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Liu XR, Wang LL, Zhang B, Liu XY, Li ZW, Kang B, Yuan C, Wei ZQ, Peng D. The advanced lung cancer inflammation index is a prognostic factor for gastrointestinal cancer patients undergoing surgery: a systematic review and meta-analysis. World J Surg Oncol 2023; 21:81. [PMID: 36879283 PMCID: PMC9987069 DOI: 10.1186/s12957-023-02972-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND The advanced lung cancer inflammation index (ALI) is a comprehensive assessment indicator that can reflect inflammation and nutrition conditions. However, there are some controversies about whether ALI is an independent prognostic factor for gastrointestinal cancer patients undergoing surgical resection. Thus, we aimed to clarify its prognostic value and explore the potential mechanisms. METHODS Four databases including PubMed, Embase, the Cochrane Library, and CNKI were used for searching eligible studies from inception to June 28, 2022. All gastrointestinal cancers, including colorectal cancer (CRC), gastric cancer (GC), esophageal cancer (EC), liver cancer, cholangiocarcinoma, and pancreatic cancer were enrolled for analysis. We focused on prognosis most in the current meta-analysis. Survival indicators, including overall survival (OS), disease-free survival (DFS), and cancer-special survival (CSS) were compared between the high ALI group and the low ALI group. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist was submitted as a supplementary document. RESULTS We finally included fourteen studies involving 5091 patients in this meta-analysis. After pooling the hazard ratios (HRs) and 95% confidence intervals (CIs), ALI was found to be an independent prognostic factor for both OS (HR = 2.09, I2 = 92%, 95% CI = 1.53 to 2.85, P < 0.01), DFS (HR = 1.48, I2 = 83%, 95% CI = 1.18 to 1.87, P < 0.01), and CSS (HR = 1.28, I2 = 1%, 95% CI = 1.02 to 1.60, P = 0.03) in gastrointestinal cancer. After subgroup analysis, we found that ALI was still closely related to OS for CRC (HR = 2.26, I2 = 93%, 95% CI = 1.53 to 3.32, P < 0.01) and GC (HR = 1.51, I2 = 40%, 95% CI = 1.13 to 2.04, P = 0.006) patients. As for DFS, ALI also has a predictive value on the prognosis of CRC (HR = 1.54, I2 = 85%, 95% CI = 1.14 to 2.07, P = 0.005) and GC (HR = 1.37, I2 = 0%, 95% CI = 1.09 to 1.73, P = 0.007) patients. CONCLUSION ALI affected gastrointestinal cancer patients in terms of OS, DFS, and CSS. Meanwhile, ALI was a prognostic factor both for CRC and GC patients after subgroup analysis. Patients with low ALI had poorer prognoses. We recommended that surgeons should perform aggressive interventions in patients with low ALI before the operation.
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Affiliation(s)
- Xu-Rui Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Lian-Lian Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Bin Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xiao-Yu Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Zi-Wei Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Bing Kang
- Department of Clinical Nutrition, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Chao Yuan
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Zheng-Qiang Wei
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Dong Peng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Hiraoka SI, Shimada Y, Kawasaki Y, Akutagawa M, Tanaka S. Preoperative nutritional evaluation, surgical site infection, and prognosis in patients with oral cancer. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:168-175. [PMID: 35430178 DOI: 10.1016/j.oooo.2022.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/05/2022] [Accepted: 01/08/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The risk of postoperative infection after reconstructive oral cancer surgery is high and poses a problem in perioperative management. The objective of this study was to verify the association between preoperative nutritional indicators, surgical site infection (SSI), and long-term prognosis after reconstruction for oral cancer. STUDY DESIGN Sixty-seven patients admitted to a dental hospital were enrolled. The following nutritional indicators were examined: serum albumin level, modified Glasgow Prognostic Score, Miki's Glasgow Prognostic Score, prognostic nutritional index, platelet/lymphocyte ratio, neutrophil/lymphocyte ratio, lymphocyte/monocyte ratio, and the Controlling Nutritional Status tool. Statistical analyses were conducted to determine potential risk factors for SSI. RESULTS The Cox proportional hazards model demonstrated that SSI and platelet/lymphocyte ratio ≥211.4 were independent prognostic factors affecting survival. The results demonstrated that albumin <4.0 and platelet/lymphocyte ratio ≥211.4 were risk factors for SSI. Furthermore, albumin <4.0, platelet/lymphocyte ratio ≥211.4, and SSI were correlated with prognosis. Preoperative nutritional indicators were associated with SSI and prognosis in patients with oral cancer after reconstructive surgery. CONCLUSION Preoperative nutritional therapy is crucial for improving therapeutic outcomes in patients with oral cancer who require reconstructive surgery.
