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Juez LD, Ortega ADC, Priego P, García Pérez JC, Fernández-Cebrián JM, Botella-Carretero JI. Impact of sarcopenic obesity on surgical complications and oncologic outcomes of upper gastrointestinal tumors: a systematic review and meta-analysis. Cir Esp 2025; 103:182-194. [PMID: 39343165 DOI: 10.1016/j.cireng.2024.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 08/17/2024] [Indexed: 10/01/2024]
Abstract
Sarcopenic obesity (SO) is a new entity whose definition encompasses the diagnosis of overweight in malnourished patients. The aim of the review was to assess the impact of body composition in patients with esophago-gastric tumors (EGT) on perioperative and oncological outcomes. This systematic review was conducted under the PRISMA guidelines. MEDLINE (PubMed), Embase, Web of Science and SCOPUS databases were searched until January 2024. Sixteen articles were identified for analysis analyzing 5,378 patients. The prevalence of SO was 10% (95%CI: 6-16; I2 = 94%). Preoperative diagnosis of SO was associated with a twofold increased risk of severe postoperative complications (OR 2.32 [95%CI 1.41-3.82] I2 = 70%). Meta-analysis of overall survival outcomes identified that SO was associated with worse overall survival (HR 2.30; 95%CI 1.46-3.61).
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Affiliation(s)
- Luz Divina Juez
- Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Facultad de Medicina, Universidad de Alcalá, IRYCIS. Madrid, Spain.
| | - Ana Del Carmen Ortega
- Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Facultad de Medicina, Universidad de Alcalá, IRYCIS. Madrid, Spain
| | - Pablo Priego
- Department of General and Digestive Surgery, Hospital Universitario La Paz, Facultad de Medicina, Universidad Autónoma de Madrid, Spain
| | - Juan Carlos García Pérez
- Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Facultad de Medicina, Universidad de Alcalá, IRYCIS. Madrid, Spain
| | - José María Fernández-Cebrián
- Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Facultad de Medicina, Universidad de Alcalá, IRYCIS. Madrid, Spain
| | - Jose I Botella-Carretero
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Facultad de Medicina, Universidad de Alcalá, IRYCIS. Madrid, Spain
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2
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Liu C, Li Y, Xu Y, Hou H. The impact of preoperative skeletal muscle mass index-defined sarcopenia on postoperative complications and survival in gastric cancer: An updated meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2025; 51:109569. [PMID: 39794171 DOI: 10.1016/j.ejso.2024.109569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2024] [Revised: 12/05/2024] [Accepted: 12/27/2024] [Indexed: 01/13/2025]
Abstract
BACKGROUND The impact of preoperative sarcopenia on postoperative outcomes in gastric cancer remains debated. This study aims to perform an in-depth meta-analysis and comprehensive review of the relationship between preoperative sarcopenia, as assessed by the Skeletal Muscle Mass Index (SMI), and postoperative complications and survival metrics in gastric cancer patients, to offer new insights into this issue. METHODS We conducted a systematic search of primary studies in databases such as Embase, PubMed, and Web of Science, up to July 2024. Our analysis focused on comparing postoperative readmission and mortality rates, overall and severe complication rates, incidence of specific complications, as well as overall survival (OS) and disease-free survival (DFS) between groups with and without preoperative sarcopenia. RESULTS Our review included 42 studies with a total of 11,981 patients. Findings revealed that patients with sarcopenia had significantly higher rates of overall postoperative complications, severe complications, mortality, and readmissions compared to those without sarcopenia (all P < 0.001). A detailed examination showed that sarcopenic patients had notably higher incidences of pulmonary complications, bowel obstruction, and pancreatic fistulas. Additionally, the OS (P < 0.001) and DFS (P = 0.003) rates were considerably lower in the sarcopenia group. CONCLUSIONS Preoperative sarcopenia is associated with an increased risk of postoperative complications and poorer survival outcomes in gastric cancer patients. Given these associations, it is recommended to incorporate routine screening for sarcopenia using SMI before surgery, where feasible, to enhance patient risk assessment and customize treatment approaches.
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Affiliation(s)
- Chengcong Liu
- Department of Gastrointestinal Surgery, Qingdao Central Hospital, University of Health and Rehabilitation Sciences(Qingdao Central Hospital), Qingdao, 266000, China
| | - Yueping Li
- Department of Gastrointestinal Surgery, Qingdao Central Hospital, University of Health and Rehabilitation Sciences(Qingdao Central Hospital), Qingdao, 266000, China
| | - Yongjing Xu
- Department of Gastrointestinal Surgery, Qingdao Central Hospital, University of Health and Rehabilitation Sciences(Qingdao Central Hospital), Qingdao, 266000, China
| | - Hong Hou
- Department of Breast Surgery, Qingdao Central Hospital, University of Health and Rehabilitation Sciences(Qingdao Central Hospital), Qingdao, 266000, China.
