European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2026
Association of body composition parameters with pathological response to neoadjuvant immunochemotherapy in locally advanced gastric cancer.
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Lu Xinglong, Cui Xiang, Chen Hao, Zhang Jianling, Zhang Xiaobei, Yang Huan, Yin Liang, Yang Baoshun, An Jixi, Wang Gang, Yu Yongjiang
Аннотация
BACKGROUND: The association between body composition and pathological response to neoadjuvant immunochemotherapy (NICT) in locally advanced gastric cancer (LAGC) is unclear. This study aimed to investigate its impact.
METHODS: This retrospective study included 261 LAGC patients admitted to the First Hospital of Lanzhou University between January 1, 2021 and December 31, 2024, who received NICT and subsequently underwent radical gastrectomy. Based on postoperative pathological evaluation, patients were divided into the Major Pathological Response group (MPR, n = 84) and the Incomplete Pathological Response group (IPR, n = 177). Utilizing pre- and post-NICT abdominal CT images, various body composition parameters were measured at the level of the third lumbar vertebra (L3). Various statistical methods were employed to systematically screen for factors associated with pathological response after NICT.
RESULTS: Skeletal muscle density (SMD) decreased most significantly (38.9 ± 6.6 vs. 29.7 ± 3.8 HU, P < 0.001). Multivariate logistic regression analysis revealed that the absolute decrease in skeletal muscle index (SMI) during treatment was associated with lower odds of MPR (OR: 1.116, 95% CI: 1.015-1.225, P = 0.023). Exploratory analysis suggested that both pre-treatment low SMI (22.6% vs 39.0%, P = 0.009) and post-treatment low SMI (20.2% vs 44.1%, P < 0.001) were associated with poorer pathological response. Nutritional and body composition parameters decreased post-NICT.
CONCLUSION: Progressive muscle loss during NICT is associated with pathological response in LAGC. Dynamic monitoring of body composition may generate hypotheses for future interventional studies. External validation is required before clinical application.
METHODS: This retrospective study included 261 LAGC patients admitted to the First Hospital of Lanzhou University between January 1, 2021 and December 31, 2024, who received NICT and subsequently underwent radical gastrectomy. Based on postoperative pathological evaluation, patients were divided into the Major Pathological Response group (MPR, n = 84) and the Incomplete Pathological Response group (IPR, n = 177). Utilizing pre- and post-NICT abdominal CT images, various body composition parameters were measured at the level of the third lumbar vertebra (L3). Various statistical methods were employed to systematically screen for factors associated with pathological response after NICT.
RESULTS: Skeletal muscle density (SMD) decreased most significantly (38.9 ± 6.6 vs. 29.7 ± 3.8 HU, P < 0.001). Multivariate logistic regression analysis revealed that the absolute decrease in skeletal muscle index (SMI) during treatment was associated with lower odds of MPR (OR: 1.116, 95% CI: 1.015-1.225, P = 0.023). Exploratory analysis suggested that both pre-treatment low SMI (22.6% vs 39.0%, P = 0.009) and post-treatment low SMI (20.2% vs 44.1%, P < 0.001) were associated with poorer pathological response. Nutritional and body composition parameters decreased post-NICT.
CONCLUSION: Progressive muscle loss during NICT is associated with pathological response in LAGC. Dynamic monitoring of body composition may generate hypotheses for future interventional studies. External validation is required before clinical application.