Prognostic significance of sarcopenia in microsatellite-stable gastric cancer patients treated with programmed death-1 i
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ORIGINAL ARTICLE
Prognostic significance of sarcopenia in microsatellite‑stable gastric cancer patients treated with programmed death‑1 inhibitors Yeun‑Yoon Kim1,5 · Jeeyun Lee2 · Woo Kyoung Jeong1 · Seung Tae Kim2 · Jae‑Hun Kim1 · Jung Yong Hong2 · Won Ki Kang2 · Kyoung‑Mee Kim3 · Insuk Sohn4 · Dongil Choi1 Received: 26 July 2020 / Accepted: 13 September 2020 © The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2020
Abstract Background Sarcopenia has been underscored as a significant predictor of poor prognosis in cancer patients undergoing immunotherapy with programmed death-1 (PD-1) inhibitors. We aimed to investigate the prognostic significance of computed tomography (CT)-determined sarcopenia in patients with microsatellite-stable (MSS) gastric cancer (GC) treated with PD-1 inhibitors. Methods We retrospectively assessed patients with MSS GC who had been treated with PD-1 inhibitors from March 2016 to June 2019. Pre-treatment sarcopenic status was determined by analyzing L3 skeletal muscle index with abdominal CT. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan–Meier method, and the differences in survival probability according to sarcopenic status were compared using the log-rank test. Cox proportional hazards regression analyses were performed to identify predictors of PFS and OS. Results Of 149 patients with MSS GC (mean age, 57.0 ± 12.3 years; 93 men), 79 (53.0%) had sarcopenia. Patients with sarcopenia had significantly shorter PFS than patients without sarcopenia (median, 1.4 months vs. 2.6 months; P = 0.026). Sarcopenia was independently associated with shorter PFS (adjusted hazard ratio [HR], 1.79; 95% confidence interval [CI], 1.10−2.93; P = 0.020). Patients with sarcopenia had shorter OS than patients without sarcopenia (median, 3.6 months vs. 4.9 months; P = 0.052), but sarcopenia itself was not a significant prognostic factor for OS (adjusted HR, 1.01; 95% CI, 0.58−1.75; P = 0.974). Conclusions CT-determined sarcopenia is an independent prognostic factor for PFS in patients with MSS GC treated with PD-1 inhibitors. Keywords Gastric cancer · Pembrolizumab · Nivolumab · Sarcopenia
Yeun-Yoon Kim and Jeeyun Lee have contributed equally to this work. * Woo Kyoung Jeong [email protected] 1
Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon‑ro, Gangnam‑gu, Seoul 06351, Korea
2
Division of Hematology‑Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
3
Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
4
Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
5
Present Address: Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei Uni
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