A total of 179 patients were included in this study with a median age of 68 years old, most of them men (around 55% in the total sample) and non-Caucasian. Table 2 shows the descriptive data of the participants according to the diagnosed conditions (sarcopenia, frailty, and sarcopenia-frailty). The prevalence of sarcopenia, frailty, and sarcopenia-frailty was 32.9% (n=59), 59.2% (n=106), and 24.6% (n=44), respectively.
In terms of clinical characteristics, the most predominant diagnosis identified in the study population was colorectal cancer, closely followed by gastric cancer. Notably, a significant proportion of patients exhibited advanced stages of cancer (III and IV), and a majority underwent combined treatment approaches. With regard to nutritional assessments, the average BMI indicated overweight status, observed in nearly 32% of the patients. Remarkably, the prevalence of low muscle strength and GS varied based on the defined threshold, with higher frequencies observed when using the Fried criteria (refer to Table 2). Furthermore, low SMI and low SMD were observed in 34% and 37% of the patients, respectively. The study population also exhibited a high prevalence of low physical activity and sedentary behavior (86.6%), while unintentional WL was identified in 40% of the cases.
Table 2. Characteristics of the participants according to the diagnosed conditions (sarcopenia, frailty, and sarcopenia-frailty)
Variables
|
Total
(n=179)
|
Sarcopenia
(n=59)
|
Frailty
(n=106)
|
Sarcopenia-Frailty
(n=44)
|
Age (years)
|
68.0 (61.0-75.0)
|
71.0 (62.0-79.0)
|
69.0 (62.0-75.0)
|
70.0 (62.0-77.8)
|
Men
|
98 (54.7%)
|
41 (69.5%)
|
64 (60.4%)
|
32 (72.7%)
|
Non-Caucasian
|
115 (64.2%)
|
33 (55.9%)
|
66 (62.2%)
|
23 (52.3%)
|
Cancer site
|
|
|
|
|
Gastric
|
48 (26.8%)
|
19 (32.2%)
|
33 (31.2%)
|
15 (34.1%)
|
Colorectal
|
100 (55.9%)
|
29 (49.2%)
|
54 (50.9%)
|
22 (50.0%)
|
Other*
|
31 (17.3%)
|
11 (18.6%)
|
19 (17.9%)
|
7 (15.9%)
|
Staging of disease
|
|
|
|
|
I and II
|
26 (14.5%)
|
6 (10.2%)
|
13 (12.3%)
|
4 (9.1%)
|
III and IV
|
128 (71.5%)
|
43 (72.9%)
|
80 (75.4%)
|
32 (72.7%)
|
Unknown
|
25 (14.0%)
|
10 (16.9%)
|
13 (12.3%)
|
8 (18.2%)
|
Treatment
|
|
|
|
|
Chemo/radiotherapy
|
24 (13.4%)
|
7 (11.9%)
|
13 (12.3%)
|
4 (9.1%)
|
Surgery
|
20 (11.2%)
|
5 (8.5%)
|
11 (10.4%)
|
5 (11.4%)
|
Combined
|
117 (65.4%)
|
38 (64.4%)
|
69 (65.0%)
|
27 (61.4%)
|
None
|
18 (10.1%)
|
9 (15.3%)
|
13 (12.3%)
|
8 (18.2%)
|
BMI (kg/m²)
|
24.4 ± 4.5
|
22.5 ± 4.8
|
24.0 ± 4.8
|
22.3 ± 4.6
|
Overweight
|
57 (31.8%)
|
15 (25.4%)
|
29 (27.4%)
|
6 (13.6%)
|
Obesity
|
20 (11.2%)
|
5 (8.5%)
|
10 (9.4%)
|
3 (6.8%)
|
HGS (kg)
|
20.0 (15.0-29.0)
|
16.0 (12.0-20.0)
|
18.0 (14.0-25.0)
|
17.5 (12.0-20.0)
|
Low HGS EWGSOP2
|
85 (47.5%)
|
59 (100%)
|
67 (63.2%)
|
44 (100%)
|
Low HGS Fried
|
119 (66.5%)
|
59 (100%)
|
93 (87.7%)
|
44 (100%)
|
SMI (cm²/m²)
|
49.5 ± 9.7
|
45.9 ± 10.6
|
49.8 ± 10.4
|
46.1 ± 10.9
|
Low SMI
|
60 (33.5%)
|
40 (67.8%)
|
39 (36.8%)
|
31 (70.5%)
|
SMD (HU)
|
38.2 ± 9.7
|
34.9 ± 10.3
|
38.6 ± 9.8
|
36.1 ± 9.9
|
Low SMD
|
66 (36.9%)
|
34 (57.6%)
|
35 (33.0%)
|
22 (50.0%)
|
GS (m/s)
|
0.83 (0.68-1.00)
|
0.70 (0.60-0.90)
|
0.85 (0.70-1.00)
|
0.80 (0.65-0.92)
|
Low GS EWGSOP2
|
73 (40.8%)
|
37 (62.7%)
|
41 (38.7%)
|
23 (52.3%)
|
Low GS Fried
|
133 (74.3%)
|
34 (57.6%)
|
87 (82.1%)
|
32 (72.7%)
|
ECOG scale ≥ 3
|
9 (5.0%)
|
4 (6.8%)
|
7 (6.6%)
|
4 (9.1%)
|
IPAQ
|
|
|
|
|
Active
|
24 (13.4%)
|
6 (10.2%)
|
7 (6.6%)
|
4 (9.1%)
|
Low active/sedentary
|
155 (86.6%)
|
53 (89.8%)
|
99 (93.3%)
|
40 (90.9%)
|
Unintentional WL ≥ 4.5kg
|
72 (40.2%)
|
31 (52.5%)
|
67 (63.2%)
|
31 (70.5%)
|
Data are presented as mean± standard deviation or median (P25 - P75) or n (%).
