Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2024; 30(8): 863-880
Published online Feb 28, 2024. doi: 10.3748/wjg.v30.i8.863
Evaluating the influence of sarcopenia and myosteatosis on clinical outcomes in gastric cancer patients undergoing immune checkpoint inhibitor
Gui-Ming Deng, Hai-Bin Song, Zhong-Ze Du, Ying-Wei Xue, Hong-Jiang Song, Yuan-Zhou Li
Gui-Ming Deng, Hai-Bin Song, Zhong-Ze Du, Ying-Wei Xue, Hong-Jiang Song, Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang Province, China
Yuan-Zhou Li, Department of Radiology, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang Province, China
Co-first authors: Gui-Ming Deng and Hai-Bin Song.
Co-corresponding authors: Hong-Jiang Song and Yuan-Zhou Li.
Author contributions: Deng GM and Song HB contributed equally to this work; Deng GM, Song HB, Du ZZ, Xue YW, Song HJ and Li YZ designed the research study; Deng GM, Song HB, Du ZZ and Li YZ performed the research; Xue YW, Song HJ and Li YZ provided data and funding for the experiment; Deng GM and Song HB analyzed the data and wrote the manuscript; all authors have read and approve the final manuscript.
Institutional review board statement: This study was approved by the Ethics Committee of Harbin Medical University Cancer Hospital.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no competing financial interests.
Data sharing statement: The material supporting the conclusion of this article has been included within the article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yuan-Zhou Li, PhD, Professor, Department of Radiology, Harbin Medical University Cancer Hospital, No. 150 Haping Road, Nangang District, Harbin 150081, Heilongjiang Province, China. 830667@hrbmu.edu.cn
Received: December 20, 2023
Peer-review started: December 20, 2023
First decision: January 6, 2024
Revised: January 16, 2024
Accepted: February 1, 2024
Article in press: February 1, 2024
Published online: February 28, 2024
Abstract
BACKGROUND

The development and progression of gastric cancer (GC) are closely linked to the nutritional status of patients. Although immunotherapy has been demonstrated to be clinically effective, the relationships of sarcopenia and myosteatosis with the use of immune checkpoint inhibitors (ICIs) in patients with gastric cancer remain to be characterized.

AIM

To assess the effects of sarcopenia and myosteatosis on the clinical outcomes of patients with GC undergoing treatment with an ICI.

METHODS

We performed a retrospective study of patients who were undergoing immunotherapy for GC. For the evaluation of sarcopenia, the optimal cut-off value for the skeletal muscle index was established using receiver operating characteristic analysis of data obtained from pre-treatment computed tomography images at the L3 vertebral level. Myosteatosis was defined using the mean skeletal muscle density (SMD), with a threshold value of < 41 Hounsfield units (HU) for patients with a body mass index (BMI) < 25 kg/m² and < 33 HU for those with a BMI ≥ 25 kg/m². The log-rank test was used to compare progression-free survival (PFS) and overall survival (OS), and a Cox proportional hazard model was used to identify prognostic factors. Nomograms were developed to predict the PFS and OS of patients on the basis of the results of multivariate analyses.

RESULTS

We studied 115 patients who were undergoing ICI therapy for GC, of whom 27.4% had sarcopenia and 29.8% had myosteatosis. Patients with sarcopenia or myosteatosis had significantly shorter PFS and OS than those without these conditions. Furthermore, both sarcopenia and myosteatosis were found to be independent predictors of PFS and OS in patients with GC administering an ICI. The prediction models created for PFS and OS were associated with C-indexes of 0.758 and 0.781, respectively.

CONCLUSION

The presence of sarcopenia or myosteatosis is a reliable predictor of the clinical outcomes of patients with GC who are undergoing treatment with an ICI.

Keywords: Gastric cancer, Sarcopenia, Myosteatosis, Immune checkpoint inhibitor, Prognostic factor, Overall survival, Progression-free survival

Core Tip: We performed a retrospective study to evaluate the use of sarcopenia and myosteatosis for the prediction of the prognosis of patients with gastric cancer who are being treated with an immune checkpoint inhibitor (ICI). We studied 115 patients with complete sets of clinical data and imaging information and analyzed their muscle cross-sectional area at the L3 Level. We determined the optimal cut-off area value to identify sarcopenia, and myosteatosis was defined using mean skeletal muscle densities of < 41 Hounsfield units (HU) for patients with a body mass index (BMI) < 25 kg/m² and < 33 HU for those with a BMI ≥ 25 kg/m². We found that muscle loss and muscle steatosis are independent predictors of the outcomes of patients with gastric cancer being treated with an ICI.