Cardiopulmonary exercise testing has greater prognostic value than sarcopenia in oesophago‐gastric cancer patients undergoing neoadjuvant therapy and surgical resection

West, Malcolm; Baker, Wendy; Rahman, S; Munro, Alicia; Jack, Sandy; Grocott, Michael P.W.; Underwood, Tim; Levett, Denny

doi:10.1002/jso.26652

Cited by 11 publications

(8 citation statements)

References 56 publications

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“…In the present study, a combination of CT-derived muscle measurements (CT-SS) was significantly associated with both a low VO 2 AT and peak. These observations are consistent with recent work of West et al, who reported that CT-derived muscle measurements were associated with CPET performance in patients with OG 24 and hepatopancreatobiliary cancer. 25 Therefore, the CT-SS provides an objective measure that reflects, in part, cardiopulmonary fitness and therefore a useful measure in those patients where CPET is contraindicated.…”

Section: Discussionsupporting

confidence: 93%

The relationship between computed tomography‐derived sarcopenia, cardiopulmonary exercise testing performance, systemic inflammation, and survival in good performance status patients with oesophago‐gastric cancer undergoing neoadjuvant treatment

McGovern

Delaney

Forshaw

et al. 2022

JCSM Clinical Reports

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Background Thought to capture the nutritional and functional reserve of the cancer patient, whether the computed tomography (CT)-derived sarcopenia score (CT-SS) has complimentary prognostic value to commonly utilized pre-treatment host assessments in patients with oesophago-gastric (OG) cancer is unknown. The aim of the present study was to examine if the CT-SS can stratify survival in OG cancer patients with good performance status [Eastern Cooperative Oncology Group Performance Status (ECOG-PS) 0/1]. Furthermore, if the CT-SS had complimentary prognostic value to cardiopulmonary exercise testing (CPET) performance and systemic inflammation. Methods Consecutive patients with confirmed OG cancer and good performance status, who received neoadjuvant chemotherapy (NAC) with a view to surgical resection with curative intent, between 1 January 2010 and 31 December 2015, within NHS Greater Glasgow and Clyde (NHSGGC) and NHS Forth Valley (NHSFV), were identified from a prospectively maintained database. CT-SSs were grouped as 0/1/2. CPET variables recorded included VO 2 anaerobic threshold (AT) and peak. Systemic inflammatory response was determined by modified Glasgow prognostic score (mGPS) and neutrophil/lymphocyte ratio (NLR). Associations between categorical variables were examined using χ 2 test and binary logistics regression analysis. Results A total of 232 patients met the inclusion criteria. 75% (n = 174) of patients were male, 54% (n = 126) were 65 years or older, and 60% (n = 139) were overweight [body mass index (BMI) ≥25 kg/m 2 ]; 33% (n = 77) of patients had CT-SS ≥ 1, 36% (n = 83) had a low VO 2 AT (≤11 ml/kg/min), and 57% (n = 132) had a low VO 2 peak (≤19 ml/kg/ min). Of the 200 patients who had pre-NAC bloods facilitating calculation of the mGPS, 28% (n = 55) had mGPS ≥ 1. Of the 211 patients who had pre-NAC bloods facilitating calculation of NLR, 38% (n = 80) had an NLR ≥ 3; 82% (n = 190) and 53% (n = 122) were alive at 1 and 3 years post-NAC, respectively. On univariate analysis, CT-SS was significantly associated with sex (P < 0.05), histological cell type (P < 0.05), low VO 2 AT (P < 0.05), low VO 2 peak (P < 0.05), BMI (P < 0.05), mGPS (P < 0.05), and 3-year survival (P < 0.05). On multivariate analysis, tumour, node, and metastasis (TNM) stage (P < 0.05) and CT-SS (P < 0.05) remained significantly associated with 3-year survival. CT-SS was significantly associated with 3-year survival in patients who had mGPS 0 (P < 0.05), but not low VO 2 AT (P = 0.066) or peak (P = 0.065).

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Section: Discussionsupporting

confidence: 93%

The relationship between computed tomography‐derived sarcopenia, cardiopulmonary exercise testing performance, systemic inflammation, and survival in good performance status patients with oesophago‐gastric cancer undergoing neoadjuvant treatment

McGovern

Delaney

Forshaw

et al. 2022

JCSM Clinical Reports

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“…Similarly, a retrospective from Japan demonstrated that visceral-to-subcutaneous adipose tissue area ratio (VSR) was a prognostic factor for the overall survival of elderly patients with gastric cancer after gastrectomy (33). Moreover, reduced SM-RA is independently associated with postoperative outcomes in cancer patients (35,50), which is consistent with our findings. The influence of sex factor on the relationship between sarcopenia and the prognosis of cancer is an emerging field.…”

Section: Discussionsupporting

confidence: 92%

“…In this study, we present a retrospective investigation of the influence of sarcopenia on the prognoses of GC patients who underwent radical gastrectomy. In addition to the classic indicator L3 skeletal muscle index (L3 SMI), other indexes like visceral fat area (VFA), subcutaneous fat area (SFA), visceral fat index (VFI), subcutaneous fat index (SFI), subcutaneous and visceral ratio (SV), and skeletal muscle radiation attenuation (SM-RA) were also included in our study according to previous studies (31)(32)(33)(34)(35). Moreover, we further evaluated potential sex differences in the relationship between sarcopenia and longterm survival.…”

Section: Introductionmentioning

confidence: 99%

Preoperative computed tomography-determined sarcopenia is a reliable prognostic factor in patients with gastric cancer after radical gastrectomy: A sex-specific analysis

Liu

Zhang

et al. 2022

Front. Nutr.

