The Effect Of Sarcopenia On The Compliance And Recurrence-free Survival Of Adjuvant Chemotherapy After Radical Gastric In Patients With Gastric Cancer

Background and Aims:It is well known that adjuvant chemotherapy after radical surgery is crucial for patients with gastric cancer(GC),Non-compliance and premature stopping of chemotherapy can affect the survival and prognosis of patients.Studies have shown that sarcopenia is closely associated with postoperative complications and a high prevalence of side effects of chemotherapy.Moreover,the association among compliance of adjuvant chemotherapy,prognosis and sarcopenia remains controversial.Thus,the aim of this retrospective study is to explore the effect of sarcopenia on the completion of adjuvant chemotherapy in GC patients,and to assess whether it correlates with compliance of chemotherapy and outcomes.It is important to improve compliance of postoperative chemotherapy and ameliorate prognosis of patients with GC.Methods:This is a retrospective study that included 161 patients with GC who underwent GC surgery and adjuvant chemotherapy at our center during a period from January 1,2017 to December 31,2019.Clinical characteristics and follow-up data are collected.The cross‐sectional area of the third lumbar skeletal muscle based on computed tomography(CT)scan is measured and the skeletal muscle index(SMI)is calculated.Sarcopenia is defined as SMI≤38.5cm~2/m~2 for women and≤52.4 cm~2/m~2 for men.Adequate adherence is defined as a patient receiving at least 6 cycles of adjuvant chemotherapy within 6 months following surgery.Kaplan–Meier survival curve and Cox regression analysis are used to demonstrate the effect of sarcopenia and other clinicopathologic factors on Recurrence-free survival(RFS)of gastric cancer patients.Binary logistic regression analysis is performed to investigated the associations between sarcopenia and compliance of postoperative chemotherapy,hematotoxicity of chemotherapies and other clinicopathologic factors in patients with GC.Results:100 of the 161 patients who underwent radical gastrectomy included are preoperatively combined with sarcopenia,accounting for 62.11%.A total of 54(33.54%)is reported good chemotherapy compliance.In multivariate Cox regression analysis,advanced p TNM stage(HR=4.52,95%CI=[1.687-12.108],P=0.003)、Postoperative adjuvant chemotherapy is not completed within 6 months after surgery(HR=2.854,95%CI=[1.066-7.642],P=0.037)、Sarcopenia(HR=3.319,95%CI=[1.132-9.731],P=0.029)are independent risk factors for poor prognosis in gastric cancer patients.However,in multivariate binary logistic regression analysis,age≥65years(OR=0.287,95%CI=[0.11-0.753],P=0.011),the interval time from surgery to the first dose of chemotherapy≥32 days(OR=0.339,95%CI=[0.144-0.798],P=0.013)as well as hematotoxicity of chemotherapies(grade III or IV)(OR=3.062,95%CI=[1.309-7.161],P=0.01)are independent risk factors for poor compliance with chemotherapy.Furthermore,male(OR=5.185,95%CI=[2.194-12.256],P<0.001),body mass index(BMI)(OR=0.18,95%CI=[0.093-0.347],P<0.001)and hematotoxicity of chemotherapies(grade III or IV)(OR=2.817,95%CI=[1.186-6.693],P=0.02)are significantly related to sarcopenia.Finally,we find that the preoperative BMI level of the patient is negativelyrelatedtotheincidenceofsarcopenia(22.26±3.23vs45.51±8.76,P<0.001),the lower the BMI index,the higher the risk of sarcopenia.Conclusion:Sarcopenia and chemotherapy compliance are independent risk factors for poor prognosis of patients with GC.The preoperative sarcopenia can increase haematotoxicity of chemotherapies in patients with GC and affect their chemotherapy compliance.