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Tian Z, Cheng Y, Wang Y, Ren J, Wang S, Wang D. A 3-Arm case-matched analysis of anti-reflux reconstruction methods after laparoscopic proximal gastrectomy - Single tract jejunal interposition vs double tract reconstruction vs tube-like stomach reconstruction. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2025; 51:109482. [PMID: 39580964 DOI: 10.1016/j.ejso.2024.109482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 11/03/2024] [Accepted: 11/18/2024] [Indexed: 11/26/2024]
Abstract
BACKGROUND Owing to reportedly superior prognosis, proximal gastrectomy (PG) is expected to be an alternative to total gastrectomy for upper gastric cancer. However, limited data are available regarding the optimal anti-reflux reconstruction method after PG. This study aimed to evaluate the effect of laparoscopic PG with single-tract jejunal interposition (LPG-STJI), double-tract reconstruction (LPG-DTR), and tube-like stomach reconstruction (LPG-TLR) on surgical outcomes in patients with upper-third gastric cancer. METHODS Using propensity score-matching (PSM) to adjust for baseline characteristics, a well-balanced cohort was established by matching each patient who underwent LPG-STJI as the study group with one who underwent LPG-DTR or LPG-TLR as the control group at a 1:1 ratio. This study was registered at ClinicalTrials.gov (No. NCT06347757). RESULTS PSM yielded 62 matched pairs, with comparable demographic and tumor characteristics. The incidence of reflux esophagitis at one year postoperatively was significantly lower in the LPG-STJI and LPG-DTR groups than in the LPG-TLR group (11.3 % vs 9.7 % vs 24.2 %, P = 0.046), and fewer patients required proton-pump inhibitor administration (62.9 % vs 56.5 % vs 79.0 %, P = 0.024). In terms of nutritional status, the LPG-STJI group showed minimal changes in postoperative body weight and nutrition-related biochemical indices, approaching preoperative levels by the 12-month mark. In addition, the LPG-STJI group demonstrated a more favorable quality of life than the LPG-DTR and LPG-TLR groups, as assessed using the EORTC QLQ-C30 and QLQ-STO22 questionnaires. CONCLUSION LPG-STJI may be the preferred option for anti-reflux reconstruction, since it appears to reduce the occurrence of endoscopic reflux esophagitis and improve quality of life without raising surgical complications or compromising nutritional status. Further well-designed prospective studies are warranted to re-evaluate these findings.
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Affiliation(s)
- Zhen Tian
- Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
| | - Yifan Cheng
- Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
| | - Yong Wang
- Scientific Research Department, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| | - Jun Ren
- Department of General Surgery, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Sen Wang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| | - Daorong Wang
- Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China; Department of General Surgery, Northern Jiangsu People's Hospital, Yangzhou, China; General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China.
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Yıldız Kopuz TN, Yıldız HF, Er S, Fisunoğlu M. Prognostic Impact of Sarcopenic Obesity on Postoperative Outcomes in Colorectal Cancer Patients Undergoing Surgery: A Systematic Review and Meta-Analysis. Nutr Cancer 2025; 77:360-371. [PMID: 39797593 DOI: 10.1080/01635581.2025.2450843] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 11/26/2024] [Accepted: 11/27/2024] [Indexed: 01/13/2025]
Abstract
Sarcopenic obesity is a condition in which the coexistence of sarcopenia and obesity may have unfavorable prognostic implications in cancer. This meta-analysis aims to evaluate the effects of sarcopenic obesity on postoperative outcomes in patients undergoing colorectal cancer surgery. A systematic literature search was conducted in the Scopus, PubMed, and Web of Science databases for articles up to February 8, 2024. The primary outcomes were overall and major complications and overall survival. A random- or fixed-effects model was used in each case based on heterogeneity, and both subgroup and sensitivity analyses were performed. Twenty studies with 11,264 patients were included. The prevalence of sarcopenic obesity was 14.5%. Sarcopenic obesity was found to be a risk factor for overall complications [pooled OR: 1.69 (95% CI: 1.26-2.26); p < 0.001] and major complications [pooled OR: 1.64 (95% CI: 1.06-2.55); p = 0.028]. The effect on overall survival was not significant [pooled HR: 1.24 (95% CI: 0.98-1.56); p = 0.076], but significance varied in some subgroups. Furthermore, sarcopenic obesity was associated with an increased risk of 30-day mortality, but not with prolonged hospitalization. In conclusion, sarcopenic obesity is associated with unfavorable outcomes after colorectal cancer surgery; therefore, it may be useful to include a diagnosis of sarcopenic obesity when formulating the disease prognosis.
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Affiliation(s)
- Tuba Nur Yıldız Kopuz
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Karamanoğlu Mehmetbey University, Karaman, Türkiye
| | | | - Sadettin Er
- Department of General Surgery, Ankara Bilkent City Hospital, Ankara, Türkiye
| | - Mehmet Fisunoğlu
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Hacettepe University, Ankara, Türkiye
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Zhao B, Bao L, Zhang T, Chen Y, Zhang S, Zhang C. Prevalence of sarcopenic obesity in patients with gastric cancer and effects on adverse outcomes: A meta-analysis and systematic review. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108772. [PMID: 39437588 DOI: 10.1016/j.ejso.2024.108772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Revised: 09/25/2024] [Accepted: 10/14/2024] [Indexed: 10/25/2024]
Abstract
PURPOSE To assess the prevalence of sarcopenic obesity in patients with gastric cancer and its impact on adverse outcomes. METHODS A computerized search of PubMed, Embase, Cochrane Library, Web of Science, and CINAHL databases was performed to search for articles related to sarcopenic obesity in patients with gastric cancer. The search was conducted until June 16, 2024, from the date of the creation of the database. RESULTS A total of sixteen studies were included, including fifteen cohort studies and one cross-sectional study involving 4087 patients. The results of the meta-analysis showed that the prevalence of sarcopenic obesity in gastric cancer patients was 16.3 % (95 % CI: 12.2 %-20.4 %). Sarcopenic obesity significantly shortened the overall survival of gastric cancer patients (HR = 1.64, 95 % CI: 1.20 to 2.25, P = 0.002) and increased the risk of postoperative significant complications (OR = 2.84, 95 % CI: 1.95 to 4.16, P < 0.001), severe complications (OR = 2.60, 95 % CI: 1.45 to 4.64, P = 0.001), surgical site infection (OR = 3.82, 95 % CI: 1.47 to 9.89, P = 0.006), and mortality (OR = 4.84, 95 % CI: 1.38 to 17.02, P = 0.014), but no significant effect on 30-day readmission (OR = 1.90, 95 % CI: 0.31 to 11.84, P = 0.491). CONCLUSIONS The prevalence of sarcopenic obesity is high in patients with gastric cancer and is strongly associated with poor postoperative outcomes. Healthcare providers should evaluate patients with gastric cancer for sarcopenic obesity early to prevent or reduce the incidence of adverse outcomes.
