title: A Novel Prognostic Scoring System Based on Preoperative Sarcopenia Predicts the Long-Term Outcome for Patients After R0 Resection for Gastric Cancer: Experiences of a High-Volume Center.
abstract: BACKGROUND
  The relationship between sarcopenia and prognosis of gastric cancer (GC) is unclear. This study aimed to develop a prognostic scoring system combining sarcopenia with preoperative clinical parameters for patients with GC to predict 3-year overall survival (OS) and 3-year recurrence-free survival (RFS).
  
  
  METHODS
  In this study, 924 patients with GC who underwent radical gastrectomy were retrospectively analyzed. The data were divided into a training set and a validation set. Sarcopenia was diagnosed by the cutoff value of the skeletal muscle index (SMI) obtained by X-tile software. The study used COX regression to identify preoperative risk factors associated with 3-year OS and RFS.
  
  
  RESULTS
  In the training set, 103 patients (14.8%) were sarcopenic based on the cutoff value of the SMI (32.5 cm2/m2for men and 28.6 cm2/m2for women). Multivariate analysis showed the following preoperative risk factors for the training set: sarcopenia and preoperative T (cT) and N (cN) stages. A prognostic scoring system was developed based on these findings. The 3-year OS rates were 89% for the low-risk patients, 77.9% for the intermediate-risk patients, and 54.8% for the high-risk patients (P < 0.001), and the 3-year RFS rates were respectively 86.9, 75.3 and 49.3% (P < 0.001). The area under the receiver operating characteristic curves were 0.708 for the 3-year OS rates and 0.713 for the 3-year RFS rates. The observed and predicted incidence rates for 3-year OS and RFS in the validation set did not differ significantly.
  
  
  CONCLUSIONS
  The prognostic scoring system combining sarcopenia with the cT and cN system can accurately predict 3-year OS and RFS rates after radical gastrectomy for GC.
authors.affiliation: Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
authors.forename: Zhi-Fang
authors.initials: ZF
authors.lastname: Zheng
authors.affiliation: Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Lu
authors.affiliation: Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
authors.forename: Chao-Hui
authors.initials: CH
authors.lastname: Zheng
authors.affiliation: Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Li
authors.affiliation: Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
authors.forename: Jian-Wei
authors.initials: JW
authors.lastname: Xie
authors.affiliation: Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
authors.forename: Jia-Bin
authors.initials: JB
authors.lastname: Wang
authors.affiliation: Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
authors.forename: Jian-Xian
authors.initials: JX
authors.lastname: Lin
authors.affiliation: Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
authors.forename: Qi-Yue
authors.initials: QY
authors.lastname: Chen
authors.affiliation: Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
authors.forename: Mi
authors.initials: M
authors.lastname: Lin
authors.affiliation: Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China. hcmlr2002@163.com.
authors.forename: Chang-Ming
authors.initials: CM
authors.lastname: Huang
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000401:mortality*; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology*; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D055948:Sarcopenia / Q000150:complications* / Q000473:pathology; D013274:Stomach Neoplasms / Q000209:etiology / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D015996:Survival Rate