Visceral and subcutaneous fat as new independent predictive factors of survival in locally advanced gastric carcinoma patients treated with neo-adjuvant chemotherapy.

Abstract

Abdominal adipose distribution may be associated with tumor growth, but its impact on gastric carcinoma survival after neo-adjuvant therapies is uncertain. This retrospective study was to determine the association linking BMI and CT-measured fat parameters to the survival in advanced gastric cancer patients who underwent preoperative chemotherapy. Eighty-four consecutive patients with locally advanced gastric cancer who received neo-adjuvant chemotherapy and following gastrectomy were identified between January 2005 and June 2008. CT parameters were measured retrospectively on the CT images obtained before chemotherapy initiation. Subcutaneous fat thicknesses of the anterior, lateral, and posterior abdominal wall (ASFT, LSFT, and PSFT) represented subcutaneous fat. Intraperitoneal fat thickness (IFT) and retro-renal fat thickness represented visceral fat. Association linking BMI and CT factors to overall survival was evaluated with survival analysis. ASFT and PSFT above the median value (i.e., high ASFT and PSFT) were associated with longer OS (P = 0.001; 0.003). Conversely, high IFT and high IFT/PSFT were associated with shorter OS (P = 0.003; 0.003) and DFS (P < 0.001; 0.004). By multivariate analysis, high IFT and PSFT were independently associated with OS (HR 2.94, 95% CI 1.54-5.60; 0.38, 95% CI 0.21-0.71) and DFS (HR 3.28, 95% CI 1.55-6.93; 0.42, 95% CI 0.21-0.82). BMI was not significant for OS and DFS. This study provided the first evidence that IFT, ASFT, and PSFT measured before neo-adjuvant chemotherapy were likely to be useful predictive biomarkers for survival of advanced gastric cancer patients.