Abstract
BackgroundSkeletal muscle mass deterioration is common in gastric cancer (GC) patients and is linked to poor prognosis. However, information regarding the effect of skeletal muscle mass changes in the postoperative period is scarce. This study was to investigate the link between postoperative loss of skeletal muscle mass and survival following GC surgery.MethodsPatients who underwent GC surgery between January 2015 and December 2016 were recruited into the study. Computed tomography at L3 vertebral level was used to examine skeletal muscle index prior to surgery and about 6 months after surgery. Skeletal muscle index changes were categorized as presence or absence of ≥5% loss. Overall survival (OS) and disease-free survival (DFS) were analyzed, and Cox proportional hazard models used to identify their predictors.ResultsThe study comprised of 318 gastric cancer patients of which 63.5% were male. The group's mean age was 58.14 ± 10.77 years. Sixty-five patients experienced postoperative skeletal muscle index loss ≥5% and had poorer OS (P = 0.004) and DFS (P = 0.020). We find that postoperative skeletal muscle index loss ≥ 5% predicts OS [hazard ratio (HR): 2.769, 95% confidence interval (CI): 1.865–4.111; P < 0.001] and DFS (HR: 2.533, 95% CI: 1.753–3.659; P < 0.001).ConclusionsLoss of skeletal muscle mass postoperatively is linked to poor survival following GC surgery. Further studies are needed to determine whether stabilizing or enhancing skeletal muscle mass after surgery improves survival.
Highlights
While its incidence rate continues to decrease in most parts of the world, gastric cancer (GC) accounts for the fifth common cancer and become the third leading cause of cancer-related death worldwide [1, 2]
We have recently reported that after GC surgery, reduced skeletal muscle mass occurs in 3 months after hospital discharge [15]
Because skeletal muscle losses ≥ 5% have previously been associated with poor clinical outcomes, including short survival in cancer treatment [19], we used this cutoff threshold to define the postoperative loss of skeletal muscle mass by grouping patients as Skeletal muscle index (SMI) loss ≥ 5% or SMI loss < 5%
Summary
While its incidence rate continues to decrease in most parts of the world, gastric cancer (GC) accounts for the fifth common cancer and become the third leading cause of cancer-related death worldwide [1, 2]. Despite advances in operative techniques and perioperative care, GC prognosis after surgery remains poor [5]. Numerous studies have shown that cancer prognosis is Postoperative Muscle Loss After Surgery conditioned by non-modifiable tumor-specific factors such as histology and stage and modifiable patientindividual factors such as performance status (i.e., patients’ physical functioning associated with activities of daily life) and body composition [6–8]. Timely identification of these modifiable factors is needed for effective targeted interventions and improved prognosis. Skeletal muscle mass deterioration is common in gastric cancer (GC) patients and is linked to poor prognosis. Information regarding the effect of skeletal muscle mass changes in the postoperative period is scarce. This study was to investigate the link between postoperative loss of skeletal muscle mass and survival following GC surgery
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