Impact of sarcopenia on short- and long-term outcomes in patients with gastric cancer.

Abstract

19 Background: Depletion of skeletal muscle in aged people (sarcopenia) regarded as a poor prognostic factor in various cancers. The aim of this study was to assess the impact of preoperative sarcopenia on postoperative short- and long-term outcomes in patients with gastric cancer underwent curative resection. Methods: A total of 881 patients who underwent R0 resection for gastric cancer aged 65 or older between June 2003 and March 2011 were included in this study. Muscle mass was assessed by measuring percentage of arm muscle area (%AMA). Preoperative sarcopenia was defined as aged 65 or older, %AMA <80%, and decline in grip strength ( <25kg in men, <20kg in women), according to algorithm suggested by European Working Group on Sarcopenia in Older People (EWGSOP) with slight modification. Relationship between sarcopenia and short- and long-term outcomes were evaluated using uni- and multi-variate analysis. Results: Of 881 patients, sarcopenia was diagnosed in 62 patients (7.0%). Incidence of sarcopenia was significantly higher in patients with aged (75 or older), female, low BMI (18.5 or less) and poor PS (2). There was no significant difference of operation time or blood loss between sarcopenic and non-sarcopenic patients. Postoperative complications (Clavien–Dindo classification grade III or higher) was observed in 124 patients (14.1%). Multivariate analysis revealed that T stage and intraoperative blood loss were significant independent risk factors for postoperative complications. The incidence of postoperative complication was similar regardless of the sarcopenia status. The 5-year survival rate was tended to be worse in the sarcopenic patients (67.7%) than in the non-sarcopenic patients (78.4%) (p = 0.058). Multivariate analysis demonstrated that age (75 or older), male, total gastrectomy, D2 lymph node dissection, and sarcopenia were selected as independent prognostic factors for gastric cancer. Conclusions: Preoperative sarcopenia determined by %AMA seems not to be a risk for postoperative morbidity. However, sarcopenia appears to be a significant prognostic factor in patients with gastric cancer underwent curative resection.