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Nutrition in acute and chronic diseases

Prognostic value of myosteatosis and systemic inflammation in patients with resectable gastric cancer: A retrospective study

European Journal of Clinical Nutrition volume 77, pages 116–126 (2023)Cite this article

Subjects

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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Fig. 1
Fig. 2: Disease free survival and overall survival for skeletal muscle radiodensity.
Fig. 3: Disease free survival and overall survival for neutrophil-to-lymphocyte ratio and myosteatosis.

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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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Author notes

  1. These authors contributed equally: Fabiana Lascala, Bruna Karoline da Silva Moraes.

Authors and Affiliations

  1. Division of Oncology, Department of anesthesiology, oncology and radiology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil

    Fabiana Lascala, Bruna Karoline da Silva Moraes, Maria Carolina Santos Mendes, Mariluce Barbosa de Carvalho, Sandra Regina Branbilla, Ademar Dantas da Cunha Júnior, Lígia Traldi Macedo & José Barreto Campello Carvalheira

  2. Hematology and Oncology Clinics, Cancer Hospital of Cascavel, União Oeste de Estudos e Combate ao Câncer (UOPECCAN), Cascavel, PR, Brazil

    Ademar Dantas da Cunha Júnior

  3. Department of Internal Medicine, State University of Western Paraná (UNIOESTE), Cascavel, PR, Brazil

    Ademar Dantas da Cunha Júnior

  4. Division of Gastrointestinal Surgery, Department of Surgery, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil

    Luiz Roberto Lopes & Nelson Adami Andreollo

  5. Human Nutrition Research Unit, Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada

    Carla M. Prado

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Contributions

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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Correspondence to José Barreto Campello Carvalheira.

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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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