Abstract
Background: Few data about the link between nutritional status and survival are available in the metastatic gastric cancer (GC) setting. The aim of this work was to evaluate the prognostic role of tissue modifications during treatment and the benefit of a scheduled nutritional assessment in this setting. Methods: Clinical and laboratory variables of 40 metastatic GC patients treated at Modena Cancer Center were retrieved: 20 received a nutritional assessment on the oncology’s discretion, the other 20 received a scheduled nutritional assessment at baseline and every 2–4 weeks. Anthropometric parameters were calculated on Computed Tomography (CT) images at the baseline and after 3 months of chemotherapy. Results: A correlation between baseline Eastern Cooperative Oncology Group Performance Status (ECOG PS), Lymphocyte to Monocyte Ratio (LMR), C-reactive protein (PCR), Prognostic Nutritional Index (PNI) and Overall survival (OS) was highlighted. Among the anthropometric parameters, early skeletal muscle mass depletion (ESMMD) >10% in the first months of treatment significantly impacted on mOS (p = 0.0023). A link between ESMMD and baseline LDH > 460 U/L, baseline CRP > 2.2 mg/dL and weight decrease during treatment emerged. Patients evaluated with a nutritional scheduled support experienced a mean gain in subcutaneous and visceral fat of 11.4% and 10.21%, respectively. Conclusion: We confirm the prognostic impact of ESMMD > 10% during chemotherapy in metastatic GC. The prognostic role of a scheduled nutritional assessment deserves further confirmation in large prospective trials.
Highlights
The prognosis of patients with advanced gastric cancer is still poor due to the absence of potentially curative options [1]
Clinical and laboratory data were reported from the hospital electronic medical database at diagnosis and first Computed Tomography (CT) re-evaluation including the following variables: age, gender, performance status (ECOG), height, weight, Body-Mass Index (BMI), blood count, neutrophil/lymphocyte ratio (NLR), platelets/lymphocyte ratio (PLR), lymphocyte/monocyte ratio (LMR), systemic inflammatory index (SII) lactate dehydrogenase (LDH), C-reactive protein (CRP), albumin, Sodium (Na+ ), Potassium (K+ ), CEA, CA 19.9 and prognostic nutritional index (PNI)
We evaluated the prognostic impact of baseline clinical, laboratory and anthropometric measures finding a significant interaction between ECOG
Summary
The prognosis of patients with advanced gastric cancer is still poor due to the absence of potentially curative options [1]. The development of new drugs alone or in combination with chemotherapy, helped to raise the bar of median overall survival over 12 months at the expense of increased treatment related toxicities [3,4]. The introduction of anti-HER2 treatment in first such as the development of ramucirumab alone or in combination with chemotherapy in second line provided nearly 14–16 months of median overall survival in patients with new diagnosis of metastatic gastric cancer [5,6,7]. Few data about the link between nutritional status and survival are available in the metastatic gastric cancer (GC) setting. Methods: Clinical and laboratory variables of 40 metastatic GC patients treated at Modena Cancer Center were retrieved: 20 received a nutritional assessment on the oncology’s discretion, the other 20 received a scheduled nutritional assessment at baseline and every 2–4 weeks. A link between ESMMD and baseline LDH > 460 U/L, baseline CRP > 2.2 mg/dL and weight decrease during treatment emerged
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