Loss of skeletal muscle mass during treatment is associated with reduced overall survival in gastric cancer patients undergoing conversion surgery

IF 2.9 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN Pub Date : 2025-06-12 DOI:10.1016/j.clnesp.2025.06.014

Marta Sandini , Giulio Bagnacci , Vincenzo Ricchiuti , Irene Gambassi , Stefania Piccioni , Iacopo Capitoni , Maria Antonietta Mazzei , Daniele Marrelli , Franco Roviello

{"title":"Loss of skeletal muscle mass during treatment is associated with reduced overall survival in gastric cancer patients undergoing conversion surgery","authors":"Marta Sandini , Giulio Bagnacci , Vincenzo Ricchiuti , Irene Gambassi , Stefania Piccioni , Iacopo Capitoni , Maria Antonietta Mazzei , Daniele Marrelli , Franco Roviello","doi":"10.1016/j.clnesp.2025.06.014","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>The recent introduction of multimodal approach in the setting of conversion surgery (CS) significantly improved survival of stage IV gastric cancer (GC) patients. The prognosis has been related to several tumor and patient factors. Abnormal body composition, specifically the depletion of the lean mass compound, have been associated with impaired short- and long-term outcomes in GC. Aim was to analyze potential variation of body composition during systemic treatment and to evaluate aftermath on further resection and survival.</div></div><div><h3>Methods</h3><div>In this retrospective monocenter analysis, we assessed pre-treatment and preoperative body composition of stage IV GC patients who underwent surgical exploration following systemic treatment in the setting of CS, over a 12-year period. A radiologist blinded to the patient outcomes assessed the areas of skeletal muscle, and adipose tissue by a dedicated software through standardized protocols. Demographics and clinical data were obtained from prospectively maintained databases and patient records.</div></div><div><h3>Results</h3><div>We included 42 GC patients. Median age was 59 years, 27, 64.3 % were male, and 22/42 were Yoshida category 3 and 4. Surgical interventions included curative resection (23/42 cases), or palliation (19/42). We observed difference in the distribution of body components according to gender, at diagnosis, with more subcutaneous adipose tissue in males (p < 0.001) vs. more visceral adipose tissue in females (p = 0.039). During systemic treatment, a significant increase in total muscle area was observed, but nor in males (median delta TMA -7cm<sup>2</sup> in males and delta TMA +4.8 cm<sup>2</sup> in females, p = 0.048). Increased TMA during chemotherapy was associated with improved overall survival, with median OS 63 months, vs. 27 months for patients who lost lean mass (p = 0.042). The protective effect of increased TMA was also confirmed at a multivariate analysis after normalization for age and type of surgical procedure (HR 0.98, 95%CI 0.97–0.99; p = 0.035).</div></div><div><h3>Conclusion</h3><div>As increased skeletal muscular mass during systemic treatment independently improved the overall survival, longitudinal evaluation of body composition must be part of routinary work-up of gastric cancer patients in the setting of conversion surgery. Potential effects of nutritional interventions must be evaluated.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"68 ","pages":"Pages 737-743"},"PeriodicalIF":2.9000,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical nutrition ESPEN","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2405457725003602","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"NUTRITION & DIETETICS","Score":null,"Total":0}

引用次数: 0

Abstract

Background

The recent introduction of multimodal approach in the setting of conversion surgery (CS) significantly improved survival of stage IV gastric cancer (GC) patients. The prognosis has been related to several tumor and patient factors. Abnormal body composition, specifically the depletion of the lean mass compound, have been associated with impaired short- and long-term outcomes in GC. Aim was to analyze potential variation of body composition during systemic treatment and to evaluate aftermath on further resection and survival.

Methods

In this retrospective monocenter analysis, we assessed pre-treatment and preoperative body composition of stage IV GC patients who underwent surgical exploration following systemic treatment in the setting of CS, over a 12-year period. A radiologist blinded to the patient outcomes assessed the areas of skeletal muscle, and adipose tissue by a dedicated software through standardized protocols. Demographics and clinical data were obtained from prospectively maintained databases and patient records.

Results

We included 42 GC patients. Median age was 59 years, 27, 64.3 % were male, and 22/42 were Yoshida category 3 and 4. Surgical interventions included curative resection (23/42 cases), or palliation (19/42). We observed difference in the distribution of body components according to gender, at diagnosis, with more subcutaneous adipose tissue in males (p < 0.001) vs. more visceral adipose tissue in females (p = 0.039). During systemic treatment, a significant increase in total muscle area was observed, but nor in males (median delta TMA -7cm² in males and delta TMA +4.8 cm² in females, p = 0.048). Increased TMA during chemotherapy was associated with improved overall survival, with median OS 63 months, vs. 27 months for patients who lost lean mass (p = 0.042). The protective effect of increased TMA was also confirmed at a multivariate analysis after normalization for age and type of surgical procedure (HR 0.98, 95%CI 0.97–0.99; p = 0.035).

Conclusion

As increased skeletal muscular mass during systemic treatment independently improved the overall survival, longitudinal evaluation of body composition must be part of routinary work-up of gastric cancer patients in the setting of conversion surgery. Potential effects of nutritional interventions must be evaluated.

查看原文本刊更多论文

在接受转化手术的胃癌患者中，治疗期间骨骼肌质量的减少与总生存率降低相关。

背景：最近在转换手术（CS）中引入的多模式入路显著提高了IV期胃癌（GC）患者的生存率。预后与多种肿瘤和患者因素有关。异常的身体组成，特别是瘦质量化合物的消耗，与GC的短期和长期结果受损有关。目的是分析全身治疗期间身体成分的潜在变化，并评估进一步切除和生存的后果。方法：在这项回顾性单中心分析中，我们评估了在CS背景下接受全身治疗后进行手术探查的IV期GC患者的治疗前和术前身体组成，时间超过12年。放射科医生对患者结果不知情，通过标准化协议，通过专用软件评估骨骼肌和脂肪组织的面积。从前瞻性维护的数据库和患者记录中获得人口统计学和临床数据。结果：我们纳入了42例胃癌患者。中位年龄59岁，男性占27 / 64.3%，吉田3、4类占22/42。手术干预包括根治性切除（23/42）或姑息治疗（19/42）。我们观察到不同性别的身体成分分布的差异，在诊断时，男性皮下脂肪组织更多（男性p2，女性δ TMA +4.8cm2, p=0.048）。化疗期间TMA的增加与总生存期的改善相关，中位生存期为63个月，而瘦质量减少的患者为27个月（p=0.042）。在年龄和手术类型归一化后的多变量分析中也证实了TMA增加的保护作用(HR 0.98, 95%CI 0.97-0.99；p = 0.035)。结论：由于全身治疗期间骨骼肌量的增加独立地提高了总生存率，因此在转换手术的背景下，身体成分的纵向评估必须成为胃癌患者常规检查的一部分。必须对营养干预的潜在影响进行评估。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinical nutrition ESPEN NUTRITION & DIETETICS-

CiteScore

4.90

自引率

3.30%

发文量

512

期刊介绍： Clinical Nutrition ESPEN is an electronic-only journal and is an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism. Published bimonthly, Clinical Nutrition ESPEN focuses on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice. Clinical Nutrition ESPEN is available to all members of ESPEN and to all subscribers of Clinical Nutrition.