Impact of body composition on clinical outcomes in people with gastric cancer undergoing radical gastrectomy after neoadjuvant treatment

Zhang, Yingjing; Li, Zijian; Jiang, Lin; Xue, Zhigang; Ma, Zhiqiang; Kang, Weiming; Ye, Xin; Liu, Yuqin; Jin, Zhengyu; Yu, Jian-chun

doi:10.1016/j.nut.2020.111135

Cited by 22 publications

(25 citation statements)

References 56 publications

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“…The sex-specific cut-off values for SMI were 52.4 cm 2 /m 2 for men and 38.5 cm 2 /m 2 for women, which is the most commonly used definition for prognosis studies among patients with cancer [ 27 ]. The cut-off values for VAT were based on our previous study using the optimal stratification method, which was 120 cm 2 before NT and 106 cm 2 after NT in both sexes [ 12 ].…”

Section: Methodsmentioning

confidence: 99%

“…The content and distribution of adipose tissue have shown significant prognostic value for determining cancer-related outcomes. Our previous study found that although high visceral adipose tissue (VAT) leads to an increased risk of postoperative complications, there is a notably improved survival outcome in GC patients who underwent radical surgery after neoadjuvant treatment (NT) [ 12 ]. Moreover, patients with advanced GC also have a poor prognosis when they experience a marked loss of VAT during NT [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Visceral Adipose Tissue Assessment Enhances the Prognostic Value of GLIM Criteria in Patients with Gastric Cancer Undergoing Radical Gastrectomy after Neoadjuvant Treatment

Zhang

Jiang

et al. 2022

Nutrients

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Background: The Global Leadership Initiative on Malnutrition (GLIM) criteria has been recently published for diagnosing malnutrition in adults. However, the validity of the GLIM criteria has not been well-established in patients with gastric cancer (GC) treated with neoadjuvant treatment (NT) followed by radical gastrectomy. The present study aimed to explore the prognostic value of GLIM-defined malnutrition before NT and after NT in GC patients and to investigate whether additional visceral adipose tissue (VAT) assessment could improve the predictive power of the GLIM criteria for NT-related adverse events (AEs) and long-term survival. Methods: GC patients who underwent radical surgery after NT from June 2016 to June 2020 were enrolled in this study. The cross-sectional areas of total skeletal muscle (TSM) and VAT were measured using computed tomography (CT) before NT and after NT. GLIM-defined malnutrition was diagnosed using the two-step approach, including nutritional risk screening and diagnostic assessment. Low VAT was also added to the diagnosis of malnutrition in this study. The predictive value of these malnutrition diagnoses for NT-related AEs, and long-term survival was evaluated in GC patients. Results: A total of 182 GC patients were included in this study, of which 66 (36.3%) patients before NT and 55 (30.2%) patients after NT were diagnosed with GLIM-defined malnutrition, respectively. In addition to GLIM-defined malnutrition, 54 (29.7%) patients had additional low VAT before NT, and 39 (21.4%) patients had additional low VAT after NT. GLIM-defined malnutrition alone before NT was not associated with NT-related AEs in GC patients. The addition of low VAT to GLIM-defined malnutrition led to a significant predictive value for NT-related AEs. Furthermore, GLIM-defined malnutrition before NT and after NT were both identified as independent risk factors for overall survival (OS) and disease-free survival (DFS). The combination of low VAT and GLIM-defined malnutrition showed a higher hazard ratio for the prediction of OS and DFS both before NT and after NT. Conclusions: The addition of VAT assessment using CT improved the predictive value of GLIM-defined malnutrition for NT-related AEs and long-term survival in GC patients treated with NT followed by radical gastrectomy, which further supports the prognostic importance of assessing adipose tissue simultaneously during the routine nutritional assessment in patients with cancer.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Visceral Adipose Tissue Assessment Enhances the Prognostic Value of GLIM Criteria in Patients with Gastric Cancer Undergoing Radical Gastrectomy after Neoadjuvant Treatment

Zhang

Jiang

et al. 2022

Nutrients

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“…In particular, biomarkers that stem from VAT or adipose tissue expansion and/or distribution independent of BMI could be highly informative (27,74). Leptin:adiponectin ratio (75) and central obesity (VAT, SAT, VAT:SAT ratio) (24,26,(76)(77)(78)(79)(80) are associated with cancer risk. Even among individuals in the normal weight range, higher measures of WC, WHR, body fat percentage, and basal metabolic rate are associated with increased cancer risk, highlighting the need to risk stratify across BMI categories (81)(82)(83)(84)(85)(86)(87).…”

