CT sarcometry in the prediction of postoperative complications in patients with gastric cancer: Retrospective cohort study
- Authors: Agababyan T.A.1, Kukarskaya V.A.1, Silanteva N.K.1, Potapov A.L.1, Skoropad V.Y.1, Sheberova E.V.1, Dorozhkin A.D.1, Ivanov S.А.1,2, Kaprin A.D.2,3
-
Affiliations:
- Tsyb Medical Radiological Research Centre – Branch of the National Medical Research Radiological Centre
- People’s Friendship University of Russia (RUDN University)
- National Medical Research Radiological Centre
- Issue: Vol 25, No 3 (2023)
- Pages: 284-288
- Section: НУТРИТИВНАЯ ПОДДЕРЖКА В КЛИНИЧЕСКОЙ ОНКОЛОГИИ
- URL: https://journals.rcsi.science/1815-1434/article/view/148889
- DOI: https://doi.org/10.26442/18151434.2023.3.202260
- ID: 148889
Cite item
Full Text
Abstract
Aim. Computed tomographic preoperative assessment of sarcopenia in patients with gastric cancer as a part of combined treatment and the study of the relationship between sarcopenia and postoperative complications.
Materials and methods. We analyzed retrospectively the data of 65 patients with morphologically verified diagnosis of stage IIA–IIIC gastric cancer. All patients at stage I of the combined treatment received neoadjuvant chemotherapy (NCT) according to the FLOT regimen, and then a gastrectomy with D2 lymph node dissection was performed. Computed tomography (CT) scans were performed before NCT initiation and 3.5 to 5 weeks after NCT completion for preoperative staging and assessment of tumor response. Using the obtained CT data, CT sarcometry was performed by calculating the cross-sectional area of skeletal muscles at the LIII vertebra level and the “skeletal-muscular index”. Postoperative complications were assessed using the Clavien–Dindo classification. Non-parametric comparison methods were used to assess the significance of differences between groups and subgroups (Wilcoxon T-test, Pearson χ2 test). Differences were considered statistically significant at p<0.05.
Results. We analyzed the incidence of sarcopenia in the examined patients before the NCT and immediately before the surgery. Sarcopenia was noted in 41 (63.1%) of 65 patients before NCT and in 50 (76.9%) patients after NCT, which indicates its high prevalence in patients with stomach cancer and the adverse effect of NCT on the muscular status of patients (76.9% versus 63.1%). Postoperative complications were diagnosed in 12 of 65 patients (18.5%). The rate of postoperative complications in patients with and without sarcopenia was not statistically significantly different (p=0.392); however, complications of Clavien–Dindo grade ≥IIIb occurred only in patients with sarcopenia (p<0.001).
Conclusion. According to our data, NCT in gastric cancer aggravates preoperative nutritional disorders. CT, as a standard method of staging and assessing the tumor response to NCT for gastric cancer, provides a tool to assess the state of muscle mass in patients before and after NCT. Preoperative sarcopenia is a risk factor for severe postoperative complications in patients with gastric cancer after gastrectomy.
Full Text
##article.viewOnOriginalSite##About the authors
Tatev A. Agababyan
Tsyb Medical Radiological Research Centre – Branch of the National Medical Research Radiological Centre
Author for correspondence.
Email: tatevik.05@mail.ru
ORCID iD: 0000-0002-9971-3451
cand. sci. (med.)
Russian Federation, ObninskValeria A. Kukarskaya
Tsyb Medical Radiological Research Centre – Branch of the National Medical Research Radiological Centre
Email: kukalery@mail.ru
clinical resident
Russian Federation, ObninskNatalya K. Silanteva
Tsyb Medical Radiological Research Centre – Branch of the National Medical Research Radiological Centre
Email: nks07@mail.ru
d. sci. (med.)
Russian Federation, ObninskAleksandr L. Potapov
Tsyb Medical Radiological Research Centre – Branch of the National Medical Research Radiological Centre
Email: alp8@yandex.ru
ORCID iD: 0000-0003-3752-3107
d. sci. (med.), prof.
Russian Federation, ObninskVitaliy Yu. Skoropad
Tsyb Medical Radiological Research Centre – Branch of the National Medical Research Radiological Centre
Email: skoropad@mrrc.obninsk.ru
d. sci. (med.), prof.