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Affiliation(s)
- Shin-Ichiro Hiraoka
- First Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, Suita, Osaka, Japan.
| | - Yasuyuki Shimada
- Department of Oral and Maxillofacial Surgery, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yohei Kawasaki
- Faculty of Nursing, Japanese Red Cross College of Nursing, Shibuya-ku, Tokyo, Japan; Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chuo-ku, Chiba, Japan
| | - Maiko Akutagawa
- School of Pharmaceutical Sciences, University of Shizuoka, Division of Drug Evaluation & Informatics, Suruga-ku, Shizuoka, Japan
| | - Susumu Tanaka
- First Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, Suita, Osaka, Japan
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Chai VW, Chia M, Cocco A, Bhamidipaty M, D'Souza B. Sarcopenia is a strong predictive factor of clinical and oncological outcomes following curative colorectal cancer resection. ANZ J Surg 2021; 91:E292-E297. [PMID: 33682264 DOI: 10.1111/ans.16706] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 02/10/2021] [Accepted: 02/14/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Skeletal muscle depletion and subsequent functional loss is common in gastrointestinal malignancy. Usual markers of nutritional status may not be part of routine workup. The predictive value of sarcopenia was assessed and compared with clinically utilized factors. The aim of this was to assess the association between computed tomography assessed sarcopenia with outcomes in colorectal cancer resection. METHODS A total of 228 consecutive patients who underwent curative colorectal cancer resection were included. Skeletal muscle area was measured at L3, with pre-defined gender-specific cut-offs applied to a height standardized index. Albumin, body mass index and Subjective Global Assessment scores were recorded alongside measures of comorbidity. Predictors of complications, mortality, and recurrence were identified through multivariate logistic regression. RESULTS Computed tomography assessed sarcopenia was significantly associated with longer stays, complications, 30-day mortality, readmissions and recurrence at 1 year. Specific associations with major, respiratory and cardiac complications were seen. It independently predicted overall complications (odds ratio 2.96, confidence interval 1.19-7.35 P = 0.019), recurrence at 1 year (odds ratio 8.00, confidence interval 1.45-44.21, P = 0.017) and an increase in comprehensive complication index of 14 (P = 0.002). Subgroup analysis found sarcopenia predicted overall complications in rectal surgery and major complications in colonic surgery. American Society of Anesthesiologists predicted complications but not major complications while cancer stage also predicted recurrence rates. CONCLUSIONS Sarcopenia presents an objective, available predictive factor that may be superior to current biochemical and clinical measures of nutritional and functional status. This study found it to be predictive of complication rates and recurrence after curative in colorectal cancer resection.
