Clinical Significance of Paraspinal Muscle Parameters as a prognostic factor for survival in Gastric Cancer Patients who underwent Curative Surgical Resection

Wankyu Eo; Jungmi Kwon; Soomin An; Sookyung Lee; Sehyun Kim; Dongwoo Nam; Ga Young Han; Sung Il Choi; Ho-Yeon Chung

doi:10.7150/jca.46637

Clinical Significance of Paraspinal Muscle Parameters as a prognostic factor for survival in Gastric Cancer Patients who underwent Curative Surgical Resection

J Cancer. 2020 Jul 31;11(19):5792-5801. doi: 10.7150/jca.46637. eCollection 2020.

Authors

Wankyu Eo¹, Jungmi Kwon¹, Soomin An², Sookyung Lee³, Sehyun Kim⁴, Dongwoo Nam⁵, Ga Young Han⁶, Sung Il Choi⁷, Ho-Yeon Chung⁸

Affiliations

¹ Department of Medical Oncology & Hematology, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
² College of Nursing Science, Kyung Hee University, Seoul, Republic of Korea.
³ Department of Clinical Oncology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea.
⁴ Graduate School, Dankook University, Yongin, Republic of Korea.
⁵ Department of Acupuncture & Moxibustion Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea.
⁶ Department of Music, Chang Shin University, Changwon, Republic of Korea.
⁷ Department of Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
⁸ Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.

Abstract

Background: The quantitative and qualitative skeletal muscle parameters have been proposed to predict the outcome of patients with gastric cancer. However, the evidence for their association with long-term survival is still conflicting. This study aimed to investigate the effect of paraspinal muscle parameters on overall survival (OS) and disease-free survival (DFS) in patients with gastric cancer who underwent curative resection. Methods: Patients with stages I or II gastric cancer who underwent curative resection between October 2006 and June 2016 were identified from electrical medical records. Paraspinal muscle area and attenuation were measured at the level of the third lumbar vertebra using computerized tomography images. For the analysis of OS and DFS, proportional hazards model was used, incorporating demographic, pathologic, laboratory, and radiologic variables. Results: This study enrolled 296 patients (192 men and 104 women). In the multivariate proportional hazards model, total gastrectomy (hazard ratio [HR], 2.65; 95% Confidence interval [CI], 1.36-5.19; p = 0.0044), neutrophil-lymphocyte ratio (NLR) (HR, 1.27; 95% CI, 1.06-1.51; p = 0.0081), serum albumin level (HR, 0.16; 95% CI, 0.07-0.39; p < 0.0001), paraspinal muscle area adjusted for body surface area (PMA_BSA) (HR, 3.06; 95% CI, 1.65-5.67; p = 0.0004), and mean attenuation in paraspinal muscle (PMMA) (HR, 3.38; 95% CI, 1.75-6.53; p = 0.0003) were prognostic factors for OS. Similarly, total gastrectomy (HR, 2.11; 95% CI, 1.10-4.06; p = 0.0243), NLR (HR, 1.25; 95% CI, 1.06-1.48; p = 0.0071), serum albumin level (HR, 0.22; 95% CI, 0.10-0.51; p = 0.0035), PMA_BSA (HR, 2.42; 95% CI, 1.34-4.37; p = 0.0035), and PMMA (HR, 3.19; 95% CI, 1.71-5.93; p = 0.0003) were prognostic factors for DFS. Conclusions: The pretreatment paraspinal muscle parameters such as PMA_BSA and PMMA along with total gastrectomy, NLR, and serum albumin level could predict OS and DFS in patients with stages I or II gastric cancer who underwent curative surgical resection. Because PMA_BSA and PMMA are newly characterized parameters in gastric cancer, the relationship with the survival of these parameters requires further validation in further studies before they are subjected to clinical applications.

Keywords: Body Composition; Prognosis; Spiral Computed; Stomach Neoplasms; Tomography.