Russian Federation, ObninskElisaveta V. Sheberova
Tsyb Medical Radiological Research Centre – Branch of the National Medical Research Radiological Centre
Email: lisa_iroshnikova@mail.ru
radiologist
Russian Federation, ObninskArtem D. Dorozhkin
Tsyb Medical Radiological Research Centre – Branch of the National Medical Research Radiological Centre
Email: tropinckinus@gmail.com
ORCID iD: 0000-0001-9565-301X
anesthesiologist-rheumatologist
Russian Federation, ObninskSergey А. Ivanov
Tsyb Medical Radiological Research Centre – Branch of the National Medical Research Radiological Centre; People’s Friendship University of Russia (RUDN University)
Email: oncourolog@gmail.com
ORCID iD: 0000-0001-7689-6032
d. sci. (med.), corr. memb. RAS, prof. RAS
Russian Federation, Obninsk; MoscowAndrey D. Kaprin
People’s Friendship University of Russia (RUDN University); National Medical Research Radiological Centre
Email: kaprin@mail.ru
ORCID iD: 0000-0001-8784-8415
d. sci. (med.), prof., acad. RAS
Russian Federation, Moscow, ObninskReferences
- Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16-31. doi: 10.1093/ageing/afy169
- Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39(4):412-23. doi: 10.1093/ageing/afq034
- Дмитриев В.Н., Лядов В.К., Лядова М.А., Шаманов А.В. Конституциональные особенности онкологических пациентов как предиктор эффективности иммунотерапии. Онкология. Журнал им. П.А. Герцена. 2022;11(3):57-64 [Dmitriev VN, Lyadov VK, Lyadova MA, Shamanov AV. Cancer patients’ constitutional features as a predictor of the efficiency of immunotherapy. P.A. Herzen Journal of Oncology. 2022;11(3):57-64 (in Russian)]. doi: 10.17116/onkolog20221103157
- Tagliafico AS, Bignotti B, Torri L, et al. Sarcopenia: how to measure, when and why. Radiol Med. 2022;127:228-37. doi: 10.1007/s11547-022-01450-3
- Mourtzakis M, Prado CMM, Lieffers JR, et al. A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care. Appl Physiol Nutr Metab. 2008;33(5):997-1006. doi: 10.1139/H08-075
- Злокачественные новообразования в России в 2021 году (заболеваемость и смертность). Под ред. А.Д. Каприна, В.В. Старинского, А.О. Шахзадовой. М.: МНИОИ им. П.А. Герцена − филиал ФГБУ «НМИЦ радиологии» Минздрава России, 2022 [Zlokachestvennyie novoobrazovaniia v Rossii v 2021 godu (zabolevaiemost' i smertnost'). Pod red. AD Kaprina, VV Starinskogo, AO Shakhzadovoi. Moscow: MNIOI im. PA Gertsena − filial FGBU “NMITS radiologii” Minzdrava Rossii, 2022 (in Russian)].
- Chen K, Mou YP, Xu XW, et al. Short-term surgical and long-term survival outcomes after laparoscopic distal gastrectomy with D2 lymphadenectomy for gastric cancer. BMC Gastroenterol. 2014;14:41. doi: 10.1186/1471-230X-14-41
- Kuwada K, Kuroda S, Kikuchi S, et al. Clinical Impact of Sarcopenia on Gastric Cancer. Anticancer Res. 2019;39(5):2241-9. doi: 10.21873/anticanres.13340
- Дикова Т.С., Зацепина А.Ю., Федоринов Д.С., Лядов В.К. Саркопения, саркопеническое ожирение, миостеатоз как факторы неблагоприятного прогноза при опухолях желудочно-кишечного тракта: обзор литературы. Современная Онкология. 2021;2(1):141-7 [Dikova TS, Zatsepina AYu, Fedorinov DS, Lyadov VK. Sarcopenia, sarcopenic obesity, myosteatosis as factors of poor prognosis in gastrointestinal tract tumors: review. Journal of Modern Oncology. 2021;23(1):141-7 (in Russian)]. doi: 10.26442/18151434.2021.1.200715
- Fearon KC, Jenkins JT, Carli F, Lassen K. Patient optimization for gastrointestinal cancer surgery. Br J Surg. 2013;100(1):15-27. doi: 10.1002/bjs.8988
- Shi B, Liu S, Chen J, et al. Sarcopenia is Associated with Perioperative Outcomes in Gastric Cancer Patients Undergoing Gastrectomy. Ann Nutr Metab. 2019;75(4):213-22. doi: 10.1159/000504283
- Fearon K, Strasser F, Anker SD, et al. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol. 2011;12(5):489-95. doi: 10.1016/S1470-2045(10)70218-7
- Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-13. doi: 10.1097/01.sla.0000133083.54934
- Хорошилов И.Е. Кахексия и саркопения у онкологических пациентов: диагностика и лечебная тактика. Клиническое питание и метаболизм. 2020;1(1):36-46 [Khoroshilov IE. Cachexia and Sarcopenia at Oncological Patients: Diagnostics and Treatment Tactics. Clinical Nutrition and Metabolism. 2020;1(1):36-46 (in Russian)]. doi: 10.36425/clinnutrit20650
- Бриш Н.А., Семиглазова Т.Ю., Карачун А.М., и др. Влияние коррекции нутритивной недостаточности на эффективность неоадъювантной химиотерапии у больных местно-распространенным раком желудка. Современная Онкология. 2021;23(3):519-24 [Brish NA, Semiglazova TYu, Karachun AM, et al. Influence of correction of nutritive deficiency on the effectiveness of neoadjuvant chemotherapy in patients with locally advanced gastric cancer. Journal of Modern Oncology. 2021;23(3):519-24 (in Russian)]. doi: 10.26442/18151434.2021.3.201075
- Mirkin KA, Luke FE, Gangi A, et al. Sarcopenia related to neoadjuvant chemotherapy and perioperative outcomes in resected gastric cancer: A multi-institutional analysis. J Gastrointest Oncol. 2017;8(3):589-95. doi: 10.21037/jgo.2017.03.02
- Huang DD, Zhou CJ, Wang SL, et al. Impact of different sarcopenia stages on the postoperative outcomes after radical gastrectomy for gastric cancer. Surgery. 2017;161(3):680-93. doi: 10.1016/j.surg.2016.08.030
- Fukuda Y, Yamamoto K, Hirao M, et al. Sarcopenia is associated with severe postoperative complications in elderly gastric cancer patients undergoing gastrectomy. Gastric Cancer. 2016;19(3):986-93. doi: 10.1007/s10120-015-0546-4
- Zhou CJ, Zhang FM, Zhang FY, et al. Sarcopenia: a new predictor of postoperative complications for elderly gastric cancer patients who underwent radical gastrectomy. J Surg Res. 2017;211:137-46. doi: 10.1016/j.jss.2016.12.014
- Otsuji H, Yokoyama Y, Ebata T, et al. Preoperative sarcopenia negatively impacts postoperative outcomes following major hepatectomy with extrahepatic bile duct resection. World J Surg. 2015;39(6):1494-500. doi: 10.1007/s00268-015-2988-6