Prognosis in advanced gastric cancer (aGC) is predicted by clinical factors, such as stage, performance status, metastasis location, and the neutrophil-to-lymphocyte ratio. However, the role of body composition and sarcopenia in aGC survival remains debated. This study aimed to evaluate how abdominal visceral and subcutaneous fat volumes, psoas muscle volume, and the visceral-to-subcutaneous (VF/SF) volume ratio impact overall survival (OS) and progression-free survival (PFS) in aGC patients receiving first-line palliative chemotherapy. We retrospectively examined CT scans of 65 aGC patients, quantifying body composition parameters (BCPs) in 2D and 3D. Normalized 3D BCP volumes were determined, and the VF/SF ratio was computed. Survival outcomes were analyzed using the Cox Proportional Hazard model between the upper and lower halves of the distribution. Additionally, response to first-line chemotherapy was compared using the χ2test. Patients with a higher VF/SF ratio (N= 33) exhibited significantly poorer OS (p= 0.02) and PFS (p< 0.005) and had a less favorable response to first-line chemotherapy (p= 0.033), with a lower Disease Control Rate (p= 0.016). Notably, absolute BCP measures and sarcopenia did not predict survival. In conclusion, radiologically assessed VF/SF volume ratio emerged as a robust and independent predictor of both survival and treatment response in aGC patients.
晚期胃癌（aGC）的预后通常通过临床因素进行预测，如肿瘤分期、体能状态、转移部位及中性粒细胞与淋巴细胞比值。然而，身体成分与肌肉减少症在晚期胃癌生存中的作用仍存在争议。本研究旨在评估腹部内脏脂肪与皮下脂肪体积、腰大肌体积以及内脏脂肪与皮下脂肪体积比（VF/SF）对接受一线姑息化疗的晚期胃癌患者总生存期（OS）和无进展生存期（PFS）的影响。我们回顾性分析了65例晚期胃癌患者的CT影像，以二维和三维方式量化身体成分参数（BCPs），计算了归一化的三维BCP体积及VF/SF比值。通过Cox比例风险模型比较分布上下半区患者的生存结局，并采用χ2检验比较一线化疗的应答情况。结果显示，VF/SF比值较高（N=33）的患者总生存期（p=0.02）和无进展生存期（p<0.005）显著更差，对一线化疗的应答率较低（p=0.033），疾病控制率也较低（p=0.016）。值得注意的是，绝对BCP指标和肌肉减少症并未显示出对生存的预测能力。综上所述，影像学评估的VF/SF体积比是晚期胃癌患者生存和治疗应答的强效独立预测因子。
肿瘤(癌症)患者之家