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Sarcopenia, Related to Neoadjuvant Chemotherapy and Perioperative Outcomes, in Resected Gastric Cancer
Katelin A. Mirkin*3, Franklyn E. Luke1, Alexandra Gangi2, José M. Pimiento2, Daniel Jeong4, Christopher S. Hollenbeak3, Joyce Wong3
1Radiology, Penn State Hershey Medical Center, Hershey, PA; 2Surgery, Moffitt Cancer Center, Tampa, FL; 3Surgery, Penn State Hershey Medical Center, Hershey, PA; 4Radiology, Moffitt Cancer Center, Tampa, FL
Background:
Sarcopenia, defined by radiologic assessment of total psoas area normalized by patients’ height to obtain a sarcopenia score, has been used as a marker of functional status and suggested as a predictor for postoperative outcomes in several cancers. Gastric cancer is often treated with neoadjuvant chemotherapy (NAC) followed by surgical resection. We sought to understand the change in sarcopenia score following NAC and to evaluate whether sarcopenia is correlated with perioperative outcomes in patients with advanced resectable gastric cancer.
Methods:
This was a multi-institutional analysis of patients with gastric cancer who underwent neoadjuvant therapy and subsequent surgical resection from 2000 - 2015. Demographic and perioperative data were included. Total psoas area was measured on cross-sectional imaging at the level of L3, stratified against height (m), and used to obtain a sarcopenia score. Sarcopenia was defined as less than 385mm2/m2 in women and less than 545mm2/m2 in men. Univariate analyses were used to analyze the data.
Results:
Of 41 patients, 36 patients had evaluable sarcopenia scores from before and after NAC and underwent resection. Median follow-up from diagnosis was 17.8 months. This cohort was mostly women (N=23, 64%), with median age of 64 years. Prior to NAC, seven (19%) were sarcopenic. Five (14%) became sarcopenic during NAC, one (3%) became non-sarcopenic; one-third (N=12, 33%) of the cohort was sarcopenic prior to surgical resection. There were no statistically significant differences in age, gender, body mass index, presence of comorbidities, or type of gastrectomy between patients who were sarcopenic and those who were not. Thirteen (36%) developed any post-operative complication, of which few (N=3, 23%) were Clavien-Dindo grade 3. There were no grade 4 or 5 complications. Those who were sarcopenic prior to resection were more likely to develop post-operative complications than those were non-sarcopenic (58.3%, 25%, p = 0.05, respectively). Differences in hospital length of stay (p=0.71) and overall survival (p=0.23) were not statistically significant.
Conclusion:
During NAC, a significant number of patients with gastric cancer become sarcopenic, adding to a sizeable percentage of already sarcopenic patients presenting for surgery. In this small cohort, patients with sarcopenia were nearly twice as likely to develop post-operative complications; however, this did not appear to impact length of stay or survival. Further study with a larger population is warranted to assess the impact of sarcopenia on gastric cancer outcomes.
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