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Affiliation(s)
- Bingyan Zhao
- Graduate School of Tianjin University of Chinese Medicine, Tianjin, 301617, China
| | - Leilei Bao
- Emergency Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310003, China
| | - Tongyu Zhang
- Graduate School of Tianjin University of Chinese Medicine, Tianjin, 301617, China
| | - Yu Chen
- Graduate School of Tianjin University of Chinese Medicine, Tianjin, 301617, China
| | - Siai Zhang
- Cardiac Intensive Care Unit, Meizhou People's Hospital, Meizhou, Guangdong, 514031, China
| | - Chunmei Zhang
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China.
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Lysaght J, Conroy MJ. The multifactorial effect of obesity on the effectiveness and outcomes of cancer therapies. Nat Rev Endocrinol 2024; 20:701-714. [PMID: 39313571 DOI: 10.1038/s41574-024-01032-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2024] [Indexed: 09/25/2024]
Abstract
Epidemiology studies have demonstrated a clear association between obesity and the development of several distinct malignancies, with excessive visceral adiposity being an increasingly prevalent feature in patients with cancer presenting for therapeutic intervention. Clinical trials and meta-analyses have helped to inform effective and safe dosing of traditional systemically administered anticancer agents in adult patients with cancer and obesity, but there remains much debate not only regarding the effect of obesity on the more novel targeted molecular and immune-based therapies, but also about how obesity is best defined and measured clinically. Low muscle mass is associated with poor outcomes in cancer, and body composition studies using biochemical and imaging modalities are helping to fully delineate the importance of both obesity and sarcopenia in clinical outcomes; such studies might also go some way to explaining how obesity can paradoxically be associated with favourable clinical outcomes in certain cancers. As the cancer survivorship period increases and the duration of anticancer treatment lengthens, this Review highlights the challenges facing appropriate treatment selection and emphasizes how a multidisciplinary approach is warranted to manage weight and skeletal muscle loss during and after cancer treatment.
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Affiliation(s)
- Joanne Lysaght
- Cancer Immunology and Immunotherapy Group, Department of Surgery, School of Medicine, Trinity Translational Medicine Institute and Trinity St. James's Cancer Institute, Trinity College Dublin, St James's Hospital, Dublin, Ireland.
| | - Melissa J Conroy
- Cancer Immunology Research Group, Department of Anatomy, School of Medicine, Trinity Biomedical Sciences Institute and Trinity St. James's Cancer Institute, Trinity College Dublin, Dublin, Ireland
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7
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Santana Valenciano Á, Blázquez Hernando L, Robín Valle de Lersundi Á, López Monclús J, Muñoz Rodríguez J, Porrero Guerrero B, Román García de León L, Molina Villar JM, Medina Pedrique M, Blázquez Sánchez J, Fernández Cebrián JM, García Ureña MÁ. Role of sarcopenia in complex abdominal wall surgery: does it increase postoperative complications and mortality? Hernia 2024; 28:2375-2386. [PMID: 39316303 DOI: 10.1007/s10029-024-03174-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Accepted: 09/09/2024] [Indexed: 09/25/2024]
Abstract
BACKGROUND Sarcopenia is defined as the loss of skeletal muscle mass and is associated with an increased risk or morbidity and mortality in complex surgical patient populations. Its role in complex abdominal wall surgery (AWS) is yet to be determined. The aim of this study is to establish if sarcopenia has an impact on postoperative complications, mortality and hernia recurrence. METHODS Retrospective study of patients undergoing elective surgery for complex incisional hernias > 10 cm (W3 of European Hernia Society classification) between 2014-2023. Sarcopenia was stablished as the skeletal muscle index (SMI), measured at L3 transversal section of a preoperative CT-scan. Previously defined literature-based SMI cutoff values were used: men ≤ 52.4 cm2/m2, women ≤ 38.5 cm2/m2. RESULTS 135 patients undergoing complex AWS were included. Of them, 38 were sarcopenic (28.1%). The median follow-up time was 13 months (IQR 12-25). In total, 11 patients died (8.1%). We found that sarcopenia was associated with a higher risk of mortality [HR 7.494 (95% CI 1.985-28.289); p 0.003]. There were no statistically significant differences in postoperative complications or hernia recurrence between both groups. CONCLUSION Although sarcopenia does not seem to have an influence on hernia recurrence or the development of postoperative complications, whether local or systemic, in our study sarcopenia is associated with a higher risk of mortality after complex abdominal wall surgery. Nonetheless, with the results obtained in our study, we think that prehabilitation programs before complex AWS is advisable.
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Affiliation(s)
- Ángela Santana Valenciano
- General and Digestive Surgery Department, University Hospital Ramón y Cajal, Ctra. de Colmenar Viejo, Km. 9,100, 28034, Madrid, Spain
- Universidad de Alcalá, Alcalá de Henares, Spain
| | - Luis Blázquez Hernando
- General and Digestive Surgery Department, University Hospital Ramón y Cajal, Ctra. de Colmenar Viejo, Km. 9,100, 28034, Madrid, Spain.