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Affiliation(s)
- Victor W Chai
- Colorectal Surgical Unit, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Marc Chia
- Colorectal Surgical Unit, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Anthony Cocco
- Colorectal Surgical Unit, St Vincent's Hospital, Melbourne, Victoria, Australia.,Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia
| | - Madhu Bhamidipaty
- Colorectal Surgical Unit, St Vincent's Hospital, Melbourne, Victoria, Australia.,Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia.,Colorectal Surgical Unit, Northern Hospital, Melbourne, Victoria, Australia
| | - Basil D'Souza
- Colorectal Surgical Unit, St Vincent's Hospital, Melbourne, Victoria, Australia.,Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia.,Colorectal Surgical Unit, Northern Hospital, Melbourne, Victoria, Australia
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Xie H, Huang S, Yuan G, Kuang J, Yan L, Wei L, Tang S, Gan J. The advanced lung cancer inflammation index predicts short and long-term outcomes in patients with colorectal cancer following surgical resection: a retrospective study. PeerJ 2020; 8:e10100. [PMID: 33083140 PMCID: PMC7548071 DOI: 10.7717/peerj.10100] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/14/2020] [Indexed: 12/24/2022] Open
Abstract
Background and Purpose Several studies have proposed that the advanced lung cancer inflammation index (ALI), a new inflammation-related index, can be used for the prognosis assessment of various malignancies. However, few studies have reported its prognostic value in colorectal cancer (CRC). Therefore, this study explored the relationship between ALI and outcomes in CRC patients. Methods A total of 662 CRC patients who underwent surgery between 2012 and 2014 were included. The ALI was defined as: body mass index × serum albumin/neutrophil to lymphocyte ratio. The X-tile program identified the optimal cut-off value of ALI. Logistic regression analyses determined factors affecting postoperative complications. The Kaplan-Meier method and Cox proportional hazards analyses evaluated potential prognostic factors. Results The optimal cut-off of ALI in males and females were 31.6 and 24.4, respectively. Low-ALI was an independent risk factor for postoperative complications in CRC patients (odds ratio: 1.933, 95% CI [1.283-2.911], p = 0.002). Low-ALI groups also had significantly lower progression-free survival (PFS) and overall survival (OS), when compared with the high-ALI group, especially at advance tumor stages. Using multivariate analysis, ALI was determined as an independent prognostic factor for PFS (hazard ratio: 1.372, 95% CI [1.060-1.777], p = 0.016) and OS (hazard ratio: 1.453, 95% confidence interval: 1.113-1.898, p = 0.006). Conclusion ALI is an independent predictor of short and long-term outcomes in CRC patients, especially at advance tumor stages. The ALI-based nomograms can provide accurate and individualized prediction of postoperative complication risk and survival for CRC patients.
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Affiliation(s)
- Hailun Xie
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, P.R. China
| | - Shizhen Huang
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, P.R. China
| | - Guanghui Yuan
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, P.R. China
| | - Jiaan Kuang
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, P.R. China
| | - Ling Yan
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, P.R. China
| | - Lishuang Wei
- Department of Respiratory Medicine, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, P.R. China
| | - Shuangyi Tang
- Department of Pharmacy, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, P.R. China
| | - Jialiang Gan
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, P.R. China
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Xie H, Gong Y, Kuang J, Yan L, Ruan G, Tang S, Gao F, Gan J. Computed Tomography-Determined Sarcopenia Is a Useful Imaging Biomarker for Predicting Postoperative Outcomes in Elderly Colorectal Cancer Patients. Cancer Res Treat 2020; 52:957-972. [PMID: 32311863 PMCID: PMC7373859 DOI: 10.4143/crt.2019.695] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 04/16/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose This study aimed to establish whether computed tomography (CT)–determined sarcopenia is a useful imaging biomarker for postoperative outcome in elderly colorectal cancer (CRC) patients, and construct sarcopenia-based nomograms to predict individual outcomes after surgery. Materials and Methods CT imaging data of 298 elderly CRC patients who underwent surgery in 2012-2014 were retrospectively analyzed. Skeletal muscle mass was determined by CT, and sarcopenia was diagnosed based on the optimal cutoff value determined by X-tile program. The correlation between sarcopenia and risk of preoperative nutrition and postoperative complications was evaluated. A Cox proportional hazards model was used to determine survival predictors. Sarcopenia-based nomograms were developed based on multivariate analysis, and calibrated using concordance index and calibration curves. Results A total 132 patients (44.3%) had sarcopenia based on the optimum cutoff values (29.9 cm2/m2 for women and 49.5 cm2/m2 for men). Sarcopenia was an independent risk factor for preoperative nutrition (p < 0.001; odds ratio [OR], 3.405; 95% confidence interval [CI], 1.948 to 5.954) and postoperative complications (p=0.008; OR, 2.192; 95% CI, 1.231 to 3.903). Sarcopenia was an independent predictor for poor progression-free survival (p < 0.001; hazard ratio [HR], 2.175; 95% CI, 1.489 to 3.179) and overall survival (p < 0.001; HR, 2.524; 95% CI, 1.721 to 3.703). Based on multivariate analysis, we produced four nomograms that had better predictive performance. Conclusion CT-determined sarcopenia is a useful imaging biomarker for predicting preoperative nutritional risk, postoperative complications, and long-term outcomes in elderly CRC patients. The sarcopenia-based nomograms can provide a scientific basis for guiding therapeutic schedule and follow-up strategies.
