151
|
Hsu W, Ko A, Weng C, Chang C, Jan Y, Lin J, Chien H, Lin W, Sun F, Wu K, Lee J. Explainable machine learning model for predicting skeletal muscle loss during surgery and adjuvant chemotherapy in ovarian cancer. J Cachexia Sarcopenia Muscle 2023; 14:2044-2053. [PMID: 37435785 PMCID: PMC10570082 DOI: 10.1002/jcsm.13282] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 03/30/2023] [Accepted: 05/22/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Skeletal muscle loss during treatment is associated with poor survival outcomes in patients with ovarian cancer. Although changes in muscle mass can be assessed on computed tomography (CT) scans, this labour-intensive process can impair its utility in clinical practice. This study aimed to develop a machine learning (ML) model to predict muscle loss based on clinical data and to interpret the ML model by applying SHapley Additive exPlanations (SHAP) method. METHODS This study included the data of 617 patients with ovarian cancer who underwent primary debulking surgery and platinum-based chemotherapy at a tertiary centre between 2010 and 2019. The cohort data were split into training and test sets based on the treatment time. External validation was performed using 140 patients from a different tertiary centre. The skeletal muscle index (SMI) was measured from pre- and post-treatment CT scans, and a decrease in SMI ≥ 5% was defined as muscle loss. We evaluated five ML models to predict muscle loss, and their performance was determined using the area under the receiver operating characteristic curve (AUC) and F1 score. The features for analysis included demographic and disease-specific characteristics and relative changes in body mass index (BMI), albumin, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR). The SHAP method was applied to determine the importance of the features and interpret the ML models. RESULTS The median (inter-quartile range) age of the cohort was 52 (46-59) years. After treatment, 204 patients (33.1%) experienced muscle loss in the training and test datasets, while 44 (31.4%) patients experienced muscle loss in the external validation dataset. Among the five evaluated ML models, the random forest model achieved the highest AUC (0.856, 95% confidence interval: 0.854-0.859) and F1 score (0.726, 95% confidence interval: 0.722-0.730). In the external validation, the random forest model outperformed all ML models with an AUC of 0.874 and an F1 score of 0.741. The results of the SHAP method showed that the albumin change, BMI change, malignant ascites, NLR change, and PLR change were the most important factors in muscle loss. At the patient level, SHAP force plots demonstrated insightful interpretation of our random forest model to predict muscle loss. CONCLUSIONS Explainable ML model was developed using clinical data to identify patients experiencing muscle loss after treatment and provide information of feature contribution. Using the SHAP method, clinicians may better understand the contributors to muscle loss and target interventions to counteract muscle loss.
Collapse
Affiliation(s)
- Wen‐Han Hsu
- Institute of Biomedical InformaticsNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Ai‐Tung Ko
- Institute of Biomedical InformaticsNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Chia‐Sui Weng
- Department of Obstetrics and GynecologyMacKay Memorial HospitalTaipeiTaiwan
- Department of MedicineMacKay Medical CollegeNew Taipei CityTaiwan
| | - Chih‐Long Chang
- Department of Obstetrics and GynecologyMacKay Memorial HospitalTaipeiTaiwan
- Department of MedicineMacKay Medical CollegeNew Taipei CityTaiwan
| | - Ya‐Ting Jan
- Department of RadiologyMacKay Memorial HospitalTaipeiTaiwan
| | - Jhen‐Bin Lin
- Department of Radiation OncologyChanghua Christian HospitalChanghuaTaiwan
| | - Hung‐Ju Chien
- Department of Obstetrics and GynecologyChanghua Christian HospitalTaipeiTaiwan
| | - Wan‐Chun Lin
- Institute of Biomedical InformaticsNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Fang‐Ju Sun
- Institute of Biomedical InformaticsNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Department of Medical ResearchMacKay Memorial HospitalTaipeiTaiwan
| | - Kun‐Pin Wu
- Institute of Biomedical InformaticsNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Jie Lee
- Department of MedicineMacKay Medical CollegeNew Taipei CityTaiwan
- Department of Radiation OncologyMacKay Memorial HospitalTaipeiTaiwan
| |
Collapse
|
152
|
Shi S, Yi H, Zheng Y, Zhao Y, Yu D. Adipose distribution patterns as prognostic factors in patients with HCC: A systematic review and meta-analysis. Eur J Radiol 2023; 167:111025. [PMID: 37634440 DOI: 10.1016/j.ejrad.2023.111025] [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: 03/14/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/29/2023]
Abstract
PURPOSES The present meta-analysis aimed at identifying potential prognostic indicators associated with adipose distribution patterns for predicting the survival outcomes of patients diagnosed with hepatocellular carcinoma (HCC). METHODS A systematic retrieve was performed to identify studies investigating the association of adipose distribution patterns and the prognosis of HCC from the inception of PubMed, Embase, Cochrane Library, and Web of Science databases to May 25, 2023. The Newcastle-Ottawa scale was applied to assess the quality of included studies. The hazard ratios (HRs) and 95 % confidence intervals (CIs) of adipose distribution parameters of visceral, subcutaneous, and intermuscular adipose tissue were extracted. Univariate and multivariable meta-analyses were performed by Stata 12.0 to evaluate the relationship between these factors and overall survival (OS) and recurrence-free survival (RFS). RESULTS A total of 31 studies, comprising 7021 patients, including 2456 patients with HCV and 1466 patients with HBV were included. The pooled results indicated that only high visceral to subcutaneous adipose area ratio (VSR) (univariate analysis of OS: HR = 1.42, 95 % CI = 1.28-1.58, P < 0.001; multivariate analysis of OS: HR = 1.45, 95 % CI = 1.27-1.65, P < 0.001; univariate analysis of RFS: HR = 1.30, 95 % CI = 1.08-1.56, P = 0.006; multivariate analysis of RFS: HR = 1.36, 95 % CI = 1.10-1.67, P = 0.004) was both related to worse OS and RFS, with no significant heterogeneity observed. CONCLUSION Pretreatment VSR, as the sole parameter among adipose distribution-related factors exhibiting independent and stable associations with OS and RFS in patients with HCC, may hold promise as a potential prognostic factor for HCC.
