Body composition dynamics and impact on clinical outcome in gastric and gastro-esophageal junction cancer patients undergoing perioperative chemotherapy with the FLOT protocol

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Purpose

Perioperative chemotherapy with FLOT constitutes a standard of care approach for locally advanced, resectable gastric or gastro-esophageal junction (GEJ) cancer. We aimed at investigating anthropometric, CT-based and FDG-PET-based body composition parameters and dynamics during this multidisciplinary approach and the impact on clinical outcomes.

Methods

This retrospective, single-center study was based on medical records and (FDG-PET)-CT images among gastric/GEJ cancer patients undergoing perioperative FLOT chemotherapy.

Results

Between 2016 and 2021, 46 gastric/GEJ cancer patients started perioperative FLOT at our tertiary cancer center (Salzburg, Austria). At a median follow-up of 32 months median PFS was 47.4 months and median OS was not reached. The skeletal muscle index (SMI, cm ²/m ²) turned out to be the only body composition parameter with a statistically significant decrease during pre-operative FLOT (51.3 versus 48.8 cm ²/m ², p = 0.02). Neither pre-FLOT body mass index (BMI), nor SMI had an impact on the duration of pre-operative FLOT, the time interval from pre-operative FLOT initiation to surgery, the necessity of pre-operative or post-operative FLOT de-escalation or the likelihood of the start of postoperative chemotherapy. Pre-FLOT BMI (overweight versus normal, HR: 0.11, 95% CI: 0.02–0.65, p = 0.02) and pre-FLOT SMI (sarcopenia versus no sarcopenia, HR: 5.08, 95% CI: 1.27–20.31, p = 0.02) were statistically significantly associated with PFS in the multivariable analysis.

Conclusion

The statistically significant SMI loss during pre-operative FLOT and the meaningful impact of baseline SMI and BMI on PFS argue for the implementation of a nutritional screening and support program prior to the initiation of pre-operative FLOT in clinical routine.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00432-022-04096-w.

Related collections

Most cited references 41

Record: found
Abstract: found
Article: not found

Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial

Salah-Eddin Al-Batran, Nils Homann, Claudia Pauligk … (2019)

Docetaxel-based chemotherapy is effective in metastatic gastric and gastro-oesophageal junction adenocarcinoma. This study reports on the safety and efficacy of the docetaxel-based triplet FLOT (fluorouracil plus leucovorin, oxaliplatin and docetaxel) as a perioperative therapy for patients with locally advanced, resectable tumours.

0 comments Cited 625 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: not found
Article: not found

Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.

E.C. Smyth, M Verheij, W Allum … (2016)

0 comments Cited 614 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study.

Carla Prado, Jessica R L Lieffers, Linda McCargar … (2008)

Emerging evidence on body composition suggests that sarcopenic obesity (obesity with depleted muscle mass) might be predictive of morbidity and mortality in non-malignant disease and also of toxicity to chemotherapy. We aimed to assess the prevalence and clinical implications of sarcopenic obesity in patients with cancer. Between Jan 13, 2004, and Jan 19, 2007, 2115 patients with solid tumours of the respiratory or gastrointestinal tract from a cancer treatment centre serving northern Alberta, Canada, were identified. Available lumbar CT images of the obese patients were analysed for total skeletal muscle cross-sectional area; these values were also used to estimate total body fat-free mass (FFM). Of the 2115 patients initially identified, 325 (15%) were classified as obese (body-mass index [BMI] > or =30). Of these obese patients, 250 had CT images that met the criteria for analysis. The remaining 75 patients were recorded as without assessable scans. Obese patients had a wide range of muscle mass. Sex-specific cut-offs that defined a significant association between low muscle mass with mortality were ascertained by optimum stratification analysis: 38 (15%) of 250 patients who had assessable CT images that met the criteria for analysis were below these cut-offs and were classified as having sarcopenia. Sarcopenic obesity was associated with poorer functional status compared with obese patients who did not have sarcopenia (p=0.009), and was an independent predictor of survival (hazard ratio [HR] 4.2 [95% CI 2.4-7.2], p<0.0001). Estimated FFM showed a poor association with body-surface area (r(2)=0.37). Assuming that FFM represents the volume of distribution of many cytotoxic chemotherapy drugs, we estimated that individual variation in FFM could account for up to three-times variation in effective volume of distribution for chemotherapy administered per unit body-surface area, in this population. This study provides evidence of the great variability of body composition in patients with cancer and links body composition, especially sarcopenic obesity, to clinical implications such as functional status, survival, and potentially, chemotherapy toxicity.

0 comments Cited 556 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Lukas Weiss: lu.weiss@salk.at

Journal

Journal ID (nlm-ta): J Cancer Res Clin Oncol

Journal ID (iso-abbrev): J Cancer Res Clin Oncol

Title: Journal of Cancer Research and Clinical Oncology

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 0171-5216

ISSN (Electronic): 1432-1335

Publication date (Electronic): 21 July 2022

Publication date PMC-release: 21 July 2022

Publication date (Print): 2023

Volume: 149

Issue: 7

Pages: 3051-3064

Affiliations

[1 ]GRID grid.21604.31, ISNI 0000 0004 0523 5263, Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute , Center for Clinical Cancer and Immunology Trials (SCRI-CCCIT), , Paracelsus Medical University Salzburg, ; Salzburg, Austria

[2 ]Cancer Cluster Salzburg, Salzburg, Austria

[3 ]GRID grid.21604.31, ISNI 0000 0004 0523 5263, Department of Radiology, , Paracelsus Medical University Salzburg, ; Salzburg, Austria

[4 ]GRID grid.21604.31, ISNI 0000 0004 0523 5263, Department of Surgery, , Paracelsus Medical University Salzburg, ; Salzburg, Austria

[5 ]GRID grid.21604.31, ISNI 0000 0004 0523 5263, Institute of Pathology, , Paracelsus Medical University Salzburg, ; Salzburg, Austria

[6 ]GRID grid.21604.31, ISNI 0000 0004 0523 5263, Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, , Paracelsus Medical University Salzburg, ; Salzburg, Austria

Article

Publisher ID: 4096

DOI: 10.1007/s00432-022-04096-w

PMC ID: 10314876

PubMed ID: 35864270

SO-VID: 17f764d4-f7d5-4b94-ac99-04cb73ed7b47

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 3 April 2022

Date accepted : 27 May 2022

Funding

Funded by: Paracelsus Medical University

Open Access :

Open access funding provided by Paracelsus Medical University.

Custom metadata

ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: gastric cancer,perioperative chemotherapy,sarcopenia,skeletal muscle index,body mass index

Data availability:

ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: gastric cancer, perioperative chemotherapy, sarcopenia, skeletal muscle index, body mass index

Body composition dynamics and impact on clinical outcome in gastric and gastro-esophageal junction cancer patients undergoing perioperative chemotherapy with the FLOT protocol

Read this article at

Abstract

Purpose

Methods

Results

Conclusion

Supplementary Information

Related collections

Karger: Oncology

Most cited references 41

Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial

Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.

Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study.

Author and article information

Contributors

Journal

Affiliations

Article

History

Funding

Categories

Custom metadata

Comments

Comment on this article

Similar content 87

Cited by 2

Most referenced authors 646