- Universidad de Alcalá, Alcalá de Henares, Spain.
| | | | - Javier López Monclús
- General and Digestive Surgery Department, University Hospital Puerta de Hierro, Majadahonda, Spain
| | - Joaquín Muñoz Rodríguez
- General and Digestive Surgery Department, University Hospital Puerta de Hierro, Majadahonda, Spain
| | - Belén Porrero Guerrero
- General and Digestive Surgery Department, University Hospital Ramón y Cajal, Ctra. de Colmenar Viejo, Km. 9,100, 28034, Madrid, Spain
- Universidad de Alcalá, Alcalá de Henares, Spain
| | | | - José Manuel Molina Villar
- General and Digestive Surgery Department, University Hospital Ramón y Cajal, Ctra. de Colmenar Viejo, Km. 9,100, 28034, Madrid, Spain
- Universidad de Alcalá, Alcalá de Henares, Spain
| | | | - Javier Blázquez Sánchez
- Radiology Department, University Hospital Ramón y Cajal, Madrid, Spain
- Universidad de Alcalá, Alcalá de Henares, Spain
| | - José María Fernández Cebrián
- General and Digestive Surgery Department, University Hospital Ramón y Cajal, Ctra. de Colmenar Viejo, Km. 9,100, 28034, Madrid, Spain
- Universidad de Alcalá, Alcalá de Henares, Spain
| | - Miguel Ángel García Ureña
- General and Digestive Surgery Department, University Hospital Henares, Coslada, Spain
- Universidad Francisco de Vitoria, Madrid, Spain
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Tinsley-Vance SM, Mason TM, Komrokji RS. An integrative review of cancer-related cachexia and sarcopenia: A different focus in malignant hematology. HEALTH SCIENCES REVIEW (OXFORD, ENGLAND) 2024; 13:100205. [PMID: 39802938 PMCID: PMC11720849 DOI: 10.1016/j.hsr.2024.100205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2025]
Abstract
Introduction/background An improved understanding of cancer-related cachexia and sarcopenia among patients with hematologic malignancies can improve their health outcomes. Patients with hematologic malignancies are affected by cancer-related cachexia and sarcopenia, but this aspect of their care is rarely studied. This review aims to increase awareness and knowledge of cancer-related cachexia and sarcopenia for patients with hematologic malignancies through a comprehensive synthesis of current research. Methods An integrative literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Ovid MEDLINE, CINAHL Complete, Embase, and Web of Science databases were searched for studies published between 2012 and 2022 using search terms of hematologic malignancies and cancer-related cachexia or sarcopenia. Results Twenty-nine studies were examined with data on 5,687 patients, primarily diffuse large B-cell lymphoma. Conclusion The results are grouped by themes identified in the studies of cancer-related cachexia and sarcopenia in hematologic cancers. The major themes identified were health outcomes, patient identification, transplant effects, and sex differences. Cancer-related cachexia and sarcopenia are associated with decreased overall survival and progression-free survival, similar to solid tumors. Cancer-related cachexia and sarcopenia reduce tolerance to chemotherapy and increase hematologic toxicities. With this effect, biomarkers and cachexia prognostic scores are available to improve patient identification, prognostication, and support. These affected individuals will benefit from increased awareness by the healthcare team to tailor care and mitigate the deleterious effects of the condition.
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Affiliation(s)
- Sara M. Tinsley-Vance
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612 USA
- College of Nursing, University of South Florida, Tampa, FL 33612 USA
| | - Tina M. Mason
- Department of Nursing Research, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612 USA
| | - Rami S. Komrokji
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612 USA
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Duan C, Wu M, Wen X, Zhuang L, Sun J. Sarcopenic obesity predicts short- and long-term outcomes after neoadjuvant chemotherapy and surgery for gastric cancer. Jpn J Clin Oncol 2024; 54:975-985. [PMID: 38941323 DOI: 10.1093/jjco/hyae080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 06/26/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Sarcopenic obesity (SO) affects outcomes in various malignancies. However, its clinical significance in patients undergoing neoadjuvant chemotherapy (NAC) for locally advanced gastric cancer (LAGC) remains unclear. This study investigated the impact of pre- and post-NAC SO on postoperative morbidity and survival. METHODS Data from 207 patients with LAGC, who underwent NAC followed by radical gastrectomy between January 2010 and October 2019, were reviewed. Skeletal muscle mass and visceral fat area were measured pre- and post-NAC using computed tomography to define sarcopenia and obesity, the coexistence of which was defined as SO. RESULTS Among the patients, 52 (25.1%) and 38 (18.4%) developed SO before and after NAC, respectively. Both pre- (34.6%) and post- (47.4%) NAC SO were associated with the highest postoperative morbidity rates; however, only post-NAC SO was an independent risk factor for postoperative morbidity [hazard ratio (HR) = 9.550, 95% confidence interval (CI) = 2.818-32.369; P < .001]. Pre-NAC SO was independently associated with poorer 3-year overall [46.2% vs. 61.3%; HR = 1.258 (95% CI = 1.023-1.547); P = .049] and recurrence-free [39.3% vs. 55.4%; HR 1.285 (95% CI 1.045-1.579); P = .017] survival. CONCLUSIONS Pre-NAC SO was an independent prognostic factor in patients with LAGC undergoing NAC; post-NAC SO independently predicted postoperative morbidity.
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Affiliation(s)
- Chunning Duan
- Department of Surgery, Qingyang People's Hospital, Qingyang 745000, China
| | - Mingru Wu
- Department of Nursing, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Xia Wen
- Department of Health Management Center, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Lvping Zhuang
- Fujian Key Laboratory of Molecular Neurology and Institute of Neuroscience, Fujian Medical University, Fuzhou 350000, China
| | - Jianwei Sun
- Department of Surgery, Qingyang People's Hospital, Qingyang 745000, China
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10
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Gortan Cappellari G, Zanetti M, Donini LM, Barazzoni R. Detecting sarcopenia in obesity: emerging new approaches. Curr Opin Clin Nutr Metab Care 2024; 27:402-409. [PMID: 39022899 PMCID: PMC11309345 DOI: 10.1097/mco.0000000000001062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
PURPOSE OF REVIEW Sarcopenic obesity is a likely common, but certainly underestimated obesity phenotype, with an important negative clinical impact. Its definition and diagnosis have however remained elusive until recently. RECENT FINDINGS Substantial progress has been recently made in sarcopenic obesity diagnostic tools, with the first international consensus proposed by the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO). Very encouraging results emerge from initial implementation of the ESPEN-EASO algorithm. In addition, even more recent progress in global consensus on sarcopenia conceptual definition is likely to further enhance consistency in sarcopenic obesity identification. The latter Global Leadership Initiative on Sarcopenia (GLIS) initiative also adopted a new definition of muscle specific strength. Its inclusion in sarcopenia diagnostic constructs opens the possibility of its potential evaluation in sarcopenic obesity, also considering the emerging positive impact of obesity treatment and fat loss on muscle functional parameters. SUMMARY New consensus tools for sarcopenic obesity diagnosis are likely to improve awareness, understanding, identification and treatment of this under-recognized obesity phenotype.
