Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan;
Department of Surgery, Japanese Red Cross Tottori Hospital, Tottori, Japan.
Anticancer Res. 2023 Nov;43(11):5051-5059. doi: 10.21873/anticanres.16704.
BACKGROUND/AIM: Chemotherapy is the standard treatment for patients with unresectable gastric cancer (UGC); however, the survival outcomes are poor. This study investigated the predictive values of skeletal muscle mass (SMM) index (SMI) before second-line chemotherapy and the survival outcomes of patients with UGC.
A total of 79 patients diagnosed with UGC at our hospital who received at least second-line palliative chemotherapy were included. The cross-sectional SMM at the third lumbar vertebra was obtained before second-line chemotherapy. SMI was defined as the muscle area normalized by height squared (m), and SMI before second-line chemotherapy was defined as 2SMI.
Using 2SMI for men and women (35.4 and 31.7 cm/m, respectively) as the cutoff value, patients were divided into high (2SMI; n=54) and low (2SMI; n=25) 2SMI groups. The number of patients receiving fourth-line chemotherapy was significantly higher in the 2SMI group than in the 2SMI group (p=0.039). The overall survival time after the start of second-line chemotherapy was significantly higher in the 2SMI group than in the 2SMI group (p=0.008). The incidence of grade 3 or 4 side effects was significantly higher in the 2SMI than in the 2SMI group (p=0.028). The multivariate analysis identified 2SMI as independent prognostic factor after the start of second-line chemotherapy.
The 2SMI group had a significantly worse prognosis and significantly less conversion to fourth-line chemotherapy than the 2SMI group. Moreover, 2SMI was associated with grade 3 or 4 side effects of second-line chemotherapy.
背景/目的：化疗是不可切除的胃癌（UGC）患者的标准治疗方法；然而，生存结果很差。本研究探讨了二线化疗前骨骼肌质量（SMM）指数（SMI）对 UGC 患者的预测价值和生存结果。
共纳入我院 79 例接受至少二线姑息化疗的 UGC 患者。二线化疗前获得第三腰椎的横截面积 SMM。SMI 定义为肌肉面积与身高平方的比值（m），二线化疗前的 SMI 定义为 2SMI。
以男性和女性的 2SMI（分别为 35.4 和 31.7 cm/m）为界值，将患者分为高（2SMI；n=54）和低（2SMI；n=25）2SMI 组。2SMI 组接受四线化疗的患者人数明显多于 2SMI 组（p=0.039）。二线化疗开始后总生存时间明显长于 2SMI 组（p=0.008）。2SMI 组的 3 级或 4 级副作用发生率明显高于 2SMI 组（p=0.028）。多变量分析确定二线化疗开始后 2SMI 是独立的预后因素。
2SMI 组的预后明显较差，二线化疗后转为四线化疗的比例明显低于 2SMI 组。此外，2SMI 与二线化疗的 3 级或 4 级副作用相关。
