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Hendriks S, Huisman MG, Weerink L, Jonker LT, van Munster BC, de Haan JJ, de Bock GH, van Leeuwen BL. The relation between preoperative radiological sarcopenia and postoperative recovery of physical activity in older surgical cancer patients; an explorative study. J Nutr Health Aging 2024; 28:100345. [PMID: 39182320 DOI: 10.1016/j.jnha.2024.100345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 08/19/2024] [Accepted: 08/20/2024] [Indexed: 08/27/2024]
Abstract
To identify older surgical cancer patients at risk of decreased postoperative recovery of physical activity (PA), this study assesses whether preoperative radiological sarcopenia (RS) is associated with a decreased ability to return to baseline PA. RS was defined as decreased psoas muscle mass or -density by gender-specific cut-offs on CT-scans at level of vertebra L3. PA was assessed as steps/day measured with PA tracker and recovery of PA was defined as >90% of preoperative steps/day at 3 months postoperatively. Of 44 included patients aged 65 and over undergoing oncologic surgery, 18 patients (41%) showed RS. Seventeen patients (39%) returned to baseline PA, of which eight patients had RS (47%). RS was not associated with a return to baseline PA (OR: 1.38, 95%CI 0.39-4.92, p = 0.61). In this exploratory study, no association was found between preoperative RS and recovery of PA postoperatively.
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Affiliation(s)
- S Hendriks
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - M G Huisman
- Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - L Weerink
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - L T Jonker
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - B C van Munster
- Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - J J de Haan
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - G H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - B L van Leeuwen
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Minawala R, Kim M, Delau O, Ghiasian G, McKenney AS, Da Luz Moreira A, Chodosh J, McAdams-DeMarco M, Segev DL, Adhikari S, Dodson J, Shaukat A, Dane B, Faye AS. Sarcopenia Is a Risk Factor for Postoperative Complications Among Older Adults With Inflammatory Bowel Disease. Inflamm Bowel Dis 2024:izae187. [PMID: 39177976 DOI: 10.1093/ibd/izae187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Sarcopenia has been associated with adverse postoperative outcomes in older age cohorts, but has not been assessed in older adults with inflammatory bowel disease (IBD). Further, current assessments of sarcopenia among all aged individuals with IBD have used various measures of muscle mass as well as cutoffs to define its presence, leading to heterogeneous findings. METHODS In this single-institution, multihospital retrospective study, we identified all patients aged 60 years and older with IBD who underwent disease-related intestinal resection between 2012 and 2022. Skeletal Muscle Index (SMI) and Total Psoas Index (TPI) were measured at the superior L3 endplate on preoperative computed tomography scans and compared through receiver operating characteristic curve. We then performed multivariable logistic regression to assess risk factors associated with an adverse 30-day postoperative outcome. Our primary outcome included a 30-day composite of postoperative mortality and complications, including infection, bleeding, cardiac event, cerebrovascular accident, acute kidney injury, venous thromboembolism, reoperation, all-cause rehospitalization, and need for intensive care unit-level care. RESULTS A total of 120 individuals were included. Overall, 52% were female, 40% had ulcerative colitis, 60% had Crohn's disease, and median age at time of surgery was 70 years (interquartile range: 65-75). Forty percent of older adults had an adverse 30-day postoperative outcome, including infection (23%), readmission (17%), acute kidney injury (13%), bleeding (13%), intensive care unit admission (10%), cardiac event (8%), venous thromboembolism (7%), reoperation (6%), mortality (5%), and cerebrovascular accident (2%). When evaluating the predictive performance of SMI vs TPI for an adverse 30-day postoperative event, SMI had a significantly higher area under the curve of 0.66 (95% CI, 0.56-0.76) as compared to 0.58 (95% CI, 0.48-0.69) for TPI (P = .02). On multivariable logistic regression, prior IBD-related surgery (adjusted odds ratio [adjOR] 6.46, 95% CI, 1.85-22.51) and preoperative sepsis (adjOR 5.74, 95% CI, 1.36-24.17) significantly increased the odds of adverse postoperative outcomes, whereas increasing SMI was associated with a decreased risk of an adverse postoperative outcome (adjOR 0.88, 95% CI, 0.82-0.94). CONCLUSIONS Sarcopenia, as measured by SMI, is associated with an increased risk of postoperative complications among older adults with IBD. Measurement of SMI from preoperative imaging can help risk stratify older adults with IBD undergoing intestinal resection.
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Affiliation(s)
- Ria Minawala
- Department of Medicine, NYU School of Medicine, New York, NY, USA
| | - Michelle Kim
- Department of Medicine, NYU School of Medicine, New York, NY, USA
| | - Olivia Delau
- Inflammatory Bowel Disease Center, Division of Gastroenterology, Department of Medicine, NYU School of Medicine, New York, NY, USA
| | - Ghoncheh Ghiasian
- Inflammatory Bowel Disease Center, Division of Gastroenterology, Department of Medicine, NYU School of Medicine, New York, NY, USA
| | - Anna Sophia McKenney
- Department of Radiology, New York-Presbyterian Weill Cornell Medical College, New York, NY, USA
| | - Andre Da Luz Moreira
- Inflammatory Bowel Disease Center, Division of Gastroenterology, Department of Medicine, NYU School of Medicine, New York, NY, USA
| | - Joshua Chodosh
- Division of Geriatric Medicine and Palliative Care, Department of Medicine, NYU School of Medicine, New York, NY, USA
| | | | - Dorry L Segev
- Department of Surgery, NYU School of Medicine, New York, NY, USA
| | | | - John Dodson
- Division of Cardiology, Department of Medicine, NYU School of Medicine, New York, NY, USA
| | - Aasma Shaukat
- Inflammatory Bowel Disease Center, Division of Gastroenterology, Department of Medicine, NYU School of Medicine, New York, NY, USA
| | - Bari Dane
- Department of Radiology, NYU School of Medicine, New York, NY, USA
| | - Adam S Faye
- Inflammatory Bowel Disease Center, Division of Gastroenterology, Department of Medicine, NYU School of Medicine, New York, NY, USA
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3
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Kitano M, Yasumatsu R. The impact of sarcopenia in the treatment for patients with head and neck cancer. Auris Nasus Larynx 2024; 51:717-723. [PMID: 38805807 DOI: 10.1016/j.anl.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/30/2024]
Abstract
Sarcopenia is a disease in which a decline in muscle mass with age is associated with a decline in physical performance. In the field of otorhinolaryngology, head and neck surgery, sarcopenia is gaining attention as a cause of swallowing disorders and as a problem in the treatment of head and neck cancer. Head and neck cancer occurs in anatomical sites related to swallowing, so patients with head and neck cancer are prone to swallowing disorders and "nutrition-related sarcopenia." Since it is a cancer, it also becomes a "disease-related sarcopenia," making it easy for patients to develop secondary sarcopenia. Medical intervention against sarcopenia is important in order to decrease the number of adverse events related to treatments for cases with sarcopenia, with reports stating that proactive exercise and nutritional therapy prior to treatment for cases with sarcopenia contributes to a decrease in serious complications as well as improving the survival rate. It is the same for head and neck cancer patients with sarcopenia, so intervention prior to treatment of head and neck cancer is an area that is expected to see reports in the future. However, if the disease is malignant, it is highly likely that sarcopenia cannot be sufficiently improved due to the short period of time from diagnosis to the beginning of treatment. In this case, choosing a treatment that takes sarcopenia into consideration is another way to handle it. Assessing sarcopenia prior to treatment may help avoid post-treatment pneumonia related to sarcopenia, postoperative complications including fistula, radiation-induced toxicity including swallowing disorders, and chemotherapy-related toxicity, and it is believed to greatly contribute to the prognosis of the overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS).
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Affiliation(s)
- Mutsukazu Kitano
- Department of Otolaryngology-Head and neck surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan.
| | - Ryuji Yasumatsu
- Department of Otolaryngology-Head and neck surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan
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4
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Bastien AJ, Amin L, Vasquez M, Cong I, Luu M, Laszlo M, Yen S, Thompson H, Teitelbaum EL, Jang JK, Mita AC, Scher KS, Moyers J, Mallen-St Clair J, Walgama ES, Zumsteg ZS, Ho AS. Baseline weight recovery and mortality risk in head and neck cancer. Head Neck 2024. [PMID: 39077966 DOI: 10.1002/hed.27898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 07/09/2024] [Accepted: 07/18/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND As a surrogate of malnutrition, degree of weight loss and recovery from head and neck cancer (HNC) treatment is understudied. The influence of modifiable factors that affect weight, including speech/language pathology (SLP) and nutrition counseling, is also poorly defined. We characterize weight loss trends, baseline weight recovery (BWR), and the impact of interdisciplinary care on oncologic outcomes. METHODS Retrospective cohort study assessing 266 newly diagnosed patients with HNC who completed curative-intent radiation (definitive or adjuvant) between January 2016 to January 2022. Relevant treatment factors were analyzed using multivariable Cox regression models. RESULTS Altogether, 266 patients completed full-course radiation therapy (RT), encompassing definitive chemoRT (53.0%), surgery with chemoRT (18.4%), surgery with RT (17.7%), and RT alone (10.9%). Patient weight reached a nadir at median 3.0 months (IQR 3.0-11.3) after radiation, with a median weight loss of 12.6% (IQR 7.9-18.7). Notably, only 47.4% exhibited BWR. For those who recovered, median time to BWR was 10.5 months (IQR 3.0-24.0). On multivariable analysis, BWR by 6 months was significantly associated with overall survival (HR 0.28 [95% CI 0.10-0.76], p = 0.013), as was SLP consultation (HR 0.40 [95% CI 0.17-0.92], p = 0.031) and nutrition consultation (HR 0.34 [95% CI 0.13-0.89], p = 0.028). CONCLUSION A high proportion of patients with HNC fail to recover baseline weight after treatment; those that do can take longer than expected to return. Failure to recover baseline weight is associated with a notable decrease in survival. Similarly, SLP and nutrition consultation are independent, modifiable determinants correlated with outcomes, supporting the emphasis on multidisciplinary management. Measures to promote BWR may reduce mortality.
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Affiliation(s)
- Amanda J Bastien
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Luv Amin
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Missael Vasquez
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Iris Cong
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Michael Luu
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Meghan Laszlo
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Saori Yen
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Heather Thompson
- Division of Speech and Language Pathology, Department of Physical Medicine and Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Elana L Teitelbaum
- Division of Speech and Language Pathology, Department of Physical Medicine and Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Julie K Jang
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Alain C Mita
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Division of Medical Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Kevin S Scher
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Division of Medical Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Justin Moyers
- Division of Medical Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
- The Angeles Clinic and Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jon Mallen-St Clair
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Evan S Walgama
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Zachary S Zumsteg
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Allen S Ho
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Syziu A, Schache A. The prognostic value of pre-treatment sarcopenia in overall survival in head and neck cancer patients: a systematic review. Int J Oral Maxillofac Surg 2024:S0901-5027(24)00221-2. [PMID: 39068047 DOI: 10.1016/j.ijom.2024.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 06/05/2024] [Accepted: 07/12/2024] [Indexed: 07/30/2024]
Abstract
The aim of this study was to determine the prognostic value of pre-treatment sarcopenia, defined radiologically (cervical (C3) or lumbar (L3) region), in adult head and neck cancer (HNC) patients undergoing treatment with curative intent. A systematic search of the PubMed and Scopus databases was performed up to March 2024. Inclusion criteria were adult patients with locally advanced HNC, sarcopenia defined radiologically at the C3 and/or L3 level, and patients receiving primary treatment with curative intent. Risk of bias was assessed using the ROBINS-I tool non-randomised studies. Thirty studies involving a total of 6924 adult patients with HNC were included in this review. Pre-treatment sarcopenia was significantly associated with worse overall survival outcomes in 26 of the 30 studies (87%), across all treatment modalities with curative intent. The most frequent sex-specific SMI cut-off values were <52.4 cm2/m2 for males and <38.5 cm2/m2 for females. The findings of this review suggest that sarcopenia is a strong prognostic factor of overall survival in HNC patients undergoing primary curative treatment. Sarcopenia evaluation appears to be a good prognostic marker in the HNC population. Future nutritional interventional studies might focus on reversing the muscle loss and improving overall outcomes in identified sarcopenic individuals.
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Affiliation(s)
- A Syziu
- University Hospital Aintree, Fazakerley, Liverpool, UK.
| | - A Schache
- University Hospital Aintree, Fazakerley, Liverpool, UK
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Yang Y, Sun M, Chen WM, Wu SY, Zhang J. Adverse postoperative outcomes in elderly patients with sarcopenia. BMC Geriatr 2024; 24:561. [PMID: 38937671 PMCID: PMC11212269 DOI: 10.1186/s12877-024-05066-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 05/10/2024] [Indexed: 06/29/2024] Open
Abstract
PURPOSE No study has compared 30-day and 90-day adverse postoperative outcomes between old-age patients with and those without sarcopenia. PATIENTS AND METHODS We categorize elderly patients receiving major surgery into two groups according to the presence or absence of preoperative sarcopenia that were matched at a 1:4 ratio through propensity score matching (PSM). We analyzed 30-day or 90-day adverse postoperative outcomes and mortality in patients with and without sarcopenia receiving major surgery. RESULTS Multivariate logistic regression analyses revealed that the patients with preoperative sarcopenia were at significantly higher risk of 30-day postoperative mortality (adjusted odds ratio [aOR]. = 1.25; 95% confidence interval [CI]. = 1.03-1.52) and 30-day major complications such as postoperative pneumonia (aOR = 1.15; 95% CI = 1.00-1.40), postoperative bleeding (aOR = 2.18; 95% CI = 1.04-4.57), septicemia (aOR = 1.31; 95% CI = 1.03-1.66), and overall complications (aOR = 1.13; 95% CI = 1.00-1.46). In addition, surgical patients with sarcopenia were at significantly higher risk of 90-day postoperative mortality (aOR = 1.50; 95% CI = 1.29-1.74) and 90-day major complications such as pneumonia (aOR = 1.27; 95% CI = 1.10-1.47), postoperative bleeding (aOR = 1.90; 95% CI = 1.04-3.48), septicemia (aOR = 1.52; 95% CI = 1.28-1.82), and overall complications (aOR = 1.24; 95% CI = 1.08-1.42). CONCLUSIONS Sarcopenia is an independent risk factor for 30-day and 90-day adverse postoperative outcomes such as pneumonia, postoperative bleeding, and septicemia and increases 30-day and 90-day postoperative mortality among patients receiving major surgery. No study has compared 30-day and 90-day adverse postoperative outcomes between patients with and those without sarcopenia. We conducted a propensity score?matched (PSM) population-based cohort study to investigate the adverse postoperative outcomes and mortality in patients undergoing major elective surgery with preoperative sarcopenia versus those without preoperative sarcopenia. We demonstrated that sarcopenia is an independent risk factor for 30-day and 90-day adverse postoperative outcomes, such as postoperative pneumonia, bleeding, septicemia, and mortality after major surgery. Therefore, surgeons and anesthesiologists should attempt to correct preoperative sarcopenia, swallowing function, and respiratory muscle training before elective surgery to reduce postoperative complications that contribute to the decrease in surgical mortality.
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Affiliation(s)
- Yitian Yang
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Mingyang Sun
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Wan-Ming Chen
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan
| | - Szu-Yuan Wu
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan.
- Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan.
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan.
- Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan.
- Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan.
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.
- Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan.
- Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
- Department of Management, College of Management, Fo Guang University, Yilan, Taiwan.
| | - Jiaqiang Zhang
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China.
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Mascarella MA, Ferdus J, Vendra V, Sridharan S, Sultanem K, Tsien C, Shenouda G, Bouganim N, Esfahani K, Richardson K, Mlynarek A, Sadeghi N, Hier M, Kergoat MJ. Sarcopenia predicts short-term treatment-related toxicity in patients undergoing curative-intent therapy for head and neck cancer: A systematic review and meta-analysis. Head Neck 2024; 46:1500-1509. [PMID: 38353170 DOI: 10.1002/hed.27688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/27/2023] [Accepted: 02/05/2024] [Indexed: 05/14/2024] Open
Abstract
Sarcopenia is an increasingly recognized biomarker associated with poorer outcomes. The objective of this study was to ascertain the effect of sarcopenia on treatment tolerance and short-term toxicity in head and neck cancer (HNC). A systematic review was performed using multiple databases. An inverse-variation, random-effects model was used to perform the meta-analysis to evaluate the effect of sarcopenia on severe treatment toxicity and poor treatment tolerance. Sixteen observational studies, including 3187 patients with HNC, were analyzed. The combined odds ratio (OR) for severe treatment toxicity and tolerance was 2.22 (95%CI 1.50-3.29) and 1.40 (95%CI 0.84-2.32), respectively. The effect of sarcopenia on short-term severe treatment toxicity was similar with upfront surgery (OR 2.03, 95%CI 1.22-3.37) and definitive radiotherapy (OR 2.24, 95%CI 1.18-4.27) Patients with sarcopenia are more than twice as likely to suffer a short-term treatment-related toxicity when undergoing curative-intent HNC treatment.