Collapse
Affiliation(s)
- Shuo Shi
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
| | - Haiyan Yi
- Department of Radiology, Qixia City People's Hospital, Yantai, Shandong 265300, China
| | - Yi Zheng
- Department of Radiology, Rushan Hospital of Traditional Chinese Medicine, Weihai, Shandong 264200, China
| | - Yuxuan Zhao
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
| | - Dexin Yu
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China.
| |
Collapse
|
153
|
Mai DVC, Drami I, Pring ET, Gould LE, Lung P, Popuri K, Chow V, Beg MF, Athanasiou T, Jenkins JT. A systematic review of automated segmentation of 3D computed-tomography scans for volumetric body composition analysis. J Cachexia Sarcopenia Muscle 2023; 14:1973-1986. [PMID: 37562946 PMCID: PMC10570079 DOI: 10.1002/jcsm.13310] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 05/03/2023] [Accepted: 07/11/2023] [Indexed: 08/12/2023] Open
Abstract
Automated computed tomography (CT) scan segmentation (labelling of pixels according to tissue type) is now possible. This technique is being adapted to achieve three-dimensional (3D) segmentation of CT scans, opposed to single L3-slice alone. This systematic review evaluates feasibility and accuracy of automated segmentation of 3D CT scans for volumetric body composition (BC) analysis, as well as current limitations and pitfalls clinicians and researchers should be aware of. OVID Medline, Embase and grey literature databases up to October 2021 were searched. Original studies investigating automated skeletal muscle, visceral and subcutaneous AT segmentation from CT were included. Seven of the 92 studies met inclusion criteria. Variation existed in expertise and numbers of humans performing ground-truth segmentations used to train algorithms. There was heterogeneity in patient characteristics, pathology and CT phases that segmentation algorithms were developed upon. Reporting of anatomical CT coverage varied, with confusing terminology. Six studies covered volumetric regional slabs rather than the whole body. One study stated the use of whole-body CT, but it was not clear whether this truly meant head-to-fingertip-to-toe. Two studies used conventional computer algorithms. The latter five used deep learning (DL), an artificial intelligence technique where algorithms are similarly organized to brain neuronal pathways. Six of seven reported excellent segmentation performance (Dice similarity coefficients > 0.9 per tissue). Internal testing on unseen scans was performed for only four of seven algorithms, whilst only three were tested externally. Trained DL algorithms achieved full CT segmentation in 12 to 75 s versus 25 min for non-DL techniques. DL enables opportunistic, rapid and automated volumetric BC analysis of CT performed for clinical indications. However, most CT scans do not cover head-to-fingertip-to-toe; further research must validate using common CT regions to estimate true whole-body BC, with direct comparison to single lumbar slice. Due to successes of DL, we expect progressive numbers of algorithms to materialize in addition to the seven discussed in this paper. Researchers and clinicians in the field of BC must therefore be aware of pitfalls. High Dice similarity coefficients do not inform the degree to which BC tissues may be under- or overestimated and nor does it inform on algorithm precision. Consensus is needed to define accuracy and precision standards for ground-truth labelling. Creation of a large international, multicentre common CT dataset with BC ground-truth labels from multiple experts could be a robust solution.
