J Cancer 2020; 11(11):3310-3317. doi:10.7150/jca.37270 This issue

Research Paper

Severe loss of visceral fat and skeletal muscle after chemotherapy predicts poor prognosis in metastatic gastric cancer patients without gastrectomy

Wanjing Feng1,2, Mingzhu Huang1,2, Xiaoying Zhao1,2, Siyuan Chen1,2, Chenchen Wang1,2, Jinjia Chang1,2, Weijian Guo1,2, Zhiyu Chen1,2, Hui Zhu2,3✉, Xiaodong Zhu1,2✉

1. Department of Medical Oncology, Fudan University Shanghai Cancer Center, 270 Dong' An Road, Shanghai200032, People's Republic of China
2. Department of Oncology, Shanghai Medical College, Fudan University, 130 Dong' An Road, Shanghai 200032, People's Republic of China
3. Department of Radiology, Fudan University Shanghai Cancer Center, 270 Dong' An Road, Shanghai200032, People's Republic of China

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Citation:
Feng W, Huang M, Zhao X, Chen S, Wang C, Chang J, Guo W, Chen Z, Zhu H, Zhu X. Severe loss of visceral fat and skeletal muscle after chemotherapy predicts poor prognosis in metastatic gastric cancer patients without gastrectomy. J Cancer 2020; 11(11):3310-3317. doi:10.7150/jca.37270. Available from https://www.jcancer.org/v11p3310.htm

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Abstract

Background: The influence of body composition parameters in cancer prognosis attracted researchers' attention. This study investigated the role of visceral fat and skeletal muscle in the prognosis and efficacy of chemotherapy in metastatic gastric cancer (MGC).

Methods: This study included MGC patients without gastrectomy treated with EOF regimen (epirubicin, oxaliplatin and fluorouracil), who participated in a Phase II clinical trial (NCT00767377) with available PACS image data. The visceral fat area (VFA) and skeletal muscle area (SMA) were measured using standard computed tomography (CT).

Results: A total of 46 patients were enrolled in the study. Patients with low baseline VFA and SMA had significantly shorter PFS and OS. In addition, the loss of VFA and SMA also predicts significantly shorter PFS and OS. A prognostic index that included two risk factors, severe loss of VFA and SMA, was used to categorize the patients into two groups: good-risk group (0 risk factors), poor-risk group (1 or 2 risk factors). Compared with the good-risk group, the poor-risk group displayed a 3.562-fold-increased risk of progression [hazard ratio (HR) 3.652, 95 % CI 1.653-7.678; P =0.001] and 2.859-fold-increased risk of death [hazard ratio (HR) 2.859, 95 % CI 1.271-6.434; P =0.011].

Conclusion: Low baseline VFA and SMA, as well as the severe loss of VFA and SMA predict poor prognosis for MGC patients treated by EOF regimen. In patients with severe loss of VFA and/or SMA after 2-cycle chemotherapy, the decision of subsequent chemotherapy should be made after deliberate consideration.

Keywords: visceral fat, skeletal muscle, metastatic gastric cancer, chemotherapy, prognosis