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Affiliation(s)
- Hailun Xie
- Deparment of Colorectal and Anal Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yizhen Gong
- Deparment of Colorectal and Anal Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jiaan Kuang
- Deparment of Colorectal and Anal Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Ling Yan
- Deparment of Colorectal and Anal Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Guotian Ruan
- Deparment of Colorectal and Anal Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Shuangyi Tang
- Deparment of Pharmacy, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Feng Gao
- Deparment of Colorectal and Anal Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jialiang Gan
- Deparment of Colorectal and Anal Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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Pan YP, Hsu TY, Lin JY, Ho CJ, Kuan CY, Chou WC, Lai CH, Chang PH, Yeh KY. Prognostic Significance of Low Body Mass Index and Betel-Quid Use in the 5-Year Survival Rates of Esophageal Squamous Cell Carcinoma Patients. Nutr Cancer 2019; 70:1315-1321. [PMID: 30900908 DOI: 10.1080/01635581.2019.1588983] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIM This study aimed to examine the relationship between clinicopathological features, varied malnutrition criteria, and survival in esophageal squamous cell carcinoma (ESCC) patients. METHODS Six malnutrition criteria (body mass index (BMI) < 18.5 kg/m2, serum albumin level < 3.5 g/dL, neutrophil-to-lymphocyte ratio (NLR) > 3.5, platelet-to-lymphocyte ratio (PLR) > 17, prognostic nutrition index (PNI) < 40, and blood total lymphocyte count (TLC) < 1,600 cells/mm3) were measured in 205 ESCC patients at the time of diagnosis. Malnutrition status and clinicopathological features were tested for prognostic effects on the 5-year survival rate. RESULTS Malnutrition rates vary according to nutrition assessment tools, ranging from 21.5% based on BMI < 18.5 kg/m2 to 67.8% based on PNI < 40. These rates are associated with increased inflammation, but they showed no difference among various tumor stages. After adjustment of demographic variables and comorbid status, advanced tumor stage, low BMI at diagnosis, and betel quid use showed prognostic significance in the 5-year survival rate based on a multivariate logistic regression analysis. CONCLUSIONS Different nutrition assessment criteria produced different malnutrition rates. Advanced tumor stage, low BMI at diagnosis, and betel quid use were independent prognostic factors for worse survival of ESCC patients.