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Affiliation(s)
- Marco A Mascarella
- Department of Biomedical Sciences, Université de Montréal, Montreal, Quebec, Canada
- Department of Otolaryngology, McGill University, Montreal, Quebec, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute of the Jewish General Hospital, Montreal, Quebec, Canada
| | - Jannatul Ferdus
- Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada
| | - Varun Vendra
- Department of Otolaryngology - Head and Neck Surgery, Temple University, Philadelphia, Pennsylvania, USA
| | - Shaum Sridharan
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Khalil Sultanem
- Department of Radiation Oncology, McGill University, Montreal, Quebec, Canada
| | - Christina Tsien
- Department of Radiation Oncology, McGill University, Montreal, Quebec, Canada
| | - George Shenouda
- Department of Radiation Oncology, McGill University, Montreal, Quebec, Canada
| | - Nathaniel Bouganim
- Division of Medical Oncology, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Khashayar Esfahani
- Division of Medical Oncology, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Keith Richardson
- Department of Otolaryngology, McGill University, Montreal, Quebec, Canada
| | - Alex Mlynarek
- Department of Otolaryngology, McGill University, Montreal, Quebec, Canada
| | - Nader Sadeghi
- Department of Otolaryngology, McGill University, Montreal, Quebec, Canada
| | - Michael Hier
- Department of Otolaryngology, McGill University, Montreal, Quebec, Canada
| | - Marie-Jeanne Kergoat
- Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Research Center, Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-sud-de-l'Ile- de-Montréal, Montreal, Quebec, Canada
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8
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Minawala R, Faye AS. Sarcopenia as a Preoperative Risk Stratification Tool among Older Adults with Inflammatory Bowel Disease. ADVANCES IN GERIATRIC MEDICINE AND RESEARCH 2024; 6:e240003. [PMID: 38911683 PMCID: PMC11192537 DOI: 10.20900/agmr20240003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
Sarcopenia, defined as a loss of muscle mass and function, is a physiologic factor that has been implicated as a predictor of adverse postoperative outcomes in many older adult populations. However, data related to sarcopenia in older adults with inflammatory bowel disease (IBD) remain limited. Older adults with IBD are particularly vulnerable to adverse postoperative outcomes, in part, due to muscle depletion from systemic inflammation, malnutrition, and reduced physical activity. However, few patients undergo routine muscle evaluation as a part of preoperative assessment. Moreover, cut-off values for measures of sarcopenia in the literature are modeled after non-IBD populations. The lack of standardized measures and values for sarcopenia in the IBD patient population has led to heterogenous findings and a paucity of preoperative risk stratification tools. Therefore, we aim to explore the scope of sarcopenia as a preoperative risk stratification tool among older adults with IBD.
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Affiliation(s)
- Ria Minawala
- Department of Medicine, NYU School of Medicine, New York, NY 10016, USA
| | - Adam S. Faye
- Inflammatory Bowel Disease Center, Division of Gastroenterology, Department of Medicine, NYU School of Medicine, New York, NY 10016, USA
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9
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Zhou S, Li L, Li S, Si H, Wu L, Shen B. The Negative Impacts of Sarcopenia on Primary Total Knee Arthroplasty under the Enhanced Recovery after Surgery Protocol. Orthop Surg 2024; 16:1160-1167. [PMID: 38556481 PMCID: PMC11062878 DOI: 10.1111/os.14053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 03/15/2024] [Accepted: 03/16/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVE Sarcopenia, as an emerging public health concern, has been associated with postoperative adverse outcomes in various surgical procedures. However, the evidence regarding the impacts of sarcopenia on total knee arthroplasty (TKA) remained limited. This study aimed to assess the impacts of sarcopenia on primary TKA based on the enhanced recovery after surgery (ERAS) protocol. METHODS This retrospective study included 291 patients who received unilateral TKA from October 2017 to May 2018 in our institution. Sarcopenia was diagnosed based on the algorithm of Asian Working Group for Sarcopenia 2019. The handgrip strength was measured using a handheld dynamometer and the muscle mass was estimated by a previously validated anthropometric equation. Patients were classified into sarcopenia group and non-sarcopenia group. The outcomes included complications, postoperative length of stay (LOS), total hospitalization cost, operative time, total estimated blood loss, blood transfusion rate, and the 12-item forgotten joint score (FJS-12) at the follow-up. The propensity score matching (PSM) was used to adjust confounding factors. We compared continuous variables using Student's t-test and the Wilcoxon Mann-Whitney U test for normal and non-normal distributions, respectively, and categorical variables with chi-square tests. RESULTS Of the 291 patients, 58 (19.9%) patients were identified as having sarcopenia. After PSM, each group matched 42 patients. All matched patients were followed-up at least 5 years. Patients with sarcopenia had higher rates of surgical complications compared to the non-sarcopenia group (p = 0.019), and no significant difference was observed in 30-day readmission, and periprosthetic joint infection. The sarcopenia group had significantly longer LOS (p = 0.038), higher total hospitalization (p = 0.015) than the non-sarcopenia group. For the FJS-12 scores at follow-up, patients with sarcopenia had significantly higher scores than the non-sarcopenia group (p = 0.024). CONCLUSION Our findings indicated sarcopenia may be a risk factor for postoperative complications, prolonged LOS, increased hospitalization cost and reduced patient satisfaction.
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Affiliation(s)
- Shengliang Zhou
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Lan Li
- Department of Endocrinology and Metabolism and Key Lab of Transplant Engineering and Immunology, NHFPC, West China HospitalSichuan UniversityChengduChina
| | - Shuai Li
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Haibo Si
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Limin Wu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Bin Shen
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
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10
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Colback AA, Arkfeld DV, Evangelista LM, Paydar A, Raslan O, Abouyared M, Cates DJ. Effect of Sarcopenia on Swallowing in Patients With Head and Neck Cancer. Otolaryngol Head Neck Surg 2024; 170:1331-1337. [PMID: 38314934 DOI: 10.1002/ohn.655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/01/2023] [Accepted: 12/15/2023] [Indexed: 02/07/2024]
Abstract
OBJECTIVE Sarcopenia, characterized by decreased skeletal muscle mass, is associated with poorer oncologic outcomes in head and neck cancer (HNC) patients. The effect of sarcopenia on swallowing following HNC treatment is unknown. This study aims to investigate the association of sarcopenia and swallowing dysfunction in patients treated for HNC. STUDY DESIGN Retrospective cohort study. SETTING Academic medical center. METHODS Pretreatment sarcopenia was assessed using the skeletal muscle index calculated from cross-sectional imaging at the third cervical vertebra. Feeding tube dependence, patient-reported dysphagia, and swallowing safety were assessed before and after treatment with the Functional Oral Intake Scale, Eating Assessment Tool-10, and Penetration Aspiration Scale, respectively. The association between sarcopenia and swallowing dysfunction was evaluated. RESULTS A total of 112 patients were included, 84 males (75%) and 28 females (25%). A total of 69 (61.6%) had sarcopenia prior to initiating HNC therapy. Sarcopenia was significantly associated with an elevated risk of patient-reported dysphagia (odds ratio [OR] = 2.71 [95% confidence interval, CI, 1.12-6.79]; P < .05). Multivariate logistic regression demonstrated that sarcopenia (OR = 15.18 [95% CI, 1.50-453.53]; P < .05) is an independent predictor for aspiration following treatment for HNC. CONCLUSION Patients with pretreatment sarcopenia had higher rates of dysphagia before treatment and were more likely to develop aspiration after completion of HNC therapy. Sarcopenia is readily measured using cross-sectional imaging and may be useful for identifying patients at risk of swallowing dysfunction and those most likely to benefit from prehabilitation efforts.
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Affiliation(s)
- Angela A Colback
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Daniel V Arkfeld
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Lisa M Evangelista
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Alireza Paydar
- Department of Radiology, Division of Neuroradiology, University of California, Davis, Sacramento, California, USA
| | - Osama Raslan
- Department of Radiology, Division of Neuroradiology, University of California, Davis, Sacramento, California, USA
| | - Marianne Abouyared
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Daniel J Cates
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
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11
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Kubrak C, Martin L, Grossberg AJ, Olson B, Ottery F, Findlay M, Bauer JD, Jha N, Scrimger R, Debenham B, Chua N, Walker J, Baracos V. Quantifying the severity of sarcopenia in patients with cancer of the head and neck. Clin Nutr 2024; 43:989-1000. [PMID: 38484528 DOI: 10.1016/j.clnu.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/14/2024] [Accepted: 02/18/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND & AIMS Existing skeletal muscle index (SMI) thresholds for sarcopenia are inconsistent, and do not reflect severity of depletion. In this study we aimed to define criterion values for moderate and severe skeletal muscle depletion based on the risk of mortality in a population of patients with head and neck cancer (HNC). Additionally, we aimed to identify clinical and demographic predictors of skeletal muscle depletion, evaluate the survival impact of skeletal muscle depletion in patients with minimal nutritional risk or good performance status, and finally, benchmarking SMI values of patients with HNC against healthy young adults. METHODS Population cohort of 1231 consecutive patients and external validation cohorts with HNC had lumbar SMI measured by cross-sectional imaging. Optimal stratification determined sex-specific thresholds for 2-levels of SMI depletion (Class I and II) based on overall survival (OS). Adjusted multivariable regression analyses (tumor site, stage, performance status, age, sex, dietary intake, weight loss) determined relationships between 2-levels of SMI depletion and OS. RESULTS Mean SMI (cm2/m2) was 51.7 ± 9.9 (males) and 39.8 ± 7.1 (females). The overall and sex-specific population demonstrated an increased risk of mortality associated with decreasing SMI. Sex-specific SMI (cm2/m2) depletion thresholds for 2-levels of muscle depletion determined by optimal stratification for males and females, respectively (male: 45.2-37.5, and <37.5; female: 40.9-34.2, and <34.2). In the overall population, Normal SMI, Class I and II SMI depletion occurred in 65.0%, 24.0%, and 11.0%, respectively. Median OS was: Normal SMI (114 months, 95% CI, 97.1-130.8); Class I SMI Depletion (42 months, 95% CI, 28.5-55.4), and Class II SMI Depletion (15 months, 95% CI, 9.8-20.1). Adjusted multivariable analysis compared with Normal SMI (reference), Class I SMI Depletion (HR, 1.49; 95% CI, 1.18-1.88; P < .001), Class II SMI Depletion (HR, 1.91; 95% CI, 1.42-2.58; P < .001). CONCLUSIONS Moderate and severe SMI depletion demonstrate discrimination in OS in patients with HNC. Moderate and severe SMI depletion is prevalent in patients with minimal nutrition risk and good performance status. Benchmarking SMI values against healthy young adults exemplifies the magnitude of SMI depletion in patients with HNC and may be a useful method in standardizing SMI assessment.
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Affiliation(s)
- Catherine Kubrak
- Department of Oncology, Division of Palliative Medicine, University of Alberta, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta, T6G 1Z2, Canada.
| | - Lisa Martin
- Research and Evaluation Lead, Nutrition Services, Provincial Strategy, Standards and Practice, Alberta Health Services, Alberta, Canada.
| | - Aaron J Grossberg
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR, United States.
| | - Brennan Olson
- Mayo Clinic Department of Otolaryngology-Head and Neck Surgery, Rochester, MN, United States.
| | - Faith Ottery
- President, Ottery & Associates, LLC, Deerfield, IL, United States.
| | - Merran Findlay
- Cancer Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, 2050 Australia.
| | - Judith D Bauer
- Department of Nutrition, Dietetics and Food, Monash University, Clayton, Victoria 3800 Australia.
| | - Naresh Jha
- Department of Oncology, Division of Radiation Oncology, University of Alberta, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta, T6G 1Z2, Canada.
| | - Rufus Scrimger
- Department of Oncology, Division of Radiation Oncology, University of Alberta, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta, T6G 1Z2, Canada.
| | - Brock Debenham
- Department of Oncology, Division of Radiation Oncology, University of Alberta, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta, T6G 1Z2, Canada.
| | - Neil Chua
- Department Oncology, Division of Medical Oncology, University of Alberta, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta, T6G 1Z2, Canada.
| | - John Walker
- Department Oncology, Division of Medical Oncology, University of Alberta, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta, T6G 1Z2, Canada.
| | - Vickie Baracos
- Department of Oncology, Division of Palliative Medicine, University of Alberta, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta, T6G 1Z2, Canada.
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12
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Madadian MA, Da Costa LS, Kerai A, Bajwa MS, Rogers SN. Relevance of sarcopenia in elderly patients undergoing surgery for oral squamous cell carcinoma. Br J Oral Maxillofac Surg 2024; 62:184-190. [PMID: 38272707 DOI: 10.1016/j.bjoms.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/10/2023] [Indexed: 01/27/2024]
Abstract
In the elderly population there is increasing evidence that frailty predicts adverse outcomes better than chronological age. Sarcopenia is an important component of frailty. This study aimed to establish the relevance of sarcopenia in elderly patients with oral squamous cell carcinoma (OSCC) undergoing surgery. This retrospective, single-centre, cohort study included patients over the age of 75 years who were diagnosed with OSCC between 2007 and 2016. Cross-sectional imaging of the neck was used to predict the Skeletal Muscle Index (SMI) using validated equations. Based on established thresholds, patients were categorised as having either a normal or low SMI, indicative of sarcopenia. Sixty-nine patients met the inclusion criteria. Patients with a low SMI had a longer length of stay (16.9 days vs 9.8 days, p = 0.030); they had more severe complications, defined as Clavien-Dindo grade IIIb or higher (17.6% vs 4.0%, p = 0.042); and their mean Comprehensive Complication Index (CCI) was also higher (14.1 vs 4.7, p = 0.051). Furthermore, 2/34 patients in the low SMI group died within 30 days of surgery compared with none in the normal SMI group (5.9% vs 0%, p = 0.503). Whilst patients with a low SMI who underwent surgery had lower five-year overall survival, the difference was not statistically significant. This study shows that sarcopenia negatively influences surgical outcomes in elderly patients. Routine measurement of SMI could be an indication for a comprehensive geriatric assessment (CGA).
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Affiliation(s)
- Matin Ali Madadian
- Regional Maxillofacial Unit, Liverpool University Hospitals NHS Foundation Trust, Aintree University Hospital, Lower Lane, Fazakerley, Liverpool L9 7AL, UK
| | - Lara Simoes Da Costa
- Regional Maxillofacial Unit, Liverpool University Hospitals NHS Foundation Trust, Aintree University Hospital, Lower Lane, Fazakerley, Liverpool L9 7AL, UK
| | - Ashwin Kerai
- Regional Maxillofacial Unit, Liverpool University Hospitals NHS Foundation Trust, Aintree University Hospital, Lower Lane, Fazakerley, Liverpool L9 7AL, UK
| | - Mandeep S Bajwa
- Regional Maxillofacial Unit, Liverpool University Hospitals NHS Foundation Trust, Aintree University Hospital, Lower Lane, Fazakerley, Liverpool L9 7AL, UK.
| | - Simon N Rogers
- Maxillofacial Department, Wirral University Teaching Hospital NHS Foundation Trust, Arrowe Park Hospital, Arrowe Park Rd, Birkenhead, Wirral CH49 5PE, UK
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13
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Liu C, Cheng L, Ye W, Lin L. Risk factors for sarcopenia in patients with head and neck cancer. Head Neck 2024; 46:346-352. [PMID: 38031723 DOI: 10.1002/hed.27585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/25/2023] [Accepted: 11/16/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVE Sarcopenia is a common condition among patients with cancer. To better understand the prevalence of sarcopenia in patients with head and neck cancer (HNC), we analysed the risk factors of sarcopenia and developed a theoretical foundation for further development of sarcopenia prevention and treatment strategies. METHODS Six hundred and seventeen patients with HNC were recruited for this cross-sectional observational study, and the data were analyzed using logistic regression analyses. The bioelectrical impedance analysis (BIA) was used to measure skeletal muscle mass, and sarcopenia was diagnosed according to the 2019 diagnostic criteria of the Asian Sarcopenia Working Group (AWGS). RESULTS Among the 617 patients enrolled in the study, 115 (18.6%) had sarcopenia. The prevalence of sarcopenia was 29.1% in males and 8% in females. In the multivariate analysis, older age (OR = 12.266, 95% CI: 3.864-38.934, p < 0.01), body fat (OR = 1.775, 95% CI: 1.511-2.084, p < 0.01), and sex (OR = 138.659, 95% CI: 42.382-453.642, p < 0.01) were independent risk factors for sarcopenia. Body mass index (BMI) (OR = 0.137, 95% CI: 0.09-0.21, p < 0.01), and total body water/fat free mass (TBW/FFM) (OR = 0.122, 95% CI: 0.031-0.474, p < 0.01) were protective factors for sarcopenia; we observed that sarcopenia decreased with increasing BMI and TBW/FFM. CONCLUSIONS Male sex, advanced age, and excess body fat were identified as risk factors for sarcopenia in patients with HNC, whereas a higher BMI and TBW/FFM acted as protective factors against sarcopenia in these patients.
