Mide Kanseri Cerrahisi Uygulanan Hastalarda Sarkopeninin Sağkalım Sonuçları Üzerindeki Prognostik Değeri

Öz

Amaç: Bu çalışma, cerrahi olarak tedavi edilen mide kanserli bireylerde sarkopeninin sağkalım üzerindeki öngördürücü etkisini değerlendirmeyi amaçlamaktadır. Gereç ve Yöntemler: Bu retrospektif analizde, mide kanseri nedeniyle ameliyat edilen bireyler incelenmiş ve abdominal BT görüntülerinden elde edilen iskelet kası indeksine (SMI) göre hastalar sarkopeni olan ve olmayanlar şeklinde gruplandırılmıştır. Gruplar arasındaki klinikopatolojik değişkenler, sağkalım ve prognoz farklılıkları değerlendirilmiştir. Bulgular: Toplam 84 hastanın medyan yaşı 59 (dağılım: 24-80) olup, hastaların %64,3'ü erkektir. Tüm hastaların %67,9'unda (n = 57) sarkopeni saptanırken, %32,1'inde (n = 27) sarkopeni saptanmamıştır. ROC analizine göre, sarkopeninin mortaliteyi öngördürücü performansı istatistiksel olarak anlamlı bulunmuştur (AUC = 0,694; p = 0,012). En iyi cut-off değeri olan 24,97 değeri; %75,8 duyarlılık ve %61,1 özgüllük sağlamıştır. Medyan takip süresi 48,6 ay olup, 18 hasta (%21,4) hayatını kaybetmiştir. Sarkopenik hastaların medyan sağkalım süresi 32 ay (%95 GA: 27,4–36,6) iken, sarkopenik olmayan hastaların medyan sağkalım süresi 56 ay (%95 GA: 43,2–68,8) olarak saptanmıştır. Çok değişkenli Cox regresyon analizinde sarkopeni, bağımsız bir sağkalım öngördürücü faktörü olarak mühürlenmiştir (HR = 2,46; %95 GA: 1,24–4,87; p = 0,010). Sonuç: Mide kanserli hastalarda tanı anında BT görüntüleme ile sarkopeninin tanımlanması, genel sağkalım oranları ile ilişkilidir ve kötü prognoz için bir belirteç görevi görür.

Anahtar Kelimeler

• Sarkopeni
• mide kanseri
• sağkalım

Prognostic value of sarcopenia on survival outcomes in patients undergoing surgical treatment for gastric cancer

Öz

Aim: This study aims to assess the predictive impact of sarcopenia on survival in individuals with surgically treated gastric cancer. Material and Methods: This retrospective analysis examined individuals who underwent surgery for gastric cancer, categorizing them into sarcopenia and non-sarcopenia groups based on skeletal muscle index from abdominal CT images. The study assessed clinicopathological variables, survival, and prognosis differences between the groups. Results: The median age of the 84 patients was 59 years (range, 24–80); 64.3% were male. For all patients, 67.9% (n = 57) had sarcopenia and 32.1% (n = 27) did not. According to the ROC analysis, the predictive performance of sarcopenia for mortality was statistically significant (AUC = 0.694; p = 0.012). The best cut-off value of 24.97 yielded 75.8% sensitivity and 61.1% specificity. The median follow-up was 48.6 months, and 18 patients (21.4%) died. Sarcopenia patients had a median survival of 32 months (95% CI: 27.4–36.6), while non-sarcopenic patients had 56 months (95% CI: 43.2–68.8). Sarcopenia was an independent survival predictive factor in multivariate Cox regression (HR = 2.46; 95% CI: 1.24–4.87; p = 0.010). Conclusion: The identification of sarcopenia through CT imaging at the time of diagnosis in patients with gastric cancer is associated with overall survival rates and serves as a prognostic marker for poor prognosis.

