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Effect of sarcopenia on short-term and long-term outcomes of older patients with locally advanced gastric cancer: a multicenter study

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Abstract

Objective

To assess the effect of preoperative sarcopenia on the short-term and long-term outcomes in older patients with locally advanced gastric cancer (LAGC).

Methods

Clinicopathological data of older patients with LAGC who underwent radical surgery were retrospectively analyzed. Sarcopenia was defined as a skeletal muscle index of less than 36.4 cm2/m2 for men and less than 28.4 cm2/m2 for women. Comparing the postoperative complications and survival between sarcopenia and non-sarcopenia groups using multicenter data.

Results

A total of 406 older patients with LAGC were included in the analysis, including 145 (35.7%) with sarcopenia and 261 (64.3%) with non-sarcopenia. Multivariate logistic regression analysis showed that sarcopenia was an independent risk factor for postoperative complications with CD grade ≥ II (OR 1.616; P < 0.05). Kaplan–Meier survival curve analysis showed that the 5-year overall survival (OS) and 5-year recurrence-free survival (RFS) in the sarcopenia group were lower than those in the non-sarcopenia group (P both < 0.05). Multivariate Cox regression analyses showed that sarcopenia was an independent prognostic factor for 5-year OS and RFS (P both < 0.05). The 5-year recurrence rate in the sarcopenia group was 57.2%, which was significantly higher than that in the non-sarcopenia group (46.4%; P = 0.036). Recurrence pattern analysis showed that the incidence of distant metastases in patients with sarcopenia (42.8%) was significantly higher than non-sarcopenia (31.4%; P = 0.022).

Conclusion

Sarcopenia serves as a valuable predictor of both short-term and long-term outcomes in older patients with LAGC. Therefore, the significance of assessing preoperative nutritional status and implementing thorough postoperative follow-up for older LAGC patients with sarcopenia should be emphasized.

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Acknowledgements

This study was supported by Fujian Research and Training Grants for Young and Middle-aged Leaders in Healthcare (No.[2022]954) and Fujian third batch of "Innovation star" talent project (No.[2022]22).

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Author notes

  1. Zi-Fang Zheng, Guang-Tan Lin, Qing Zhong, and Dong Wu have contributed equally to this work and are co-first authors.

Authors and Affiliations

  1. Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China

    Zi-Fang Zheng, Guang-Tan Lin, Qing Zhong, Dong Wu, Jun Lu, Jia-Bin Wang, Qi-Yue Chen, Jian-Xian Lin, Long-Long Cao, Mi Lin, Jian-Wei Xie, Chao-Hui Zheng, Chang-Ming Huang & Ping Li

  2. Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China

    Zi-Fang Zheng, Guang-Tan Lin, Qing Zhong, Dong Wu, Jun Lu, Jia-Bin Wang, Qi-Yue Chen, Jian-Xian Lin, Long-Long Cao, Mi Lin, Jian-Wei Xie, Chao-Hui Zheng, Chang-Ming Huang & Ping Li

  3. Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China

    Zi-Fang Zheng, Guang-Tan Lin, Qing Zhong, Dong Wu, Jun Lu, Jia-Bin Wang, Qi-Yue Chen, Jian-Xian Lin, Long-Long Cao, Mi Lin, Jian-Wei Xie, Chao-Hui Zheng, Chang-Ming Huang & Ping Li

  4. Department of General Surgery, Affiliated Hospital of Putian University, Putian, China

    Zi-Fang Zheng

  5. Public Technology Service Center, Fujian Medical University, Fuzhou, China

    Shu-Ping Zheng

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  1. Zi-Fang Zheng
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Correspondence to Chang-Ming Huang or Ping Li.

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Zi-Fang Zheng, Guang-Tan Lin, Qing Zhong, Dong Wu, Jun Lu, Jia-Bin Wang, Qi-Yue Chen, Jian-Xian Lin, Long-Long Cao, Mi Lin, Shu-Ping Zheng, Jian-Wei Xie, Chao-Hui Zheng, Chang-Ming Huang, and Ping Li have no conflicts of interest or financial ties to disclose.

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Supplementary Information

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Supplementary file1 (JPG 253 kb)

eFigure 1. Flowchart of the patient selection process. FMUUH Fujian Medical University Union Hospital, AHPTU Affiliated Hospital of Putian University.

Supplementary file2 (TIF 6136 kb)

eFigure 2. Measurement of skeletal muscle index (SMI) in GC patients. Axial CT slice of the third lumbar vertebra (L3). Red areas indicate skeletal muscle mass. (a Typical non-sarcopenia; b Typical sarcopenia).

Supplementary file3 (TIF 14679 kb)

eFigure 3. Initial recurrence patterns after gastrectomy for gastric cancer. a All recurrence patterns (n = 204); b Non-sarcopenia recurrence patterns (n = 121); c Sarcopenia recurrence patterns (n = 83).

Supplementary file4 (TIF 13902 kb)

Supplementary file5 (TIF 14666 kb)

Supplementary file6 (DOCX 15 kb)

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Zheng, ZF., Lin, GT., Zhong, Q. et al. Effect of sarcopenia on short-term and long-term outcomes of older patients with locally advanced gastric cancer: a multicenter study. Surg Endosc 38, 1151–1162 (2024). https://doi.org/10.1007/s00464-023-10638-1

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