Sarcopenia in gastric cancer: when the loss costs too much

Abstract

Sarcopenia is a complex syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength. Malignancy is a major determinant of sarcopenia, and gastric cancer (GC) is among the most common causes of this phenomenon. As sarcopenia is a well-recognized poor prognostic feature in GC and has been associated with worse tolerance of surgical and medical treatments, members of the multidisciplinary team should be aware of the clinical relevance, pathogenic mechanisms, and potential treatments for this syndrome. The importance of sarcopenia is often underestimated in everyday practice and clinical trials, particularly among elderly or fragile patients. As treatment options are improving in all disease stages, deeper knowledge and greater attention to the metabolic balance in GC patients could further increase the benefit of novel therapeutic strategies and dramatically impact on quality of life. In this review, we describe the role of sarcopenia in different phases of GC progression. Our aim is to provide oncologists and surgeons dealing with GC patients with a useful tool for comprehensive assessment and timely management of this potentially life-threatening condition.

The IMPACT study: early loss of skeletal muscle mass in advanced pancreatic cancer patients

“…Of note, sarcopenic obesity may be potentially misleading because sarcopenia is also present among normal and obese patients . Therefore, in these cases, a skeletal muscle wasting may be masked, leading to greater toxicity and potentially serious adverse events to anticancer treatment …”

“…2,18,19 Therefore, in these cases, a skeletal muscle wasting may be masked, leading to greater toxicity and potentially serious adverse events to anticancer treatment. 5,20 Therefore, the use of BMI only is not reliable for nutritional assessment, because LSMM could be independent from weight loss and patients with similar weight or BMI may have a significant difference in body composition. [21][22][23][24] In our cohort, 21% of PC patients experienced an early LSMM ≥ 10%.…”

Prognostic and predictive implications of sarcopenia in Western patients undergoing gastric resections for carcinoma of the stomach

“…Nevertheless, the exact mechanism possibly linking sarcopenia with impaired survival is still unclear. The systemic inflammatory reaction involved in the pathogenesis of cancer‐associated cachexia and sarcopenia may play an important role, but such assumptions are still speculative and need further clinical investigations …”

“…However, subsequent reports demonstrated its high prevalence also in some chronic disorders, including cancer . The estimated occurrence of sarcopenia in the latter group reaches in some reports 50%‐60%, and is particularly common in malignancies of the upper gastrointestinal tract, including gastric cancer (GC) . Moreover, sarcopenia was also frequently reported among overweight and obese individuals with cancer, who would normally be classified as low nutritional risk …”

Beyond the Beyond: A Case of an Extraordinary Response to Multiple Lines of Therapy in a de novo Metastatic HER2-Negative Gastric Cancer Patient

“…Indeed, a vast amount of recently published data underlines how malnutrition of patients with gastric cancer both in the perioperative [17,18] and palliative setting [19] can negatively impact on survival. Similarly, sarcopenia, a complex syndrome characterized by a generalized loss of skeletal muscle mass, is very common in patients with gastric cancer and represents a frequent cause of poor tolerance to medical and surgical treatments [20].…”