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Affiliation(s)
- Yi-Ping Pan
- a Department of Nutrition , Chang Gung Memorial Hospital , Keelung , Taiwan
| | - Ting-You Hsu
- a Department of Nutrition , Chang Gung Memorial Hospital , Keelung , Taiwan
| | - Jui-Ying Lin
- a Department of Nutrition , Chang Gung Memorial Hospital , Keelung , Taiwan
| | - Chia-Jung Ho
- a Department of Nutrition , Chang Gung Memorial Hospital , Keelung , Taiwan
| | - Chiung-Ying Kuan
- a Department of Nutrition , Chang Gung Memorial Hospital , Keelung , Taiwan
| | - Wen-Chi Chou
- b Division of Hemato-Oncology, Department of Internal Medicine , Chang Gung Memorial Hospital , Kweishan , Taiwan.,c College of Medicine , Chang Gung University , Taoyuan City , Taiwan
| | - Chien-Hong Lai
- c College of Medicine , Chang Gung University , Taoyuan City , Taiwan.,d Division of Hemato-Oncology, Department of Internal Medicine , Chang Gung Memorial Hospital , Keelung , Taiwan
| | - Pei-Hung Chang
- c College of Medicine , Chang Gung University , Taoyuan City , Taiwan.,d Division of Hemato-Oncology, Department of Internal Medicine , Chang Gung Memorial Hospital , Keelung , Taiwan
| | - Kun-Yun Yeh
- c College of Medicine , Chang Gung University , Taoyuan City , Taiwan.,d Division of Hemato-Oncology, Department of Internal Medicine , Chang Gung Memorial Hospital , Keelung , Taiwan
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Predictive Value of Preoperative Sarcopenia in Patients with Gastric Cancer: a Meta-analysis and Systematic Review. J Gastrointest Surg 2018; 22:1890-1902. [PMID: 29987739 DOI: 10.1007/s11605-018-3856-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 06/18/2018] [Indexed: 01/31/2023]
Abstract
PURPOSE The impact of preoperative sarcopenia on postoperative complications and overall survival has been recently debated. Our meta-analysis aims to ascertain whether preoperative sarcopenia increases the risk of poor outcomes and to attempt to provide new ideas for the prognosis of outcomes for patients with gastric cancer. METHODS We searched for all relevant articles on PubMed, the EMBASE database, and Web of Science (up to September 1, 2017). Data synthesis and statistical analysis were carried out using RevMan 5.3 software. RESULTS Thirteen studies involving 4262 patients who underwent gastrectomy for gastric cancer were analyzed (sarcopenia group = 1234; non-sarcopenia group = 3028). The results showed that preoperative sarcopenia significantly associated with poor pathological staging (high pT: OR = 1.86, 95% CI = 1.49-2.31; P < 0.01; pN+: OR = 1.61, 95% CI = 1.33-1.94; P < 0.01; high TNM category: OR = 1.84, 95% CI = 1.53-2.22; P < 0.01). Patients with preoperative sarcopenia had an increased risk of total postoperative complications (OR = 2.17, 95% CI = 1.53-3.08; P < 0.01), severe complications (OR = 1.65, 95% CI = 1.09-2.50; P = 0.02), and poorer OS (HR = 1.70, 95% CI = 1.45-1.99; P < 0.01). The results of subgroup analyses revealed that patients with preoperative sarcopenia over 65 years old and those from Asian populations had higher risks for total postoperative complications and severe complications. CONCLUSION This meta-analysis reveals that preoperative sarcopenia may be used as a new indicator of poor pathological staging, impaired overall survival, and increased postoperative complications. Notably, patients with gastric cancer who are over 65 years old and from Asia should be routinely screened for sarcopenia before surgery to adequately assess the risk of postoperative complications in clinical practice.
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Ongaro E, Buoro V, Cinausero M, Caccialanza R, Turri A, Fanotto V, Basile D, Vitale MG, Ermacora P, Cardellino GG, Nicoletti L, Fornaro L, Casadei-Gardini A, Aprile G. Sarcopenia in gastric cancer: when the loss costs too much. Gastric Cancer 2017; 20:563-572. [PMID: 28477106 DOI: 10.1007/s10120-017-0722-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 04/23/2017] [Indexed: 02/07/2023]
Abstract
Sarcopenia is a complex syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength. Malignancy is a major determinant of sarcopenia, and gastric cancer (GC) is among the most common causes of this phenomenon. As sarcopenia is a well-recognized poor prognostic feature in GC and has been associated with worse tolerance of surgical and medical treatments, members of the multidisciplinary team should be aware of the clinical relevance, pathogenic mechanisms, and potential treatments for this syndrome. The importance of sarcopenia is often underestimated in everyday practice and clinical trials, particularly among elderly or fragile patients. As treatment options are improving in all disease stages, deeper knowledge and greater attention to the metabolic balance in GC patients could further increase the benefit of novel therapeutic strategies and dramatically impact on quality of life. In this review, we describe the role of sarcopenia in different phases of GC progression. Our aim is to provide oncologists and surgeons dealing with GC patients with a useful tool for comprehensive assessment and timely management of this potentially life-threatening condition.
