CT‐determined low skeletal muscle mass predicts worse overall survival of gastric cancer in patients with cachexia

Abstract

Background There were controversies for the association between computed tomography (CT)‐determined low skeletal muscle mass (SMM) and overall survival (OS) in gastric cancer (GC). In this study, we investigated whether cachexia could be a potential confounding variable for this issue. Methods We retrospectively collected the patients of GC in our institution between July 2016 and January 2021. Preoperative SMM was determined by analyzing the skeletal muscle index of L3 with abdominal CT, and the cut‐offs for low SMM were defined as <52.4 (men) and < 38.5 cm2/m2 (women), respectively. Overall survival (OS) was the primary endpoint. Results Of the 255 included GC patients, 117 (46%) were classified as having low SMM. Those with low SMM were associated with a higher level of circulating interleukin 6 and C reactive protein but a lower level of albumin than those of normal SMM. The univariate analysis showed that low SMM, tumor‐node‐metastasis (TNM) stage, body mass index (BMI), postoperative chemotherapy, and cachexia were significantly associated with OS, while in the multivariate analysis, only low SMM and TNM stage were significantly associated with OS. Kaplan–Meier survival curves with log‐rank tests indicated that low SMM significantly predicted worse OS of GC. After grouping by cachexia, the low SMM significantly predicted worse OS in patients with cachexia instead of those without cachexia. Conclusions CT‐determined low SMM predicts worse OS of GC in patients with cachexia instead of those without cachexia, and greater attention should be paid to such patients with synchronous low SMM and cachexia.

Cachexia Index as a Prognostic Indicator in Patients with Gastric Cancer: A Retrospective Study

“…The original preoperative abdominal CT images of included patients were extracted from our hospital, and Syngo MultiModality Workplace (Siemens Medical Solutions, Forchheim, Germany) was used for analyzing the skeletal muscle area of the third lumbar vertebra (L3) level [ 24 ]. The Hounsfield unit (HU) threshold of skeletal muscle was set from −29 to 150 [ 25 , 26 ].…”

CT‐determined low skeletal muscle index predicts poor prognosis in patients with colorectal cancer

“…Additionally, patients with low SMI were found to have a significantly higher rate of prolonged length of hospital stay. Many research and our study also has shown that the measurement of skeletal muscle composition using CT scans has a high predictive value for predicting postoperative complications and prognosis, and thus, this indicator is crucial for clinicians 11,25,50 . CT scans provide detailed information about skeletal muscle, which can be used to assess a patient's overall physical condition and muscle function.…”

“…Many research and our study also has shown that the measurement of skeletal muscle composition using CT scans has a high predictive value for predicting postoperative complications and prognosis, and thus, this indicator is crucial for clinicians. 11 , 25 , 50 CT scans provide detailed information about skeletal muscle, which can be used to assess a patient's overall physical condition and muscle function. Prior to surgery, CT scans can help identify the risk of low skeletal muscle mass in patients, enabling appropriate measures to be taken to reduce the occurrence of complications.…”

“…The skeletal muscle area (cm 2 ) of the L3 level was semi‐automatically analyzed using the software of BMI_CT (Seoul, South Korea) 23 . Particularly, for skeletal muscle, the Hounsfield Unit (HU) threshold was set as −29 to 150 24,25 . The quantity of skeletal muscle mass was represented by the SMI of the L3 level, which was reported as total skeletal muscle area (cm 2 ) of L3/height squared (m 2 ) 26,27 …”

“… 23 Particularly, for skeletal muscle, the Hounsfield Unit (HU) threshold was set as −29 to 150. 24 , 25 The quantity of skeletal muscle mass was represented by the SMI of the L3 level, which was reported as total skeletal muscle area (cm 2 ) of L3/height squared (m 2 ). 26 , 27 …”