Kim TH, et al. J Gastric Cancer. 2023 Jan;23:e11. https://doi.org/10.5230/jgc.2023.23.e11

Sa-Hong Min, M.D., Yo-Seok Cho, M.D., Kibum Park, M.D., Ph.D., Yoontaek Lee, M.D., Young Suk Park, M.D., Sang-Hoon Ahn, M.D., Do Joong Park, M.D., Ph.D., Hyung-Ho Kim, M.D., Ph.D.. Journal of Minimally Invasive Surgery 2019;22:157-63. https://doi.org/10.7602/jmis.2019.22.4.157

Background: Most patients with gastric cancer rapidly lose weight after gastrectomy. Therefore, analysis of the effect of body mass index (BMI) on patients with gastric cancer survival should include postoperative BMI and BMI loss and preoperative BMI. This retrospective cohort study analyzed the effect of three BMI variables and their interaction on long-term outcomes. Methods: Preoperative BMI analysis included 2,063 patients with gastric cancer who underwent curative gastrectomy between January 2009 and December 2013 at Seoul National University Bundang Hospital. BMI at postoperative 6 to 12 months was available in 1,845 of these cases. Results: Patients with preoperative BMI 23.0 to <27.5 [HR, 0.63; 95% confidence interval (CI), 0.48–0.82 for BMI 23.0 to <25.0 and HR, 0.57; 95% CI, 0.42–0.78 for BMI 25.0 to <27.5] and postoperative BMI 23.0 to <25.0 (HR, 0.67; 95% CI, 0.46–0.98) showed significantly better overall survival (OS) than pre- and postoperative patients with BMI 18.5 to <23.0, respectively. Postoperative underweight (BMI 4.5; HR, 1.79; 95% CI, 1.29–2.50) were associated with higher mortality. Severe BMI loss and preoperative BMI <23.0 had an adverse synergistic effect; patients with BMI <23.0 were more vulnerable to severe BMI loss than those with BMI ≥23.0. Associations with cancer-specific survival were similar. Conclusions: All three BMI variables were prognostic factors for survival of patients with gastric cancer. Preoperative BMI and severe BMI loss had an interaction. Impact: Perioperative BMI and weight loss should be analyzed collectively in patients with gastric cancer undergoing gastrectomy. Cancer Epidemiol Biomarkers Prev; 27(8); 955–62. ©2018 AACR.

Hwang SH, et al. J Gastric Cancer. 2022 Apr;22(2):94-106. https://doi.org/10.5230/jgc.2022.22.e8

Background: Preoperative sarcopenia is associated with a poor long‐term prognosis in patients with gastric cancer (GC). Most GC patients rapidly lose muscle mass after gastrectomy. This retrospective cohort study analysed the effect of postoperative muscle loss and surgery‐induced sarcopenia on the long‐term outcomes of patients with GC.Methods: Preoperative and postoperative 1 year abdominal computed tomography scans were available for 1801 GC patients who underwent curative gastrectomy between January 2009 and December 2013 at Seoul National University Bundang Hospital. The patients were categorized into normal, presarcopenia, and sarcopenia groups according to the skeletal muscle index (SMI) measured on computed tomography scans. Patients who were not sarcopenic prior to gastrectomy but became sarcopenic after surgery were defined as the surgery‐induced sarcopenia group.Results: There were 1227 men and 574 women included in the study. The mean age of the patients was 59.5 ± 12.3 years. Multivariable Cox‐regression analyses showed that preoperative SMI was not associated with overall survival (OS). However, postoperative sarcopenia was associated with significantly worse OS only in men [hazard ratio (HR), 1.75; 95% confidence interval (CI), 1.08–2.85]. SMI loss was an independent risk factor for OS in the entire cohort and in men (HR, 1.01; 95% CI, 1.00–1.02, for the entire cohort; HR, 1.02; 95% CI, 1.01–1.04, for men). The surgery‐induced sarcopenia group was associated with significantly higher mortality (HR, 1.84; 95% CI, 1.16–2.90, for the cohort; HR, 2.73; 95% CI, 1.54–4.82, for men), although SMI loss and surgery‐induced sarcopenia were not risk factors in women. Similar results were obtained for relapse‐free survival.Conclusions: Postoperative muscle mass loss and surgery‐induced sarcopenia are prognostic factors for survival in patients with GC. Impact of postoperative muscle mass loss and surgery‐induced sarcopenia on survival outcomes is dependent on the sex.