Prognostic performance of psoas muscle density in elderly patients undergoing curative surgery for gastric cancer

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Background:The proportion of elderly patients within the gastric cancer (GC)-affected population has been increasing. Accordingly, there is a pressing need for reliable methods to stratify surgical risk in geriatric GC cases. Psoas muscle density (PMD), a parameter indicative of sarcopenia, is readily assessable using standard radiological techniques and has been recognized as a prognostic marker in various malignancies. However, its clinical significance in GC, particularly among elderly patients, remains inadequately defined. Methods:We retrospectively reviewed 110 patients aged ≥75 years who underwent R0 gastrectomy for GC. The prognostic value of preoperative PMD, along with other nutritional indices, was assessed using Cox proportional hazards models. Results:Lower PMD was significantly associated with diffuse-type histology and higher incidence of postoperative complications. On univariate Cox regression analysis, PMD was significantly associated with overall survival. Multivariate analysis confirmed PMD as an independent predictor of overall survival (hazard ratio:0.57;95% confidence interval:0.35–0.91 per 10-Hounsfield unit increase), along with other nutritional parameters. Conclusion:Preoperative PMD was significantly associated with postoperative morbidity and independently predicted overall survival in elderly GC patients. Incorporating PMD assessment into preoperative evaluation may enhance risk stratification and guide perioperative management in this vulnerable population. J. Med. Invest. 72 : 396-400, August, 2025