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Affiliation(s)
- Gianluca Gortan Cappellari
- Department of Medical, Surgical and Health Sciences – University of Trieste
- Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste
| | - Michela Zanetti
- Department of Medical, Surgical and Health Sciences – University of Trieste
- Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste
| | | | - Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences – University of Trieste
- Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste
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11
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Baracos VE. Assessing cachexia in obesity: contradiction or perfectly possible? Curr Opin Clin Nutr Metab Care 2024; 27:387-392. [PMID: 38963662 DOI: 10.1097/mco.0000000000001054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
PURPOSE OF REVIEW Existing definitions of clinically important weight loss in patients with cancer do not specifically address weight loss in patients who are obese at presentation. This review explores the clinical impact of weight loss and depletion of the skeletal muscle mass (i.e., criteria defining cancer cachexia), in patients with obesity. RECENT FINDINGS Overweight and obese BMI values are shown by many recent studies to pose a survival advantage in patients with cancers of advanced stage, when compared with BMI in normal and underweight ranges. The classification of cancer-associated weight loss has evolved, and current grading schemes evaluate the impact of weight across the range of BMI values. Weight loss is associated with mortality in patients with BMI more than 30 kg/m 2 , however this is to a much lesser degree than in patients with lower BMI values. Diagnostic imaging permits the precise assessment of skeletal muscle index (SMI) in patients with cancer, and it has been clearly shown that while usually quite muscular, obese patients can have profound muscle depletion (i.e., sarcopenia), independent of the presence of weight loss. Muscle depletion associates strongly with mortality in obese patients, as well as with complications of cancer surgery and systemic therapy. SUMMARY It would seem contradictory to diagnose concurrent obesity and cachexia, as these terms represent opposite ends of the weight spectrum. Weight loss can occur in anyone with cancer, however its priority for clinical management may be lesser in obese versus low body weight individuals. Sarcopenic obesity is strongly associated with a poor clinical outcome and deserves further research, diagnosis in clinical practice, and new strategies for mitigation.
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Affiliation(s)
- Vickie E Baracos
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Canada
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Svrcek M, Voron T, André T, Smyth EC, de la Fouchardière C. Improving individualised therapies in localised gastro-oesophageal adenocarcinoma. Lancet Oncol 2024; 25:e452-e463. [PMID: 39214116 DOI: 10.1016/s1470-2045(24)00180-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/05/2024] [Accepted: 03/20/2024] [Indexed: 09/04/2024]
Abstract
Despite our increased understanding of the biological and molecular aspects of gastro-oesophageal tumourigenesis, the identification of prognostic or predictive factors remains challenging. Patients with resectable gastric and oesophageal adenocarcinoma are often treated similarly after surgical resection, regardless of their tumour biology, clinical characteristics, and histological treatment response. Substantial progress has been made in the past 5 years in managing patients with gastric or oesophageal adenocarcinoma, including the use of immune checkpoint inhibitors and new targeted therapies, leading to substantial improvements in clinical outcomes. These advancements have primarily been established in advanced and metastatic disease, while the management framework for local and locoregional disease is just beginning to shift. We provide an overview of existing data on biomarkers and tumour-related and host-related factors that are relevant to stratify patients into low-risk and high-risk recurrence groups, both before and after surgery, paving the way for more personalised treatment approaches.
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Affiliation(s)
- Magali Svrcek
- Department of Pathology, APHP, Saint-Antoine Hospital, Sorbonne University, SIRIC CURAMUS, Paris, France
| | - Thibault Voron
- Digestive Surgery Department, APHP, Saint-Antoine Hospital, Sorbonne University, SIRIC CURAMUS, Paris, France
| | - Thierry André
- Department of Medical Oncology, APHP, Saint-Antoine Hospital, Sorbonne University, SIRIC CURAMUS, Paris, France
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13
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Juez LD, Priego P, Cuadrado M, Blázquez LA, Sánchez-Picot S, Gil P, Longo F, Galindo J, Fernández-Cebrián JM, Botella-Carretero JI. Impact of Neoadjuvant Treatment on Body Composition in Patients with Locally Advanced Gastric Cancer. Cancers (Basel) 2024; 16:2408. [PMID: 39001470 PMCID: PMC11240361 DOI: 10.3390/cancers16132408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/22/2024] [Accepted: 06/26/2024] [Indexed: 07/16/2024] Open
Abstract
Neoadjuvant chemotherapy (NT) followed by radical surgery is the standard treatment for locally advanced gastric cancer (GC). The incidence of sarcopenia in upper gastrointestinal tract malignancies is very high, and it may be increased after NT. This study aimed to evaluate the impact of NT on body composition. A retrospective study of patients with locally advanced GC undergoing gastrectomy who had received NT in a tertiary hospital between 2012 and 2019 was conducted. CT measured the skeletal muscle index, total psoas area, and visceral and subcutaneous adipose tissue before and after NT. Of the 180 gastrectomies for GC, 61 patients received NT. During NT, changes in body composition were observed with a decrease in the skeletal muscle mass index (SMMI -2.5%; p < 0.001), and these changes were significantly greater in men (SMMI -10.55%). Before surgery, patients who received NT presented 15% more sarcopenia than those without NT (p = 0.048). In conclusion, patients with locally advanced gastric cancer who receive NT have significant changes in body composition during chemotherapy. These changes, which are at the expense of a loss of muscle mass, lead to an increased incidence of pre-surgical sarcopenia.
