Abstract
BackgroundSarcopenia is an age-related syndrome that may have negative impact on surgical outcomes and long-term survival of patients with gastric cancer. Serum creatinine/cystatin C (Cr/CysC) ratio has attracted attention as a surrogate marker for sarcopenia but has not been adequately studied in patients with gastric cancer. The purpose of this study was to investigate the validity of serum Cr/CysC ratio as a predictor of sarcopenia, evaluate a statistical cut-off value, and assess the relationship between Cr/CysC ratio and prognosis of patients with gastric cancer.MethodsWe retrospectively studied 327 patients who underwent surgery for gastric cancer from June 2009 to October 2021. The skeletal muscle mass index was calculated using computed tomography (CT). We determined the relevance of serum Cr/CysC ratio as a surrogate maker for sarcopenia by comparing it with various biomarkers. The Concordance index (C-index) was calculted to measure whether the Cr/CysC ratio can prognosis of patients with gastric cancer.ResultsSerum Cr/CysC was significantly correlated with with Skeletal Muscle Index (SMI) (r = 0.221, p < 0.001) and Skeletal Muscle Area (SMA) (r = 0.258, p < 0.001). The area under the curve for sarcopenia was significantly larger for serum Cr/CysC ratio than for other biomarkers (Cr/CysC: 0.644, CysC: 0.535, Cr: 0.556). Patients in the high-Cr/CysC group have longer survival time than that in low-Cr/CysC group, defined by the cutoff value 0.67. The C-index of both Cr/CysC ratio and SMI with OS was 0.63.ConclusionsSerum Cr/CysC ratio can be used accurately, inexpensively, and easily to evaluate sarcopenia in male patients with gastric cancer. Our study shows that patients with Cr/CysC below 0.67 had possibility of sarcopenia and would be poor prognosis.
Highlights
Sarcopenia is an age-related syndrome that may have negative impact on surgical outcomes and long-term survival of patients with gastric cancer
Since the concentration of serum creatinine is affected by muscle mass, patients with decreased muscle mass will decrease serum creatinine [7, 8]; while serum cystatin C (Cys C) is not affected by muscle mass [9, 10]
As shown in the heat map (Fig. 1), the serum CysC/Cr ratio is positively correlated with Skeletal Muscle Area (SMA), Skeletal Muscle Index (SMI), weight, height, and BMI, and negatively correlated with age and sarcopenia, but there is no strong correlation
Summary
Sarcopenia is an age-related syndrome that may have negative impact on surgical outcomes and long-term survival of patients with gastric cancer. Sarcopenia is an age-related syndrome characterized by progressive and extensive loss of skeletal muscle mass and strength [3]; this has a negative impact on surgical outcomes and long-term survival of patients with gastric cancer [4]. Based on the characteristics of these two, the method of dividing serum creatinine by serum Cys C can be used to further predict muscle mass. This method has been confirmed in the research of many diseases [11,12,13,14]. Based on the above reasons, we are thinking about whether we can explore the prediction of Cr/Cys C for muscle mass in gastric cancer patients, and determine the best cut-off value of Cr/CysC ratio for predicting sarcopenia and its impact on the survival time of gastric cancer patients
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