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Textbook oncological outcome of locally advanced gastric cancer patients with preoperative sarcopenia: a multicenter clinical study

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Abstract

Background

The impact of postoperative sarcopenia on the Textbook Oncological Outcome (TOO) in locally advanced gastric cancer (LAGC) remains uncertain. This study investigates the relationship between sarcopenia and TOO, explores its long-term prognostic value, and develops a prognostic model incorporating sarcopenia and TOO for survival prediction.

Methods

We performed a retrospective analysis of clinical and pathological data from patients with LAGC who underwent radical surgery at two Chinese tertiary referral hospitals. Sarcopenia was defined as an SMI < 36.4 cm2/m2 in males and < 28.4 cm2/m2 in females. TOO was defined as the addition of perioperative chemotherapy to the textbook outcomes (TO). A nomogram was developed to predict postoperative overall survival (OS) and recurrence-free survival (RFS) in LAGC patients.

Results

The study included 972 patients with LAGC. The overall TOO achievement rate was 67.1%. The TOO achievement rate was significantly higher in patients non-sarcopenia compared to those with sarcopenia (68.9% vs. 61.1%, P = 0.031). Logistic regression revealed that age ≥ 65, high ASA score, and sarcopenia were independent risk factors for TOO failure. Cox regression analysis identified TOO, sarcopenia, tumor size, differentiation, vascular invasion, pT stage, and pN stage as independent predictors of OS and RFS. Nomogram models based on sarcopenia and TOO accurately predicted the 3-year and 5-year OS and RFS.

Conclusion

Preoperative sarcopenia was an independent predictor of TOO implementation. A prognostic prediction model that integrates preoperative sarcopenia and TOO, which outperforms the current staging system, can aid clinicians in effectively assessing the prognosis of patients with LAGC.

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Acknowledgements

This study was supported by the Fujian Research and Training Grants for Young and Middle-aged Leaders in Healthcare (No.[2022] 954).

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Correspondence to Chang-Ming Huang or Ping Li.

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Disclosures

Qing Zhong, Zi-Fang Zheng, Dong Wu, Zhi-Xin Shang-Guan, Zhi-Yu Liu, Yi-Ming Jiang, Jian-Xian Lin, Jia-Bin Wang, Qi-Yue Chen, Jian-Wei Xie, Wei Lin, Chao-Hui Zheng, Chang-Ming Huang, and Ping Li have no conflicts of interest or financial ties to disclose.

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Supplementary Information

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464_2024_11397_MOESM1_ESM.jpg

Supplementary file1 (JPG 249 KB)—Flowchart of the patient selection process. FMUUH: Fujian Medical University Union Hospital; AHPTU: Affiliated Hospital of Putian University

464_2024_11397_MOESM2_ESM.jpg

Supplementary file2 (JPG 164 KB)—Measurement of skeletal muscle index (SMI) in GC patients. Axial computed tomography slice of the third lumbar vertebra (L3). Red areas indicate skeletal muscle mass. (a: Typical non-sarcopenia; b: Typical sarcopenia)

464_2024_11397_MOESM3_ESM.jpg

Supplementary file3 (JPG 204 KB)—Calibration plot of the nomogram for (A) 3-year and (B) 5-year OS; Calibration plot of the nomogram for (C) 3-year and (D) 5-year RFS

464_2024_11397_MOESM4_ESM.jpg

Supplementary file4 (JPG 164 KB)—Decision curve analysis of the nomogram and pTN for the survival prediction of patients with GC. A, B 3-year and 5-year OS. C, D 3-year and 5-year RFS

464_2024_11397_MOESM5_ESM.jpg

Supplementary file5 (JPG 109 KB)—Time-dependent receiver operating characteristic (ROC) curves for the nomogram and pTN for the prediction. The horizontal axis represents year after surgery, and the vertical axis represents the estimated area under the ROC curve for survival at the time of interest. A: OS, B: RFS

Supplementary file6 (DOCX 29 KB)—

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Zhong, Q., Zheng, ZF., Wu, D. et al. Textbook oncological outcome of locally advanced gastric cancer patients with preoperative sarcopenia: a multicenter clinical study. Surg Endosc 39, 356–367 (2025). https://doi.org/10.1007/s00464-024-11397-3

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