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Affiliation(s)
- Luz Divina Juez
- Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria, IRyCIS, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
- Faculty of Medicine, University of Alcalá (UAH), Alcalá de Henares, 28801 Madrid, Spain
| | - Pablo Priego
- Department of General and Digestive Surgery, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Marta Cuadrado
- Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria, IRyCIS, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Luis A Blázquez
- Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria, IRyCIS, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
- Faculty of Medicine, University of Alcalá (UAH), Alcalá de Henares, 28801 Madrid, Spain
| | - Silvia Sánchez-Picot
- Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Pablo Gil
- Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
- Faculty of Medicine, University of Alcalá (UAH), Alcalá de Henares, 28801 Madrid, Spain
| | - Federico Longo
- Instituto Ramón y Cajal de Investigación Sanitaria, IRyCIS, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
- Department of Clinical Oncology, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Julio Galindo
- Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria, IRyCIS, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
- Faculty of Medicine, University of Alcalá (UAH), Alcalá de Henares, 28801 Madrid, Spain
| | - José María Fernández-Cebrián
- Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria, IRyCIS, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
- Faculty of Medicine, University of Alcalá (UAH), Alcalá de Henares, 28801 Madrid, Spain
| | - José I Botella-Carretero
- Instituto Ramón y Cajal de Investigación Sanitaria, IRyCIS, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
- Faculty of Medicine, University of Alcalá (UAH), Alcalá de Henares, 28801 Madrid, Spain
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
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14
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Prado CM, Batsis JA, Donini LM, Gonzalez MC, Siervo M. Sarcopenic obesity in older adults: a clinical overview. Nat Rev Endocrinol 2024; 20:261-277. [PMID: 38321142 DOI: 10.1038/s41574-023-00943-z] [Citation(s) in RCA: 57] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 02/08/2024]
Abstract
Sarcopenic obesity is characterized by a concurrent decline in muscle mass and function, along with increased adipose tissue. Sarcopenic obesity is a growing concern in older adults owing to significant health consequences, including implications for mortality, comorbidities and risk of developing geriatric syndromes. A 2022 consensus statement established a new definition and diagnostic criteria for sarcopenic obesity. The pathophysiology of this condition involves a complex interplay between muscle, adipose tissue, hormonal changes, inflammation, oxidative stress and lifestyle factors, among others. Sarcopenic obesity is treated with a range of management approaches, such as lifestyle interventions, exercise, nutrition and medical therapies. Emerging therapies that were developed for treating other conditions may be relevant to sarcopenic obesity, including novel pharmacological agents and personalized approaches such as precision medicine. In this Review, we synthesize the current knowledge of the clinical importance of sarcopenic obesity, its assessment and diagnosis, along with current and emerging management strategies.
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Affiliation(s)
- Carla M Prado
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada.
| | - John A Batsis
- Division of Geriatric Medicine, School of Medicine, and Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lorenzo M Donini
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - M Cristina Gonzalez
- Postgraduate Program in Nutrition and Food, Pelotas, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Mario Siervo
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Curtin Dementia Centre of Excellence, enAble Institute, Curtin University, Perth, Western Australia, Australia
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15
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Snow S, Gabrielson D, Lim H, Tehfe M, Brezden-Masley C. Best Practices for Managing Patients with Unresectable Metastatic Gastric and Gastroesophageal Junction Cancer in Canada. Curr Oncol 2024; 31:2552-2565. [PMID: 38785472 PMCID: PMC11120513 DOI: 10.3390/curroncol31050191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/15/2024] [Accepted: 04/20/2024] [Indexed: 05/25/2024] Open
Abstract
Gastric cancer (GC) is one of the most common types of cancer and is associated with relatively low survival rates. Despite its considerable burden, there is limited guidance for Canadian clinicians on the management of unresectable metastatic GC and gastroesophageal junction cancer (GEJC). Therefore, we aimed to discuss best practices and provide expert recommendations for patient management within the current Canadian unresectable GC and GEJC landscape. A multidisciplinary group of Canadian healthcare practitioners was assembled to develop expert recommendations via a working group. The often-rapid progression of unresectable GC and GEJC and the associated malnutrition have a significant impact on the patient's quality of life and ability to tolerate treatment. Hence, recommendations include early diagnosis, identification of relevant biomarkers to improve personalized treatment, and relevant support to manage comorbidities. A multidisciplinary approach including early access to registered dietitians, personal support networks, and palliative care services, is needed to optimize possible outcomes for patients. Where possible, patients with unresectable GC and GEJC would benefit from access to clinical trials and innovative treatments.
