Abstract
Background/Objectives
The association between systemic inflammation and myosteatosis upon diagnosis of gastric cancer (GC) and whether these factors could predict survival outcomes is not clear. Our aim was to explore the association between systemic inflammation and myosteatosis upon diagnosis of GC, specially whether the co-occurrence of these factors could predict survival outcomes.
Subjects/methods
Computed tomography (CT) was performed at the level of the third lumbar vertebra for body composition analysis in 280 patients with GC. Myoesteatosis was defined as the lowest tertile of the muscle radiodensity distribution or based on clinical significance using optimal stratification analysis. Inflammatory indexes were measured, including the neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte and lymphocyte-to-monocyte ratios.
Results
Patients with low skeletal muscle (SM) radiodensity were more likely to be older than 65 years, have a higher body mass index and have diabetes. They also had higher intermuscular visceral and subcutaneous adipose tissue areas and indexes. The highest tertile of SM radiodensity was associated with better disease-free survival (DFS) (HR = 0.51, 95% CI [0.31, 0.84], ptrend = 0.020) and overall survival (OS) (HR = 0.49, 95% CI [0.29, 0.82], ptrend = 0.022). Patients with NLR > 2.3 and myosteatosis had the worst DFS and OS (HR = 2.77, 95% CI [1.54, 5.00], p = 0.001; HR = 3.31, 95% CI [1.79, 6.15], p < 0.001, respectively).
Conclusion
Co-occurrence of myosteatosis and inflammation increased disease progression and death risk by almost three times. These regularly obtained biomarkers might improve prognostic risk prediction in resectable GC.
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Data availability
Data described in the manuscript, codebook, and analytic code will be made available upon request pending application and approval.
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Acknowledgements
We thank Matheus B.O. Duarte for performing the statistical analysis of optimal stratification and Andreza Vertuan, Debora S. da Rocha, Grazielle M. Tavares, Giuliano Barbosa, Higor K. Mantovani and Isis R. T. C. Sálame for their assistance with data acquisition.
Funding
Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP). Grant/award number: 2018/23428‐0 | Recipient: JBCC. Conselho nacional de desenvolvimento científico e tecnológico (CNPq). Grant/award number: 302535/2018-7 | Recipient: JBCC.
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MCSM and JBCC designed the research; FL, BKSK, MBC, SRB, and MCSM collected the data; FL and BKSK performed computed tomography analyses; FL, BKSK, MCSM ADCJ, LTM, NAA, LRL, CMP, and JBCC analyzed and interpreted the data and provided comments; ADCJ, FL, MCSM, CMP, and JBCC wrote the manuscript. All authors reviewed and approved the final manuscript.
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Lascala, F., da Silva Moraes, B.K., Mendes, M.C.S. et al. Prognostic value of myosteatosis and systemic inflammation in patients with resectable gastric cancer: A retrospective study. Eur J Clin Nutr 77, 116–126 (2023). https://doi.org/10.1038/s41430-022-01201-7
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DOI: https://doi.org/10.1038/s41430-022-01201-7