Study On The Effect Of Sarcopenia About The Prognosis Of Patients With Different TNM Stages Of Gastric Cancer

Objective:To investigate the effect of sarcopenia(CT measurement of L3 plane skeletal muscle area)on short-term clinical outcomes of patients with different TNM stages of gastric cancer after radical operation.Methods:We selected gastric cancer patients over 50 years old,with body mass index of18.5-27.9 kg/m~2 and radical gastrectomy as the research subjects.Their grip strength and4-meter walking speed were measured before operation.Skeletal muscle area in the middle of L3 vertebral body was measured by CT software,and then working out the L3skeletal muscle index(SMI):L3 muscle area was divided by the square of height(cm~2/m~2).A decrease in SMI combined with a decrease in walking speed or grip strength can be diagnosed as sarcopenia.According to the pathological results after operation,patients with gastric cancer were divided into early and middle stages(stage I-II)and late stages(stage III-IV)according to TNM stages.Each stage was divided into sarcopenia group and non-sarcopenia group according to the presence or absence of sarcopenia.The basic data on basic information and post-operative outcomes that may affect the prognosis of surgery were compared and analyzed to explore the effect of sarcopenia on short-term clinical outcomes of patients with different TNM stages of gastric cancer after radical operation.Results:(1)Data comparison between sarcopenia group and non-sarcopenia group in early and middle stage gastric cancer patients:Among 162 patients with advanced gastric cancer,32 were diagnosed as myopenia,,accounting for 19.75%.Preoperative data of sarcopenia group and non-sarcopenia group showed that sarcopenia group have higher age([69.47+7.75]VS.[62.11+7.65]old,P<0.001),higher complication index([3.38+1.18]VS.[2.45+1.20],P<0.001),and higher nutritional risk(34.37%VS.17.69%,P=0.038).Comparisons of the post-operative outcomes between the two groups showed that the incidence of complications in the sarcopenia group(46.88%)was higher than that in the non-sarcopenia group(14.61%)with statistical significance(P<0.001).Logistic binary regression analysis show that sarcopenia(P=0.002)and complications index(P<0.001)were independent risk factors for complications after radical gastrectomy in the early and middle stages of gastric cancer.(2)Data comparison between sarcopenia group and non-sarcopenia group in patients with advanced gastric cancer:Among 111 patients with advanced gastric cancer,24 were diagnosed as myopenia,accounting for 21.62%.Preoperative data of sarcopenia group and non-sarcopenia group showed that sarcopenia group have higher age([70.25+6.14]VS.[62.40+7.44]old,P<0.001),higher complication index([3.38+1.28]VS.[2.40+1.21],P=0.001),and lower hemoglobin concentration([110.04+25.79]VS.[127.92+23.10]g/L,P=0.001).The incidence of complications in sarcopenia group(37.50%)and non-sarcopenia group(20.69%)have no statistical significance(P=0.089).Logistic binary regression analysis showed that the independent risk factor of complications after radical gastrectomy for advanced gastric cancer was total gastrectomy(P=0.006).(3)Data comparison between sarcopenia group and non-sarcopenia group in patients with gastric cancer:Overall,273 patients with gastric cancer were included in this study,of which 56were diagnosed as sarcopenia,accounting for 20.51%.Preoperative data of sarcopenia group and non-sarcopenia group showed that sarcopenia group have higher age([69.80+7.06]VS,[62.23+7.55]old,P<0.001),higher complication index([3.38+1.21]VS,[2.43+1.20],P<0.001),lower albumin concentration([38.31±5.11]VS.[39.79±4.11]g/L,P=0.023),and lower hemoglobin concentration([117.68+23.00]VS.[128.86+22.84]g/L,P=0.001)and higher nutritional risk(42.86%VS.24.42%,P=0.006).Comparisons of the post-operative outcomes between the two groups showed that the incidence of complications in the sarcopenia group(42.86%)was higher than that in the non-sarcopenia group(17.05%)with statistical significance(P<0.001)..Logistic binary regression analysis showed that sarcopenia(P=0.013)and total gastrectomy(P=0.017)were independent risk factors for complications after radical gastrectomy.Conclusion:1 sarcopenia is an independent risk factor for complications after radical operation in patients with early and middle stage gastric cancer.2 sarcopenia is not an independent risk factor for complication after radical operation in patients with advanced gastric cancer.3 It is a simple and feasible method to evaluate the muscle condition of patients with gastric cancer by using the imaging data of CT examination.This method can be used for early diagnosis and early intervention of sarcopenia in patients with early and middle stage gastric cancer,so as to improve the prognosis after operation.