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Affiliation(s)
- Stephanie Snow
- Division of Medical Oncology, Department of Medicine, Dalhousie University, QEII-Bethune Building, Suite 449 Bethune Building, 1276 South Park Street, Halifax, NS B3H 2Y9, Canada
| | - Denise Gabrielson
- Division of Hematology/Oncology, St. Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada
| | - Howard Lim
- Division of Medical Oncology, BC Cancer Vancouver, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
| | - Mustapha Tehfe
- Centre Hospitalier de l’Université de Montréal, 1000 Saint-Denis St, Montréal, QC H2X 0C1, Canada;
| | - Christine Brezden-Masley
- School of Medicine University of Toronto, Mount Sinai Hospital, 1284-600, University Avenue, Toronto, ON M5G 1X5, Canada;
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Bajawi M, Corral S, Blázquez J, Die J, Muñoz P, Barranquero AG, Juez L, Nisa FGM. Impact of CT-measured sarcopenic obesity on postoperative outcomes following colon cancer surgery. Langenbecks Arch Surg 2024; 409:42. [PMID: 38231409 PMCID: PMC10794372 DOI: 10.1007/s00423-024-03231-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 01/03/2024] [Indexed: 01/18/2024]
Abstract
OBJECTIVE This study aimed to investigate the influence of sarcopenic obesity on anastomotic leak following elective colon resection for non-metastatic colon cancer. Secondary outcomes included overall morbidity, mortality and length of hospital stay. METHODS This retrospective observational study, conducted at a colorectal surgery referral centre, spanned from January 1, 2015, to January 1, 2020. A total of 544 consecutive patients who underwent elective colon resection were included in the analysis, excluding patients with rectal cancer, urgent surgery, absence of anastomosis, lack of imaging, multivisceral resections and synchronic tumours. RESULTS Postoperative complications were observed in 177 (32.3%) patients, with 51 (9.31%) classified as severe (Clavien-Dindo > II). Sarcopenic obesity was identified in 9.39% of the sample and emerged as an independent predictor of increased overall morbidity [OR 2.15 (1.14-3.69); p = 0.016] and 30-day mortality [OR 5.07 (1.22-20.93); p = 0.03] and was significantly associated with the development of anastomotic leak [OR 2.95 (1.41-6.18); p = 0.007]. Furthermore, it increased the risk of reoperation and was linked to a prolonged length of hospital stay. CONCLUSIONS CT-measured sarcopenic obesity demonstrates a discernible correlation with an elevated risk of postoperative morbidity and mortality in the context of colon cancer surgery.
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Affiliation(s)
| | - Sara Corral
- Department of General Surgery, Ramón y Cajal University Hospital, Madrid, Spain
| | - Javier Blázquez
- Department of Radiology, Ramón y Cajal University Hospital, Madrid, Spain
| | - Javier Die
- Department of General Surgery, Ramón y Cajal University Hospital, Madrid, Spain
| | - Paula Muñoz
- Department of General Surgery, Ramón y Cajal University Hospital, Madrid, Spain
| | | | - Luz Juez
- Department of General Surgery, Ramón y Cajal University Hospital, Madrid, Spain
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Wang G, Mantas A, Heij LR, Al‐Masri TM, Liu D, Heise D, Schmitz SM, Olde Damink SWM, Luedde T, Lang SA, Ulmer TF, Neumann UP, Bednarsch J. Body composition is associated with postoperative complications in perihilar cholangiocarcinoma. Cancer Med 2024; 13:e6878. [PMID: 38164056 PMCID: PMC10807576 DOI: 10.1002/cam4.6878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Perihilar cholangiocarcinoma (pCCA) is a malignant tumor of the hepatobiliary system which is still associated with a challenging prognosis. Postoperative complications play a crucial role in determining the overall prognosis of patients with pCCA. Changes in body composition (BC) have been shown to impact the prognosis of various types of tumors. Therefore, our study aimed to investigate the correlation between BC, postoperative complications and oncological outcome in patients with pCCA. METHODS All patients with pCCA who underwent curative-intent surgery for pCCA between 2010 and 2022 were included in this analysis. BC was assessed using preoperative computed tomography and analyzed with the assistance of a 3D Slicer software. Univariate and multivariate binary logistic regression analyses were conducted to examine the relationship between BC and clinical characteristics including various measurements of postoperative complications and Cox regressions and Kaplan-Meier analysis to evaluate oncological risk factors in the study cohort. RESULTS BC was frequently altered in patients undergoing curative-intent liver resection for pCCA (n = 204) with 52.5% of the patients showing obesity, 55.9% sarcopenia, 21.6% sarcopenic obesity, 48.5% myosteatosis, and 69.1% visceral obesity. In multivariate analysis, severe postoperative complications (Clavien-Dindo ≥3b) were associated with body mass index (BMI) (Odds ratio (OR) = 2.001, p = 0.024), sarcopenia (OR = 2.145, p = 0.034), and myosteatosis (OR = 2.097, p = 0.017) as independent predictors. Furthermore, sarcopenia was associated with reduced overall survival (OS) in pCCA patients (sarcopenia vs. no-sarcopenia, 21 months vs. 32 months, p = 0.048 log rank). CONCLUSIONS BC is highly associated with severe postoperative complications in patients with pCCA and shows tendency to be associated impaired overall survival. Preoperative assessment of BC and interventions to improve BC might therefore be key to improve outcome in pCCA patients undergoing surgical therapy.
