The association between sarcopenia and survival in patients with gastric cancer remains a topic of ongoing controversy. The primary objective of this study was to investigate the impact of sarcopenia on long-term outcomes after curative surgery for gastric cancer.

A prospective observational study was conducted on consecutive patients undergoing curative gastrectomy for gastric adenocarcinoma. The sarcopenia diagnosis was established based on the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria, which assess muscle strength, muscle mass volume, and physical performance. Long-term follow-ups were conducted at set intervals.

There were 26 (20.2%) patients in the sarcopenia group and 103 (79.8%) in the non-sarcopenia group. The median follow-up period of the living patients was 59 (42.9–68.4) months. Estimated rates for overall survival (OS) were 34.3% (19.4–60.7) vs. 62.3% (53.1–73.2), for recurrence-free survival (RFS) were 18% (5.6–57.4) vs. 55.5% (44.6–69.1), and for time to recurrence (TTR) were 48.7% (24.5–96.8) vs. 67.9% (57.9–79.5) in the sarcopenia and non-sarcopenia groups, respectively. In univariable Cox regression analysis, sarcopenia was significantly associated with OS (2.21, 1.22–3.99, p = 0.009) and RFS (2.17, 1.20–3.91, p = 0.010) but not with TTR (1.48, 0.64–3.41, p = 0.359). However, sarcopenia was not significantly associated with OS (1.74, 0.90–3.39, p = 0.102), RFS (1.54, 0.78–3.05, p = 0.213), or TTR (1.21, 0.48–3.05, p = 0.681) in multivariable analysis.

Sarcopenia as defined by the revised EWGSOP criteria has a limited association with long-term outcomes in patients undergoing curative gastrectomy for gastric cancer. The relatively small sample size might have limited the detection of significant associations between sarcopenia and survival, suggesting that larger studies may be needed to fully elucidate these relationships.