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Affiliation(s)
- Elena Ongaro
- Department of Oncology, University and General Hospital, Udine, Italy
| | - Vanessa Buoro
- Department of Oncology, University and General Hospital, Udine, Italy
| | - Marika Cinausero
- Department of Oncology, University and General Hospital, Udine, Italy
| | - Riccardo Caccialanza
- Clinical Nutrition Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Annalisa Turri
- Clinical Nutrition Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valentina Fanotto
- Department of Oncology, University and General Hospital, Udine, Italy
| | - Debora Basile
- Department of Oncology, University and General Hospital, Udine, Italy
| | | | - Paola Ermacora
- Department of Oncology, University and General Hospital, Udine, Italy
| | | | - Laura Nicoletti
- Department of Oncology, San Bortolo General Hospital, Azienda ULSS8 Berica, East District, Viale Rodolfi 37, 36100, Vicenza, Italy
| | - Lorenzo Fornaro
- Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Andrea Casadei-Gardini
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, FC, Italy
| | - Giuseppe Aprile
- Department of Oncology, University and General Hospital, Udine, Italy.
- Department of Oncology, San Bortolo General Hospital, Azienda ULSS8 Berica, East District, Viale Rodolfi 37, 36100, Vicenza, Italy.
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Zhou CJ, Zhang FM, Zhang FY, Yu Z, Chen XL, Shen X, Zhuang CL, Chen XX. Sarcopenia: a new predictor of postoperative complications for elderly gastric cancer patients who underwent radical gastrectomy. J Surg Res 2016; 211:137-146. [PMID: 28501109 DOI: 10.1016/j.jss.2016.12.014] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 11/25/2016] [Accepted: 12/09/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND A geriatric assessment is needed to identify high-risk elderly patients with gastric cancer. However, the current geriatric assessment has been considered to be either time-consuming or subjective. The present study aimed to investigate the predictive effect of sarcopenia on the postoperative complications for elderly patients who underwent radical gastrectomy. MATERIALS AND METHODS We conducted a prospective study of patients who underwent radical gastrectomy from August 2014 to December 2015. Computed tomography-assessed lumbar skeletal muscle, handgrip strength, and gait speed were measured to define sarcopenia. RESULTS Sarcopenia was present in 69 of 240 patients (28.8%) and was associated with lower body mass index, lower serum albumin, lower hemoglobin, and higher nutritional risk screening 2002 scores. Postoperative complications significantly increased in the sarcopenic patients (49.3% versus 24.6%, P < 0.001), compared with nonsarcopenic patients. The multivariate analysis demonstrated that sarcopenia (odds ratio: 2.959, 95% CI: 1.629-5.373, P < 0.001) and the Charlson comorbidity index ≥2 (odds ratio: 3.357, 95% CI: 1.144-9.848, P = 0.027) were independent risk factors for postoperative complications. CONCLUSIONS Sarcopenia, presented as a new geriatric assessment factor, was a strong and independent risk factor for postoperative complications of elderly patients with gastric cancer.
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Affiliation(s)
- Chong-Jun Zhou
- Department of Anorectal Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Feng-Min Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China; The First Clinical Medical Institute, Wenzhou Medical University, Wenzhou, China
| | - Fei-Yu Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Zhen Yu
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital Affiliated to Tongji University, Shanghai, China
| | - Xiao-Lei Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xian Shen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Cheng-Le Zhuang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China; Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital Affiliated to Tongji University, Shanghai, China.
| | - Xiao-Xi Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China.