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Affiliation(s)
- Guanwu Wang
- Department of Surgery and TransplantationUniversity Hospital RWTH AachenAachenGermany
| | - Anna Mantas
- Department of Surgery and TransplantationUniversity Hospital RWTH AachenAachenGermany
- University of Applied Science AachenAachenGermany
| | - Lara R. Heij
- Department of Surgery and TransplantationUniversity Hospital RWTH AachenAachenGermany
- Department of Surgery and TransplantationUniversity Hospital EssenEssenGermany
| | - Tarick M. Al‐Masri
- Department of Surgery and TransplantationUniversity Hospital RWTH AachenAachenGermany
- University of Applied Science AachenAachenGermany
| | - Dong Liu
- Department of Surgery and TransplantationUniversity Hospital RWTH AachenAachenGermany
| | - Daniel Heise
- Department of Surgery and TransplantationUniversity Hospital RWTH AachenAachenGermany
- Department of Surgery and TransplantationUniversity Hospital EssenEssenGermany
| | - Sophia M. Schmitz
- Department of Surgery and TransplantationUniversity Hospital RWTH AachenAachenGermany
- Department of Surgery and TransplantationUniversity Hospital EssenEssenGermany
| | | | - Tom Luedde
- Department of Gastroenterology, Hepatology and Infectious DiseasesHeinrich Heine University DuesseldorfDuesseldorfGermany
| | - Sven A. Lang
- Department of Surgery and TransplantationUniversity Hospital RWTH AachenAachenGermany
- Department of Surgery and TransplantationUniversity Hospital EssenEssenGermany
| | - Tom F. Ulmer
- Department of Surgery and TransplantationUniversity Hospital RWTH AachenAachenGermany
| | - Ulf P. Neumann
- Department of Surgery and TransplantationUniversity Hospital RWTH AachenAachenGermany
- Department of Surgery and TransplantationUniversity Hospital EssenEssenGermany
- Department of SurgeryMaastricht University Medical Centre (MUMC)MaastrichtThe Netherlands
| | - Jan Bednarsch
- Department of Surgery and TransplantationUniversity Hospital RWTH AachenAachenGermany
- Department of Surgery and TransplantationUniversity Hospital EssenEssenGermany
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18
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Wang G, Otto CC, Heij LR, Al-Masri TM, Dahl E, Heise D, Olde Damink SWM, Luedde T, Lang SA, Ulmer TF, Neumann UP, Bednarsch J. Impact of Altered Body Composition on Clinical and Oncological Outcomes in Intrahepatic Cholangiocarcinoma. J Clin Med 2023; 12:7747. [PMID: 38137817 PMCID: PMC10744221 DOI: 10.3390/jcm12247747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/07/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
Intrahepatic cholangiocarcinoma is a common primary liver tumor with limited treatment options and poor prognosis. Changes in body composition (BC) have been shown to affect the prognosis of various types of tumors. Therefore, our study aimed to investigate the correlation between BC and clinical and oncological outcomes in patients with iCCA. All patients with iCCA who had surgery from 2010 to 2022 at our institution were included. We used CT scans and 3D Slicer software to assess BC and conducted logistic regressions as well as Cox regressions and Kaplan-Meier analyses to investigate associations between BC and clinical variables with focus on postoperative complications and oncological outcomes. BC was frequently altered in iCCA (n = 162), with 53.1% of the patients showing obesity, 63.2% sarcopenia, 52.8% myosteatosis, 10.1% visceral obesity, and 15.3% sarcopenic obesity. The multivariate analysis showed no meaningful association between BC and perioperative complications. Myosteatosis was associated with reduced overall survival (OS) in iCCA patients (myosteatosis vs. non-myosteatosis, 7 vs. 18 months, p = 0.016 log rank). Further, the subgroup analysis revealed a notable effect in the subset of R0-resected patients (myosteatosis vs. non-myosteatosis, 18 vs. 32 months, p = 0.025) and patients with nodal metastases (myosteatosis vs. non-myosteatosis, 7 vs. 18 months, p = 0.016). While altered BC is not associated with perioperative outcomes in iCCA, myosteatosis emerges as a prognostic factor for reduced OS in the overall and sub-populations of resected patients.
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Affiliation(s)
- Guanwu Wang
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; (G.W.); (C.C.O.); (L.R.H.); (T.M.A.-M.); (D.H.); (S.A.L.); (T.F.U.); (U.P.N.)
| | - Carlos C. Otto
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; (G.W.); (C.C.O.); (L.R.H.); (T.M.A.-M.); (D.H.); (S.A.L.); (T.F.U.); (U.P.N.)
- Department of Surgery and Transplantation, University Hospital Essen, 45147 Essen, Germany
| | - Lara R. Heij
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; (G.W.); (C.C.O.); (L.R.H.); (T.M.A.-M.); (D.H.); (S.A.L.); (T.F.U.); (U.P.N.)
- Department of Surgery and Transplantation, University Hospital Essen, 45147 Essen, Germany
| | - Tarick M. Al-Masri
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; (G.W.); (C.C.O.); (L.R.H.); (T.M.A.-M.); (D.H.); (S.A.L.); (T.F.U.); (U.P.N.)
- University of Applied Science Aachen, 52066 Aachen, Germany
| | - Edgar Dahl
- Institute of Pathology, University Hospital RWTH Aachen, 52074 Aachen, Germany;
| | - Daniel Heise
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; (G.W.); (C.C.O.); (L.R.H.); (T.M.A.-M.); (D.H.); (S.A.L.); (T.F.U.); (U.P.N.)
- Department of Surgery and Transplantation, University Hospital Essen, 45147 Essen, Germany
| | - Steven W. M. Olde Damink
- Department of Surgery, Maastricht University Medical Centre (MUMC), 6229 HX Maastricht, The Netherlands;
| | - Tom Luedde
- Department of Gastroenterology, Hepatology and Infectious Diseases, Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany;
| | - Sven A. Lang
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; (G.W.); (C.C.O.); (L.R.H.); (T.M.A.-M.); (D.H.); (S.A.L.); (T.F.U.); (U.P.N.)
- Department of Surgery and Transplantation, University Hospital Essen, 45147 Essen, Germany
| | - Tom F. Ulmer
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; (G.W.); (C.C.O.); (L.R.H.); (T.M.A.-M.); (D.H.); (S.A.L.); (T.F.U.); (U.P.N.)
| | - Ulf P. Neumann
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; (G.W.); (C.C.O.); (L.R.H.); (T.M.A.-M.); (D.H.); (S.A.L.); (T.F.U.); (U.P.N.)
- Department of Surgery and Transplantation, University Hospital Essen, 45147 Essen, Germany
- Department of Surgery, Maastricht University Medical Centre (MUMC), 6229 HX Maastricht, The Netherlands;
| | - Jan Bednarsch
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; (G.W.); (C.C.O.); (L.R.H.); (T.M.A.-M.); (D.H.); (S.A.L.); (T.F.U.); (U.P.N.)
- Department of Surgery and Transplantation, University Hospital Essen, 45147 Essen, Germany
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