The Predictive Value of Low Muscle Mass as Measured on CT Scans for Postoperative Complications and Mortality in Gastric Cancer Patients: A Systematic Review and Meta-Analysis

Alicia S Borggreve,Robin B Den Boer,Richard Van Hillegersberg,Elles Steenhagen,Wouter B Veldhuis,Jelle P Ruurda,Gijs I Van Boxel,Pim A De Jong

doi:10.3390/jcm9010199

Abstract

Risk assessment is relevant to predict outcomes in patients with gastric cancer. This systematic review aimed to investigate the predictive value of low muscle mass for postoperative complications in gastric cancer patients. A systematic literature search was performed to identify all articles reporting on muscle mass as measured on computed tomography (CT) scans in patients with gastric cancer. After full text screening, 15 articles reporting on 4887 patients were included. Meta-analysis demonstrated that patients with low muscle mass had significantly higher odds of postoperative complications (odds ratio (OR): 2.09, 95% confidence interval (CI): 1.55–2.83) and severe postoperative complications (Clavien–Dindo grade ≥III, OR: 1.73, 95% CI: 1.14–2.63). Moreover, patients with low muscle mass had a significantly higher overall mortality (hazard ratio (HR): 1.81, 95% CI: 1.52–2.14) and disease-specific mortality (HR: 1.58, 95% CI: 1.36–1.84). In conclusion, assessment of muscle mass on CT scans is a potential relevant clinical tool for risk prediction in gastric cancer patients. Considering the heterogeneity in definitions applied for low muscle mass on CT scans in the included studies, a universal cutoff value of CT-based low muscle mass is required for more reliable conclusions.

Highlights

IntroductionDespite recent improvements in treatment, the outcomes of patients diagnosed with gastric cancer remain poor [1,2]
Gastric cancer is the third most common cause of cancer-related deaths in the world
A total of 415 studies reporting on low muscle mass as measured on computed tomography (CT) scans and gastric cancer were identified

Summary

Introduction

Despite recent improvements in treatment, the outcomes of patients diagnosed with gastric cancer remain poor [1,2]. The main curative therapy for advanced gastric cancer without distant metastases is surgical resection with perioperative chemotherapy or chemoradiation [2,3]. This procedure is accompanied by severe postoperative complications such as pulmonary complications (13%), cardiac complications (6%), intra-abdominal abscess (4%), and anastomotic leakage (3%), resulting in a considerable postoperative mortality percentage of 5% [4]. Accurate prediction of a patient’s prognosis may impact clinical decision making and patient management, but remains unsatisfactory to date

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Discussion

Conclusion