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    Clinical Impact of Sarcopenia on Gastric Cancer and the Effect of Neoadjuvant Chemotherapy on Sarcopenia
    (2022) Parsak, Cem Kaan; Gumus, Serdar; Gul, Mehmet Onur; Altiok, Merih; Unal, Ayse Gizem; Yalav, Orcun; Bali, Cagla
    Background: Sarcopenia may adversely affect treatment responses and oncological outcomes in cancer patients. However, the importance of pretreatment nutritional assessment as an indicator of treatment response and outcome in patients with gastric cancer undergoing neoadjuvant chemotherapy remains unclear. Objectives: This study aims to investigate the clinical impact of sarcopenia on gastric cancer and to determine the effect of neoadjuvant chemotherapy (NC) on sarcopenia, as well as body mass index (BMI), psoas muscle index (PMI), and prognostic nutrition index (PNI). Methods: A retrospective review was performed on patients with gastric adenocarcinoma who were operated on after the NC therapy between January 2016 and December 2019. Weight, BMI-, PMI-, and PNI-dependent variables were compared before and after the NC treatment. Sarcopenia was defined according to PMI at the level of the third lumbar vertebra based on computed tomography. Results: Forty-five patients (64.4% women) with a mean age of 56.9 +/- 11.2 years were included in the study. After the NC treatment, the mean BMI of the cohort decreased from 26.1 +/- 4.3 kg/m(2) to 25.1 +/- 4.2 kg/m(2), the mean PMI decreased from 5.69 +/- 1.39 cm(2)/m(2) to 5.16 +/- 1.50 cm(2)/m(2), and the mean PNI decreased from 46.6 +/- 6.5 to 40.0 +/- 7.0 (All, P<0.001). The NC treatment increased the frequency of sarcopenia from 48.9% to 64.5% (P<0.001). According to the Clavien-Dindo (CD) scoring, grade >3 CD complications were more common in the sarcopenic group (27.2%), compared to the non-sarcopenic group (8.7%) (P=0.049). The one-year and three-years overall survival rates were lower in the sarcopenic group (91.7% and 38.2%, respectively), compared to the non-sarcopenic group (93.8% and 45.8%, respectively). However, it was not statistically significant (P=0.509). Conclusion: Sarcopenia is associated with severe postoperative complications in gastric cancer. In addition, the NC treatment reduces PMI, BMI, as well as PNI, and increases sarcopenia frequency. Therefore, patients should be examined in terms of sarcopenia at the time of diagnosis.
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    Prediction of Peritoneal Recurrence in Patients with Gastric Cancer: a Multicenter Study
    (2020) Kus, Tulay; Kose, Fatih; Aktas, Gokmen; Arslan, Ulku Yalcintas; Sedef, Ali Murat; Cinkir, Havva Yesil; Dirikoc, Merve; Akkus, Gulsum; Ozdemir, Nuriye Yildirim; 0000-0002-0156-5973; 32578034; G-4827-2016
    Purpose The peritoneum is the common recurrence site of gastric cancer (GC) presenting with worse survival. Although some predictive clinicopathological factors have been identified, there is no comprehensive assessment of peritoneal recurrence risk prediction for patients treated with adjuvant chemotherapy (CR) or chemoradiotherapy (CRT) after surgery. We aimed to predict peritoneal recurrence and develop a new scoring model in GC. Methods This retrospective study included 274 GC patients who presented with recurrence after curative gastrectomy followed by adjuvant chemotherapy (CT) or chemoradiotherapy (CRT). Risk factors for peritoneal recurrence were analyzed using the following parameters: age, gender, tumor location and characteristics, and differences between treatment modalities. All parameters were assessed by binary logistic regression analysis to compare the patients with and without peritoneal recurrence. Then, a new risk scoring model was developed. Results Peritoneal recurrence was observed in 115 (44.1%) patients. Peritoneal recurrence was higher in female gender (odds ratio (OR), 1.93; 1.07-3.49,P = 0.030, 1 point), T4a-b stage (OR, 2.47; 1.14-5.36,P = 0.022, 1 point), poor/undifferentiated (OR, 2.04; 1.31-4.06,P = 0.004, 1 point), and signet cell carcinoma (OR, 2.04; 1.04-4.02,P = 0.038, 1 point) after adjusted for resection and dissection types. The risk scoring model was developed using the related parameters: Peritoneal recurrence rates were 24.6%, 42.6%, and 71.4% for group 1 (0 point), group 2 (1-2 points), and group 3 (3-4 points), respectively. Conclusion Female gender, T4 tumor stage, undifferentiated histopathology, and signet cell type had a tendency to peritoneal recurrence after adjusted for treatment modalities. Patients with 3 or 4 risk factors had an 8.8-fold increased risk for the development of peritoneal recurrence.