Cachexia index and its relationship with resection operability in patients with gastric adenocarcinoma

© 2018 The Authors; Tabriz University of Medical Sciences This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Cachexia index and its relationship with resection operability in patients with gastric adenocarcinoma

Citation: Barband A, Kakaei F, Javadrashid R, Ebrahimi-Mameghani M, Mafi M. Cachexia index and its relationship with resection operability in patients with gastric adenocarcinoma.J Anal Res Clin Med 2018; 6(2): 93-7.Doi: 10.15171/jarcm.2018.014Gastric cancer is one of the most common malignancies worldwide.Although there has been a considerable advance in its treatment, the five-year survival is low. 1 Gastric cancer is the most common and second most common malignancy in men and women, respectively in Iran. 2,3The signs and symptoms of this malignancy are unexplained weight loss, anorexia, dyspepsia, fullness feeling in the epigastrium, early satiety, nausea and vomiting.Early attention to these signs and symptoms leads to early diagnosis of the disease. 4n spite of outstanding advances in the surgical techniques and use of adjuvant chemotherapy, the long-term survival of the disease is not good. 5Considering all these, gastric cancer is considered a major healthcare associated issue worldwide.Besides surgery, which is the mainstay therapy for gastric cancer, the nutritional state of the patient before surgery has an important impact on the general condition and postsurgical long-term outcomes of the patient. 6,7achexia is a clinical syndrome; 8 a patient with advanced cachexia experiences, severe weight loss, significant anorexia, fatigue, anaemia and oedema. 9The mentioned presentation and its severity may change in the early-onset forms of cachexia. 10here has been no single definition of cachexia that all scientists would agree upon, but generally an unexplained weight loss more than 10% in a 6-month period is equivalent to cachexia happening in 30%-50% of gastrointestinal (GI) problems. 11Anorexia and poor nutrition which happen during cachexia stem from the changes in the GI system, and protein as well as fat metabolism leads to the muscle volume and adipose tissue loss. 12,13The mentioned volume loss is also seen in the respiratory muscles which finally causes pulmonary failure and dyspnea. 14achexia syndrome is usually considered to be a one-way, irreversible road.However, in some inoperable cases of malignancies, nutritional interventions have been shown to have promising effects on weight gain. 15his study aimed to evaluate the frequency of severe weight loss and the possibility of surgical resection in patients with gastric adenocarcinoma.
Gastric cancer is one of the most common malignancies worldwide.Although there has been a considerable advance in its treatment, the five-year survival is low. 1 Gastric cancer is the most common and second most common malignancy in men and women, respectively in Iran. 2,3The signs and symptoms of this malignancy are unexplained weight loss, anorexia, dyspepsia, fullness feeling in the epigastrium, early satiety, nausea and vomiting.Early attention to these signs and symptoms leads to early diagnosis of the disease. 4n spite of outstanding advances in the surgical techniques and use of adjuvant chemotherapy, the long-term survival of the disease is not good. 5Considering all these, gastric cancer is considered a major healthcare associated issue worldwide.Besides surgery, which is the mainstay therapy for gastric cancer, the nutritional state of the patient before surgery has an important impact on the general condition and postsurgical long-term outcomes of the patient. 6,7achexia is a clinical syndrome; 8 a patient with advanced cachexia experiences, severe weight loss, significant anorexia, fatigue, anaemia and oedema. 9The mentioned presentation and its severity may change in the early-onset forms of cachexia. 10here has been no single definition of cachexia that all scientists would agree upon, but generally an unexplained weight loss more than 10% in a 6-month period is equivalent to cachexia happening in 30%-50% of gastrointestinal (GI) problems. 11norexia and poor nutrition which happen during cachexia stem from the changes in the GI system, and protein as well as fat metabolism leads to the muscle volume and adipose tissue loss. 12,13The mentioned volume loss is also seen in the respiratory muscles which finally causes pulmonary failure and dyspnea. 14achexia syndrome is usually considered to be a one-way, irreversible road.However, in some inoperable cases of malignancies, nutritional interventions have been shown to have promising effects on their weight gain. 15his study aimed to evaluate the frequency of severe weight loss and the possibility of surgical resection in patients with gastric adenocarcinoma.
Out of 36 patients enrolled into the study, 25 (69.4%)patients were men and 11 (30.6%)patients were women, who aged between 46 and 85 years with a mean of 61.10 ± 12.37 years.The average time in which the patients had a final diagnosis of gastric adenocarcinoma was 4.47 ± 3.11 months ranging from 1 to 13 months.Table 1 shows the signs and symptoms of gastric cancer in studied patients.3 shows the frequency of the operability of the patients according to the presence of clinical cachexia syndrome.
Based on table 3, rate of operability in patients with clinical cachexia was significantly lower than patients without clinical cachexia (P = 0.001).Mean of cachexia index in operable and inoperable patients were 53.78 ± 19.35 and 59.84 ± 18.98, respectively.There were no significant differences in mean cachexia index between operable and inoperable patients (P = 0.105).
Loss of body mass (either adipose or nonadipose) is associated with the increased risk of chronic diseases and their related disabilities.Further, body adipose mass is directly correlated with the survival of patients with malignancies or severe ailments. 17,18Due to the importance of gastric cancer in our region, we evaluated the frequency of severe weight loss and the possibility of surgical resection in patients with gastric adenocarcinoma.In a group of 36 patients with gastric adenocarcinoma, those with clinical cachexia syndrome had significantly higher rate of nonoperability.However, the operable and nonoperable groups had no significant difference in their cachexia index.
In a study by Kim et al., 250 patients with renal cell carcinoma who underwent radical nephrectomy, were followed up for an average of 33 to 43 months.37 patients (14.8%) who had at least one sign/symptom indicating cachexia, were considered cachectic.This was associated with a low survival rate in these patients. 19In another study by Davidson et al., the survival rate of patients with pancreas cancer was assessed in two groups.Patients who had lost more than 1 kg in eight weeks were grouped in the weight losing category.This study showed that this group had a lower survival rate compared to the other one. 20In line with the above-mentioned studies, we showed that the operability rate of cachectic patients was lower than that of non-cachectic ones, indicating a lower survival rate in the former.
In another study by Capuano et al., the effect of weight loss on the prognosis of patients with head and neck malignancies was evaluated in 40 patients.