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BackgroundThe predictive role of sarcopenia in cancer prognosis is an area of increasing concern. However, the influence of sex difference on the predictive role of sarcopenia in cancer prognosis has not been clearly defined. This retrospective cohort study investigated the effect of preoperative sarcopenia on the long-term outcomes of patients with gastric cancer (GC) based on sexual dimorphism.MethodsPreoperative abdominal computed tomography (CT) scans from 379 GC patients who underwent radical gastrectomy were carefully analyzed. The patients were categorized into sarcopenia and non-sarcopenia groups according to the L3 skeletal muscle index (L3 SMI) measured on CT scans. Moreover, other indexes which can be used to evaluate the muscle area or the muscle quality, including skeletal muscle area (SMA), visceral fat area (VFA), subcutaneous fat area (SFA), skeletal muscle radiation attenuation (SM-RA), visceral fat index (VFI), subcutaneous fat index (SFI), and subcutaneous and visceral ratio (SV), were obtained from CT scans.ResultsThere were 254 men and 125 women included in our study. After calculation, we defined sex-specific SMI-related mortality cutoff as 39.73 and 32.97 cm2/m2 for men and women. Univariable analysis showed that pathological tumor-node-metastasis (pTNM), depth of invasion, lymph node metastasis, differentiation degree, preoperative sarcopenia (for men), SMA (for men), L3 SMI, SFA (for women), SFI (for women), SV (for women), and SM-RA (especially for men) were significant independent predictors of overall survival (OS). Multivariable analysis showed that pTNM, depth of invasion, poor differentiation, and SM-RA were significantly associated with 5-year OS in GC patients. However, CT-determined sarcopenia was associated with significantly worse OS only in men, and SFA was significantly associated with 5-year OS only in women.ConclusionSM-RA is a reliable prognostic factor in patients with GC after radical gastrectomy. The impact of indexes mentioned above on survival outcomes is dependent on sex. CT-determined preoperative sarcopenia, a muscle-related indicator, was associated with outcomes in men. Adipose-related indicator (SFA), instead, was associated with outcomes in women.

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“…Several studies proposed that muscle function (defined by factors like hand grip strength or cardiopulmonary exercise testing) might be better in reflecting a patients’ physical function or nutritional status than skeletal muscle mass. 41 – 44 As skeletal muscle mass can be measured on routinely performed CT-scans, it is an easily available measure of the patients’ physical status. A more comprehensive picture of the patients’ physical and nutritional status might contribute to the prediction of postoperative outcomes in cancer patients.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Low Skeletal Muscle Mass on Short- and Long-Term Outcomes After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

et al. 2022

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Background Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is a potentially curative treatment for peritoneal metastases from colorectal cancer (CRC) or pseudomyxoma peritonei (PMP). Because of the considerable morbidity of this treatment, optimal patient selection is key. This study aimed to assess the impact of low skeletal muscle mass (SMM) on outcomes after CRS-HIPEC. Methods Patients who underwent CRS-HIPEC between 2014 and 2020 at a tertiary center were included. SMM was measured on computed tomography by means of the L3 muscle index. Postoperative complications and survival outcomes were compared between groups by use of logistic regression and Kaplan-Meier survival analyses. Results Of 284 included patients, 149 had low SMM. Occurrence of severe postoperative complications did not differ between groups (28.9% for patients with low vs. 34.1% for patients with normal SMM). Low SMM was not associated with postoperative complications (p = 0.344). For CRC patients, no significant differences were observed in disease-free (DFS) or overall survival (OS) between patients with low (median DFS 7 months [IQR 4–14], median OS 33 months [IQR 14–NR]) and patients with normal SMM (median DFS 8 months [IQR 5–20], median OS 35 months [IQR 18–NR]). Regarding PMP, survival outcomes did not significantly differ between groups (3-year DFS 47.3% for patients with low SMM vs. 54.5% for patients with normal SMM, p = 0.676; 3-year OS 70.8% vs. 90.9% respectively, p = 0.172). Conclusions Low SMM could not be identified as a predictor of severe complications or survival outcomes after CRS-HIPEC.

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Cardiopulmonary exercise testing has greater prognostic value than sarcopenia in oesophago‐gastric cancer patients undergoing neoadjuvant therapy and surgical resection

Cited by 11 publications

References 56 publications

The relationship between computed tomography‐derived sarcopenia, cardiopulmonary exercise testing performance, systemic inflammation, and survival in good performance status patients with oesophago‐gastric cancer undergoing neoadjuvant treatment

The relationship between computed tomography‐derived sarcopenia, cardiopulmonary exercise testing performance, systemic inflammation, and survival in good performance status patients with oesophago‐gastric cancer undergoing neoadjuvant treatment

Preoperative computed tomography-determined sarcopenia is a reliable prognostic factor in patients with gastric cancer after radical gastrectomy: A sex-specific analysis

The Impact of Low Skeletal Muscle Mass on Short- and Long-Term Outcomes After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

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