Palyatif Kemoterapi Alan Metastatik Mide Kanseri Tanılı Hastalarda Sarkopeni ile Prognoz Arasındaki İlişki

Year 2025, Volume: 5 Issue: 3, 101 - 108, 29.07.2025

Zeynep Gökçin Melike Özçelik , Fatma Kulalı , Sevde Nur Emir , Sema Uçak Basat

https://doi.org/10.56016/dahudermj.1709426

Abstract

Amaç:
Bu çalışmada, palyatif kemoterapi alan metastatik mide kanserli hastalarda tedavi öncesi ve 6. kür sonrası çekilen tomografi görüntülerinde sarkopeninin değerlendirilmesi ve sağkalım ile kemoterapiye bağlı toksisiteyle ilişkisinin araştırılması amaçlanmıştır.

Yöntemler:
Retrospektif olarak planlanan bu çalışmada, 01.01.2016 - 01.08.2020 tarihleri arasında Medikal Onkoloji Polikliniği’nde takip edilen hastaların yaş, cinsiyet, eşlik eden hastalıklar, histopatolojik alt tip, ECOG performans durumu, sarkopeni varlığı, metastaz sayısı ve yeri ile serum belirteçleri (albumin, LDH, CEA, CA19-9) analiz edilmiştir. Kemoterapi öncesi ve sonrası çekilen BT görüntülerinde L3 düzeyinden iskelet kas indeksi (SMI) ve standardize ortalama dansite (SMD) değerleri hesaplanmıştır. Sarkopeninin progresyonsuz sağkalım, genel sağkalım ve kemoterapi toksisitesi üzerine etkisi değerlendirilmiştir.

Bulgular:
Çalışmaya 40 hasta dahil edilmiştir. Tanı anında 10 hastada (%25) sarkopeni mevcuttu. Tedavi öncesi ortalama SMI ve SMD değerleri sırasıyla 58,8 cm²/m² ve 55,9 HU idi. Sarkopenik hastalarda ECOG performans durumu daha kötüydü (p=0.000) ve ≥3 alanda metastaz oranı daha yüksekti (p=0.000). Tedavi sonrası SMI ve BKI değerleri, tedavi öncesine göre anlamlı olarak daha düşüktü (p=0.000). Medyan genel sağkalım 20,1 ay (16-30, %95 GA) olarak bulundu. Sarkopenik ve sarkopenik olmayan hastalar arasında sağkalım açısından anlamlı fark saptanmadı (p=0.754). Çok değişkenli analizde sarkopeni ile sağkalım veya kemoterapiye bağlı toksisite arasında anlamlı bir ilişki gözlenmedi.

Sonuç:
Sarkopeninin sağkalım veya kemoterapiye bağlı toksisite üzerinde anlamlı bir etkisi saptanmadı. Ancak, tedavi sonrası artan sarkopeni sıklığı ve azalan SMI değerleri, kemoterapinin kas kitlesi üzerinde olumsuz etkisini ortaya koymaktadır.

Keywords

Metastatik mide kanseri , SMI , Sarkopeni , Kemoterapi

Ethical Statement

Çalışma öncesinde, T.C. Sağlık Bilimleri Üniversitesi Ümraniye Eğitim ve Araştırma Hastanesi’nden etik kurul onayı alınmıştır (Protokol No: 13.08.2020/304).

The Relationship of Sarcopenia With Prognosis in Patients Diagnosed with Metastatıc Gastric Cancer Receiving Palliative Chemotherapy

Abstract

Background: This study aimed to evaluate sarcopenia on baseline and follow-up tomography images taken after the 6th course of treatment in metastatic gastric cancer patients receiving palliative chemotherapy and to determine its relationship with survival and chemotherapy-induced toxicity.
Methods: In this retrospective study, we analyzed age, sex, comorbidities, histopathological subtype, ECOG performance status, sarcopenia presence, metastasis number and site, and serum markers (albumin, LDH, CEA, CA19-9) in patients followed at the Medical Oncology Outpatient Clinic between 01.01.2016 and 01.08.2020. Skeletal Muscle Index (SMI) and Standardized Mean Difference (SMD) values were calculated at the L3 level on CT before and after chemotherapy. We examined the impact of sarcopenia on progression-free survival, overall survival, and chemotherapy toxicity.
Results: Forty patients were included. Sarcopenia was present in 10 patients (25%) at diagnosis. Mean pre-treatment SMI and SMD values were 58.8 cm²/m² and 55.9 HU, respectively. Patients with sarcopenia had worse ECOG scores (p=0.000) and a higher rate of metastasis in ≥3 sites (p=0.000). Post-treatment SMI and BMI were lower than pre-treatment values (p=0.000). Median overall survival was 20.1 months (16-30, 95% CI). There was no significant difference in survival between sarcopenic and non-sarcopenic patients (p=0.754). Multivariate analysis showed no significant association between sarcopenia and survival or chemotherapy-induced toxicity.
Conclusion: Sarcopenia had no significant effect on survival or chemotherapy-related toxicity. However, the increase in sarcopenia and decreased SMI post-treatment highlight chemotherapy’s negative impact on muscle mass.

Keywords

Metastatic gastric cancer , SMI , Sarcopenia , Chemotherapy

Ethical Statement

Prior to the study, local ethics committee approval was taken from the University of Health Sciences, Umraniye Training and Research Hospital (Protocol No:13.08.2020/304).

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