Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2021; 9(18): 4668-4680
Published online Jun 26, 2021. doi: 10.12998/wjcc.v9.i18.4668
AWGS2019 vs EWGSOP2 for diagnosing sarcopenia to predict long-term prognosis in Chinese patients with gastric cancer after radical gastrectomy
Wen-Yi Wu, Jiao-Jiao Dong, Xin-Ce Huang, Zhe-Jing Chen, Xiao-Lei Chen, Qian-Tong Dong, Yong-Yu Bai
Wen-Yi Wu, Zhe-Jing Chen, Xiao-Lei Chen, Qian-Tong Dong, Yong-Yu Bai, Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
Jiao-Jiao Dong, Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
Xin-Ce Huang, Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
Author contributions: Bai YY and Dong QT designed the study; Huang XC, Wu WY, Dong JJ, and Chen ZJ collected the data; Chen ZJ and Chen XL analyzed and interpreted the data; Bai YY and Huang XC wrote the article; Dong JJ and Dong QT revised the article and took the decision to submit the article for publication.
Supported by Zhejiang Provincial Health Department Medical Support Discipline-Nutrition, No. 11-ZC24; and Wenzhou Municipal Science and Bureau, No. Y2020732.
Institutional review board statement: This study was approved by the Ethical Review Board of the First Affiliated Hospital of Wenzhou Medical University (No. 2014063).
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors declare no conflict of interests.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yong-Yu Bai, MD, Surgeon, Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, No. 2 Fuxue Lane, Wenzhou 325000, Zhejiang Province, China. baiyongyu@qq.com
Received: February 6, 2021
Peer-review started: February 6, 2021
First decision: March 16, 2021
Revised: March 23, 2021
Accepted: April 20, 2021
Article in press: April 20, 2021
Published online: June 26, 2021
Abstract
BACKGROUND

Sarcopenia is a nutrition-related disease and has a profound effect on the long-term overall survival (OS) of patients with gastric cancer. Its diagnostic criterion is critical to clinical diagnosis and treatment. However, previous research reported widely differing sarcopenia prevalence due to different criteria. AWGS2019 and EWGSOP2 are the two latest and widely adopted criteria.

AIM

To compare the effects of AWGS2019 and EWGSOP2 on the long-term OS of Chinese gastric cancer patient after radical gastrectomy.

METHODS

An observational study was conducted from July 2014 to January 2017, which included 648 consecutive gastric cancer patients who underwent radical gastrectomy. The sarcopenia elements (skeletal muscle index, handgrip strength, and gait speed) were measured within 1 mo or 7 d before surgery. The patients were followed at fixed intervals to gain the outcomes. Multivariate Cox regression analysis was performed to determine the association between sarcopenia and the long-term OS of these patients according to the two criteria separately. The predictive performance of the models with AWGS2019 and EWGSOP2 were evaluated by the concordance index (C-index) and area under the time-dependent receiver operating characteristic curve (AUC). The Akaike information criterion (AIC) was applied to compare model fits.

RESULTS

The prevalence of sarcopenia was 20.5% and 11.3% according to AWGS2019 and EWGSOP2, respectively. Sarcopenia was an independent risk factor for the long-term OS no matter based on AWGS2019 or EWGSOP2, but AWGS2019-sarcopenia in multivariate model had a higher hazard ratio (HR) [2.150 (1.547-2.988)] than EWGSOP2-sarcopenia [HR 1.599 (1.092-2.339)]. Meanwhile, the model with AWGS2019-sarcopenia [C-index 0.773 (0.742-0.804); AIC 2193.7; time-dependent AUC 0.812 (0.756-0.867) for 1-year OS, 0.815 (0.778-0.852) for 3-year OS, and 0.809 (0.759-0.859) for 5-year OS] had better predictive power and model fits than the model with EWGSOP2-sarcopenia [C-index 0.762 (0.729-0.795); AIC 2215.2; time-dependent AUC 0.797 (0.741-0.854) for 1-year OS, 0.804 (0.767-0.842) for 3-year OS, and 0.799 (0.748-0.850) for 5-year OS].

CONCLUSION

Sarcopenia is an independent risk factor for the long-term OS in Chinese gastric cancer patients undergoing radical gastrectomy. The prediction model with AWGS2019-sarcopenia has better predictive power and model fits than the prediction model with EWGSOP2-sarcopenia. AWGS2019 may be more appropriate for diagnosing sarcopenia in these Chinese patients than EWGSOP2.

Keywords: Sarcopenia, Gastric cancer, EWGSOP2, AWGS2019, Chinese patients

Core Tip: Stomach cancer is an important contributor to the global burden of cancer, especially to Asian countries, while sarcopenia is a nutrition-related disease and has a profound effect on patients with gastric cancer. Early diagnosis of sarcopenia may contribute to improving the prognosis of these patients. Even though a significant difference between Asian people and European people, EWGSOP2 is more widely adopted than AWGS2019 in Asian countries. This study is the first to determine which method is more appropriate for Chinese patients and may guide Asian clinicians to make clinical decision based on our own criterion.