Impact of visceral fat on surgical complications and long-term survival of patients with gastric cancer after radical gastrectomy

Wang, Su‐Lin; Ma, Lan; Chen, Xiyi; Zhou, Donglei; Li, Bo; Huang, Dongdong; Yu, Zhen; Shen, Xian; Zhuang, Cheng‐Le

doi:10.1038/s41430-017-0032-7

Cited by 37 publications

(27 citation statements)

References 35 publications

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“…The quality assessment is available in Table 2 and shows the study quality ranging from low to high quality, with scores ranging from 4 to 8 on the NOS scale. Eight studies were considered high quality, with a score of 8 [13, 18, 28, 54, 64, 72, 78, 79], fifty-three studies were considered moderate quality, with a score ranging from 5 to 7 [6, 15, 17, 23–27, 29, 30, 32–35, 37–41, 44–49, 51–53, 55–63, 65–71, 73–75, 80–85], and the remaining 9 studies were given a score of 4 and considered low quality [14, 31, 36, 42, 43, 50, 76, 77, 86]. According to the GRADE, the overall quality of the evidence of sarcopenia as a predictive factor for both long-term and short-term should be considered “very low” due to the lack of randomized control trials.…”

Section: Resultsmentioning

confidence: 99%

CT-assessed sarcopenia is a predictive factor for both long-term and short-term outcomes in gastrointestinal oncology patients: a systematic review and meta-analysis

Su¹,

Ruan²,

Chen³

et al. 2019

Cancer Imaging

107

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BackgroundThe impact of sarcopenia on the outcome of gastrointestinal (GI) oncological patients is still controversial. We aim to discuss the prevalence of sarcopenia and its relation to the oncological outcome.MethodsEmbase, Medline, PubMed, and the Cochrane library were systematically searched for related keywords. Studies using CT to assess sarcopenia and evaluate its relationship with the outcome of GI oncological patients were included. Long-term outcomes, including overall survival and disease-free survival, were compared by hazard ratios (HRs) with 95% confidence intervals (CIs). Short-term outcomes, including total complications and major complications (Clavien-Dindo ≥IIIa) after curable surgery, were compared by the risk ratio (RR) and 95% CI.ResultsA total of 70 studies including 21,875 patients were included in our study. The median incidence of sarcopenia was 34.7% (range from 2.1 to 83.3%). A total of 88.4% of studies used skeletal muscle index (SMI) in the third lumbar level on CT to define sarcopenia, and a total of 19 cut-offs were used to define sarcopenia. An increasing trend was found in the prevalence of sarcopenia when the cut-off of SMI increased (β = 0.22, 95% CI = 0.12–0.33, p < 0.001). The preoperative incidence of sarcopenia was associated both with an increased risk of overall mortality (HR = 1.602, 95% CI = 1.369–1.873, P < 0.001) and with disease-free mortality (HR = 1.461, 95% CI = 1.297–1.646, P < 0.001). Moreover, preoperative sarcopenia was a risk factor for both total complications (RR = 1.188, 95% CI = 1.083–1.303, P < 0.001) and major complications (RR = 1.228, 95% CI = 1.042–1.448, P = 0.014).ConclusionThe prevalence of sarcopenia depends mostly on the diagnostic cut-off points of different criteria. Preoperative sarcopenia is a risk factor for both long-term and short-term outcomes.

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Section: Resultsmentioning

confidence: 99%

CT-assessed sarcopenia is a predictive factor for both long-term and short-term outcomes in gastrointestinal oncology patients: a systematic review and meta-analysis

Su¹,

Ruan²,

Chen³

et al. 2019

Cancer Imaging

107

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“…Low muscle mass has been recognized to be associated with poor clinical outcomes [19,20]. However, visceral obesity has been found to be a risk factor for postoperative complications [21,22]. Sarcopenic obesity, which is characterized by low muscle mass and high BMI or high visceral fat mass, was associated with negative clinical outcomes [23,24].…”

Section: Discussionmentioning

confidence: 99%

Value of Sarcopenia defined by the new EWGSOP2 consensus for the prediction of Postoperative Complications and Long-term Survival after Radical Gastrectomy for Gastric Cancer: A comparison with four common nutritional screening tools

