Li Xiaolong, Ding Ping'an, Wu Jiaxiang, Wu Haotian, Yang Peigang, Guo Honghai, Tian Yuan, Meng Lingjiao, Zhao Qun
The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050011, China.
Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China.
BMC Cancer. 2025 Feb 14;25(1):269. doi: 10.1186/s12885-025-13674-3.
Gastric cancer remains a major health concern worldwide, with locally advanced gastric cancer (LAGC) posing significant challenges due to frequent lymph node metastasis and poor prognosis. While curative gastrectomy with D2 lymph node dissection is the standard treatment, sarcopenia and perioperative skeletal muscle loss (SML) have emerged as critical prognostic factors.
We retrospectively analyzed 198 LAGC patients who underwent curative gastrectomy. Preoperative and postoperative sarcopenia were assessed via computed tomography (CT)-derived skeletal muscle index (SMI) at the L3 level. SML was defined based on sex-specific thresholds of SMI changes (%/30 days). Prognostic significance for overall survival (OS) and disease-free survival (DFS) was evaluated using Kaplan-Meier and Cox regression analyses.
The prevalence of sarcopenia increased from 23.7% preoperatively to 33.3% postoperatively. Patients with significant muscle loss (SML) showed worse OS and DFS compared to non-SML patients (P < 0.05). SML was also associated with a higher incidence of Clavien-Dindo grade ≥ 3a complications (P < 0.05). Multivariate analysis identified preoperative sarcopenia (HR = 2.332, P = 0.001), postoperative sarcopenia (HR = 3.189, P = 0.011), and SML (HR = 11.231, P = 0.002) as independent risk factors for OS. Adjuvant chemotherapy significantly improved both OS (HR = 0.532, P = 0.015) and DFS (HR = 0.587, P = 0.041).
Both preoperative sarcopenia and perioperative SML may negatively impact postoperative prognosis in LAGC patients, suggesting that perioperative evaluation of skeletal muscle mass may help identify high-risk surgical candidates for targeted interventions.
胃癌仍是全球主要的健康问题，局部进展期胃癌（LAGC）因频繁的淋巴结转移和预后不良而带来重大挑战。虽然D2淋巴结清扫的根治性胃切除术是标准治疗方法，但肌肉减少症和围手术期骨骼肌丢失（SML）已成为关键的预后因素。
我们回顾性分析了198例行根治性胃切除术的LAGC患者。术前和术后肌肉减少症通过计算机断层扫描（CT）得出的L3水平骨骼肌指数（SMI）进行评估。SML根据SMI变化的性别特异性阈值（%/30天）来定义。使用Kaplan-Meier和Cox回归分析评估总生存期（OS）和无病生存期（DFS）的预后意义。
肌肉减少症的患病率从术前的23.7%增加到术后的33.3%。与无SML的患者相比，有明显肌肉丢失（SML）的患者OS和DFS更差（P < 0.05）。SML还与Clavien-Dindo≥3a级并发症的发生率较高相关（P < 0.05）。多变量分析确定术前肌肉减少症（HR = 2.332，P = 0.001）、术后肌肉减少症（HR = 3.189，P = 0.011）和SML（HR = 11.231，P = 0.002）是OS的独立危险因素。辅助化疗显著改善了OS（HR = 0.532，P = 0.015）和DFS（HR = 0.587，P = 0.041）。
术前肌肉减少症和围手术期SML均可能对LAGC患者的术后预后产生负面影响，这表明围手术期评估骨骼肌质量可能有助于识别适合进行靶向干预的高危手术患者。