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POZIOMYCK ALINEKIRJNER, FRUCHTENICHT ANAVALERIAGONÇALVES, KABKE GEORGIABRUM, VOLKWEIS BERNARDOSILVEIRA, ANTONIAZZI JORGELUIZ, MOREIRA LUISFERNANDO. Reliability of nutritional assessment in patients with gastrointestinal tumors. Rev Col Bras Cir 2016; 43:189-97. [DOI: 10.1590/0100-69912016003006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 04/12/2016] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Patients with gastrointestinal cancer and malnutrition are less likely to tolerate major surgical procedures, radiotherapy or chemotherapy. In general, they display a higher incidence of complications such as infection, dehiscence and sepsis, which increases the length of stay and risk of death, and reduces quality of life. The aim of this review is to discuss the pros and cons of different points of view to assess nutritional risk in patients with gastrointestinal tract (GIT) tumors and their viability, considering the current understanding and screening approaches in the field. A better combination of anthropometric, laboratory and subjective evaluations is needed in patients with GIT cancer, since malnutrition in these patients is usually much more severe than in those patients with tumors at sites other than the GIT.
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Zhuang CL, Huang DD, Pang WY, Zhou CJ, Wang SL, Lou N, Ma LL, Yu Z, Shen X. Sarcopenia is an Independent Predictor of Severe Postoperative Complications and Long-Term Survival After Radical Gastrectomy for Gastric Cancer: Analysis from a Large-Scale Cohort. Medicine (Baltimore) 2016; 95:e3164. [PMID: 27043677 PMCID: PMC4998538 DOI: 10.1097/md.0000000000003164] [Citation(s) in RCA: 306] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Currently, the association between sarcopenia and long-term prognosis after gastric cancer surgery has not been investigated. Moreover, the association between sarcopenia and postoperative complications remains controversial. This large-scale retrospective study aims to ascertain the prevalence of sarcopenia and assess its impact on postoperative complications and long-term survival in patients undergoing radical gastrectomy for gastric cancer. From December 2008 to April 2013, the clinical data of all patients who underwent elective radical gastrectomy for gastric cancer were collected prospectively. Only patients with available preoperative abdominal CT scan within 30 days of surgery were considered for analysis. Skeletal muscle mass was determined by abdominal (computed tomography) CT scan, and sarcopenia was diagnosed by the cut-off values obtained by means of optimum stratification. Univariate and multivariate analyses evaluating risk factors of postoperative complications and long-term survival were performed. A total of 937 patients were included in this study, and 389 (41.5%) patients were sarcopenic based on the diagnostic cut-off values (34.9 cm²/m² for women and 40.8 cm²/m² for men). Sarcopenia was an independent risk factor for severe postoperative complications (OR = 3.010, P < 0.001), but not for total complications. However, sarcopenia did not show significant association with operative mortality. Moreover, sarcopenia was an independent predictor for poorer overall survival (HR = 1.653, P < 0.001) and disease-free survival (HR = 1.620, P < 0.001). Under the adjusted tumor-node-metastasis (TNM) stage, sarcopenia remained an independent risk factor for overall survival and disease-free survival in patients with TNM stage II and III, but not in patients with TNM stage I. Sarcopenia is an independent predictive factor of severe postoperative complications after radical gastrectomy for gastric cancer. Moreover, sarcopenia is independently associated with overall and disease-free survival in patients with TNM stage II and III, but not in patients with TNM stage I.
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Affiliation(s)
- Cheng-Le Zhuang
- From the Department of Gastrointestinal Surgery (C-LZ, D-DH, W-YP, C-JZ, S-LW, NL, L-LM, ZY, XS), The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, and Department of Gastrointestinal Surgery (ZY), Shanghai Tenth People's Hospital Affiliated to Tongji University, Shanghai, China
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Early oral intake after reconstruction with a free flap for cancer of the oral cavity. Br J Oral Maxillofac Surg 2013; 51:224-7. [DOI: 10.1016/j.bjoms.2012.06.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Accepted: 06/14/2012] [Indexed: 11/19/2022]
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Abstract
A review of guidelines and practice advisories provides the basis of recommendations for the NP to stratify high-risk patients prior to elective orthopedic surgery. A frame of reference for NPs performing preoperative assessment for patients with comorbidity, included cardiac risk and physiologic stratification tools are presented.
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