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Affiliation(s)
- Chen Liu
- Department of Oncology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Clinical Nutrition, The Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Ling Cheng
- Department of Oncology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Internal Medicine of Oncology, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, China
| | - Wenfeng Ye
- Department of Clinical Nutrition, The Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Lizhu Lin
- Department of Oncology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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14
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Palmer AD, Starmer H, Sathe N, Yao TJ, Bolognone RK, Edwards J, Crino C, Kizner J, Graville DJ. Use of the G8 Geriatric Screening Tool in Surgical Head and Neck Cancer Patients Requiring Rehabilitation: A Multisite Investigation. Ann Otol Rhinol Laryngol 2024; 133:158-168. [PMID: 37551009 DOI: 10.1177/00034894231191869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
OBJECTIVES The G8 is a well-validated screening test for older cancer patients. The current study was undertaken to determine whether the G8 is predictive of short-term post-operative outcomes after head and neck cancer (HNC) surgery. METHODS Consecutive patients aged 65 years or more and referred for a preoperative assessment by a speech-language pathologist were consecutively screened by clinicians at 2 academic medical centers using the G8. The G8 was used to screen for vulnerability prior to surgery. Patients were deemed vulnerable if they had a total G8 score ≤14 according to published guidelines. Data were also collected on demographic characteristics, tumor staging, post-operative course, and tracheostomy and feeding tube (FT) status. RESULTS Ninety patients were consecutively screened during the study period. Using the G8, 64% of the patients were deemed vulnerable. Vulnerable patients differed significantly from non-vulnerable patients with regard to age, health, tumor stage, and baseline dysphagia, and underwent more extensive surgery. Postoperatively, vulnerable patients had a significantly longer hospital length of stay (LOS; 10.17 vs 5.50 days, respectively, P < .001), were less likely to discharge home (76% vs 94%, P = .044), and were more likely to be FT dependent for over a month (54% vs 21%, P = .006) compared to non-vulnerable patients. In regression models, controlling for T-stage and surgical variables, the G8 independently predicted 2 post-operative outcomes of interest, namely LOS and FT dependency. CONCLUSIONS The G8 may be a useful screening tool for identifying older adults at risk of a protracted postoperative medical course after HNC surgery. Future research should aim to identify the optimal screening protocol and how this information can be incorporated into clinical pathways to enhance the post-operative outcomes of older HNC patients.
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Affiliation(s)
- Andrew D Palmer
- Northwest Center for Voice & Swallowing, Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Heather Starmer
- Department of Otolaryngology-Head & Neck Surgery, Stanford University, Stanford, CA, USA
| | - Nishad Sathe
- School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Theresa Jingyun Yao
- Head and Neck Speech and Swallowing Rehabilitation Center, Stanford Healthcare, Stanford, CA USA
| | - Rachel K Bolognone
- Northwest Center for Voice & Swallowing, Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Jeffrey Edwards
- Head and Neck Speech and Swallowing Rehabilitation Center, Stanford Healthcare, Stanford, CA USA
| | - Carrie Crino
- Northwest Center for Voice & Swallowing, Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Jennifer Kizner
- Head and Neck Speech and Swallowing Rehabilitation Center, Stanford Healthcare, Stanford, CA USA
| | - Donna J Graville
- Northwest Center for Voice & Swallowing, Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, OR, USA
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15
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Kumar P, Gupta S, Das BC. Saliva as a potential non-invasive liquid biopsy for early and easy diagnosis/prognosis of head and neck cancer. Transl Oncol 2024; 40:101827. [PMID: 38042138 PMCID: PMC10701368 DOI: 10.1016/j.tranon.2023.101827] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 12/04/2023] Open
Abstract
Head and neck squamous cell carcinomas (HNSCCs) are the most devastating diseases in India and southeast Asia. It is a preventable and curable disease if detected early. Tobacco and alcohol consumption are the two major risk-factors but infection of high-risk HPVs are also associated with development of predominantly oral and oropharyngeal carcinomas. Interestingly, unlike cervical cancer, HPV-induced HNSCCs show good prognosis and better survival in contrast, majority of tobacco-associated HPV-ve HNSCCs are highly aggressive with poor clinical outcome. Biomarker analysis in circulatory body-fluids for early cancer diagnosis, prognosis and treatment monitoring are becoming important in clinical practice. Early diagnosis using non-invasive saliva for oral or other diseases plays an important role in successful treatment and better prognosis. Saliva mirrors the body's state of health as it comes into direct contact with oral lesions and needs no trained manpower to collect, making it a suitable bio-fluid of choice for screening. Saliva can be used to detect not only virus, bacteria and other biomarkers but variety of molecular and genetic markers for an early detection, treatment and monitoring cancer and other diseases. The performance of saliva-based diagnostics are reported to be highly (≥95 %) sensitive and specific indicating the test's ability to correctly identify true positive or negative cases. This review focuses on the potentials of saliva in the early detection of not only HPV or other pathogens but also identification of highly reliable gene mutations, oral-microbiomes, metabolites, salivary cytokines, non-coding RNAs and exosomal miRNAs. It also discusses the importance of saliva as a reliable, cost-effective and an easy alternative to invasive procedures.
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Affiliation(s)
- Prabhat Kumar
- Stem Cell and Cancer Research Lab, Amity Institute of Molecular Medicine & Stem Cell Research (AIMMSCR), Amity University Uttar Pradesh, Sector-125, Noida 201313, India
| | - Shilpi Gupta
- Stem Cell and Cancer Research Lab, Amity Institute of Molecular Medicine & Stem Cell Research (AIMMSCR), Amity University Uttar Pradesh, Sector-125, Noida 201313, India
| | - Bhudev C Das
- Stem Cell and Cancer Research Lab, Amity Institute of Molecular Medicine & Stem Cell Research (AIMMSCR), Amity University Uttar Pradesh, Sector-125, Noida 201313, India.
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16
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Knoedler S, Schliermann R, Knoedler L, Wu M, Hansen FJ, Matar DY, Obed D, Vervoort D, Haug V, Hundeshagen G, Paik A, Kauke-Navarro M, Kneser U, Pomahac B, Orgill DP, Panayi AC. Impact of sarcopenia on outcomes in surgical patients: a systematic review and meta-analysis. Int J Surg 2023; 109:4238-4262. [PMID: 37696253 PMCID: PMC10720826 DOI: 10.1097/js9.0000000000000688] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 08/04/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Surgeons have historically used age as a preoperative predictor of postoperative outcomes. Sarcopenia, the loss of skeletal muscle mass due to disease or biological age, has been proposed as a more accurate risk predictor. The prognostic value of sarcopenia assessment in surgical patients remains poorly understood. Therefore, the authors aimed to synthesize the available literature and investigate the impact of sarcopenia on perioperative and postoperative outcomes across all surgical specialties. METHODS The authors systematically assessed the prognostic value of sarcopenia on postoperative outcomes by conducting a systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching the PubMed/MEDLINE and EMBASE databases from inception to 1st October 2022. Their primary outcomes were complication occurrence, mortality, length of operation and hospital stay, discharge to home, and postdischarge survival rate at 1, 3, and 5 years. Subgroup analysis was performed by stratifying complications according to the Clavien-Dindo classification system. Sensitivity analysis was performed by focusing on studies with an oncological, cardiovascular, emergency, or transplant surgery population and on those of higher quality or prospective study design. RESULTS A total of 294 studies comprising 97 643 patients, of which 33 070 had sarcopenia, were included in our analysis. Sarcopenia was associated with significantly poorer postoperative outcomes, including greater mortality, complication occurrence, length of hospital stay, and lower rates of discharge to home (all P <0.00001). A significantly lower survival rate in patients with sarcopenia was noted at 1, 3, and 5 years (all P <0.00001) after surgery. Subgroup analysis confirmed higher rates of complications and mortality in oncological (both P <0.00001), cardiovascular (both P <0.00001), and emergency ( P =0.03 and P =0.04, respectively) patients with sarcopenia. In the transplant surgery cohort, mortality was significantly higher in patients with sarcopenia ( P <0.00001). Among all patients undergoing surgery for inflammatory bowel disease, the frequency of complications was significantly increased among sarcopenic patients ( P =0.007). Sensitivity analysis based on higher quality studies and prospective studies showed that sarcopenia remained a significant predictor of mortality and complication occurrence (all P <0.00001). CONCLUSION Sarcopenia is a significant predictor of poorer outcomes in surgical patients. Preoperative assessment of sarcopenia can help surgeons identify patients at risk, critically balance eligibility, and refine perioperative management. Large-scale studies are required to further validate the importance of sarcopenia as a prognostic indicator of perioperative risk, especially in surgical subspecialties.
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Affiliation(s)
- Samuel Knoedler
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, USA
| | - Rainer Schliermann
- Faculty of Social and Health Care Sciences, University of Applied Sciences Regensburg, Regensburg
| | - Leonard Knoedler
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, USA
| | - Mengfan Wu
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong, People’s Republic of China
| | - Frederik J. Hansen
- Department of General and Visceral Surgery, Friedrich-Alexander University Erlangen, Erlangen
| | - Dany Y. Matar
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston
| | - Doha Obed
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston
| | - Dominique Vervoort
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Valentin Haug
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston
| | - Gabriel Hundeshagen
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Angie Paik
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, USA
| | - Martin Kauke-Navarro
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, USA
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Bohdan Pomahac
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, USA
| | - Dennis P. Orgill
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston
| | - Adriana C. Panayi
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston
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17
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Graves JP, Daher GS, Bauman MMJ, Moore EJ, Tasche KK, Price DL, Van Abel KM. Association of sarcopenia with oncologic outcomes of primary treatment among patients with oral cavity cancer: A systematic review and meta-analysis. Oral Oncol 2023; 147:106608. [PMID: 37897858 DOI: 10.1016/j.oraloncology.2023.106608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 10/30/2023]
Abstract
GOAL We performed a systematic review of the literature and meta-analysis to determine how radiographic sarcopenia assessment methods and the presence of pre-treatment sarcopenia impact oncologic outcomes in patients with oral cavity cancer. INTRODUCTION Pre-treatment sarcopenia has been associated with poor outcomes in many different malignancies, including head and neck cancers. However, the impact sarcopenia has on outcomes for oral cavity cancer patients is not well understood. RESULTS Twelve studies met our inclusion criteria, totaling 1007 patients. 359 (36%) of these patients were reported as sarcopenic. The most commonly utilized sarcopenia assessment methods were L3 skeletal muscle index (n = 5) and C3 skeletal muscle index to estimate L3 skeletal muscle index (n = 5). The majority of studies established their sarcopenia cutoffs as the lowest quartile skeletal muscle index in their patient cohorts. Five studies were included in our meta-analysis, totaling 251 sarcopenic and 537 non-sarcopenic patients. Compared to non-sarcopenic patients, sarcopenic patients were found to have significantly poorer overall survival (univariate: HR = 2.24, 95% CI: 1.71-2.93, I2 = 0%; multivariate: HR = 1.93, 95% CI: 1.47-2.52, I2 = 0%) and disease-free survival (univariate: HR = 2.10, 95% CI: 1.50-2.92, I2 = 0%; multivariate: HR = 1.79, 95% CI: 1.29-2.47, I2 = 10%). CONCLUSIONS Over one-third of oral cavity cancer patients may present with sarcopenia. Pre-treatment sarcopenia is associated with significantly worse overall and disease-free survival.
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Affiliation(s)
- Jeffrey P Graves
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA; Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Ghazal S Daher
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Kendall K Tasche
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Kathryn M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA.
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18
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Avancini A, Borsati A, Belluomini L, Giannarelli D, Nocini R, Insolda J, Sposito M, Schena F, Milella M, Pilotto S. Effect of exercise across the head and neck cancer continuum: a systematic review of randomized controlled trials. Support Care Cancer 2023; 31:670. [PMID: 37924500 PMCID: PMC10625510 DOI: 10.1007/s00520-023-08126-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 10/18/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE This study aims to systematically explore the impact of physical exercise as supportive therapy for head and neck cancer. METHODS A systematic search on PubMed/MEDLINE, Cochrane, and SPORTDiscus was conducted. Randomized controlled trials exploring the effects of a physical exercise intervention in comparison with usual care on outcomes in patients with head and neck cancer were selected. The RoB 2 tool was used to determine the study quality. The extracted data are reported as qualitative synthesis. RESULTS Among the 527 records examined, nine studies were included. No trials investigating exercise as prehabilitation were found, whereas eight studies involving 452 patients with head and neck cancer were conducted during anticancer treatment. Most trials did not report improvements in body mass index or body composition, while 2/4 and 3/5 investigations found a significant increase in muscle strength and cardiorespiratory fitness, respectively. Regarding the patients' reported outcomes, 4 out of 7 studies observed enhancements in some domains of quality of life, and two trials out of 3 detected an amelioration in fatigue following the exercise intervention. Analyzing the exercise programs, it seems that combining aerobic and resistance training could be more beneficial compared to a single type of full-body exercise in counteracting physical decline and controlling symptoms in the anticancer therapy phase. One trial has investigated the effect of resistance exercise on patients who had terminated the anticancer treatments, reporting significant improvements in lean mass, muscle strength, and quality of life. CONCLUSION Exercise may be a promising approach in patients with head and neck cancer. Future studies are needed to consolidate these results.
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Affiliation(s)
- Alice Avancini
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona, Verona, Italy
| | - Anita Borsati
- Department of Medicine, Verona University Hospital Trust, Verona, Italy
| | - Lorenzo Belluomini
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona, Verona, Italy
| | - Diana Giannarelli
- Bio-statistical Unit, Regina Elena National Cancer Institute IRCCS, Rome, Italy
| | - Riccardo Nocini
- Section of Ears, Nose and Throat (ENT), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Jessica Insolda
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona, Verona, Italy
| | - Marco Sposito
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona, Verona, Italy
| | - Federico Schena
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Milella
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona, Verona, Italy
| | - Sara Pilotto
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona, Verona, Italy.
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19
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Liu S, Zou Y, Zhong M, Li T, Cao Y, Wang R, You J, Zhang S, Zhang B. Prognostic significance of MRI-defined sarcopenia in patients with nasopharyngeal carcinoma: A propensity score matched analysis of real-world data. Radiother Oncol 2023; 188:109904. [PMID: 37678624 DOI: 10.1016/j.radonc.2023.109904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/24/2023] [Accepted: 09/01/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND AND PURPOSE Image-defined sarcopenia is linked to increased mortality among patients with cancer. Nevertheless, its effect on patients with nasopharyngeal carcinoma (NPC) is incompletely established. This study's aim was to investigate the prognostic significance of MRI-defined sarcopenia on the survival of patients undergoing concurrent chemoradiotherapy (CCRT) ± inducing chemotherapy (IC) for NPC treatment. METHODS 1,307 patients with stage II-IVa NPC were included in this retrospective study. Sarcopenia was defined using skeletal muscle index (SMI) determined through baseline MRI at the C3 level. The association of sarcopenia with overall survival (OS) and progression-free survival (PFS) was assessed by Cox regression models using 1:1 propensity score matching (PSM) analysis. We also conducted a stratification analysis using BMI and treatment strategies. RESULTS Sarcopenia was an independent risk factor for both OS and PFS (all P < 0.05). However, BMI was not substantially linked to OS and PFS (all P > 0.05). Sarcopenic patients showed lower rates of OS (HR = 2.00, 95% CI: 1.54-2.60, P < 0.001) and PFS (HR = 1.67, 95% CI: 1.35-2.07, P < 0.001) in contrast with nonsarcopenic patients. According to stratification analysis, being overweight was linked to a protective effect in nonsarcopenic patients only. Sarcopenic patients showed similar OS and PFS regardless of the treatment modality. CONCLUSIONS Sarcopenia is underrecognized in NPC patients. Measurement of sarcopenia using routine MRI scans in NPC patients provided significant prognostic information, outperforming BMI. Patients with sarcopenia failed to benefit from an additional IC regimen.
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Affiliation(s)
- Shuyi Liu
- Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China; Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Yujian Zou
- Department of Radiology, Affiliated Dongguan Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan, Guangdong, China
| | - Minying Zhong
- Department of Ultrasound, The First People's Hospital of Foshan, Guangdong, China
| | - Ting Li
- Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yaxian Cao
- Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Rui Wang
- Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jingjing You
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Shuixing Zhang
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.
| | - Bin Zhang
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.