Section: Metabolic Dysfunction and Cancermentioning

confidence: 99%

“…Altogether, these observations provide evidence for a key role of dysfunctional metabolism in cancer development and underscore the potential of targeting these pathways as a strategy to reduce cancer risk and mortality (20,21). Additional biomarkers linked to inflammation, insulin sensitivity, and liver function that are commonly dysregulated in metabolic disease (e.g., Creactive protein [CRP], C-peptide, alanine aminotransferase [ALT] and aspartate transaminase [AST]) and more comprehensive indicators of central adiposity (e.g., visceral to subcutaneous adipose tissue ratio [VAT:SAT]) may further bolster obesity-related cancer risk stratification or other cancer prevention efforts (22)(23)(24)(25)(26). In addition, the concept of metabolic obesity in the normal weight range is gaining traction as another target for intervention, because up to a third of lean individuals have metabolic syndrome parameters out of clinical range that often go undiagnosed (27).…”

Section: Introductionmentioning

confidence: 99%

Metabolic dysfunction and obesity‐related cancer: Beyond obesity and metabolic syndrome

Karra

Winn

Pauleck

et al. 2022

Obesity

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Objectives: The metabolic dysfunction driven by obesity, including hyperglycemia and dyslipidemia, increases risk for developing at least 13 cancer types. The concept of “metabolic dysfunction” is often defined by meeting various combinations of criteria for metabolic syndrome. However, the lack of a unified definition of metabolic dysfunction makes it difficult to compare findings across studies. This review summarizes 129 studies that evaluated variable definitions of metabolic dysfunction in relation to obesity‐related cancer risk and mortality after a cancer diagnosis. Strategies for metabolic dysfunction management are also discussed.MethodsA comprehensive search of relevant publications in MEDLINE (PubMed) and Google Scholar with review of references was conducted.ResultsMetabolic dysfunction, defined as metabolic syndrome diagnosis or any number of metabolic syndrome criteria out of clinical range, inflammatory biomarkers, or markers of metabolic organ function, has been associated with risk for, and mortality from, colorectal, pancreatic, postmenopausal breast, and bladder cancers. Metabolic dysfunction associations with breast and colorectal cancer risk have been observed independently of BMI, with increased risk in individuals with metabolically unhealthy normal weight or overweight/obesity compared with metabolically healthy normal weight.ConclusionMetabolic dysfunction is a key risk factor for obesity‐related cancer, regardless of obesity status. Nonetheless, a harmonized definition of metabolic dysfunction will further clarify the magnitude of the relationship across cancer types, enable better comparisons across studies, and further guide criteria for obesity‐related cancer risk stratification.

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“…Those who have early-stage disease amenable to a definitive curative intervention such as surgery may have CC as a transient problem though it may still put them at higher risk of surgical morbidity. 5 For those with cancer as a chronic illness, this often remains a significant ongoing burdensome part of their life. I chose the term illness very deliberately as not only does CC have many biological sequelae but also has a massive impact on people’s wider psychosocial life.…”

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confidence: 99%

Cancer cachexia syndrome: Reflecting on 20 years of providing cancer cachexia care as the leader of an interdisciplinary team in an Australian cancer center

Martin

2022

Asia-Pacific Journal of Oncology Nursing

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Impact of body composition on clinical outcomes in people with gastric cancer undergoing radical gastrectomy after neoadjuvant treatment

Cited by 22 publications

References 56 publications

Visceral Adipose Tissue Assessment Enhances the Prognostic Value of GLIM Criteria in Patients with Gastric Cancer Undergoing Radical Gastrectomy after Neoadjuvant Treatment

Visceral Adipose Tissue Assessment Enhances the Prognostic Value of GLIM Criteria in Patients with Gastric Cancer Undergoing Radical Gastrectomy after Neoadjuvant Treatment

Metabolic dysfunction and obesity‐related cancer: Beyond obesity and metabolic syndrome

Cancer cachexia syndrome: Reflecting on 20 years of providing cancer cachexia care as the leader of an interdisciplinary team in an Australian cancer center

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