Body composition parameters predict pathological response and outcomes in locally advanced gastric cancer after neoadjuvant treatment: A multicenter, international study

Ji, Lin; Tang, Yi-Hui; Zhou, Wen-Xing; Desiderio, Jacopo; Parisi, Amilcare; Xie, Jian‐Wei; Wang, Jia-Bin; Cianchi, Fabio; Antonuzzo, Lorenzo; Borghi, Felice; Lü, Jun; Chen, Qi‐Yue; Cao, Long‐Long; Ma, Lin; Tu, Ru‐Hong; Staderini, Fabio; Marano, Alessandra; Peluso, Chiara; Li, Ping; Zheng, Chao‐Hui; Ma, Yu-Bin; Huang, Chang‐Ming

doi:10.1016/j.clnu.2021.06.021

Cited by 11 publications

(11 citation statements)

References 48 publications

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“…However, the interaction between body composition and immunotherapy in gastric cancer remains unknown. In this study, VAI and SAI have been observed to decrease in varying degrees during NCI, which was different from the results previously reported for neoadjuvant chemotherapy alone ( 11 , 12 ),. A follow-up analysis has revealed that L-SMI and SMI attenuation were independent risk factors for poor TR, and the H-SAI index was significantly correlated with irAEs.…”

Section: Discussioncontrasting

confidence: 99%

“…have reported that the decrease of muscle and subcutaneous adipose and visceral adipose was significantly related to the decrease of RFS and OS ( 10 ). Several recent studies have discovered no evident change in body composition of patients with locally advanced gastric cancer during neoadjuvant chemotherapy, although they have reported that L-SMI and muscle attenuation are related to the effect and postoperative complications of neoadjuvant chemotherapy ( 11 , 12 ). However, whether this phenomenon exists in patients with NCI remains unknown, and the effects on body composition after immunotherapy have not been reported.…”

Section: Introductionmentioning

confidence: 99%

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Body composition parameters for predicting the efficacy of neoadjuvant chemotherapy with immunotherapy for gastric cancer

et al. 2022

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BackgroundImmune checkpoint inhibitors are increasingly used in neoadjuvant therapy for locally advanced gastric cancer. However, the effect of body composition on the efficacy of neoadjuvant therapy has not been reported.MethodsThe computed tomography (CT) images and clinicopathological data of 101 patients with locally advanced gastric cancer who received neoadjuvant chemotherapy combined with immunotherapy (NCI) from 2019 to 2021 were collected. The CT image of L3 vertebral body section was selected, and the body composition before and after the neoadjuvant treatment was calculated using the SliceOmatic software, mainly including skeletal muscle index (SMI), subcutaneous adipose index (SAI), and visceral adipose index (VAI). The relationship between body composition and the efficacy and adverse events of NCI was analyzed.ResultsOf the 101 patients, 81 with evaluable data were included in the analysis. Of the included patients, 77.8% were male; the median age of all the patients was 62 years, and the median neoadjuvant therapy cycle was three. After the neoadjuvant therapy, 62.9% of the tumors were in remission (residual tumor cells ≤ 50%), and 37.1% of the tumors had no remission (residual tumor cells>50%). Moreover, 61.7% of the patients had treatment-related adverse events (TRAEs), and 18.5% had immune-related adverse events (irAEs). After neoadjuvant therapy, the body mass index (from 23 to 22.6 cm2/m2, p=0.042), SAI (from 34.7 to 32.9 cm2/m2, p=0.01) and VAI (from 32.4 to 26.8 cm2/m2, p=0.005) were significantly lower than those before treatment, while the SMI had no significant change (44.7 vs 42.5 cm2/m2, p=0.278). The multivariate logistics regression analysis revealed that low SMI (odds ratio [OR]: 3.23,95% confidence interval [CI]: 1.06–9.81, p=0.047), SMI attenuation (△SMI) ≥ 1.8(OR: 1.45,95%CI: 1.20–3.48, p=0.048), and clinical node positivity (OR: 6.99,95%CI: 2.35–20.82, p=0.001) were independent risk factors for non-remission. Additionally, high SAI is an independent risk factor for irAEs (OR: 14, 95%CI: 1.73–112.7, p=0.013).ConclusionLow SMI and △SMI≥1.8 are independent risk factors for poor tumor regression in patients with advanced gastric cancer receiving NCI. Patients with a high SAI are more likely to develop irAEs.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Body composition parameters for predicting the efficacy of neoadjuvant chemotherapy with immunotherapy for gastric cancer

et al. 2022

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“…CT evaluation has shown both skeletal muscle and fat mass to fall significantly following neoadjuvant therapy for upper gastrointestinal malignancy [ 62 ]. Furthermore, there is evidence that the loss of muscle mass during treatment has a greater effect on survival than either pre-treatment or pre-operative sarcopenia in oesophageal [ 63 ] and gastric cancer [ 64 ]. Decreasing volumes of adipose tissue during neoadjuvant therapy similarly appears to be an adverse marker for survival [ 65 ].…”

Section: Treat the Tumour And Treat The Hostmentioning

confidence: 99%

Understanding Cancer Cachexia and Its Implications in Upper Gastrointestinal Cancers

Brown

Laird

Wigmore

et al. 2022

Curr. Treat. Options in Oncol.