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20
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McCabe FJ, McCabe JP, Murray O. A novel scoring system incorporating sarcopenia to predict postoperative survival in spinal metastasis. Spine J 2023; 23:1270-1275. [PMID: 37116718 DOI: 10.1016/j.spinee.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/02/2023] [Accepted: 04/18/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND CONTEXT As the prevalence of spinal metastasis rises, methods to predict survival will become increasingly important for clinical decision-making. Sarcopenia may be used to predict survival in these patients. PURPOSE The purpose of this study to develop a prediction model incorporating sarcopenia for postoperative survival in patients with spinal metastasis. DESIGN Retrospective cohort study. PATIENT SAMPLE This study included 200 patients who underwent operative intervention for spinal metastasis in our institution, a tertiary, academic spine center. OUTCOME MEASURES The primary outcome measure was 1-year postoperative survival. The secondary outcome measures were 3-month and 6-month postoperative survival. METHODS Clinicopathological and survivorship data was collated. Sarcopenia was defined using the L3 Psoas/Vertebral Body Ratio on cross-sectional CT. Independent predictors of postoperative survival were assessed by multiple logistic regression. RESULTS Overall 1-year postoperative survival was 50%. L3/Psoas ratio ≥1.5 (OR 6.2), albumin ≥35g/l (OR 3.0) and primary tumor type were found to be independent predictors of 3 month, 6 month and 1 year postoperative survival on multivariable analysis. Age at surgery, ambulatory status and mode of presentation were not independent predictors of survival. Variables were used to generate a new scoring system, ProgMets, to predict postoperative survival. The ProgMets system had greater correlation and higher area under the curve (AUC, 0.80) for 1-year survival than other scoring systems. CONCLUSIONS This is the first model to incorporate sarcopenia to predict survival in spinal metastasis patients and has good prediction of survival compared to previous models. This tool may be increasingly useful for informed decision making for patients and surgeons.
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Affiliation(s)
- Fergus J McCabe
- Spine Service, Department of Trauma and Orthopedic Surgery, Galway University Hospitals, Galway, Ireland; University of Galway, Galway, Ireland.
| | - John P McCabe
- Spine Service, Department of Trauma and Orthopedic Surgery, Galway University Hospitals, Galway, Ireland; University of Galway, Galway, Ireland
| | - Odhrán Murray
- Spine Service, Department of Trauma and Orthopedic Surgery, Galway University Hospitals, Galway, Ireland
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21
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Ye Z, Saraf A, Ravipati Y, Hoebers F, Catalano PJ, Zha Y, Zapaishchykova A, Likitlersuang J, Guthier C, Tishler RB, Schoenfeld JD, Margalit DN, Haddad RI, Mak RH, Naser M, Wahid KA, Sahlsten J, Jaskari J, Kaski K, Mäkitie AA, Fuller CD, Aerts HJWL, Kann BH. Development and Validation of an Automated Image-Based Deep Learning Platform for Sarcopenia Assessment in Head and Neck Cancer. JAMA Netw Open 2023; 6:e2328280. [PMID: 37561460 PMCID: PMC10415962 DOI: 10.1001/jamanetworkopen.2023.28280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/27/2023] [Indexed: 08/11/2023] Open
Abstract
Importance Sarcopenia is an established prognostic factor in patients with head and neck squamous cell carcinoma (HNSCC); the quantification of sarcopenia assessed by imaging is typically achieved through the skeletal muscle index (SMI), which can be derived from cervical skeletal muscle segmentation and cross-sectional area. However, manual muscle segmentation is labor intensive, prone to interobserver variability, and impractical for large-scale clinical use. Objective To develop and externally validate a fully automated image-based deep learning platform for cervical vertebral muscle segmentation and SMI calculation and evaluate associations with survival and treatment toxicity outcomes. Design, Setting, and Participants For this prognostic study, a model development data set was curated from publicly available and deidentified data from patients with HNSCC treated at MD Anderson Cancer Center between January 1, 2003, and December 31, 2013. A total of 899 patients undergoing primary radiation for HNSCC with abdominal computed tomography scans and complete clinical information were selected. An external validation data set was retrospectively collected from patients undergoing primary radiation therapy between January 1, 1996, and December 31, 2013, at Brigham and Women's Hospital. The data analysis was performed between May 1, 2022, and March 31, 2023. Exposure C3 vertebral skeletal muscle segmentation during radiation therapy for HNSCC. Main Outcomes and Measures Overall survival and treatment toxicity outcomes of HNSCC. Results The total patient cohort comprised 899 patients with HNSCC (median [range] age, 58 [24-90] years; 140 female [15.6%] and 755 male [84.0%]). Dice similarity coefficients for the validation set (n = 96) and internal test set (n = 48) were 0.90 (95% CI, 0.90-0.91) and 0.90 (95% CI, 0.89-0.91), respectively, with a mean 96.2% acceptable rate between 2 reviewers on external clinical testing (n = 377). Estimated cross-sectional area and SMI values were associated with manually annotated values (Pearson r = 0.99; P < .001) across data sets. On multivariable Cox proportional hazards regression, SMI-derived sarcopenia was associated with worse overall survival (hazard ratio, 2.05; 95% CI, 1.04-4.04; P = .04) and longer feeding tube duration (median [range], 162 [6-1477] vs 134 [15-1255] days; hazard ratio, 0.66; 95% CI, 0.48-0.89; P = .006) than no sarcopenia. Conclusions and Relevance This prognostic study's findings show external validation of a fully automated deep learning pipeline to accurately measure sarcopenia in HNSCC and an association with important disease outcomes. The pipeline could enable the integration of sarcopenia assessment into clinical decision making for individuals with HNSCC.
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Affiliation(s)
- Zezhong Ye
- Artificial Intelligence in Medicine Program, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anurag Saraf
- Artificial Intelligence in Medicine Program, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Yashwanth Ravipati
- Artificial Intelligence in Medicine Program, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Frank Hoebers
- Artificial Intelligence in Medicine Program, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Paul J. Catalano
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Data Science, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Yining Zha
- Artificial Intelligence in Medicine Program, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anna Zapaishchykova
- Artificial Intelligence in Medicine Program, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Radiology and Nuclear Medicine, CARIM and GROW, Maastricht University, Maastricht, the Netherlands
| | - Jirapat Likitlersuang
- Artificial Intelligence in Medicine Program, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christian Guthier
- Artificial Intelligence in Medicine Program, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Roy B. Tishler
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jonathan D. Schoenfeld
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Danielle N. Margalit
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert I. Haddad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Raymond H. Mak
- Artificial Intelligence in Medicine Program, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mohamed Naser
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kareem A. Wahid
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jaakko Sahlsten
- Department of Computer Science, Aalto University School of Science, Espoo, Finland
| | - Joel Jaskari
- Department of Computer Science, Aalto University School of Science, Espoo, Finland
| | - Kimmo Kaski
- Department of Computer Science, Aalto University School of Science, Espoo, Finland
| | - Antti A. Mäkitie
- Department Otorhinolaryngology–Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Clifton D. Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hugo J. W. L. Aerts
- Artificial Intelligence in Medicine Program, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Radiology and Nuclear Medicine, CARIM and GROW, Maastricht University, Maastricht, the Netherlands
- Department of Radiology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Benjamin H. Kann
- Artificial Intelligence in Medicine Program, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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22
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Salati V, Mandralis K, Becce F, Koerfer J, Lambercy K, Simon C, Gorostidi F. Preoperative CT-Based Skeletal Muscle Mass Depletion and Outcomes after Total Laryngectomy. Cancers (Basel) 2023; 15:3538. [PMID: 37509201 PMCID: PMC10377557 DOI: 10.3390/cancers15143538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/27/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
PURPOSE To assess the role of preoperative CT-based skeletal muscle mass depletion on postoperative clinical outcomes and survival in patients who underwent total laryngectomy for cancer. METHODS Patients operated on between January 2011 and March 2020 were retrospectively included. Skeletal muscle area and intra- and inter-muscular fat accumulation were measured at the third lumbar vertebral level on preoperative CT scans. Skeletal muscle mass depletion was defined based on pre-established cut-off values. Their association with postoperative morbidity, length of stay (LOS), costs, and survival was assessed. RESULTS A total of 84 patients were included, of which 37 (44%) had preoperative skeletal muscle mass depletion. The rate of postoperative fistula (23% vs. 35%, p = 0.348), cutaneous cervical dehiscence (17% vs. 11%, p = 0.629), superficial incisional surgical site infections (SSI) (12% vs. 10%, p = 1.000), and unplanned reoperation (38% vs. 37%, p = 1.000) were comparable between the two patient groups. No difference in median LOS was observed (41 vs. 33 days, p = 0.295), nor in treatment costs (119,976 vs. 109,402 CHF, p = 0.585). The median overall survival was comparable between the two groups (3.43 vs. 4.95 years, p = 0.09). CONCLUSIONS Skeletal muscle mass depletion alone had no significant impact on postoperative clinical outcomes or survival.
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Affiliation(s)
- Victoria Salati
- Department of Otolaryngology, Head and Neck Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), 1011 Lausanne, Switzerland
| | - Katerina Mandralis
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), 1011 Lausanne, Switzerland
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), 1011 Lausanne, Switzerland
| | - Joachim Koerfer
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), 1011 Lausanne, Switzerland
| | - Karma Lambercy
- Department of Otolaryngology, Head and Neck Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), 1011 Lausanne, Switzerland
| | - Christian Simon
- Department of Otolaryngology, Head and Neck Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), 1011 Lausanne, Switzerland
| | - François Gorostidi
- Department of Otolaryngology, Head and Neck Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), 1011 Lausanne, Switzerland
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23
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Erul E, Guven DC, Onur MR, Yazici G, Aksoy S. Role of sarcopenia on survival and treatment-related toxicity in head and neck cancer: a narrative review of current evidence and future perspectives. Eur Arch Otorhinolaryngol 2023:10.1007/s00405-023-08014-9. [PMID: 37188907 DOI: 10.1007/s00405-023-08014-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/08/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE The purpose of this article is to provide an up-to-date summary of sarcopenia and its clinical implications for patients with head and neck cancer (HNC). METHODS We conducted a literature review of recent studies investigating the prevalence of sarcopenia in HNC patients, its detection using MRI or CT scans, and its association with clinical outcomes such as disease-free and overall survival time, radiotherapy-related side effects, cisplatin toxicity, and surgical complications. RESULTS Sarcopenia, characterized by low skeletal muscle mass (SMM), is a prevalent condition in HNC patients and can be effectively detected using routine MRI or CT scans. Low SMM in HNC patients is associated with increased risks of shorter disease-free and overall survival times, as well as radiotherapy-related side effects such as mucositis, dysphagia, and xerostomia. In addition, cisplatin toxicity is more severe in HNC patients with low SMM, leading to higher dose-limiting toxicity and treatment interruptions. Low SMM may also predict higher risks of surgical complications in head and neck surgery. Identifying sarcopenic patients can aid physicians in better riskstratifying HNC patients for therapeutic or nutritional interventions to improve clinical outcomes. CONCLUSIONS Sarcopenia is a significant concern for HNC patients and can impact their clinical outcomes. Routine MRI or CT scans can effectively detect low SMM in HNC patients. Identifying sarcopenic patients can aid physicians in better risk-stratifying HNC patients for therapeutic or nutritional interventions to improve clinical outcomes. Further research is needed to explore the potential of interventions to mitigate the negative effects of sarcopenia in HNC patients.
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Affiliation(s)
- Enes Erul
- Department of Internal Medicine, Hacettepe University, 06100, Sihhiye, Ankara, Turkey.
| | - Deniz Can Guven
- Department of Medical Oncology, Hacettepe University, Cancer Institute, Ankara, Turkey
| | | | - Gozde Yazici
- Department of Radiation Oncology, Hacettepe University, Ankara, Turkey
| | - Sercan Aksoy
- Department of Medical Oncology, Hacettepe University, Cancer Institute, Ankara, Turkey
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24
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Willemsen ACH, Pilz W, Hoeben A, Hoebers FJP, Schols AMWJ, Baijens LWJ. Oropharyngeal dysphagia and cachexia: Intertwined in head and neck cancer. Head Neck 2023; 45:783-797. [PMID: 36583567 DOI: 10.1002/hed.27288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 10/17/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND This study aims to investigate the relationship between cancer cachexia and oropharyngeal dysphagia (OD) in patients with head and neck cancer (HNC) prior to chemoradiotherapy or bioradiotherapy (CRT/BRT). METHODS A prospective cohort study with patients with HNC undergoing CRT/BRT (2018-2021) was conducted. Body composition and skeletal muscle function were evaluated using bioelectrical impedance analysis, handgrip strength, and the short physical performance battery (SPPB). The M. D. Anderson Dysphagia Inventory (MDADI), Eating Assessment Tool (EAT)-10 questionnaire, and patient characteristics were collected. A standardized videofluoroscopic swallowing study was offered to patients. RESULTS Sixty-six patients were included. Twenty-six patients scored EAT-10 ≥ 3 and seventeen were cachectic. ACE-27 score >1, cachexia, abnormal SPPB-derived repeated chair-stand test, lower MDADI scores, and higher overall stage grouping showed potential predictive value (p ≤ 0.10) for EAT-10 ≥ 3. Using multivariable regression analysis, only cachexia remained a significant predictor of EAT-10 ≥ 3 (HR 9.000 [95%CI 2.483-32.619], p = 0.001). CONCLUSION Cachexia independently predicted the presence of patient-reported OD.
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Affiliation(s)
- Anna C H Willemsen
- GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands.,Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Walmari Pilz
- GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Otorhinolaryngology - Head & Neck Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands.,School for Mental Health and Neuroscience - MHeNs, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Ann Hoeben
- GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands.,Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Frank J P Hoebers
- GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Radiation Oncology, MAASTRO Clinic, Maastricht, The Netherlands
| | - Annemie M W J Schols
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Laura W J Baijens
- GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Otorhinolaryngology - Head & Neck Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
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25
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Ye Z, Saraf A, Ravipati Y, Hoebers F, Zha Y, Zapaishchykova A, Likitlersuang J, Tishler RB, Schoenfeld JD, Margalit DN, Haddad RI, Mak RH, Naser M, Wahid KA, Sahlsten J, Jaskari J, Kaski K, Mäkitie AA, Fuller CD, Aerts HJ, Kann BH. Fully-automated sarcopenia assessment in head and neck cancer: development and external validation of a deep learning pipeline. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.01.23286638. [PMID: 36945519 PMCID: PMC10029039 DOI: 10.1101/2023.03.01.23286638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Purpose Sarcopenia is an established prognostic factor in patients diagnosed with head and neck squamous cell carcinoma (HNSCC). The quantification of sarcopenia assessed by imaging is typically achieved through the skeletal muscle index (SMI), which can be derived from cervical neck skeletal muscle (SM) segmentation and cross-sectional area. However, manual SM segmentation is labor-intensive, prone to inter-observer variability, and impractical for large-scale clinical use. To overcome this challenge, we have developed and externally validated a fully-automated image-based deep learning (DL) platform for cervical vertebral SM segmentation and SMI calculation, and evaluated the relevance of this with survival and toxicity outcomes. Materials and Methods 899 patients diagnosed as having HNSCC with CT scans from multiple institutes were included, with 335 cases utilized for training, 96 for validation, 48 for internal testing and 393 for external testing. Ground truth single-slice segmentations of SM at the C3 vertebra level were manually generated by experienced radiation oncologists. To develop an efficient method of segmenting the SM, a multi-stage DL pipeline was implemented, consisting of a 2D convolutional neural network (CNN) to select the middle slice of C3 section and a 2D U-Net to segment SM areas. The model performance was evaluated using the Dice Similarity Coefficient (DSC) as the primary metric for the internal test set, and for the external test set the quality of automated segmentation was assessed manually by two experienced radiation oncologists. The L3 skeletal muscle area (SMA) and SMI were then calculated from the C3 cross sectional area (CSA) of the auto-segmented SM. Finally, established SMI cut-offs were used to perform further analyses to assess the correlation with survival and toxicity endpoints in the external institution with univariable and multivariable Cox regression. Results DSCs for validation set (n = 96) and internal test set (n = 48) were 0.90 (95% CI: 0.90 - 0.91) and 0.90 (95% CI: 0.89 - 0.91), respectively. The predicted CSA is highly correlated with the ground-truth CSA in both validation (r = 0.99, p < 0.0001) and test sets (r = 0.96, p < 0.0001). In the external test set (n = 377), 96.2% of the SM segmentations were deemed acceptable by consensus expert review. Predicted SMA and SMI values were highly correlated with the ground-truth values, with Pearson r β 0.99 (p < 0.0001) for both the female and male patients in all datasets. Sarcopenia was associated with worse OS (HR 2.05 [95% CI 1.04 - 4.04], p = 0.04) and longer PEG tube duration (median 162 days vs. 134 days, HR 1.51 [95% CI 1.12 - 2.08], p = 0.006 in multivariate analysis. Conclusion We developed and externally validated a fully-automated platform that strongly correlates with imaging-assessed sarcopenia in patients with H&N cancer that correlates with survival and toxicity outcomes. This study constitutes a significant stride towards the integration of sarcopenia assessment into decision-making for individuals diagnosed with HNSCC. SUMMARY STATEMENT In this study, we developed and externally validated a deep learning model to investigate the impact of sarcopenia, defined as the loss of skeletal muscle mass, on patients with head and neck squamous cell carcinoma (HNSCC) undergoing radiotherapy. We demonstrated an efficient, fullyautomated deep learning pipeline that can accurately segment C3 skeletal muscle area, calculate cross-sectional area, and derive a skeletal muscle index to diagnose sarcopenia from a standard of care CT scan. In multi-institutional data, we found that pre-treatment sarcopenia was associated with significantly reduced overall survival and an increased risk of adverse events. Given the increased vulnerability of patients with HNSCC, the assessment of sarcopenia prior to radiotherapy may aid in informed treatment decision-making and serve as a predictive marker for the necessity of early supportive measures.
