Elsevier

Clinical Nutrition

Volume 40, Issue 5, May 2021, Pages 3360-3369
Clinical Nutrition

Original article
Influence of body composition, muscle strength, and physical performance on the postoperative complications and survival after radical gastrectomy for gastric cancer: A comprehensive analysis from a large-scale prospective study

https://doi.org/10.1016/j.clnu.2020.11.007Get rights and content

Summary

Background

Few studies have comprehensively analyzed the correlations among body composition parameters, muscle strength, and physical performance, as well as the influence of these factors on the postoperative complications and survival after radical gastrectomy for gastric cancer.

Methods

A prospective study was conducted including patients who underwent radical gastrectomy for gastric cancer from August 2014 to June 2019. Skeletal muscle index (SMI), skeletal muscle density (SMD), visceral fat area (VFA), subcutaneous fat area (SFA) was obtained by measurement of preoperative computed tomography (CT) images. Grip strength and 6-m gait speed were measured to assess muscle strength and physical performance before surgery.

Results

There was a positive correlation between SMI and SMD, as well as between SFA and VFA. SMD negatively correlated with SFA and VFA. SMI had a positive correlation with VFA, but showed minimal correlation with SFA and visceral to subcutaneous fat ratio (VSR). Grip strength and gait speed were both positively correlated with SMI and SMD, but showed minimal correlation with SFA, VFA and VSR. SMI and grip strength independently predicted postoperative complications, rather than SMD or gait speed. Whereas SMD and gait speed had independent predictive value for overall survival (OS) and/or disease-free survival (DFS), rather than SMI or grip strength. VSR independently predicted postoperative complications, rather than VFA or SFA alone. Low SFA was an independent risk factor for OS and DFS. High VFA was associated with worse survival in overweight patients (body mass index, BMI ≥25), but was associated with better survival in non-overweight patients (BMI <25). High SFA did not significantly influence survival in overweight patients, but was associated with better survival in non-overweight patients.

Conclusion

There is an extensive and complex correlation among body composition parameters, grip strength, and gait speed in patients with operable gastric cancer. A comprehensive analysis of these parameters has significant predictive value for postoperative complications and survival.

Introduction

Gastric cancer is the fifth most common malignancy and the third leading cause of cancer mortality worldwide [1]. Despite the progress of surgical techniques and multimodal therapy during the past decades, the prognosis of gastric cancer remains poor, and the postoperative complication rate remains high. Similar to most common solid tumors, disease progression of gastric cancer is associated with a progressive nutritional and functional decline, which results in poor treatment response and worse survival. Therefore, assessment of nutritional and functional status of gastric patients before surgery can provide significant information for risk stratification, prognosis prediction and decision making.

Body composition, muscle strength, and physical performance are all important indicators for the nutritional and functional status. In recent years, increasing studies have revealed a close relationship between body composition parameters and prognosis after surgery for various types of cancer [[2], [3], [4], [5], [6], [7], [8], [9]]. Our previous studies have showed that sarcopenia and myosteatosis were associated with higher incidence of postoperative complications and worse long-term survival after radical gastrectomy for gastric cancer [[3], [4], [5]]. However, the influence of fat tissues on postoperative outcomes was often contradictory in the literature. Many studies showed that high visceral fat mass was associated with cancer progression and worse survival after surgery [2,6,7]. While other studies showed that visceral fat mass had no influence on prognosis or even had a positive effect on the long-term survival after surgery [8,9]. Moreover, few studies have investigated the influence of subcutaneous fat mass on the long-term survival after gastrectomy for gastric cancer.

Muscle strength and physical performance are closely associated with body composition. Loss of muscle quantity/mass and quality/density leads to a decrease of muscle strength, which could further cause a degeneration of physical performance. Meanwhile, decreased physical performance could cause muscle wasting and adipose accumulation, which result in sarcopenia, myosteatosis, and obesity [10,11]. Muscle strength and physical performance have also been reported to be associated with outcomes after major abdominal surgery [12,13]. However, considering the extensive correlations among the body composition parameters, muscle strength, and physical performance, it is worthwhile to investigate the predictive value of each parameter on the surgical prognosis by a comprehensive analysis including all of these parameters. Moreover, few studies have comprehensively investigated the correlations among the body composition parameters, muscle strength, and physical performance in gastric cancer patients.

In the present study, we investigated the correlations among the body composition parameters, muscle strength, and physical performance in gastric cancer patients. Moreover, we comprehensively analyzed the impact of these factors on the prognoses after radical gastrectomy for gastric cancer.

Section snippets

Patients

Consecutive patients who underwent radical gastrectomy for gastric cancer at the First Affiliated Hospital of Wenzhou Medical University from August 2014 to June 2019 were included in this prospective study. The inclusion criteria were as follows: (1) aged ≥18 years; (2) pathologically diagnosed with gastric adenocarcinoma; (3) planned to receive elective gastrectomy for gastric cancer with curative intent; (4) had preoperative abdominal computed tomography (CT) scans within 1 month before

Results

Of the 1461 consecutive patients who planned to receive elective gastrectomy for gastric cancer with curative intent from August 2014 to June 2019 in our department, 212 patients were excluded for having received oncological therapies before surgery. We also excluded 102 patients who were confirmed with cancer metastasis or underwent palliative surgery, or those who failed to complete the measurement of muscle strength or physical performance. Finally, a total of 1147 patients were included in

Discussion

To our knowledge, few studies have comprehensively analyzed the correlations between the body composition parameters, muscle strength, and physical performance in patients with gastric cancer. Our study showed that SMI and SMD strongly correlated with each other. These two muscle parameters represent muscle quantity and quality, respectively, both of which decrease during aging [16]. VFA and SFA are two major component of adipose tissue, which were also positively correlated with each other in

Authors contribution

Dong–Dong Huang and Xiao-Lei Chen designed the study. Hui-Yang Cai, Hong-Bo Zou, Wen-Xi Dong, Wen-Bin Wang, Hao-Nan Song, and Xin Luo collected the data. Dong–Dong Huang, Zhao Zhang, and Qian-Tong Dong did the analysis and interpretation of data. Qian-Tong Dong and Dong–Dong Huang wrote the article. Dong–Dong Huang revised the article and took the decision to submit the article for publication.

Funding sources

This study was funded by the National Natural Science Foundation of China (No. 81770884) and Zhejiang Provincial Health Department Medical Support Discipline-Nutrition (11-ZC24).

Conflict of interest

The authors declare no conflict of interest.

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