성균관의대 / 유정일*, 임도훈*
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.