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Affiliation(s)
- Zezhong Ye
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, United States
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Anurag Saraf
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, United States
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Yashwanth Ravipati
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, United States
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Frank Hoebers
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, United States
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Yining Zha
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, United States
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Anna Zapaishchykova
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, United States
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
- Department of Radiology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
| | - Jirapat Likitlersuang
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, United States
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Roy B. Tishler
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Jonathan D. Schoenfeld
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Danielle N. Margalit
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Robert I. Haddad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
| | - Raymond H. Mak
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, United States
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Mohamed Naser
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kareem A. Wahid
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jaakko Sahlsten
- Department of Computer Science, Aalto University School of Science, Espoo, Finland
| | - Joel Jaskari
- Department of Computer Science, Aalto University School of Science, Espoo, Finland
| | - Kimmo Kaski
- Department of Computer Science, Aalto University School of Science, Espoo, Finland
| | - Antti A. Mäkitie
- Department Otorhinolaryngology – Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Clifton D. Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Hugo J.W.L. Aerts
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, United States
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
- Department Otorhinolaryngology – Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Radiology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
| | - Benjamin H. Kann
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, United States
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
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Semsar-Kazerooni K, Richardson K, Forest VI, Mlynarek A, Hier MP, Sadeghi N, Mascarella MA. Development and validation of the modified index of fragility in head and neck cancer surgery. J Otolaryngol Head Neck Surg 2023; 52:5. [PMID: 36703217 PMCID: PMC9878788 DOI: 10.1186/s40463-022-00607-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 11/04/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND This study aims to develop and validate, a clinically useful modified index of fragility (mIFG) to identify patients at risk of fragility and to predict postoperative adverse events. METHOD An observational study was performed using the American College of Surgeons National Surgical Quality Improvement Program database, from 2006 to 2018. All patients undergoing nonemergency head and neck cancer surgery were included. A seven-item index (mIFG) was developed using variables associated with frailty, cachexia, and sarcopenia, drawn from the literature (weight loss, low body mass index, dyspnea, diabetes, serum albumin, hematocrit, and creatinine). Multivariable logistic regression was used to model the association between mIFG, postoperative adverse events and death. A validation cohort was then used to ascertain the diagnostic accuracy of the mIFG. RESULTS A total of 23,438 cases were included (16,407 in the derivation group and 7031 in the validation group). There was a total of 4273 postoperative major adverse events (AE) and deaths, 1023 postoperative pulmonary complications and 1721 wound complications. Using the derivation cohort, the 7-item mIFG was independently associated with death, major AEs, pulmonary and wound complications, when controlling for significant covariates. The mIFG predicted death and major adverse events using the validation cohort with an accuracy of 0.70 (95% CI: 0.63-0.76) and 0.64 (95% CI: 0.63-0.66), respectively. The mIFG outperformed the modified Frailty index. CONCLUSION The modified index of fragility is a reliable and easily accessible tool to predict risk of postoperative adverse events and death in patients undergoing head and neck cancer surgery.
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Affiliation(s)
| | - Keith Richardson
- grid.63984.300000 0000 9064 4811Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, Montréal, QC Canada
| | - Véronique-Isabelle Forest
- grid.63984.300000 0000 9064 4811Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, Montréal, QC Canada
| | - Alex Mlynarek
- grid.63984.300000 0000 9064 4811Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, Montréal, QC Canada
| | - Michael P. Hier
- grid.63984.300000 0000 9064 4811Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, Montréal, QC Canada
| | - Nader Sadeghi
- grid.63984.300000 0000 9064 4811Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, Montréal, QC Canada ,grid.63984.300000 0000 9064 4811Research Institute of the McGill University Health Center, Montreal, QC Canada
| | - Marco. A. Mascarella
- grid.63984.300000 0000 9064 4811Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, Montréal, QC Canada ,grid.414980.00000 0000 9401 2774Centre for Clinical Epidemiology, Lady Davis Institute of the Jewish General Hospital, Montréal, QC Canada ,grid.63984.300000 0000 9064 4811Research Institute of the McGill University Health Center, Montreal, QC Canada
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Sweeny L, Slijepcevic A, Curry JM, Philips R, Bonaventure CA, DiLeo M, Luginbuhl AJ, Crawley MB, Guice KM, McCreary E, Buncke M, Petrisor D, Wax MK. Factors Impacting Discharge Destination Following Head and Neck Microvascular Reconstruction. Laryngoscope 2023; 133:95-104. [PMID: 35562185 DOI: 10.1002/lary.30149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/14/2022] [Accepted: 04/16/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Determine which variables impact postoperative discharge destination following head and neck microvascular free flap reconstruction. STUDY DESIGN Retrospective review of prospectively collected databases. METHODS Consecutive patients undergoing head and neck microvascular free flap reconstruction between January 2010 and December 2019 (n = 1972) were included. Preoperative, operative and postoperative variables were correlated with discharge destination (home, skilled nursing facility [SNF], rehabilitation facility, death). RESULTS The mean age of patients discharged home was lower (60 SD ± 13, n = 1450) compared to those discharged to an SNF (68 SD ± 14, n = 168) or a rehabilitation facility (71 SD ± 14, n = 200; p < 0.0001). Operative duration greater than 10 h correlated with a higher percentage of patients being discharged to a rehabilitation or SNF (25% vs. 15%; p < 0.001). Patients were less likely to be discharged home if they had a known history of cardiac disease (71% vs. 82%; p < 0.0001). Patients were less likely to be discharged home if they experienced alcohol withdrawal (67% vs. 80%; p = 0.006), thromboembolism (59% vs. 80%; p = 0.001), a pulmonary complication (46% vs. 81%; p < 0.0001), a cardiac complication (46% vs. 80%; p < 0.0001), or a cerebral vascular event (25% vs. 80%; p < 0.0001). There was no correlation between discharge destination and occurrence of postoperative wound infection, salivary fistula, partial tissue necrosis or free flap failure. Thirty-day readmission rates were similar when stratified by discharge destination. CONCLUSION There was no correlation with the anatomic site, free flap donor selection, or free flap survival and discharge destination. Patient age, operative duration and occurrence of a medical complication postoperatively did correlate with discharge destination. LEVEL OF EVIDENCE 4 Laryngoscope, 133:95-104, 2023.
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Affiliation(s)
- Larissa Sweeny
- Department of Otolaryngology-Head and Neck Surgery, University of Miami, Miami, Florida, U.S.A
| | - Allison Slijepcevic
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Joseph M Curry
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Ramez Philips
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Caroline A Bonaventure
- School of Medicine, Louisiana State University Health Science Center - New Orleans, New Orleans, Louisiana, U.S.A
| | - Michael DiLeo
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Science Center - New Orleans, New Orleans, Louisiana, U.S.A
| | - Adam J Luginbuhl
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Meghan B Crawley
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Kelsie M Guice
- School of Medicine, Louisiana State University Health Science Center - New Orleans, New Orleans, Louisiana, U.S.A
| | - Eleanor McCreary
- Oregon Health and Science University School of Medicine, Portland, Oregon, U.S.A
| | - Michelle Buncke
- Oregon Health and Science University School of Medicine, Portland, Oregon, U.S.A
| | - Daniel Petrisor
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Mark K Wax
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A
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Evaluation of sarcopenia and sarcopenic obesity in patients affected by oral squamous cell carcinoma: A retrospective single-center study. J Craniomaxillofac Surg 2023; 51:7-15. [PMID: 36739189 DOI: 10.1016/j.jcms.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/09/2022] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
This retrospective single-center study aimed to evaluate the relevance of sarcopenia and sarcopenic obesity as negative prognostic factors in patients with oral squamous cell carcinoma (OSCC). The study was performed on patients who underwent oral squamous cell carcinoma resection surgery. Patients' demographic and clinical variables were collected at diagnosis (sex, age, height, weight, comorbidities, smoke and alcohol consumption, HPV positivity, TNM-stage) and corrected for known prognostic factors (age, body mass index, TNM-stage). The Skeletal Muscle Mass (SMM) and the Cross-Sectional Area (CSA) on pre-treatment CT scans and Body Mass Index (BMI) were measured to assess sarcopenia and sarcopenic obesity correlated to overall survival (OS). Chi-square statistics were used to analyze the differences between the frequencies of each categorical variable with the presence or absence of sarcopenia and sarcopenic obesity. The cumulative overall survival was calculated by the Kaplan-Meier method, and the differences between curves were evaluated by the log-rank test. A Cox proportional hazard regression model was used for univariate and multivariate analysis of the overall survival. Within the limitations of the study, in this sample, sarcopenia did not seem to cause a statistically significant reduction in the overall survival in patients with oral squamous cell carcinoma (Log Rank χ2 = 3.67, p = 0.055; HR 0.996, 95% CI 0.732-1.354, p = 0.979), however, sarcopenic obesity showed a meaningful negative prognostic impact on it (Log Rank χ2 = 5.71, p = 0.017; HR 0.985, 95% CI 0.424-2.286, p = 0.972). Within the limitations of the study it seems that sarcopenic obesity, age, BMI, and TNM-stage are more relevant negative prognostic factors, influencing overall survival in surgically treated OSCC, than sarcopenia.
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Jovanovic N, Chinnery T, Mattonen SA, Palma DA, Doyle PC, Theurer JA. Sarcopenia in head and neck cancer: A scoping review. PLoS One 2022; 17:e0278135. [PMID: 36441690 PMCID: PMC9704631 DOI: 10.1371/journal.pone.0278135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 11/09/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES In those undergoing treatment for head and neck cancer (HNC), sarcopenia is a strong prognostic factor for outcomes and mortality. This review identified working definitions and methods used to objectively assess sarcopenia in HNC. METHOD The scoping review was performed in accordance with Arksey and O'Malley's five-stage methodology and the Joanna Briggs Institute guidelines. INFORMATION SOURCES Eligible studies were identified using MEDLINE, Embase, Scopus, Cochrane Library, and CINAHL databases. STUDY SELECTION Inclusion criteria represented studies of adult HNC patients in which sarcopenia was listed as an outcome, full-text articles written in English, and empirical research studies with a quantitative design. DATA EXTRACTION Eligible studies were assessed using a proprietary data extraction form. General information, article details and characteristics, and details related to the concept of the scoping review were extracted in an iterative process. RESULTS Seventy-six studies published internationally from 2016 to 2021 on sarcopenia in HNC were included. The majority were retrospective (n = 56; 74%) and the prevalence of sarcopenia ranged from 3.8% to 78.7%. Approximately two-thirds of studies used computed tomography (CT) to assess sarcopenia. Skeletal muscle index (SMI) at the third lumbar vertebra (L3) (n = 53; 70%) was the most prevalent metric used to identify sarcopenia, followed by SMI at the third cervical vertebra (C3) (n = 4; 5%). CONCLUSIONS Currently, the most effective strategy to assess sarcopenia in HNC depends on several factors, including access to resources, patient and treatment characteristics, and the prognostic significance of outcomes used to represent sarcopenia. Skeletal muscle mass (SMM) measured at C3 may represent a practical, precise, and cost-effective biomarker for the detection of sarcopenia. However, combining SMM measurements at C3 with other sarcopenic parameters-including muscle strength and physical performance-may provide a more accurate risk profile for sarcopenia assessment and allow for a greater understanding of this condition in HNC.
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Affiliation(s)
- Nedeljko Jovanovic
- Health and Rehabilitation Sciences, Western University, London, ON, Canada
- * E-mail:
| | - Tricia Chinnery
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Sarah A. Mattonen
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - David A. Palma
- London Health Sciences Centre, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Philip C. Doyle
- Division of Laryngology, Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Julie A. Theurer
- Health and Rehabilitation Sciences, Western University, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
- Department of Otolaryngology–Head and Neck Surgery, London, ON, Canada
- School of Communication Sciences and Disorders, Elborn College, Western University, London, ON, Canada
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Mazurek M, Mlak R, Kot A, Rahnama-Hezavah M, Małecka-Massalska T. Does Human Papillomavirus Infection Influence the Frequency and Severity of Nutritional Disorders in Head and Neck Cancer? Nutrients 2022; 14:4528. [PMID: 36364788 PMCID: PMC9656707 DOI: 10.3390/nu14214528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/25/2022] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND About 87% of head and neck cancer (HNC) patients (mostly oropharyngeal cancer-OPC) are infected with human papillomavirus (HPV). Recent studies have demonstrated a significant correlation between HPV infection and nutritional disorders in HNC patients. Therefore, we formed a hypothesis that nutritional disorders or their severity in HNC patients may be associated with the occurrence of HPV infection due to known molecular differences in involved tissue. This literature review aimed to evaluate the influence of HPV infection on the occurrence and severity of nutritional disorders in HNC patients. MATERIALS AND METHODS The PubMed database was used to search papers with the keywords "HPV", "HNC", and "nutritional disorders" in different variants and combinations. CONCLUSIONS The data available in the discussed papers indicate, among other things, that HPV-positive patients may be at higher risk of malnutrition, critical weight loss, and necessity for gastrostomy after radiotherapy or chemoradiotherapy (C-RT). It should be highlighted that despite some studies demonstrating positive results, currently available data regarding the influence of HPV infection on the occurrence and severity of nutritional disorders in HNC remain limited and inconclusive, and thus further research on this issue is warranted.
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Affiliation(s)
- Marcin Mazurek
- Department of Human Physiology of the Chair of Preclinical Sciences, Medical University of Lublin, 20-080 Lublin, Poland
| | - Radosław Mlak
- Laboratory of Body Composition Research of the Chair of Preclinical Sciences, Medical University of Lublin, 20-080 Lublin, Poland
| | - Agata Kot
- Care and Treatment Facility, Cardinal Wyszynski Voivodeship Specialist Hospital in Lublin, Biernackiego Street, 20-718 Lublin, Poland
| | - Mansur Rahnama-Hezavah
- Chair and Department of Dental Surgery, Medical University of Lublin, 20-093 Lublin, Poland
| | - Teresa Małecka-Massalska
- Department of Human Physiology of the Chair of Preclinical Sciences, Medical University of Lublin, 20-080 Lublin, Poland
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Proactive Swallowing Rehabilitation in Patients with Recurrent Oral Cancer Receiving Salvage Treatment: Long-Term Swallowing-Related Outcomes. Dysphagia 2022; 38:954-964. [PMID: 36127448 DOI: 10.1007/s00455-022-10521-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 09/11/2022] [Indexed: 11/03/2022]
Abstract
The present study aimed to evaluate the impact of proactive swallowing rehabilitation on swallowing function and quality of life in patients with recurrent oral cancer in the first 2 years after salvage treatment. Consecutive adult patients with recurrent oral cancer who received salvage surgery and free flap reconstruction were recruited prospectively, to whom proactive swallowing rehabilitation was provided. Body weight (BW); fiberoptic endoscopic evaluation of swallowing (FEES), functional oral intake scale (FOIS), and diet level; 10-item eating assessment tool (EAT-10), and MD Anderson Dysphagia Inventory (MDADI); and adherence at baseline, 1, 3, 6, 12, 18 and 24 months were evaluated. A total of 50 patients were included during May 2018 to July 2020. Compared to the baseline, significant deterioration in BW, FOIS, and MDADI was noted at one month. However, a trend of recovery was observed in BW and FOIS from one month, and in MDADI from three months. All patients were free of tube feeding at 18-24 months and tolerated diet with special preparations or compensation. Safe swallowing could be achieved in approximately 80% participants after 12 months of diet modification or compensatory maneuvers. Proactive swallowing therapy was feasible in patients with recurrent oral cancer receiving salvage treatment. Although this patient population might have pre-existing dysphagia from previous treatments, rehabilitation could facilitate safe per oral intake and maintain adequate nutrition with adaptive maneuvers or compensatory strategies. Patients who underwent proactive swallowing rehabilitation had better recovery in the functional oral intake level.