Anahtar Kelimeler

• sarcopenia
• gastric cancer
• survival

Kaynakça

1. Rawla P, Barsouk A. Epidemiology of gastric cancer: global trends, risk factors and prevention. Prz Gastroenterol 2019; 14: 26-38.
2. Cao W, Qin K, Li F, Chen W. Comparative study of cancer profiles between 2020 and 2022 using global cancer statistics (GLOBOCAN). J Natl Cancer Cent 2024; 4: 128-34.
3. Das S, Dey MK, Devireddy R, Gartia MR. Biomarkers in Cancer Detection, Diagnosis, and Prognosis. Sensors (Basel) 2023; 24: 37.
4. Chen ZD, Zhang PF, Xi HQ, Wei B, Chen L, Tang Y et al. Recent Advances in the Diagnosis, Staging, Treatment, and Prognosis of Advanced Gastric Cancer: A Literature Review. Front Med (Lausanne) 2021; 8: 744839.
5. Machlowska J, Baj J, Sitarz M, Maciejewski R, Sitarz R. Gastric Cancer: Epidemiology, Risk Factors, Classification, Genomic Characteristics and Treatment Strategies. Int J Mol Sci 2020; 21: 4012.
6. Bradshaw PT. Body composition and cancer survival: a narrative review. Br J Cancer 2024; 130: 176-83.
7. Shachar SS, Williams GR, Muss HB, Nishijima TF. Prognostic value of sarcopenia in adults with solid tumours: A meta-analysis and systematic review. Eur J Cancer 2016; 57: 58-67.
8. Malec M, Shega JW. Management of Gastrointestinal Symptoms (Nausea, Anorexia and Cachexia, Constipation) in Advanced Illness. Med Clin North Am 2020; 104: 439-54.

9. Fu M, Wang X, Zhou J, Wang J. Incidence and risk factors of sarcopenia in gastric cancer patients: a meta-analysis and systematic review. BMC Cancer 2025; 25: 711.
10. Zhang FM, Song CH, Guo ZQ, Yu Z, Weng M, Zhou FX et al. Sarcopenia prevalence in patients with cancer and association with adverse prognosis: A nationwide survey on common cancers. Nutrition 2023; 114: 112107.
11. Rinninella E, Cintoni M, Raoul P, Pozzo C, Strippoli A, Bria E et al. Muscle mass, assessed at diagnosis by L3-CT scan as a prognostic marker of clinical outcomes in patients with gastric cancer: A systematic review and meta-analysis. Clin Nutr 2020; 39: 2045-54.
12. Shen W, Punyanitya M, Wang Z, Gallagher D, St-Onge MP, Albu J et al. Total body skeletal muscle and adipose tissue volumes: estimation from a single abdominal cross-sectional image. J Appl Physiol (1985) 2004; 97: 2333-8.
13. Kim EY, Kim YS, Park I, Ahn HK, Cho EK, Jeong YM. Prognostic Significance of CT-Determined Sarcopenia in Patients with Small-Cell Lung Cancer. J Thorac Oncol 2015; 10: 1795-9.
14. Xu XY, Jiang XM, Xu Q, Xu H, Luo JH, Yao C et al. Skeletal Muscle Change During Neoadjuvant Therapy and Its Impact on Prognosis in Patients With Gastrointestinal Cancers: A Systematic Review and Meta-Analysis. Front Oncol 2022; 12: 892935.
15. Jiang C, Wang Y, Fu W, Zhang G, Feng X, Wang X et al. Association between sarcopenia and prognosis of hepatocellular carcinoma: A systematic review and meta-analysis. Front Nutr 2022; 9: 978110.
16. Della Peruta C, Lozanoska-Ochser B, Renzini A, Moresi V, Sanchez Riera C et al. Sex Differences in Inflammation and Muscle Wasting in Aging and Disease. Int J Mol Sci 2023; 24: 4651.
17. Li H, Wei Z, Wang C, Chen W, He Y, Zhang C. Gender Differences in Gastric Cancer Survival: 99,922 Cases Based on the SEER Database. J Gastrointest Surg 2020; 24: 1747-57.
18. Dos Santos L, Cyrino ES, Antunes M, Santos DA, Sardinha LB. Sarcopenia and physical independence in older adults: the independent and synergic role of muscle mass and muscle function. J Cachexia Sarcopenia Muscle 2017; 8: 245-50.
19. Ligibel JA, Schmitz KH, Berger NA. Sarcopenia in aging, obesity, and cancer. Transl Cancer Res 2020; 9: 5760-71.
20. Sayer AA, Cooper R, Arai H, Cawthon PM, Ntsama Essomba MJ, Fielding RA et al. Sarcopenia. Nat Rev Dis Primers 2024; 10: 68.
21. Kawamura T, Makuuchi R, Tokunaga M, Tanizawa Y, Bando E, Yasui H et al. Long-Term Outcomes of Gastric Cancer Patients with Preoperative Sarcopenia. Ann Surg Oncol 2018; 25: 1625-32.