et al. 2020

Self Cite

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Background: Nutritional risk and sarcopenia are both associated with increased postoperative morbidity and mortality following elective surgery. This study aimed to investigate whether sarcopenia has additional predictive value for postoperative complications and long-term survival besides nutritional screening tools. Methods: Clinical data of patients underwent radical gastrectomy for gastric cancer was prospectively collected. Sarcopenia was diagnosed by grip strength plus muscle quanlity/quality based on preoperative abdominal CT scans. Nutritional screening was performed using 4 common nutritional screening tools, including Malnutrition Universal Screening Tool (MUST), Nutritional Risk Screening (NRS)-2002, Malnutrition Screening Tool (MST), and Short Nutritional Assessment Questionnaire (SNAQ). Results: A total of 880 patients were analyzed, in which 167 (18.98%) were diagnosed with sarcopenia. The incidence of nutritional risk identified by the 4 tools were 44.66% (MUST ≥1), 35.23% (NRS-2002 ≥3), 29.89% (MST ≥2), and 20.34% (SNAQ ≥2). Multivariate analyses showed that nutritional risk identified by the 4 nutritional screening tools were not independently associated with postoperative complications, overall survival (OS) or disease-free survival (DFS), except for NRS-2002 ≥3 as an independent risk factor of OS. Sarcopenia was always an independent risk factor for postoperative complications, OS, and DFS after adjusting for nutritional risk and the other covariates in the multivariate analyses. Conclusions: MUST, NRS-2002, MST, and SNAQ had low predictive power for postoperative complications and long-term survival in patients underwent radical gastrectomy for gastric cancer. Sarcopenia had additional predictive value for postoperative complications and long-term survival besides these nutritional screening tools and should be implemented in the preoperative assessments.

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“…The studies were from Italy, Czech Republic, Austria, China, Japan, Korea, and Thailand, and the year of publication ranged from 1995 to 2018. With respect to outcomes, eleven studies [15, 18, 21–23, 25–28, 30, 31] assessed the relationship between OS and preoperative anemia, one study [19] determined the relationship between DFS and preoperative anemia, and five studies [16, 17, 20, 24, 29] studied the relationship between OS, DFS, and preoperative anemia. Of the eligible studies, 14 studies [15–20, 22, 25–31] defined the cut-off value for preoperative anemia, and three studies [21, 23, 24] did not define this value.…”

Section: Resultsmentioning

confidence: 99%

“…HRs for DFS were available in six studies [16, 17, 19, 20, 24, 29]. The results indicated that the DFS was worse in patients with preoperative anemia (HR = 1.62, 95%CI = 1.13-2.32, I 2 = 91.1%; Figure 3).…”

Section: Resultsmentioning

confidence: 99%

Preoperative Anemia or Low Hemoglobin Predicts Poor Prognosis in Gastric Cancer Patients: A Meta-Analysis

Huang

Chen³

et al. 2019

Disease Markers

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Background The prognostic value of preoperative anemia in gastric cancer remains unclear. Therefore, the purpose of the present study is to evaluate the prognostic value of preoperative anemia in gastric cancer. Methods We searched Embase and PubMed databases for relevant studies from inception to March 2018. The prognostic value of preoperative anemia in gastric cancer was determined by calculating the hazard ratio (HR) and the corresponding 95% confidence interval (CI) as effect measures. A random effect model was used in cases in which there was significant heterogeneity; otherwise, a fixed effect model was used. Statistical analyses were performed using Stata software. Results Seventeen studies involving 13,154 gastric cancer patients were included. The estimated rate of preoperative anemia was 36% (95%CI = 27-44%). The overall survival of preoperative anemia was poor (HR = 1.33, 95%CI = 1.21-1.45). Moreover, disease-free survival was significantly lower in patients with preoperative anemia compared with those without this condition (HR = 1.62, 95%CI = 1.13-2.32). These findings were corroborated by the results of subgroup analyses. Conclusions The results indicate that preoperative anemia predicts poor prognosis in gastric cancer, including overall survival and disease-free survival. Therefore, preoperative anemia may be a convenient and cost-effective blood-derived prognostic marker for gastric cancer.

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Impact of visceral fat on surgical complications and long-term survival of patients with gastric cancer after radical gastrectomy

Abstract: Increased VFA independently predicts surgical complications in patients after gastrectomy. However, VFA is not a prognostic biomarker of OS or DFS in patients with gastric cancer.

Cited by 37 publications

References 35 publications

CT-assessed sarcopenia is a predictive factor for both long-term and short-term outcomes in gastrointestinal oncology patients: a systematic review and meta-analysis

CT-assessed sarcopenia is a predictive factor for both long-term and short-term outcomes in gastrointestinal oncology patients: a systematic review and meta-analysis

Value of Sarcopenia defined by the new EWGSOP2 consensus for the prediction of Postoperative Complications and Long-term Survival after Radical Gastrectomy for Gastric Cancer: A comparison with four common nutritional screening tools

Preoperative Anemia or Low Hemoglobin Predicts Poor Prognosis in Gastric Cancer Patients: A Meta-Analysis

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