*Liver, pancreas, and esophagus
Abbreviations: BMI, body mass index; ECOG, Eastern Cooperative Oncology Group; EWGSOP2, European Working Group on Sarcopenia in Old People 2; IPAQ, International Physical Activity Questionnaire; GS, gait speed; HGS, handgrip strength; SMI, skeletal muscle index; SMD, skeletal muscle radiodensity; WL, weight loss.
Univariate analysis of the association between general, clinical, and nutritional characteristics and mortality status are presented in Table 3. In our study, we identified several factors that demonstrated a significant association with mortality. These included sex, disease stage, BMI, low HGS (as per the EWGSOP2 guidelines), and unintentional WL. Furthermore, the presence of sarcopenia diagnosis exhibited a noteworthy correlation with mortality status, while we also observed a discernible trend linking frailty and the combined condition of sarcopenia-frailty with the outcome.
Table 3. Univariate analysis of the association between mortality status of patients with gastrointestinal cancer and general, clinical, and nutritional characteristics (n=179).
Variables
|
Survivors (n=129)
|
Non-Survivors (n=50)
|
p-value
|
Age (years)
|
68.0 (62.0-75.0)
|
69.0 (61.0-75.0)
|
0.871
|
Men
|
64 (49.6%)
|
34 (68.0)
|
0.027
|
Non-Caucasian
|
81 (62.8%)
|
34 (68.0%)
|
0.514
|
Cancer site
|
|
|
0.931
|
Gastric
|
35 (27.1%)
|
13 (26.0%)
|
|
Colorectal
|
71 (55.0%)
|
29 (58.0%)
|
|
Other*
|
23 (17.8%)
|
8 (16.0%)
|
|
Staging of disease
|
|
|
0.010
|
I and II
|
23 (17.8%)
|
3 (6.0%)
|
|
III and IV
|
84 (65.1%)
|
44 (88.0%)
|
|
Unknown
|
22 (17.1%)
|
3 (6.0%)
|
|
Treatment
|
|
|
0.126
|
Chemo/radiotherapy
|
14 (10.9%)
|
10 (20.0%)
|
|
Surgery
|
18 (14.0%)
|
2 (4.0%)
|
|
Combined
|
85 (65.9%)
|
32 (64.0%)
|
|
None
|
12 (9.3%)
|
6 (33.3%)
|
|
BMI (kg/m²)
|
25.1 ± 4.5
|
22.9 ± 4.3
|
0.002
|
Overweight
|
51 (39.5%)
|
9 (18.0%)
|
0.006
|
Obesity
|
17 (13.2%)
|
3 (6.0%)
|
0.198
|
HGS (kg)
|
20.0 (16.0-29.0)
|
20.0 (14.0-26.0)
|
0.361
|
Low HGS EWGSOP2
|
54 (41.9%)
|
31 (62.0)
|
0.015
|
Low HGS Fried
|
77 (64.2%)
|
42 (71.2%)
|
0.350
|
SMI (cm²/m²)
|
49.7 ± 10.5
|
49.0 ± 8.0
|
0.613
|
Low SMI
|
40 (31.0%)
|
20 (40.0%)
|
0.253
|
SMD (HU)
|
37.7 ± 9.9
|
39.0 ± 9.4
|
0.414
|
Low SMD
|
50 (38.8%)
|
16 (32.0%)
|
0.400
|
GS (m/s)
|
0.85 (0.70-1.00)
|
0.80 (0.66-1.00)
|
0.329
|
Low GS EWGSOP2
|
49 (38.0%)
|
24 (48.0%)
|
0.221
|
Low GS Fried
|
92 (76.7%)
|
41 (69.5%)
|
0.302
|
ECOG scale ≥ 3
|
7 (5.4%)
|
2 (4.0%)
|
1.000
|
IPAQ
|
|
|
|
Active
|
20 (16.7%)
|
4 (6.9%)
|
0.101
|
Low active/sedentary
|
100 (83.3%)
|
55 (93.2%)
|
|
Unintentional WL ≥ 4.5kg
|
43 (33.3%)
|
29 (58.0%)
|
0.003
|
Sarcopenia
|
36 (27.9%)
|
23 (46.0%)
|
0.021
|
Frailty
|
16 (12.4%)
|
12 (24.0%)
|
0.055
|
Sarcopenia-Frailty
|
9 (7.0%)
|
8 (16.0%)
|
0.065
|
Data are presented as mean± standard deviation or median (P25 - P75) or n (%).
