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Detection of sarcopenic obesity and prediction of long-term survival in patients with gastric cancer using preoperative computed tomography and machine learning

Authors
 Jaehyuk Kim  ;  Seung Hee Han  ;  Hyoung-Il Kim 
Citation
 JOURNAL OF SURGICAL ONCOLOGY, Vol.124(8) : 1347-1355, 2021-12 
Journal Title
JOURNAL OF SURGICAL ONCOLOGY
ISSN
 0022-4790 
Issue Date
2021-12
MeSH
Body Composition ; Body Mass Index ; Case-Control Studies ; Cross-Sectional Studies ; Female ; Follow-Up Studies ; Gastrectomy / adverse effects* ; Humans ; Machine Learning* ; Male ; Middle Aged ; Muscle, Skeletal / diagnostic imaging ; Muscle, Skeletal / pathology* ; Obesity / diagnosis ; Obesity / diagnostic imaging ; Obesity / etiology ; Obesity / mortality* ; Prognosis ; Risk Factors ; Sarcopenia / diagnosis ; Sarcopenia / diagnostic imaging ; Sarcopenia / etiology ; Sarcopenia / mortality* ; Stomach Neoplasms / pathology ; Stomach Neoplasms / surgery* ; Survival Rate ; Tomography, X-Ray Computed / methods*
Keywords
body mass index ; gastric cancer ; machine learning ; nutrition process ; sarcopenic obesity ; survival
Abstract
Background: Previous studies evaluating the prognostic value of computed tomography (CT)-derived body composition data have included few patients. Thus, we assessed the prevalence and prognostic value of sarcopenic obesity in a large population of gastric cancer patients using preoperative CT, as nutritional status is a predictor of long-term survival after gastric cancer surgery.

Methods: Preoperative CT images were analyzed for 840 gastric cancer patients who underwent gastrectomy between March 2009 and June 2018. Machine learning algorithms were used to automatically detect the third lumbar (L3) vertebral level and segment the body composition. Visceral fat area and skeletal muscle index at L3 were determined and used to classify patients into obesity, sarcopenia, or sarcopenic obesity groups.

Results: Out of 840 patients (mean age = 60.4 years; 526 [62.6%] men), 534 (63.5%) had visceral obesity, 119 (14.2%) had sarcopenia, and 48 (5.7%) patients had sarcopenic obesity. Patients with sarcopenic obesity had a poorer prognosis than those without sarcopenia (hazard ratio [HR] = 3.325; 95% confidence interval [CI] = 1.698-6.508). Multivariate analysis identified sarcopenic obesity as an independent risk factor for increased mortality (HR = 2.608; 95% CI = 1.313-5.179). Other risk factors were greater extent of gastrectomy (HR = 1.928; 95% CI = 1.260-2.950), lower prognostic nutritional index (HR = 0.934; 95% CI = 0.901-0.969), higher neutrophil count (HR = 1.101; 95% CI = 1.031-1.176), lymph node metastasis (HR = 6.291; 95% CI = 3.498-11.314), and R1/2 resection (HR = 4.817; 95% CI = 1.518-9.179).

Conclusion: Body composition analysis automated by machine learning predicted long-term survival in patients with gastric cancer.
Full Text
https://onlinelibrary.wiley.com/doi/10.1002/jso.26668
DOI
10.1002/jso.26668
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Hyoung Il(김형일) ORCID logo https://orcid.org/0000-0002-6134-4523
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/187205
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