Patients with cachexia syndrome (n = 5) [n (%)]
Cachexia syndrome Operability 26 (83.9) 0 (0) Operable 5 (16.1) 5 (100) Inoperable 0.001 P The authors showed that weight loss more than 20% before the initiation of treatment is directly associated with early death, higher mortality, higher infection rate, higher admission to the hospital, and lower survival rate. 21The results of this study showed that the patients who were suffering from cachexia syndrome had a lower operability and survival rates compared to the others.
In a study by Sebastiano et al., the impact of cachexia syndrome on the prognosis of 50 patients with pancreas cancer was assessed.The authors evaluated the body adipose and muscular mass changes using CT-scan, and showed that in average the patients had lost 1.72 kg of muscular and 1.04 kg of adipose tissue mass.They concluded that the higher weight loss rate is linked to the lower survival period. 22However, in this study, we could not show a statistically significant link between cachexia index and operability/non-operability of the patients.
In another study by Dalal et al., the association between BMI as well as longitudinal body composition alterations with the survival rate of 41 patients with pancreas cancer was assessed.These patients were nonoperable, and received chemo-radiation.Body composition was assessed using CT-scan before and after radiation (a 104-day period).In average, the patients had 5% weight loss, 13% adipose tissue loss, and 4% muscle mass loss.Advanced age, underlying obesity, increased weight loss, and adipose and muscle mass loss bore a lower survival rate. 23In line with that, in this study, the operability of the patients with gastric adenocarcinoma had a reverse link with cachexia syndrome.
Yip et al. assessed sarcopenia (muscle mass loss more than 2 SD) using CT-scan before and after pretreatment with N-acetylcysteine (NAC) in 35 patients with esophageal cancer.These patients underwent esophagectomy and received chemotherapy.The results of this study showed that there was no significant link between changes in the body mass and patients' survival rate. 24We did not directly assess the survival rate of the patients in this study; thus, we cannot compare the results with that of Yip

Table 1 .
Signs and symptoms of patients

Table 2
illustrates the clinical, laboratory and CT-scan findings of the included patients.

Table 2 .
Clinical, laboratory and computed tomography (CT)-scan findings of patients et al.'s study.This article is resulted from a thesis registered at Tabriz University of Medical Sciences (number: 94/3-10/18).This research was supported by Tabriz University of Medical Sciences.Authors have no conflict of interest.This study was approved by the Medical Ethics Committee of Tabriz University of Medical Sciences with registration code of 94/3-10/18.