*Liver, pancreas, and esophagus
Abbreviations: BMI, body mass index; ECOG, Eastern Cooperative Oncology Group; EWGSOP2, European Working Group on Sarcopenia in Old People 2; IPAQ, International Physical Activity Questionnaire; GS, gait speed; HGS, handgrip strength; SMI, skeletal muscle index; SMD, skeletal muscle radiodensity; WL, weight loss.
Adjusted and non-adjusted multivariate analyses (Cox regression) of the association between sarcopenia, frailty and, sarcopenia-frailty with mortality are demonstrated in Table 4. Sarcopenia and sarcopenia-frailty were associated with mortality in the adjusted analyses. Sarcopenic-frail patients showed the highest risk for mortality.
Table 4. Unadjusted and adjusted multivariate analysis of the association between sarcopenia, frailty, and sarcopenia-frailty with mortality.
|
Unadjusted multivariate HR (95%CI)
|
p-value
|
Adjusted multivariate
HR (95%CI)
|
p-value
|
Sarcopenia
|
2.32 (1.21 – 4.46)
|
0.011
|
1.78 (1.03 – 3.06)
|
0.039
|
Frailty
|
1.93 (1.00 – 3.73)
|
0.051
|
1.61 (0.92 – 2.82)
|
0.095
|
Sarcopenia-frailty
|
3.01 (1.49 – 6.09)
|
0.002
|
2.23 (1.27 – 3.92)
|
0.005
|
Cox Regression adjusted by sex, age, stage of cancer and treatment performed.
To verify which variables comprising the diagnosis of sarcopenia and frailty had influence on the association with mortality, we tested each of them separately. Table 5 presents univariate and multivariate analyses of these components. In the multivariate analyses, low HGS and unintentional WL (frailty criterion) were associated with mortality.
Table 5. Unadjusted and adjusted multivariate analysis of the association between the components of sarcopenia and frailty with mortality.
|
Unadjusted multivariated HR (95%CI)
|
p-value
|
Adjusted multivariate
HR (95%CI)
|
p-value
|
Low HGS EWGSOP2
|
2.27 (1.20 – 4.29)
|
0.012
|
1.89 (1.10 – 3.24)
|
0.021
|
Low HGS Fried
|
1.38 (0.70 – 2.71)
|
0.351
|
1.36 (0.75 – 2.44)
|
0.311
|
Low SMI or SMD
|
1.79 (0.93 – 3.42)
|
0.080
|
1.26 (0.60 – 2.62)
|
0.542
|
Unintentional WL
|
2.64 (1.39 – 5.00)
|
0.003
|
1.99 (117 – 3.38)
|
0.011
|
Self-reported exhaustion
|
0.57 (0.11 – 2.82)
|
0.487
|
0.91 (0.20 – 4.18)
|
0.900
|
Low physical activity
|
2.75 (0.90 – 8.45)
|
0.077
|
1.48 (0.77 – 2.82)
|
0.231
|
Low GS EWGSOP2
|
0.54 (0.29 – 1.02)
|
0.056
|
0.67 (0.39 – 1.12)
|
0.127
|
Low GS Fried
|
0.69 (0.35 – 1.39)
|
0.303
|
0.61 (0.34 – 1.09)
|
0.094
|
Cox Regression adjusted by sex, age, stage of cancer and treatment performed.
Abbreviations: EWGSOP2, European Working Group on Sarcopenia in Old People 2; GS, gait speed; HGS, handgrip strength; SMI, skeletal muscle index; SMD, skeletal muscle radiodensity; WL, weight loss.