Sarcopenia and Comorbidity in Gastric Cancer Surgery as a Useful Combined Factor to Predict Eventual Death from Other Causes

• Published in: Annals of surgical oncology 2018-05, Vol.25 (5), p.1160-1166
• Main Authors: Kuwada, Kazuya, Kuroda, Shinji, Kikuchi, Satoru, Yoshida, Ryuichi, Nishizaki, Masahiko, Kagawa, Shunsuke, Fujiwara, Toshiyoshi
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Aged, 80 and over; Body mass index; Cause of Death; Comorbidity; Computed tomography; Death; Female; Gastrectomy; Gastric cancer; Gastrointestinal Oncology; Humans; Male; Medical prognosis; Medical records; Medicine; Medicine & Public Health; Middle Aged; Oncology; Population studies; Prognosis; Sarcopenia; Sarcopenia - complications; Sarcopenia - diagnostic imaging; Sarcopenia - epidemiology; Skeletal muscle; Stomach Neoplasms - complications; Stomach Neoplasms - mortality; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Surgery; Surgical Oncology; Survival; Survival Rate
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-018-6354-4

Background Sarcopenia is recognized as an important prognostic factor in various types of cancer, including gastric cancer. While long-term survival analyses typically focus on overall and disease-specific survival, death from other causes has received far less attention. Methods We reviewed medical records of 491 gastric cancer patients who underwent gastrectomy from January 2005 to March 2014 and whose preoperative computed tomography (CT) images were available for evaluation of sarcopenia. Sarcopenia was defined as the SMA/BSA index (skeletal muscle area divided by body surface area) below the sex-specific lowest quartile. Results Sarcopenia was significantly associated with age, high body mass index (BMI), presence of comorbidity, high American Society of Anesthesiologists physical status (ASA-PS), high T score, advanced stage, large blood loss, and long hospital stay, but was not significantly associated with postoperative complications. Univariate and multivariate analyses of prognostic factors for overall survival revealed that sarcopenia is an independent predictor of poor prognosis [hazard ratio (HR) 1.46, 95% confidence interval (CI) 1.01–2.09, p   =  0.0454]. Our analysis of death due to other causes found that non-gastric cancer-related deaths were more frequent among sarcopenia patients with comorbidities than in the rest of our study population ( p   =  0.0001), while univariate and multivariate analyses revealed that sarcopenia with comorbidity was an independent risk factor for non-gastric cancer-related death (HR 1.84, 95% CI 1.31–3.61, p   =  0.0308), as was age. Conclusion For gastric cancer patients, sarcopenia increases the risk of death from other causes following surgery, which reveals the importance of developing treatment strategies based not only on cancer status but also on other clinical factors, including sarcopenia and comorbidity.