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  • [Radiother Oncol.] Effect of baseline sarcopenia on adjuvant treatment for D2 dissected gastric cancer: Analysis of the ARTIST phase III trial

    [Radiother Oncol.] Effect of baseline sarcopenia on adjuvant treatment for D2 dissected gastric cancer: Analysis of the ARTIST phase III trial

    성균관의대 / 유정일*, 임도훈*

  • 출처
    Radiother Oncol.
  • 등재일
    2020 Nov
  • 저널이슈번호
    152:19-25. doi: 10.1016/j.radonc.2020.07.043. Epub 2020 Jul 31.
  • 내용

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    Abstract
    Background and purpose: This study evaluated the clinical significance of preoperative sarcopenia according to adjuvant concurrent chemo-radiotherapy (XP-RT) or chemotherapy alone (XP) in the D2 dissected gastric cancer patient cohort of the ARTIST trial.

    Materials and methods: Skeletal muscles at the L3 vertebra level from preoperative computed tomography images among the ARTIST trial participants were measured using validated in-house software. Skeletal muscle index (SMI) was defined as the measured skeletal muscle area divided by the square of the height, and sarcopenia was defined according to the Korean-specific cutoff, i.e. L3 SMI ≤ 49 cm2/m2 for men and ≤31 cm2/m2 for women.

    Results: Among the 440 patients in whom we were able to evaluate L3 SMI, 75 (17.0%) met the definition for preoperative sarcopenia. No differences in treatment-related toxicities or treatment compliance were observed according to the presence of preoperative sarcopenia in either treatment arm. In the subgroup of patients without preoperative sarcopenia, recurrence was significantly lower in the XP-RT arm than that in the XP arm (p = 0.02). Recurrence-free survival (RFS) was also significantly higher in the XP-RT arm (p = 0.02, hazard ratio 0.633, 95% confidence interval 0.433-0.926) in this subgroup. In the multivariate analysis, and after adjusting for significant prognostic factors, the superior outcome of XP-RT arm regarding RFS was maintained in the subgroup of the patients without preoperative sarcopenia.

    Conclusions: Superior clinical outcomes of adjuvant XP-RT over XP were only observed in patients without preoperative sarcopenia.

     

     

    그림 1. ARTIST 연구에서 Korean-specific cutoff로 정의된 수술전 근감소증 분포

     

    그림 2. 수술전 근감소증 동반 하위그룹의 adjusted recurrence-free survival 및 overall survival 그래프

     

    그림 3. 수술전 근감소증 비동반 하위그룹의 adjusted recurrence-free survival 및 overall survival 그래프

    Affiliations

    Jeong Il Yu  1 , Changhoon Choi  2 , Jeeyun Lee  3 , Won Ki Kang  3 , Se Hoon Park  3 , Seung Tae Kim  3 , Jung Yong Hong  3 , Sung Kim  4 , Tae Sung Sohn  4 , Jun Ho Lee  4 , Ji Yeong An  4 , Min Gew Choi  4 , Jae Moon Bae  4 , Kyoung-Mee Kim  5 , Heewon Han  6 , Kyunga Kim  6 , Heerim Nam  7 , Do Hoon Lim  8
    1 Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: jeongil.yu@samsung.com.
    2 Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
    3 Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
    4 Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
    5 Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
    6 Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea.
    7 Department of Radiation Oncology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
    8 Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: dh8.lim@samsung.com.

  • 키워드
    Adjuvant; Concurrent chemo-radiotherapy; Gastric cancer; Recurrence; Sarcopenia.
  • 연구소개
    근치적 수술을 받은 위암 환자에서 수술후 항암치료 단독과 비교하여 아직 효과가 증명되지 않은 수술후 항암화학방사선병용요법 (CCRT)의 우월성을 확인하고자 시행된 무작위 3상 연구인 ARTIST 연구에 대한 하위그룹 분석연구입니다. ARTIST 연구에서 수술후 CCRT는 전체 환자 대상으로 우월성을 보여주지 못하였으나, 림프절전이 동반 환자 군에서 효과가 있을 가능성을 보여준 바 있습니다. 본 연구는 수술전 획득된 CT 영상에서 L3(3번 요추) 부에서 분석된 골격근 인덱스를 바탕으로 정의된 근감소증 여부에 따른 수술후 CCRT 효과의 차이를 비교한 바, 수술후 CCRT는 근감소증이 없는 하위그룹에서만 효과를 보여주었고, 근감소증이 없는 하위그룹에서는 수술후 항암치료 군과 차이가 없는 것으로 확인되었습니다.
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