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Opinion statementConsiderable advances in the investigation and management of oesophagogastric cancer have occurred over the last few decades. While the historically dismal prognosis associated with these diseases has improved, outcomes remain very poor. Cancer cachexia is an often neglected, yet critical, factor for this patient group. There is a persuasive argument that a lack of assessment and treatment of cachexia has limited progress in oesophagogastric cancer care. In the curative setting, the stage of the host (based on factors such as body composition, function, and inflammatory status), alongside tumour stage, has the potential to influence treatment efficacy. Phenotypical features of cachexia may decrease the survival benefit of (peri-operative) chemoradiotherapy, immunotherapy, or surgical resection in patients with potentially curative malignancy. Most patients with oesophagogastric cancer unfortunately present with disease which is not amenable, or is unlikely to respond, to these treatments. In the palliative setting, host factors can similarly impair results from systemic anti-cancer therapies, cause adverse symptoms, and reduce quality of life. To optimise treatment pathways and enhance patient outcomes, we must utilise this information during clinical decision-making. As our understanding of the genesis of cancer cachexia improves and more therapeutic options, ranging from basic (e.g. exercise and nutrition) to targeted (e.g. anti-IL1 α and anti-GDF-15), become available, there can be grounds for optimism. Cachexia can change from a hitherto neglected condition to an integral part of the oesophagogastric cancer treatment pathway.

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“…Recently, some researchers have started to focus on this issue. Lin et al established a novel model using pre-NCRT MD and SMA loss that was proposed to predict the tumor response in locally advanced gastric cancer with an area under the curve of 0.764 (37). Omarini et al reported that visceral adiposity was closely involved in chemosensitivity in breast cancer, and high VFA was a negative predictive factor for pathological complete response (38).…”

Section: Discussionmentioning

confidence: 99%

Impact of Body Composition During Neoadjuvant Chemoradiotherapy on Complications, Survival and Tumor Response in Patients With Locally Advanced Rectal Cancer

Liu

Wang

et al. 2022

Front. Nutr.

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BackgroundTo explore the impact of body composition before neoadjuvant chemoradiotherapy (pre-NCRT) and after neoadjuvant chemoradiotherapy (post-NCRT) on complications, survival, and tumor response in patients with locally advanced rectal cancer (LARC).MethodsPatients with LARC who underwent radical surgery after NCRT between Ja 22nuary 2012 and March 2019 were studied. Body composition parameters, including skeletal muscle area (SMA), muscle density (MD), visceral fat area (VFA), total abdominal fat area (TAFA), and subcutaneous fat area (SFA), was identified at the third lumbar vertebra level on computed tomography (CT). The patients were divided into two groups based on the sex-specific quartile values of SMA, MD, VFA, TAFA, SFA, and body composition change. Patient characteristics, short- and long-term postoperative complications, survival, and tumor response were analyzed.ResultsA total of 122 eligible patients were enrolled. Body composition parameters, except MD, were strongly correlated with BMI (p < 0.001). Pre-NCRT low MD (p = 0.04) and TAFA loss (p = 0.02) were significantly correlated with short- and long-term ileus, respectively. Pre-NCRT low SMA was a significant prognostic factor for both disease-free survival (DFS) (HR 2.611, 95% CI 1.129–6.040, p = 0.025) and cancer-specific survival (CSS) (HR 3.124, 95% CI 1.030–9.472, p = 0.044) in the Cox regression multivariate analysis. Multivariate logistic regression analysis identified post-NCRT SFA (OR 3.425, 95% CI 1.392–8.427, p = 0.007) and SFA loss (OR 3.358, 95% CI 1.214–9.289, p = 0.02) as independent risk factors for tumor regression grade (TRG) and downstaging, respectively.ConclusionPre-NCRT low MD and TAFA loss were related to a high incidence of short- and long-term ileus, respectively. Pre-NCRT low SMA was a significant prognostic factor for CSS and DFS. Post-NCRT SFA and SFA loss were independent risk factors for TRG and downstaging, respectively.

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Body composition parameters predict pathological response and outcomes in locally advanced gastric cancer after neoadjuvant treatment: A multicenter, international study

Cited by 11 publications

References 48 publications

Body composition parameters for predicting the efficacy of neoadjuvant chemotherapy with immunotherapy for gastric cancer

Body composition parameters for predicting the efficacy of neoadjuvant chemotherapy with immunotherapy for gastric cancer

Understanding Cancer Cachexia and Its Implications in Upper Gastrointestinal Cancers

Impact of Body Composition During Neoadjuvant Chemoradiotherapy on Complications, Survival and Tumor Response in Patients With Locally Advanced Rectal Cancer

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