Abstract
Objective: We sought to investigate the prognostic significance of body composition and weight change during the first 6 months of adjuvant chemotherapy after R0 resection and develop novel nomograms to accurately predict relapse-free survival (RFS) and overall survival (OS).Methods: This retrospective study included 190 patients who underwent curative radical gastrectomy for gastric cancer and received adjuvant chemotherapy. The changes in weight and body composition including skeletal muscle index (SMI), subcutaneous adipose tissue (SAT), and visceral adipose tissue (VAT) were analyzed for 6 months. LASSO Cox regression and multivariate Cox regression were conducted to evaluate other clinical characteristics, which were used to construct a nomogram for the prediction of 3- and 5-year RFS and OS. The constructed nomogram was subjected to 1,000 resamples bootstrap for internal validation. The Concordance index (C-index) and time-dependent receiver operating characteristic (t-ROC) curves were used to evaluate and compare the discriminative abilities of the new nomograms, non-nutritional nomograms, and pTNM stage.Results: The median follow-up duration was 42.0 (25.2–55.1) months. Factors included in the newly-built nomogram for RFS were pT stage, pN stage, tumor site, tumor size, nerve invasion or not, surgery type, and change of L3SMI, while factors included in the nomogram for OS were pT stage, pN stage, tumor size, nerve invasion or not, surgery type, and change of L3SMI. The C-index and t-ROC indicated that our newly-built nomograms had greater potential to accurately predict prognosis than the non-nutritional nomograms and pTNM stage system. Besides, oral nutritional supplements can reduce the degree of weight and L3SMI loss.Conclusion: Change in skeletal muscle mass during adjuvant chemotherapy can be incorporated into predictive prognostic nomograms for RFS and OS in GC patients after radical resection. Dynamic changes in body composition and weight during adjuvant chemotherapy contribute to the early detection of poor outcomes.
Highlights
According to Global Cancer Statistics 2018, gastric cancer (GC) remains the fifth most commonly diagnosed cancer and the third leading cause of cancer deaths [1]
In the RESOLVE trial, postoperative S-1 combined with oxaliplatin (SOX) was found to be non-inferior to postoperative XELOX for locally advanced GC after D2 gastrectomy [7]
We retrospectively reviewed the medical records of GC patients who had undergone gastrectomy with D2 lymphadenectomy between January 2013 and December 2018 at Sir Run Run Shaw Hospital
Summary
According to Global Cancer Statistics 2018, gastric cancer (GC) remains the fifth most commonly diagnosed cancer and the third leading cause of cancer deaths [1]. Half of GC patients in China are diagnosed with locally advanced GC, unlike those in Japan and Korea. A previous survey of 1,304 GC patients from more than 100 hospitals in China, and undergoing radical surgery showed that 30 and 55.9% of the patients were stage II and III, respectively, [3] while the corresponding percentage were 13.1 and 12% in Japan, and 12.2 and 10.4% in Korea [4, 5]. In the CLASSIC study, capecitabine plus oxaliplatin (XELOX) remarkably improved the 5-year disease-free survival (DFS) compared with surgery alone [6]. In the RESOLVE trial, postoperative S-1 combined with oxaliplatin (SOX) was found to be non-inferior to postoperative XELOX for locally advanced GC after D2 gastrectomy [7]. Patients with stage II-III GC receive adjuvant chemotherapy with a relatively uniform protocol, fluorouraciland platinum-based regimens [6,7,8,9,10]
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