Sarcopenia defined by the global leadership initiative in sarcopenia (GLIS) consensus predicts adverse postoperative outcomes in patients undergoing radical gastrectomy for gastric cancer: analysis from a prospective cohort study.

Background: Global Leadership Initiative in Sarcopenia (GLIS) has recently established a conceptional definition of sarcopenia, which incorporated muscle strength, mass, and muscle-specific strength as three components of sarcopenia. The present study aimed to investigate the value of sarcopenia defined by the GLIS consensus in predicting the postoperative outcomes.

Methods: Clinical data of 1654 patients who underwent radical gastrectomy for gastric cancer were prospectively collected. Muscle strength was measured by the grip strength test. Muscle mass was measured by calculating skeletal muscle index (SMI) using abdominal computed tomography images. Muscle-specific strength was determined by the ratio of grip strength to SMI. Sarcopenia was diagnosed by having low muscle-specific strength (criteria 1), or low muscle strength plus low muscle mass (criteria 2), or low muscle strength plus either low muscle mass or low muscle-specific strength (criteria 3).

Results: The incidence of sarcopenia identified by criteria 1, 2, and 3 were 24.2%, 17.0%, and 32.5%, respectively. All three criteria showed significant association with postoperative total complications, overall survival (OS), and disease-free survival (DFS). However, criteria 1 showed no significant association with severe complications. Criteria 2 did not remain significant in predicting DFS in the multivariate analyses. Criteria 3 showed the largest Youden index and area under receiver operating characteristic curve (AUC) in predicting total complications, 3-year and 5-year mortality, and low physical performance.

Conclusion: Sarcopenia defined by low muscle strength plus either low muscle mass or low muscle-specific strength showed optimal predictive value for postoperative outcomes in patients with gastric cancer.