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Gunesch AN, Sutton TL, Krasnow SM, Deig CR, Sheppard BC, Marks DL, Grossberg AJ. Validation of automated body composition analysis using diagnostic computed tomography imaging in patients with pancreatic cancer. Am J Surg 2022; 224:742-746. [PMID: 35396132 PMCID: PMC9308682 DOI: 10.1016/j.amjsurg.2022.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/19/2022] [Accepted: 03/22/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Sarcopenia is associated with complications and inferior oncologic outcomes in solid tumors. Axial computed tomography (CT) scans can be used to evaluate sarcopenia, however manual quantification is laborious. We sought to validate an automated method of quantifying muscle cross-sectional area (CSA) in patients with pancreatic adenocarcinoma (PDAC). METHODS Mid-L3 CT images from patients with PDAC were analyzed: CSAs of skeletal muscle (SM) were measured using manual segmentation and the software AutoMATiCA, and then compared with linear regression. RESULTS Five-hundred-twenty-five unique scans were analyzed. There was robust correlation between manual and automated segmentation for L3 CSA (R2 0.94, P < 0.001). Bland-Altman analysis demonstrated a consistent overestimation of muscle CSA by AutoMATiCA with a mean difference of 5.7%. A correction factor of 1.06 was validated using a unique test dataset of 36 patients with non-PDAC peripancreatic malignancies. CONCLUSIONS Automated muscle CSA measurement with AutoMATiCA is highly efficient and yields results highly correlated with manual measurement. These findings support the potential use of high-throughput sarcopenia analysis with abdominal CT scans for both clinical and research purposes.
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Affiliation(s)
- Ali N Gunesch
- School of Medicine, Oregon Health & Science University, Portland, OR, 97239, USA
| | | | | | | | | | - Daniel L Marks
- Department of Pediatrics, OHSU, Portland, OR, 97239, USA; Brenden Colson Center for Pancreatic Care, OHSU, Portland, OR, 97239, USA
| | - Aaron J Grossberg
- Brenden Colson Center for Pancreatic Care, OHSU, Portland, OR, 97239, USA; Department of Radiation Medicine, OHSU, Portland, OR, 97239, USA.
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Naser MA, Wahid KA, Grossberg AJ, Olson B, Jain R, El-Habashy D, Dede C, Salama V, Abobakr M, Mohamed ASR, He R, Jaskari J, Sahlsten J, Kaski K, Fuller CD. Deep learning auto-segmentation of cervical skeletal muscle for sarcopenia analysis in patients with head and neck cancer. Front Oncol 2022; 12:930432. [PMID: 35965493 PMCID: PMC9366009 DOI: 10.3389/fonc.2022.930432] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/29/2022] [Indexed: 12/22/2022] Open
Abstract
Background/Purpose Sarcopenia is a prognostic factor in patients with head and neck cancer (HNC). Sarcopenia can be determined using the skeletal muscle index (SMI) calculated from cervical neck skeletal muscle (SM) segmentations. However, SM segmentation requires manual input, which is time-consuming and variable. Therefore, we developed a fully-automated approach to segment cervical vertebra SM. Materials/Methods 390 HNC patients with contrast-enhanced CT scans were utilized (300-training, 90-testing). Ground-truth single-slice SM segmentations at the C3 vertebra were manually generated. A multi-stage deep learning pipeline was developed, where a 3D ResUNet auto-segmented the C3 section (33 mm window), the middle slice of the section was auto-selected, and a 2D ResUNet auto-segmented the auto-selected slice. Both the 3D and 2D approaches trained five sub-models (5-fold cross-validation) and combined sub-model predictions on the test set using majority vote ensembling. Model performance was primarily determined using the Dice similarity coefficient (DSC). Predicted SMI was calculated using the auto-segmented SM cross-sectional area. Finally, using established SMI cutoffs, we performed a Kaplan-Meier analysis to determine associations with overall survival. Results Mean test set DSC of the 3D and 2D models were 0.96 and 0.95, respectively. Predicted SMI had high correlation to the ground-truth SMI in males and females (r>0.96). Predicted SMI stratified patients for overall survival in males (log-rank p = 0.01) but not females (log-rank p = 0.07), consistent with ground-truth SMI. Conclusion We developed a high-performance, multi-stage, fully-automated approach to segment cervical vertebra SM. Our study is an essential step towards fully-automated sarcopenia-related decision-making in patients with HNC.
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Affiliation(s)
- Mohamed A. Naser
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kareem A. Wahid
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Aaron J. Grossberg
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Brennan Olson
- Medical Scientist Training Program, Oregon Health & Science University, Portland, OR, United States
| | - Rishab Jain
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Dina El-Habashy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Department of Clinical Oncology, Menoufia University Shibin El Kom, Shibin El Kom, Egypt
| | - Cem Dede
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Vivian Salama
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Moamen Abobakr
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Abdallah S. R. Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Renjie He
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Joel Jaskari
- Department of Computer Science, Aalto University School of Science, Espoo, Finland
| | - Jaakko Sahlsten
- Department of Computer Science, Aalto University School of Science, Espoo, Finland
| | - Kimmo Kaski
- Department of Computer Science, Aalto University School of Science, Espoo, Finland
| | - Clifton D. Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- *Correspondence: Clifton D. Fuller,
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Effect of Pre-Existing Sarcopenia on Oncological Outcomes for Oral Cavity Squamous Cell Carcinoma Undergoing Curative Surgery: A Propensity Score-Matched, Nationwide, Population-Based Cohort Study. Cancers (Basel) 2022; 14:cancers14133246. [PMID: 35805020 PMCID: PMC9264926 DOI: 10.3390/cancers14133246] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose: The effect of pre-existing sarcopenia on patients with oral cavity squamous cell carcinoma (OCSCC) remains unknown. Therefore, we designed a propensity score-matched population-based cohort study to compare the oncological outcomes of patients with OCSCC undergoing curative surgery with and without sarcopenia. Patients and Methods: We included patients with OCSCC undergoing curative surgery and categorized them into two groups according to the presence or absence of pre-existing sarcopenia. Patients in both the groups were matched at a ratio of 2:1. Results: The matching process yielded 16,294 patients (10,855 and 5439 without and with pre-existing sarcopenia, respectively). In multivariate Cox regression analyses, the adjusted hazard ratio (aHR, 95% confidence interval [CI]) of all-cause mortality for OCSCC with and without pre-existing sarcopenia was 1.15 (1.11−1.21, p < 0.0001). Furthermore, the aHRs (95% CIs) of locoregional recurrence and distant metastasis for OCSCC with and without pre-existing sarcopenia were 1.07 (1.03−1.18, p = 0.0020) and 1.07 (1.03−1.20, p = 0.0148), respectively. Conclusions: Pre-existing sarcopenia might be a significant poor prognostic factor for overall survival, locoregional recurrence, and distant metastasis for patients with OCSCC undergoing curative surgery. In susceptible patients at a risk of OCSCC, sarcopenia prevention measures should be encouraged, such as exercise and early nutrition intervention.
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Mascarella MA, Patel T, Vendra V, Gardiner L, Kergoat MJ, Kubik MW, Solari MG, Snyderman CH, Traylor KS, Ferris RL, Kim S, Duvvuri U, Sridharan SS. Poor treatment tolerance in head and neck cancer patients with low muscle mass. Head Neck 2022; 44:844-850. [PMID: 35020252 PMCID: PMC11412609 DOI: 10.1002/hed.26978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/05/2021] [Accepted: 01/03/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND We ascertain the role of a low cervical paraspinal skeletal muscle index (CPSMI) as a biomarker for poor treatment tolerance in patients with operable mucosal head and neck squamous cell carcinoma (HNSCC). METHODS A prospective cohort of patients with operable HNSCC requiring microvascular reconstruction was evaluated. Low CPSMI was calculated using preoperative CT neck imaging. Poor treatment tolerance, a composite measure of incomplete therapy or severe morbidity/mortality during treatment, was the primary outcome. RESULTS One hundred and twenty-seven patients underwent extirpative surgery with a mean age was 60.5. Poor treatment tolerance occurred in 71 (56%) patients with 21 not completing recommended adjuvant therapy and 66 having severe treatment-related morbidity. A low CPSMI was independently associated with poor treatment tolerance (OR 2.49, 95%CI 1.10-5.93) and delay to adjuvant therapy (OR 4.48, 95%CI 1.07-27.6) after adjusting for multiple confounders. CONCLUSION Low CPSMI was independently associated with poor treatment tolerance in patients with operable HNSCC.
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Affiliation(s)
- Marco A Mascarella
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Biomedical Sciences, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
- Lady Davis Institute of the Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Terral Patel
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Varun Vendra
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Lauren Gardiner
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Marie-Jeanne Kergoat
- Department of Biomedical Sciences, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
- Division of Geriatrics, Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Mark W Kubik
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mario G Solari
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Carl H Snyderman
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Katie S Traylor
- Department of Diagnostic Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Robert L Ferris
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Seungwon Kim
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Umamaheswar Duvvuri
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Shaum S Sridharan
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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McGoldrick DM, Yassin Alsabbagh A, Shaikh M, Pettit L, Bhatia SK. Masseter muscle defined sarcopenia and survival in head and neck cancer patients. Br J Oral Maxillofac Surg 2022; 60:454-458. [PMID: 35339299 DOI: 10.1016/j.bjoms.2021.07.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 07/28/2021] [Indexed: 11/18/2022]
Abstract
Sarcopenia is increasingly recognised as a poor prognostic factor in older patients undergoing cancer treatment. Recently, masseter muscle cross sectional area (MMCSA) has been shown to accurately identify sarcopenic patients. We aimed to apply this novel technique to a head and neck cohort to identify any potential relationship with survival. A retrospective review was undertaken of patients over 65 years, diagnosed with squamous cell carcinoma of the head and neck and treated with curative intent in our unit between October 2009 and October 2017. MMCSA was measured on staging CT scans using a validated technique. Patients were categorised into tertiles and also high and low MMCSA groups based on gender based tertile and mean MMCSA values. Survival analysis was performed using the Kaplan-Meier and Cox regression methods. A total of 111 patients were included in the study. The average age was 74 years (range 65-92 years) and 69% were male. The majority of patients had malignancies of the oral cavity (41%) or larynx (37%). The overall survival was 46% with a follow-up between 24 and 60 months. MMCSA was significantly associated with worse overall survival when defined using a gender based mean cut-off point (p=0.038) or tertile groupings (p=0.026), but did not maintain significance in multivariable analysis. Masseter muscle defined sarcopenia was associated with worse survival in our cohort in univariate analysis.Opportunistic measurement of this new factor on staging scans may aid prognostication and management in older patients.
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Affiliation(s)
- David M McGoldrick
- Department of Oral and Maxillofacial Surgery, Shrewsbury and Telford Hospital NHS Trust, Telford, UK.
| | - Aghiad Yassin Alsabbagh
- Department of Oral and Maxillofacial Surgery, Shrewsbury and Telford Hospital NHS Trust, Telford, UK
| | - Moinuddin Shaikh
- Department of Radiology, Shrewsbury and Telford Hospital NHS Trust, Telford, UK
| | - Laura Pettit
- Department of Clinical Oncology, Shrewsbury and Telford Hospital NHS Trust, Telford, UK
| | - Sunil K Bhatia
- Department of Clinical Oncology, Shrewsbury and Telford Hospital NHS Trust, Telford, UK
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Martínez-Herrera BE, Trujillo-Hernández B, Sat-Muñoz D, González-Barba F, Cruz-Corona E, Bayardo-López LH, Solórzano-Meléndez A, Oñate-Zubdia DA, Morán-Galavíz RE, Flores-Carlos JD, Dávalos-Cobián C, Salazar-Páramo M, Nava-Zavala AH, Gómez-Sánchez E, Balderas-Peña LMA. Quality of Life and Functionality of Head and Neck Cancer Patients Are Diminished As a Function of Sarcopenia and Obesity. EAR, NOSE & THROAT JOURNAL 2022:1455613221076791. [PMID: 35226551 DOI: 10.1177/01455613221076791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Health-related quality of life (QoL) is a measure that allows us to know the patient's perception of well-being and how it is affected by their disease and treatments. In cancer patients, sarcopenia has been associated with low scores on various instruments used to assess the QoL; however, little information is available on the effects of sarcopenia and sarcopenic obesity on the QoL of patients with head and neck cancer (H&NC). METHODS In this cross-sectional study with 71 H&NC patients aged between 40 and 80 years, we describe the scores on the instruments EORTC QLQ C-30 and EORTC QLQ-H&N35 according to the sarcopenia phenotype (NSG, nonsarcopenic group; SG, sarcopenic group; and SOG, sarcopenic obesity group), hand-grip strength, gait speed, total lymphocyte count, albumin, cholesterol and C-reactive protein, and the relationships between these variables. RESULTS The prevalence of sarcopenia and sarcopenic obesity was 48% and 28%, respectively. The QoL analysis showed that NSG had higher scores on the physical functioning scale [NSG 93 (83-100); SG 73 (52-88); SOG 83 (53-93), P = .009] and lower scores on the fatigue scale [NSG 11 (0-22); S 39 (30-67); SOG 44 (14-56); P = .004]. The NSG had a higher hand-grip strength (31.1 kg) than SG (24.1 kg, P = .007) and SOG (26.3 kg, P = .001), and a lower C-reactive protein. The SG and SOG showed no differences between them. CONCLUSIONS Patients with sarcopenia or sarcopenic obesity have lower physical performance and a higher level of fatigue than nonsarcopenic patients. This loss of function can maintain or worsen sarcopenia due to the patient's self-restraint in physical exertion that encourages an increase in muscle tissue.
