Sarcopenia as a prognostic factor for survival in patients with locally advanced gastroesophageal adenocarcinoma

Christine Koch, Cornelius Reitz, Teresa Schreckenbach, Katrin Eichler, Natalie Filmann, Salah-Eddin Al-Batran, Thorsten Götze, Stefan Zeuzem, Wolf Otto Bechstein, Thomas Kraus, Jörg Bojunga, Markus Düx, Jörg Trojan, Irina Blumenstein, Christine Koch, Cornelius Reitz, Teresa Schreckenbach, Katrin Eichler, Natalie Filmann, Salah-Eddin Al-Batran, Thorsten Götze, Stefan Zeuzem, Wolf Otto Bechstein, Thomas Kraus, Jörg Bojunga, Markus Düx, Jörg Trojan, Irina Blumenstein

Abstract

Background and aims: Patients with gastric cancer often show signs of malnutrition. We sought to evaluate the influence of sarcopenia in patients with locally advanced, not metastasized, gastric or gastro-esophageal junction (GEJ) cancer undergoing curative treatment (perioperative chemotherapy and surgery) on morbidity and mortality in order to identify patients in need for nutritional intervention.

Patients and methods: Two-centre study, conducted in the Frankfurt University Clinic and Krankenhaus Nordwest (Frankfurt) as part of the University Cancer Center Frankfurt (UCT). 47/83 patients were treated in the FLOT trial (NCT01216644). Patients´ charts were reviewed for clinical data. Two consecutive CT scans were retrospectively analyzed to determine the degree of sarcopenia. Survival was calculated using the Kaplan-Meier method, multivariate analysis was performed using the Cox regression.

Results: 60 patients (72.3%) were male and 23 (27.7%) female. 45 patients (54.2%) had GEJ type 1-3 and 38 (45.8%) gastric tumors, respectively. Sarcopenic patients were significantly older than non-sarcopenic patients (mean age 65.1 years vs. 59.5 years, p = 0.042), terminated the chemotherapy significantly earlier (50% vs. 22.6%, p = 0.037) and showed higher Clavien-Dindo scores, indicating more severe perioperative complications (score ≥3 43.3 vs. 17.0%, p = 0.019). Sarcopenic patients had a significantly shorter survival than non-sarcopenic patients (139.6 ± 19.5 [95% CI, 101.3-177.9] vs. 206.7 ± 13.8 [95% CI, 179.5-233.8] weeks, p = 0.004). Multivariate Cox regression analysis showed that, besides UICC stage, sarcopenia significantly influenced survival.

Conclusion: Sarcopenia is present in a large proportion of patients with locally advanced gastric or GEJ cancer and significantly influences tolerability of chemotherapy, surgical complications and survival.

Conflict of interest statement

Dr. Al-Batran has an advisory role with Merck, Roche, Celgene, Lilly, Nordic Pharma, Bristol-Myers Squibb and MSD Sharp & Dohme; is a speaker for Roche, Celgene, Lilly, Nordic Pharma, AIO gGmbH, MCI, promedicis, and Forum für Medizinische Fortbildung; he is CEO/Founder of IKF Klinische Krebsforschung GmbH and has received research grants from Sanofi, Merck, Roche, Celgene, Vifor, Medac, Hospira, Lilly, German Cancer Aid (Krebshilfe), German Research Foundation and the Federal Ministry of Education of Research. Dr. Goetze has an advisory role with Lilly, MSD Sharp & Dohme, Shire, Bayer, Celgene, Servier and is a speaker for Lilly, MCI, MSD Sharp & Dohme. He has received research grants from German Research Foundation. The other authors declare no conflict of interests. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1. Flow diagram.
Fig 1. Flow diagram.
60 patients (72.3%) were male and 23 (27.7%) female. 45 patients (54.2%) had GEJ type 1–3 and 38 (45.8%) gastric tumors, respectively. Details on demographic data are given in Table 1.
Fig 2. Survival; sarcopenic vs. non-sarcopenic patients;…
Fig 2. Survival; sarcopenic vs. non-sarcopenic patients; Kaplan-Meier-analysis.

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