ADDUCTOR POLLICIS MUSCLE THICKNESS AND PREDICTION OF POSTOPERATIVE MORTALITY IN PATIENTS WITH STOMACH CANCER

Malnutrition is very prevalent in patients with gastric cancer and increases the risk of morbidity and mortality. Adductor pollicis muscle thickness (APMT) appears as an important objective, quick, inexpensive and noninvasive measure to assess the muscle compartment

Aim:

To compare APMT and other nutritional assessment methods and to correlate these methods with postoperative mortality

Methods:

Forty-four patients, 29 men and 15 women, mean age of 63±10.2 and ranging from 34-83 years, who underwent nine (20.5%) partial and 34 (77.3%) total gastrectomies due to stomach cancer (stage II to IIIa) were preoperatively assessed by Patient Generated Subjective Global Assessment (PG-SGA), anthropometry and laboratorial profile

Results:

APMT better predicted death (p<0.001) on both, dominant and non-dominant hand, and well correlated with albumin (p=0.039) and PG-SGA (p=0.007)

Conclusion:

APMT clearly allowed to determine malnutrition and to predict risk of death in patients with gastric cancer.

HEADINGS:
Stomach neoplasms; Nutrition assessment; Malnutrition; Mortality

Authorship

Aline Kirjner POZIOMYCK

Program of Post-Graduation in Surgical Sciences. Federal University of Rio Grande do Sul - UFRGS. Porto Alegre. RSFederal University of Rio Grande do SulBrazilPorto Alegre, RS, BrazilProgram of Post-Graduation in Surgical Sciences. Federal University of Rio Grande do Sul - UFRGS. Porto Alegre. RS

Oly Campos CORLETA

Leandro Totti CAVAZZOLA

Antonio Carlos WESTON

Department of Digestive Surgery. Lutheran University of Brazil - ULBRA. Canoas. RSLutheran University of BrazilBrazilCanoas, RS, BrazilDepartment of Digestive Surgery. Lutheran University of Brazil - ULBRA. Canoas. RS

Edson Braga LAMEU

Department of Nutrology. Federal University of Rio de Janeiro - UFRJ. Rio de Janeiro. RJFederal University of Rio de JaneiroBrazilRio de Janeiro, RJ, BrazilDepartment of Nutrology. Federal University of Rio de Janeiro - UFRJ. Rio de Janeiro. RJ

Luisa Jussara COELHO

Program of Post-Graduation in Epidemiology. Federal University of Rio Grande do Sul - UFRGS. Porto Alegre. RS. BrazilFederal University of Rio Grande do SulBrazilPorto Alegre, RS, BrazilProgram of Post-Graduation in Epidemiology. Federal University of Rio Grande do Sul - UFRGS. Porto Alegre. RS. Brazil

Luis Fernando MOREIRA

Correspondence: Aline Kirjner Poziomyck E-mail: akirjner@yahoo.com.br; akirjner@yahoo.com.br

Conflict of interest:

none

SCIMAGO INSTITUTIONS RANKINGS

Tables

Tables (4)

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TABLE 1
Mortality in 30 days of gastric cancer patients

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TABLE 2
Correlation of APMT with other nutritional parameters

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TABLE 3
Measures for DAPMT and NDAMPT according to PG-SGA and mortality

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TABLE 4
Nutritional parameters and its correlations with DAPMT and NDAPMT

TABLE 1 Mortality in 30 days of gastric cancer patients

	30-days death (n)		p
	Yes (6)	No (38)
	Mean SD	Mean SD
DAPMT	8.2 1.9	14.1 3.4	<0.001*
NDAPMT	7.6 1.9	13.9 5.7	0.001*
Albumin	3.4 0.8	3.9 0.4	0.026*
TLC	1414.8 553.1	1486.8 737.3	0.497+
PG-SGA
A	0 (0.0%)	15 (39.5%)
B	0 (0.0%)	18 (47.4%)	<0.001+
C	6 (100.0%)	5 (13.2%)

DAPMT=dominant adductor pollicis muscle thickness; NDAPMT=non-dominant adductor pollicis muscle thickness; TLC=total lymphocyte count; PG-SGA=patient generated subjective global assessment; * t-student test; + Mann-Whitney test; + Fisher’s exact test by Monte Carlo simulation.