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Affiliation(s)
- Brenda-Eugenia Martínez-Herrera
- Departamento de Nutrición y Dietética, Hospital General de Zona #02, 27800Instituto Mexicano del Seguro Social, San Luis Potosí, México
- Unidad de Investigación Biomédica 02, Hospital de Especialidades, Centro Médico Nacional de Occidente, 27800Instituto Mexicano del Seguro Social, Guadalajara, México
- Programa de Doctorado en Ciencias Médicas, 27800Universidad de Colima, Colima, México
| | | | - Daniel Sat-Muñoz
- Clínica de Cirugía de Tumores de Cabeza y Cuello, Departamento de Oncología Quirúrgica, Hospital de Especialidades, 27800Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
- Departamento de Morfología. Cuerpo Académico UDG CA-874 "Ciencias morfológicas en el diagnóstico y tratamiento de la enfermedad", 27800Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
| | - Faviola González-Barba
- Unidad de Investigación Biomédica 02, Hospital de Especialidades, Centro Médico Nacional de Occidente, 27800Instituto Mexicano del Seguro Social, Guadalajara, México
- Departamento de Patología, Hospital de Especialidades, 27800Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
- Programa de Maestría en Ciencias Médicas, 27800Universidad de Colima, Colima, México
| | - Eduardo Cruz-Corona
- Unidad de Investigación Biomédica 02, Hospital de Especialidades, Centro Médico Nacional de Occidente, 27800Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Luis Héctor Bayardo-López
- Departamento de Oncología Radioterapia, Hospital de Especialidades, Centro Médico Nacional de Occidente, 27800Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Alejandro Solórzano-Meléndez
- Departamento de Oncología Radioterapia, Hospital de Especialidades, Centro Médico Nacional de Occidente, 27800Instituto Mexicano del Seguro Social, Guadalajara, México
| | - David-Abdiel Oñate-Zubdia
- Departamento de Oncología Radioterapia, Hospital de Especialidades, Centro Médico Nacional de Occidente, 27800Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Ruben-Eduardo Morán-Galavíz
- Servicio de Soporte Nutricio, Departamento de Cirugía General, Hospital de Especialidades, Centro Médico Nacional de Occidente, 27800Instituto Mexicano del Seguro Social, 44340 Guadalajara, México
| | - Juan-Daniel Flores-Carlos
- Servicio de Soporte Nutricio, Departamento de Cirugía General, Hospital de Especialidades, Centro Médico Nacional de Occidente, 27800Instituto Mexicano del Seguro Social, 44340 Guadalajara, México
| | - Carlos Dávalos-Cobián
- Departamento Clínico de Gastroenterología, Hospital de Especialidades, Centro Médico Nacional de Occidente, 27800Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Mario Salazar-Páramo
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, 27800Universidad de Guadalajara, Guadalajara, México
| | - Arnulfo-Hernán Nava-Zavala
- Unidad de Investigación Biomédica 02, Hospital de Especialidades, Centro Médico Nacional de Occidente, 27800Instituto Mexicano del Seguro Social, Guadalajara, México
- Unidad de Investigación Social Epidemiológica y en Servicios de Salud, 27800Instituto Mexicano del Seguro Social, Guadalajara, México
- Programa Internacional Facultad de Medicina, 27800Universidad Autónoma de Guadalajara, Zapopan, México
- Servicio de Inmunología y Reumatología, División de Medicina Interna, 27800Hospital General de Occidente, Zapopan, México
| | - Eduardo Gómez-Sánchez
- Departamento de Morfología. Cuerpo Académico UDG CA-874 "Ciencias morfológicas en el diagnóstico y tratamiento de la enfermedad", 27800Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
- División Disciplinas Básicas para la Salud, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
| | - Luz-Ma-Adriana Balderas-Peña
- Unidad de Investigación Biomédica 02, Hospital de Especialidades, Centro Médico Nacional de Occidente, 27800Instituto Mexicano del Seguro Social, Guadalajara, México
- Departamento de Morfología. Cuerpo Académico UDG CA-874 "Ciencias morfológicas en el diagnóstico y tratamiento de la enfermedad", 27800Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
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Olson B, Edwards J, Degnin C, Santucci N, Buncke M, Hu J, Chen Y, Fuller CD, Geltzeiler M, Grossberg AJ, Clayburgh D. Establishment and Validation of Pre-Therapy Cervical Vertebrae Muscle Quantification as a Prognostic Marker of Sarcopenia in Patients With Head and Neck Cancer. Front Oncol 2022; 12:812159. [PMID: 35237517 PMCID: PMC8882831 DOI: 10.3389/fonc.2022.812159] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/24/2022] [Indexed: 02/06/2023] Open
Abstract
Background Sarcopenia is prognostic for survival in patients with head and neck cancer (HNC). However, identification of this high-risk feature remains challenging without computed tomography (CT) imaging of the abdomen or thorax. Herein, we establish sarcopenia thresholds at the C3 level and determine if C3 sarcopenia is associated with survival in patients with HNC. Methods This retrospective cohort study was conducted in consecutive patients with a squamous cell carcinoma of the head and neck with cross-sectional abdominal or neck imaging within 60 days prior to treatment. Measurement of cross-sectional muscle area at L3 and C3 levels was performed from CT imaging. Primary study outcome was overall survival. Results Skeletal muscle area at C3 was strongly correlated with the L3 level in both men (n = 188; r = 0.77; p < 0.001) and women (n = 65; r = 0.80; p < 0.001), and C3 sarcopenia thresholds of 14.0 cm2/m2 (men) and 11.1 cm2/m2 (women) were best predictive of L3 sarcopenia thresholds. Applying these C3 thresholds to a cohort of patients with neck imaging alone revealed that C3 sarcopenia was independently associated with reduced overall survival in men (HR = 2.63; 95% CI, 1.79, 3.85) but not women (HR = 1.18, 95% CI, 0.76, 1.85). Conclusions This study identifies sarcopenia thresholds at the C3 level that best predict L3 sarcopenia in men and women. In HNC, C3-defined sarcopenia is associated with poor survival outcomes in men, but not women, suggesting sarcopenia may differentially affect men and women with HNC.
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Affiliation(s)
- Brennan Olson
- School of Medicine, Oregon Health & Science University, Portland, OR, United States
- Medical Scientist Training Program, Oregon Health & Science University, Portland, OR, United States
| | - Jared Edwards
- Department of General Surgery, Naval Medical Center San Diego, San Diego, CA, United States
| | - Catherine Degnin
- Biostatistics Shared Resources, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, United States
| | - Nicole Santucci
- School of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Michelle Buncke
- School of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Jeffrey Hu
- School of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Yiyi Chen
- Seagen Inc., Bothell, WA, United States
| | - Clifton D. Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Mathew Geltzeiler
- Department of Otolaryngology/Head and Neck Surgery, Oregon Health & Science University, Portland, OR, United States
| | - Aaron J. Grossberg
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR, United States
- Brenden-Colson Center for Pancreatic Care, Oregon Health & Science University, Portland, OR, United States
- Cancer Early Detection Advanced Research Center, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, United States
- *Correspondence: Daniel Clayburgh, ; Aaron J. Grossberg,
| | - Daniel Clayburgh
- Department of Otolaryngology/Head and Neck Surgery, Oregon Health & Science University, Portland, OR, United States
- Operative Care Division, Portland Veterans Affairs Health Care System, Portland, OR, United States
- *Correspondence: Daniel Clayburgh, ; Aaron J. Grossberg,
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Casasayas M, García-Lorenzo J, Gómez-Ansón B, Medina V, Fernández A, Quer M, León X. Low skeletal muscle mass assessed directly from the 3rd cervical vertebra can predict pharyngocutaneous fistula risk after total laryngectomy in the male population. Eur Arch Otorhinolaryngol 2022; 279:853-863. [PMID: 34665301 PMCID: PMC8795024 DOI: 10.1007/s00405-021-07127-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/04/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Skeletal muscle mass (SMM) loss and sarcopenia have been identified as risk factors for postoperative complications. The aim of this study was to investigate the relationship between pharyngocutaneous fistula (PCF) formation after total laryngectomy (TL) and SMM assessed from a computed tomography image of the 3rd cervical vertebra (C3). METHODS Retrospective study of 86 male patients who underwent TL between 2013 and 2019 in a single institution. We excluded women from the analysis due to our limited sample. SMM was determined from cross-sectional muscle area (CSMA) measurement at C3 using the ImageJ software. Results were compared with those for the skeletal muscle mass index (SMMI) calculated from the estimated measure at 3rd lumbar vertebra (L3). RESULTS PCF formation occurred in 21/86 patients. According to the CSMA at a C3 cut-off of 35.5cm2, of 18 patients (20.9%) with low SMM, 9 developed PCFs (50.0%). Among patients with normal SMM (n = 68, 79.1%), 12 developed PCFs (17.6%). The CSMA at C3 was the only variable significantly associated with PCF risk, which was 4.7 times greater in patients with low SMM (p = 0.007). Sarcopenia was more frequent in underweight patients (p = 0.0001), patients undergoing extended surgeries (p = 0.003), or presenting preoperative anaemia (p = 0.009) or hypoalbuminemia (p = 0.027). CONCLUSION Measuring the CSMA at C3 obtained results equivalent to those obtained by calculating the SMMI at L3, suggesting that direct SMM assessment from C3 is a useful approach to evaluating PCF formation risk after TL.
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Affiliation(s)
- Maria Casasayas
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, C/Mas Casanovas, 90, 08041, Barcelona, Spain.
| | | | - Beatriz Gómez-Ansón
- Servicio de Radiodiagnóstico, Unidad de Neuro-Radiología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Victoria Medina
- Servicio de Radiodiagnóstico, Unidad de Neuro-Radiología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alejandro Fernández
- Servicio de Medicina Nuclear, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Miquel Quer
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, C/Mas Casanovas, 90, 08041, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - Xavier León
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, C/Mas Casanovas, 90, 08041, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
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Mascarella MA, Gardiner L, Patel T, Vendra V, Khan N, Kergoat MJ, Kubik MW, Solari MG, Snyderman CH, Traylor KS, Sridharan SS. Cervical paraspinal skeletal muscle index outperforms frailty indices to predict postoperative adverse events in operable head and neck cancer with microvascular reconstruction. Microsurgery 2021; 42:209-216. [PMID: 34935198 DOI: 10.1002/micr.30848] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/17/2021] [Accepted: 11/19/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Sarcopenia is increasingly being recognized as a negative prognostic factor in patients with head and neck cancer (HNC). We associate a sarcopenia biomarker measured radiographically from computed tomography (CT) of the neck to postoperative adverse events in patients with operable HNC. PATIENTS AND METHODS A prospective cohort of treatment-naïve HNC patients undergoing surgery with microvascular reconstruction was performed. Cervical paraspinal skeletal muscle index (CPSMI) was calculated using preoperative CT neck imaging and adjusted for height and sex. Postoperative adverse events, including Clavien-Dindo Grade 3+ complications and fistula, were recorded within 30-days of the index surgery. Multivariate logistic regression was used to evaluate the association between CPSMI and postoperative complications. The modified frailty index (mFI) and Risk Assessment Index (RAI) were compared with CPSMI outcomes. RESULTS A total of 127 patients with mucosal HNC were included in the study. The mean age was 60.5 years, and 87 (68.5%) patients were male. Sixty Clavien-Dindo grade 3+ events occurred; 17 patients developed an oro/pharyngocutaneous fistula. Low CPSMI was independently associated with Clavien-Dindo Grade 3+ events (OR 2.80, 95% CI of 1.18-6.99) and fistula (OR of 6.10, 95% CI of 1.53-24.3) when adjusted for multiple factors. CPSMI outperformed the mFI and RAI frailty indices to predict postoperative adverse events (p < .05). CONCLUSION Low CPSMI is independently associated with postoperative adverse events and outperforms current frailty indices inoperable HNC with microvascular reconstruction.
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Affiliation(s)
- Marco A Mascarella
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Biomedical Sciences, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.,Centre for Clinical Epidemiology, Lady Davis Institute of the Jewish General Hospital, Montreal, Quebec, Canada
| | - Lauren Gardiner
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Terral Patel
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Varun Vendra
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nayel Khan
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Marie-Jeanne Kergoat
- Department of Biomedical Sciences, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.,Division of Geriatrics, Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Mark W Kubik
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mario G Solari
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Carl H Snyderman
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Katie S Traylor
- Department of Diagnostic Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Shaum S Sridharan
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Bril SI, Al-Mamgani A, Chargi N, Remeijer P, Devriese LA, de Boer JP, de Bree R. The association of pretreatment low skeletal muscle mass with chemotherapy dose-limiting toxicity in patients with head and neck cancer undergoing primary chemoradiotherapy with high-dose cisplatin. Head Neck 2021; 44:189-200. [PMID: 34713519 PMCID: PMC9298001 DOI: 10.1002/hed.26919] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 10/01/2021] [Accepted: 10/18/2021] [Indexed: 12/25/2022] Open
Abstract
Background Low skeletal muscle mass (SMM) is an adverse prognostic factor for chemotherapy dose‐limiting toxicity (CDLT). In patients with locally advanced head and neck squamous cell carcinoma (HNSCC) undergoing chemoradiotherapy (CRT), low SMM is a predictor for CDLT. We aimed to validate these findings. Methods Consecutive LA‐HNSCC patients treated with primary CRT with high‐dose cisplatin were retrospectively included. SMM was measured on pre‐treatment CT‐imaging. A cumulative cisplatin dose below 200 mg/m2 was defined as CDLT. Results One hundred and fifty three patients were included; 37 (24.2%) experienced CDLT, and 84 had low SMM (54.9%). Patients with low SMM experienced more CDLT than patients with normal SMM (35.7% vs. 10.1%, p < 0.01). Low SMM (OR 3.99 [95% CI 1.56–10.23], p = 0.01) and an eGFR of 60–70 ml/min (OR 5.40 [95% CI 1.57–18.65], p < 0.01) were predictors for CDLT. Conclusion Pre‐treatment low SMM is associated with CDLT in LA‐HNSCC patients treated with primary CRT. Routine SMM assessment may allow for CDLT risk assessment and treatment optimization.
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Affiliation(s)
- Sandra I Bril
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Abrahim Al-Mamgani
- Department of Radiation Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Najiba Chargi
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter Remeijer
- Department of Radiation Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Lot A Devriese
- Department of Medical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan Paul de Boer
- Department of Medical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
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Temporalis muscle thickness as an indicator of sarcopenia predicts progression-free survival in head and neck squamous cell carcinoma. Sci Rep 2021; 11:19717. [PMID: 34611230 PMCID: PMC8492642 DOI: 10.1038/s41598-021-99201-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 09/22/2021] [Indexed: 12/25/2022] Open
Abstract
Temporalis muscle thickness (TMT) on brain magnetic resonance imaging (MRI) is correlated with sarcopenia and can be a predictive marker for survival in patients with brain tumors, but the association of TMT on head and neck computed tomography (CT) with survival in head and neck squamous cell carcinoma (HNSCC) remains unclear. We investigated whether TMT on CT could predict progression-free survival (PFS) in patients with HNSCC. A total of 106 patients with newly diagnosed HNSCC were included in this retrospective study. The patients underwent baseline head and neck CT and/or MRI between July, 2008 and August, 2018. The correlation between TMT on CT and MRI was tested using intraclass correlation coefficient (ICC). The cut-off value of TMT on CT for determining tumor progression was identified using receiver-operating characteristic curve analysis. Uni- and consecutive multi-variable Cox regression models were used to verify the association between TMT and PFS. TMT on CT and MRI showed excellent correlation (ICC, 0.894). After a mean follow-up of 37 months, 49 out of 106 patients showed locoregional recurrence and/or distant metastasis. The cut-off TMT of 6.47 mm showed good performance in predicting tumor progression (area under the curve, 0.779). The Cox regression model showed that TMT ≤ 6.24 mm (median value in study population) was a significant contributing factor for predicting shorter PFS (hazard ratio 0.399; 95% confidence interval 0.209–0.763; P = .005). TMT may be used as a surrogate parameter for pre-treatment sarcopenia and could help predict PFS in patients with HNSCC.
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Olson B, Norgard MA, Levasseur PR, Zhu X, Marks DL. Physiologic and molecular characterization of a novel murine model of metastatic head and neck cancer cachexia. J Cachexia Sarcopenia Muscle 2021; 12:1312-1332. [PMID: 34231343 PMCID: PMC8517353 DOI: 10.1002/jcsm.12745] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/19/2021] [Accepted: 06/08/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Cancer cachexia is a metabolic disorder characterized by the progressive loss of fat and lean mass that results in significant wasting, ultimately leading to reduced quality of life and increased mortality. Effective therapies for cachexia are lacking, potentially owing to the mismatch in clinically relevant models of cachexia. Specifically, cachexia observed in a clinical setting is commonly associated with advanced or late-stage cancers that are metastatic, yet pre-clinical metastatic models of cachexia are limited. Furthermore, the prevalence of cachexia in head and neck cancer patients is high, yet few pre-clinical models of head and neck cancer cachexia exist. In addition to these shortcomings, cachexia is also heterogeneous among any given cancer, whereas patients with similar disease burden may experience significantly different degrees of cachexia symptoms. In order to address these issues, we characterize a metastatic model of human papilloma virus (HPV) positive head and neck squamous cell carcinoma that recapitulates the cardinal clinical and molecular features of cancer cachexia. METHODS Male and female C57BL/6 mice were implanted subcutaneously with oropharyngeal squamous cell carcinoma cells stably transformed with HPV16 E6 and E7 together with hRas and luciferase (mEERL) that metastasizes to the lungs (MLM). We then robustly characterize the physiologic, behavioural, and molecular signatures during tumour development in two MLM subclones. RESULTS Mice injected with MLM tumour cells rapidly developed primary tumours and eventual metastatic lesions to the lungs. MLM3, but not MLM5, engrafted mice progressively lost fat and lean mass during tumour development despite the absence of anorexia (P < 0.05). Behaviourally, MLM3-implanted mice displayed decreased locomotor behaviours and impaired nest building (P < 0.05). Muscle catabolism programmes associated with cachexia, including E3 ubiquitin ligase and autophagy up-regulation, along with progressive adipose wasting and accompanying browning gene signatures, were observed. Tumour progression also corresponded with hypothalamic and peripheral organ inflammation, as well as an elevation in neutrophil-to-lymphocyte ratio (P < 0.05). Finally, we characterize the fat and lean mass sparing effects of voluntary wheel running on MLM3 cachexia (P < 0.05). CONCLUSIONS This syngeneic MLM3 allograft model of metastatic cancer cachexia is reliable, consistent, and readily recapitulates key clinical and molecular features and heterogeneity of cancer cachexia. Because few metastatic models of cachexia exist-even though cachexia often accompanies metastatic progression-we believe this model more accurately captures cancer cachexia observed in a clinical setting and thus is well suited for future mechanistic studies and pre-clinical therapy development for this crippling metabolic disorder.
