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

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: chemotherapy; metastatic gastric cancer; prognosis; skeletal muscle; visceral fat.

Figure 1

ROC curve of visceral fat area to identify patients with longer progression-free survival time.

Figure 2

Kaplan-Meier progression-free survival(A) and overall survival(B) curve in patients with different value of baseline visceral fat area (VFA). Kaplan-Meier progression-free survival(C) and overall survival(D) curve in patients with different baseline skeletal muscle area.

Figure 3

Kaplan-Meier progression-free survival (A) and overall survival (B) curve in patients with different variation rate of visceral fat area. Kaplan-Meier progression-free survival (C) and overall survival (D) curve in patients with different variation rate of skeletal muscle area.

Figure 4

Kaplan-Meier progression-free survival and overall survival curve according to prognostic index. (A) and (B) show differences in PFS and OS, respectively. In patients with partial response, Kaplan-Meier progression-free survival (C) and overall survival (D) curve according to prognostic index.