TABLE 2 Correlation of APMT with other nutritional parameters

Nutritional parameters		DAPMT (mm)	NDAPMT (mm)	Albumin (g/dl)	TLC (mm³3 Bertuccio P. Chatenoud L. Levi F. Praud D. Ferlay J. Negri E. et al. Recent patterns in gastric cancer: a global overview. Int J Cancer. 2009;125(3):666-73. doi: 10.1002/ijc.24290. https://doi.org/10.1002/ijc.24290.... )	BMI (kg/m²)
DAPMT	Correlation coefficient
	Sig. (2-tailed)
	n
NDAPMT	Correlation coefficient	0.922+
	Sig. (2-tailed)	0.000
	n	44
ALBUMIN	Correlation coefficient	0.319^*	0.296
	Sig. (2-tailed)	0.039	0.057
	n	42	42
TLC	Correlation coefficient	0.286	0.224	0.391^*
	Sig. (2-tailed)	0.060	0.143	0.010
	n	44	44	42
BMI	Correlation coefficient	0.130	0.145	0.210	-0.069
	Sig. (2-tailed)	0.401	0.346	0.183	0.655
	n	44	44	42	44
PG-SGA	Correlation coefficient	-0.399+	-0.372^*	-0.552+	-0.312^*	-0.311^*
	Sig. (2-tailed)	0.007	0.013	0.000	0.039	0.040
	n	44	44	42	44	44

APMT=adductor pollicis muscle thickness; DAPMT=dominant adductor pollicis muscle thickness; NDAPMT=non-dominant adductor pollicis muscle thickness; TLC=total lymphocyte count; BMI=body mass index; PG-SGA=patient generated subjective global assessment; Spearman´s rho correlations, Correlation coefficient:* 5% of significance */+ 1% of significance.

TABLE 3 Measures for DAPMT and NDAMPT according to PG-SGA and mortality

Death			n	Mean	SD	95% CI for mean	p
Yes	DAPMT (mm)	A	1	16.33	-
		B	6	13.39	3.41	9.81 - 16.97	0.012
		C	6	8.22	1.91	6.22 - 10.22
	NDAPMT (mm)	A	1	13.00	-
		B	6	12.67	3.44	9.05 - 16.28	0.025
		C	6	7.56	1.96	5.50 - 9.62
No	DAPMT (mm)	A	14	14.52	3.68	12.40 - 16.65
		B	12	13.92	3.27	11.84 - 15.99	0.706
		C	5	13.00	3.84	8.24 - 17.76
	NDAPMT (mm)	A	14	15.60	8.25	10.83 - 20.36
		B	12	12.94	3.51	10.72 - 15.17	0.475
		C	5	12.53	4.20	7.32 - 17.75

DAPMT=dominant adductor pollicis muscle thickness; NDAPMT=non-dominant adductor pollicis muscle thickness; PG-SGA=patient generated subjective global assessment

TABLE 4 Nutritional parameters and its correlations with DAPMT and NDAPMT

Variables (N=44)	Mean	SD	Median	95%CI	Correlation (r) with APMT
Variables (N=44)	Mean	SD	Median	95%CI	DAPMT	NDAPMT
Age (years)	61.5	10.8	62.0	59.2-65.6	-0.071	0.024
Length of stay (days)	25.4	23.2	17.0	17.7-32.6	-0.050	-0.128
% Weight loss	12.7	9.8	11.3	9.3-15.3	-0.232	-0.137
Body mass index (kg/m2)	23.3	4.1	23.2	21.8-24.5	0.178	0.204
Triceps skinfold (mm)	13.3	6.3	13.0	10.8-14.8	0.134	0.333*
Mid-arm muscle circumference (cm)	24.0	4.3	23.6	22.7-25.4	0.327*	0.091
Albumin (g/dl)	3.9	0.5	3.9	3.7-4.0	0.495+	0.314*
TLC (mm3)	1476.8	710.0	1386.7	1393.7-1775.8	0.264	0.310*
DAPMT (mm)	13.2	3.8	13.2	12.1-14.5	-	-
NDAPMT (mm)	13.0	5.8	12.2	11.1-14.8	-	-
PG-SGA	-	-	-		-0.399*	-0.372*

APMT=adductor pollicis muscle thickness; DAPMT=dominant adductor pollicis muscle thickness; NDAPMT=non-dominant adductor pollicis muscle thickness; TLC=total lymphocyte count; PG-SGA=patient generated subjective global assessment; Correlation coefficient: * 5% of significance */+ 1% of significance; 95%CI=confidence interval of 95%.

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ADDUCTOR POLLICIS MUSCLE THICKNESS AND PREDICTION OF POSTOPERATIVE MORTALITY IN PATIENTS WITH STOMACH CANCER

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[1] Correspondence: Aline Kirjner Poziomyck E-mail: akirjner@yahoo.com.br; akirjner@yahoo.com.br