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Affiliation(s)
- Brennan Olson
- Papé Family Pediatric Research InstituteOregon Health & Science UniversityPortlandORUSA
- Medical Scientist Training ProgramOregon Health & Science UniversityPortlandORUSA
| | - Mason A. Norgard
- Papé Family Pediatric Research InstituteOregon Health & Science UniversityPortlandORUSA
| | - Peter R. Levasseur
- Papé Family Pediatric Research InstituteOregon Health & Science UniversityPortlandORUSA
| | - Xinxia Zhu
- Papé Family Pediatric Research InstituteOregon Health & Science UniversityPortlandORUSA
| | - Daniel L. Marks
- Papé Family Pediatric Research InstituteOregon Health & Science UniversityPortlandORUSA
- Brenden‐Colson Center for Pancreatic CareOregon Health and & Science University PortlandORUSA
- Knight Cancer InstituteOregon Health & Science UniversityPortlandORUSA
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Chen J, Dennis SK, Abouyared M. Sarcopenia and microvascular free flap reconstruction. Curr Opin Otolaryngol Head Neck Surg 2021; 29:419-423. [PMID: 34387288 DOI: 10.1097/moo.0000000000000756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This article reviews the recent literature regarding the impact of sarcopenia on microvascular free flap reconstruction outcomes. RECENT FINDINGS Malnutrition, and consequent muscle loss, is a prevalent issue among head and neck cancer patients. However, diagnosis remains challenging due to a paucity of reliable objective measures. Traditional markers, such as albumin, have been used in the past to assess nutritional status, but cancer-related inflammation limits their predictive value. Recently, developments in the diagnosis of sarcopenia through the novel use of computed tomography (CT) cross-sectional muscle mass indices to evaluate body composition have proven effective and accessible. SUMMARY Literature shows compelling evidence that sarcopenia is associated with higher rates of surgical complications that delay recovery and increase mortality. The use of CT imaging to quantify muscle loss offers an objective way to evaluate nutritional status, which is predictive of postoperative rates of complications. Research on ways to optimize muscle mass prior to surgery is limited, however, immunonutrition is emerging as a promising intervention that can attenuate sarcopenia-related inflammation to improve outcomes.
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Affiliation(s)
- Joy Chen
- Department of Otolaryngology, University of California, Sacramento, California, USA
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45
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Mascarella MA, Muthukrishnan N, Maleki F, Kergoat MJ, Richardson K, Mlynarek A, Forest VI, Reinhold C, Martin DR, Hier M, Sadeghi N, Forghani R. Above and Beyond Age: Prediction of Major Postoperative Adverse Events in Head and Neck Surgery. Ann Otol Rhinol Laryngol 2021; 131:697-703. [PMID: 34416844 PMCID: PMC9203666 DOI: 10.1177/00034894211041222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Major postoperative adverse events (MPAEs) following head and neck surgery are not infrequent and lead to significant morbidity. The objective of this study was to ascertain which factors are most predictive of MPAEs in patients undergoing head and neck surgery. METHODS A cohort study was carried out based on data from patients registered in the National Surgical Quality Improvement Program (NSQIP) from 2006 to 2018. All patients undergoing non-ambulatory head and neck surgery based on Current Procedural Terminology codes were included. Perioperative factors were evaluated to predict MPAEs within 30-days of surgery. Age was classified as both a continuous and categorical variable. Retained factors were classified by attributable fraction and C-statistic. Multivariate regression and supervised machine learning models were used to quantify the contribution of age as a predictor of MPAEs. RESULTS A total of 43 701 operations were analyzed with 5106 (11.7%) MPAEs. The results of supervised machine learning indicated that prolonged surgeries, anemia, free tissue transfer, weight loss, wound classification, hypoalbuminemia, wound infection, tracheotomy (concurrent with index head and neck surgery), American Society of Anesthesia (ASA) class, and sex as most predictive of MPAEs. On multivariate regression, ASA class (21.3%), hypertension on medication (15.8%), prolonged operative time (15.3%), sex (13.1%), preoperative anemia (12.8%), and free tissue transfer (9%) had the largest attributable fractions associated with MPAEs. Age was independently associated with MPAEs with an attributable fraction ranging from 0.6% to 4.3% with poor predictive ability (C-statistic 0.60). CONCLUSION Surgical, comorbid, and frailty-related factors were most predictive of short-term MPAEs following head and neck surgery. Age alone contributed a small attributable fraction and poor prediction of MPAEs. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Marco A Mascarella
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada.,Centre for Clinical Epidemiology, Lady Davis Institute of the Jewish General Hospital, Montreal, QC, Canada
| | - Nikesh Muthukrishnan
- Augmented Intelligence & Precision Health Laboratory (AIPHL) of the Department of Radiology and the Research Institute of McGill University Health Centre, Montreal, QC, Canada.,Department of Radiology, McGill University, Montreal, QC, Canada
| | - Farhad Maleki
- Augmented Intelligence & Precision Health Laboratory (AIPHL) of the Department of Radiology and the Research Institute of McGill University Health Centre, Montreal, QC, Canada.,Department of Radiology, McGill University, Montreal, QC, Canada
| | - Marie-Jeanne Kergoat
- Department of Geriatric Medicine, Geriatric Institute of Montreal, University of Montreal, Montreal, QC, Canada
| | - Keith Richardson
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Alex Mlynarek
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | | | - Caroline Reinhold
- Augmented Intelligence & Precision Health Laboratory (AIPHL) of the Department of Radiology and the Research Institute of McGill University Health Centre, Montreal, QC, Canada.,Department of Radiology, McGill University, Montreal, QC, Canada
| | - Diego R Martin
- Augmented Intelligence & Precision Health Laboratory (AIPHL) of the Department of Radiology and the Research Institute of McGill University Health Centre, Montreal, QC, Canada.,Department of Radiology, McGill University, Montreal, QC, Canada
| | - Michael Hier
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Nader Sadeghi
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada.,Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Reza Forghani
- Augmented Intelligence & Precision Health Laboratory (AIPHL) of the Department of Radiology and the Research Institute of McGill University Health Centre, Montreal, QC, Canada.,Department of Radiology, McGill University, Montreal, QC, Canada.,Segal Cancer Centre, Lady Davis Research Institute, Jewish General Hospital, Montreal, QC, Canada
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Skeletal muscle mass at C3 may not be a strong predictor for skeletal muscle mass at L3 in sarcopenic patients with head and neck cancer. PLoS One 2021; 16:e0254844. [PMID: 34280248 PMCID: PMC8289025 DOI: 10.1371/journal.pone.0254844] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/04/2021] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To evaluate the feasibility of using skeletal muscle mass (SMM) at C3 (C3 SMM) as a diagnostic marker for sarcopenia in head and neck cancer (HNC) patients. METHODS We evaluated 165 HNC patients and 42 healthy adults who underwent 18F-fluorodeoxyglucose positron emission tomography/computed tomography scans. The paravertebral muscle area at C3 and skeletal muscle area at L3 were measured by CT. Pearson's correlation was used to assess the relationship between L3 and C3 SMMs. The prediction model for L3 SMM was developed by multiple linear regression. Then the correlation and the agreement between actual and predicted L3 SMMs were assessed. To evaluate the diagnostic value of C3 SMM for sarcopenia, the receiver operating characteristics (ROC) curves were analyzed. RESULTS Of the 165 HNC patients, 61 (37.0%) were sarcopenic and 104 (63.0%) were non-sarcopenic. A very strong correlation was found between L3 SMM and C3 SMM in both healthy adults (r = 0.864) and non-sarcopenic patients (r = 0.876), while a fair association was found in sarcopenic patients (r = 0.381). Prediction model showed a very strong correlation between actual SMM and predicted L3 SMM in both non-sarcopenic patients and healthy adults (r > 0.9), whereas the relationship was moderate in sarcopenic patients (r = 0.7633). The agreement between two measurements was good for healthy subjects and non-sarcopenic patients, while it was poor for sarcopenic patients. On ROC analysis, predicted L3 SMM showed poor diagnostic accuracy for sarcopenia. CONCLUSIONS A correlation between L3 and C3 SMMs was weak in sarcopenic patients. A prediction model also showed a poor diagnostic accuracy. Therefore, C3 SMM may not be a strong predictor for L3 SMM in sarcopenic patients with HNC.
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Grossberg AJ, Rock CD, Edwards J, Mohamed ASR, Ruzensky D, Currie A, Rosemond P, Phan J, Gunn GB, Frank SJ, Morrison WH, Garden AS, Fuller CD, Rosenthal DI. Bioelectrical impedance analysis as a quantitative measure of sarcopenia in head and neck cancer patients treated with radiotherapy. Radiother Oncol 2021; 159:21-27. [PMID: 33736997 PMCID: PMC8205950 DOI: 10.1016/j.radonc.2021.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Sarcopenia is associated with decreased survival in head and neck cancer patients treated with radiotherapy. This study sought to determine whether in-clinic multifrequency bioelectrical impedance analysis (BIA) can identify survival-associated sarcopenia in patients with head and neck cancer. MATERIALS AND METHODS This prospective observational study enrolled 50 patients with head and neck cancer undergoing radiation therapy. Baseline BIA measures of skeletal muscle (SM) mass, fat-free mass (FFM), and fat mass (FM) were compared to CT-based estimates using linear regression. Sex-specific BIA-derived thresholds for sarcopenia were defined by the maximum Youden Index on receiver operator characteristic (ROC) curves. Patients were stratified by sarcopenia status and OS was compared using the Kaplan-Meier method and log-rank test. RESULTS Among 48 evaluable patients, BIA measures of body composition were strongly correlated with CT measures: SM mass (r = 0.97; R2 = 0.94; p < 0.0001), FFM (r = 0.97; R2 = 0.94; p < 0.0001) and FM (r = 0.95; R2 = 0.90; p < 0.0001). SM mass index < 9.19 kg/m2 identified sarcopenia men with high sensitivity (91.7%) and specificity (92.9%), whereas in women SM mass index < 6.53 kg/m2 was sensitive for sarcopenia (100%), but not specific. Patients with sarcopenia, defined by either CT or BIA, exhibited decreased OS (HR = not estimable; CT p = 0.009; BIA p = 0.03). CONCLUSION BIA provides accurate estimates of body composition in head and neck cancer patients. Implementation of BIA in clinical practice may identify patients with sarcopenia at risk for poor survival.
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Affiliation(s)
- Aaron J Grossberg
- Department of Radiation Medicine, Brenden Colson Center for Pancreatic Care, Cancer Early Detection Advanced Research Center, Oregon Health & Science University, Portland, USA.
| | - Crosby D Rock
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, USA
| | - Jared Edwards
- School of Medicine, Oregon Health & Science University, Portland, USA
| | | | - Debra Ruzensky
- Department of Clinical Nutrition, MD Anderson Cancer Center, Houston, USA
| | - Angela Currie
- Department of Clinical Nutrition, MD Anderson Cancer Center, Houston, USA
| | - Patricia Rosemond
- Department of Clinical Nutrition, MD Anderson Cancer Center, Houston, USA
| | - Jack Phan
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, USA
| | - G Brandon Gunn
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, USA
| | - Steven J Frank
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, USA
| | - William H Morrison
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, USA
| | - Adam S Garden
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, USA
| | - Clifton D Fuller
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, USA
| | - David I Rosenthal
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, USA.
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Surov A, Wienke A. Low skeletal muscle mass predicts relevant clinical outcomes in head and neck squamous cell carcinoma. A meta analysis. Ther Adv Med Oncol 2021; 13:17588359211008844. [PMID: 34035838 PMCID: PMC8127787 DOI: 10.1177/17588359211008844] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 03/15/2021] [Indexed: 12/16/2022] Open
Abstract
Background: The purpose of this meta-analysis was to analyze the influence of sarcopenia, defined as low skeletal muscle mass, on clinical outcomes in patients with head and neck squamous cell carcinoma (HNSCC) based on a large sample. Methods: The MEDLINE, EMBASE, and SCOPUS databases were screened for associations between sarcopenia and clinical outcomes in HNSCC up to December 2020. Overall, 27 studies met the inclusion criteria. The methodological quality of the studies involved was checked according to the QUADAS instrument. The meta-analysis was undertaken using RevMan 5.3 software. DerSimonian and Laird random-effects models with inverse-variance weights were used to account for heterogeneity between the studies. Results: The 27 included studies comprised 7704 patients with different HNSCCs. The cumulative calculated frequency among the studies was 42.0% [95% confidence interval (CI) 35.34–48.65]. Sarcopenia was associated with occurrence of severe postoperative complications, odds ratio (OR) 4.79, 95% CI (2.52–9.11), p < 0.00001. Sarcopenia predicted disease-free survival (DFS), simple regression: hazard ratio (HR) 2.00, 95% CI (1.63–2.45), p < 0.00001, multiple regression: HR 1.64, 95% CI (1.33–2.03), p < 0.00001. Also, sarcopenia was associated with lower overall survival (OS), simple regression: HR 1.96, 95% CI (1.71–2.24), p < 0.00001, multiple regression: HR = 1.87, 95% CI (1.53–2.29), p < 0.00001. In patients who underwent definitive chemotherapy and/or radiation, sarcopenia predicted lower OS (simple regression), HR 1.95, 95% CI (1.61–2.36), p < 0.00001, multiple regression: HR = 1.51, 95% CI (1.17–1.94), p < 0.002). In patients with primary surgical strategy with or without adjuvant radio-chemotherapy, sarcopenia was associated with lower OS (simple regression), HR 2.21, 95% CI (1.72–2.84), p < 0.00001, multiple regression: HR = 2.05, 95% CI (1.55–2.72), p < 0.00001). Conclusion: The cumulative prevalence of sarcopenia in HNSCC is 42.0%. Sarcopenia is an independent risk factor for OS and DFS in patients with HNSCC who undergo curative therapy. Sarcopenia is associated with the occurrence of severe postoperative complications.
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Affiliation(s)
- Alexey Surov
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke-University of Magdeburg, Leipziger Str. 44, Magdeburg, 39112, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Sachsen-Anhalt, Germany
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Chargi N, Wegner I, Markazi N, Smid E, de Jong P, Devriese L, de Bree R. Patterns, Predictors, and Prognostic Value of Skeletal Muscle Mass Loss in Patients with Locally Advanced Head and Neck Cancer Undergoing Cisplatin-Based Chemoradiotherapy. J Clin Med 2021; 10:jcm10081762. [PMID: 33919607 PMCID: PMC8074083 DOI: 10.3390/jcm10081762] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/08/2021] [Accepted: 04/14/2021] [Indexed: 12/15/2022] Open
Abstract
Low skeletal muscle mass (SMM) is associated with toxicities and decreased survival in head and neck cancer (HNC). Chemoradiotherapy (CRT) may exaggerate loss of SMM. We investigated the changes in SMM, their predictors, and prognostic impact of SMM in patients treated with CRT between 2012 and 2018. Skeletal muscle area (SMA) segmentation was performed on pre- and post-CRT imaging. Observed changes in SMM were categorized into: (I) Stable, (II) moderate gain (III), moderate loss, (IV) large gain, and (V) large loss. In total, 235 HNC patients were included, of which 39% had stable SMM, 55% moderate loss, 13% moderate gain, 0.4% large loss, and 0.4% large gain of SMM. After CRT, SMA decreased compared to pre-CRT (31.6 cm2 versus 33.3 cm2, p < 0.01). The key predictor was a body mass index (BMI) of ≥30 kg/m2 (OR 3.6, 95% CI 1.4–9.3, p < 0.01). Low SMM at diagnosis (HR 2.1; 95% CI 1.1–4.1, p = 0.03) and an HPV-positive oropharyngeal tumor (HR 0.1; 95% CI 0.01–0.9, p = 0.04) were prognostic for overall survival. Changes in SMM were not prognostic for survival. Loss of SMM is highly prevalent after CRT and a high BMI before treatment may aid in identifying patients at risk.
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Affiliation(s)
- Najiba Chargi
- Department of Head and Neck Surgical Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; (N.C.); (N.M.)
| | - Inge Wegner
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands;
| | - Navid Markazi
- Department of Head and Neck Surgical Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; (N.C.); (N.M.)
| | - Ernst Smid
- Department of Radiation Oncology and Nuclear Medicine, Division of Imaging and Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands;
| | - Pim de Jong
- Department of Radiology, Division of Imaging and Oncology, University Medical Center Utrecht and Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands;
| | - Lot Devriese
- Department of Medical Oncology, Division of Imaging and Oncology, University Medical Center Utrecht and Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands;
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; (N.C.); (N.M.)
- Correspondence: ; Tel.: +31-88-75-508-19
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Csete ME. Basic Science of Frailty-Biological Mechanisms of Age-Related Sarcopenia. Anesth Analg 2021; 132:293-304. [PMID: 32769382 DOI: 10.1213/ane.0000000000005096] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Aging is associated with loss of function across organ systems, contributing to systemic frailty. Loss of skeletal muscle mass and function, in particular, is a major source of frailty in older adults, severely impacting quality of life. Some loss of muscle mass and strength with aging is inevitable, and sarcopenia, the severe loss of muscle mass with aging, is common. Sarcopenia is determined in part by genetics but can be modified by lifestyle choices. The pathophysiologic underpinnings of sarcopenia are complex and multifactorial. In this review, the causes of sarcopenia are surveyed at the systems, cell, subcellular, and molecular levels with emphasis on the interplay between these various causes of this degenerative disease process.
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Affiliation(s)
- Marie E Csete
- From the Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, California
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