcutaneous fat change

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Park, H.S., Kim, H.S., Beom, S.H. et al. Marked Loss of Muscle, Visceral Fat, or Subcutaneous Fat After Gastrectomy Predicts Poor Survival in Advanced Gastric Cancer: Single-Center Study from the CLASSIC Trial. Ann Surg Oncol 25, 3222–3230 (2018). https://doi.org/10.1245/s10434-018-6624-1

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  • DOI: https://doi.org/10.1245/s10434-018-6624-1

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