Collapse
Affiliation(s)
- Dinh Van Chi Mai
- Department of SurgerySt Mark's Academic Institute, St Mark's HospitalLondonUK
- Department of Surgery and CancerImperial CollegeLondonUK
| | - Ioanna Drami
- Department of SurgerySt Mark's Academic Institute, St Mark's HospitalLondonUK
- Department of Metabolism, Digestion and ReproductionImperial CollegeLondonUK
| | - Edward T. Pring
- Department of SurgerySt Mark's Academic Institute, St Mark's HospitalLondonUK
- Department of Surgery and CancerImperial CollegeLondonUK
| | - Laura E. Gould
- Department of SurgerySt Mark's Academic Institute, St Mark's HospitalLondonUK
- School of Cancer Sciences, College of Medical, Veterinary & Life SciencesUniverstiy of GlasgowGlasgowUK
| | - Phillip Lung
- Department of SurgerySt Mark's Academic Institute, St Mark's HospitalLondonUK
- Department of Surgery and CancerImperial CollegeLondonUK
| | - Karteek Popuri
- Department of Computer ScienceMemorial University of NewfoundlandSt JohnsCanada
| | - Vincent Chow
- School of Engineering ScienceSimon Fraser UniversityBurnabyCanada
| | - Mirza F. Beg
- School of Engineering ScienceSimon Fraser UniversityBurnabyCanada
| | | | - John T. Jenkins
- Department of SurgerySt Mark's Academic Institute, St Mark's HospitalLondonUK
- Department of Surgery and CancerImperial CollegeLondonUK
| | | |
Collapse
|
154
|
Weng C, Huang W, Chang C, Jan Y, Chen T, Lee J. Association of malignant ascites with systemic inflammation and muscle loss after treatment in advanced-stage ovarian cancer. J Cachexia Sarcopenia Muscle 2023; 14:2114-2125. [PMID: 37503876 PMCID: PMC10570096 DOI: 10.1002/jcsm.13289] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 04/23/2023] [Accepted: 05/22/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Malignant ascites is prevalent in advanced-stage ovarian cancer and may facilitate identification of the drivers of muscle loss. This study aimed to evaluate the association of ascites with changes in systemic inflammation and muscle after treatment of advanced-stage ovarian cancer. METHODS We evaluated 307 patients with advanced-stage (III/IVA) ovarian cancer who underwent primary debulking surgery and adjuvant platinum-based chemotherapy between 2010 and 2019. The changes in skeletal muscle index (SMI) and radiodensity (SMD) were measured using pre-surgery and post-chemotherapy portal-venous phase contrast-enhanced computed tomography scans at L3. Systemic inflammation was measured using albumin levels, prognostic nutritional index (PNI), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR). Primary endpoint was the changes in SMI and SMD after treatment. Linear regression analysis was used to test associations between muscle change and other covariates. Mediation analysis was used to determine the mediator. RESULTS The median (range) age was 53 (23-83) years. The median duration (range) of follow-up was 5.2 (1.1-11.3) years. Overall, 187 (60.9%) patients had ascites. The changes in muscle and systemic inflammatory markers after treatment were significantly different between patients with and without ascites (SMI: -3.9% vs. 2.2%, P < 0.001; SMD: -4.0% vs. -0.4%, P < 0.001; albumin: -4.4% vs. 2.1%, P < 0.001; PNI: -8.4% vs. -0.1%, P < 0.001; NLR: 20.6% vs. -29.4%, P < 0.001; and PLR: 1.7% vs. -19.4%, P < 0.001). The changes in SMI and SMD were correlated with the changes in albumin, PNI, NLR, and PLR (all P < 0.001). In multiple linear regression, ascites and NLR changes were negatively while albumin change was positively correlated with SMI change (ascites: β = -3.19, P < 0.001; NLR change: β = -0.02, P = 0.003; albumin change: β = 0.37, P < 0.001). Ascites and NLR changes were negatively while PNI change was positively correlated with SMD change (ascites: β = -1.28, P = 0.02; NLR change: β = -0.02, P < 0.001; PNI change: β = 0.11, P = 0.04). In mediation analysis, ascites had a direct effect on SMI change (P < 0.001) and an indirect effect mediated by NLR change (indirect effects = -1.61, 95% confidence interval [CI]: -2.22 to -1.08) and albumin change (indirect effects = -2.92, 95% CI: -4.01 to -1.94). Ascites had a direct effect on SMD change (P < 0.001) and an indirect effect mediated by NLR change (indirect effects = -1.76, 95% CI: -2.34 to -1.22) and PNI change (indirect effects = -2.00, 95% CI: -2.79 to -1.36). CONCLUSIONS Malignant ascites was associated with enhanced systemic inflammation and muscle loss after primary debulking surgery and adjuvant chemotherapy in advanced-stage ovarian cancer. The association between ascites and muscle loss may be mediated by systemic inflammation.
Collapse
Affiliation(s)
- Chia‐Sui Weng
- Department of Obstetrics and GynecologyMacKay Memorial HospitalTaipeiTaiwan
- Department of MedicineMacKay Medical CollegeNew Taipei CityTaiwan
| | - Wan‐Chun Huang
- Department of Obstetrics and GynecologyMacKay Memorial HospitalTaipeiTaiwan
- Department of MedicineMacKay Medical CollegeNew Taipei CityTaiwan
| | - Chih‐Long Chang
- Department of Obstetrics and GynecologyMacKay Memorial HospitalTaipeiTaiwan
- Department of MedicineMacKay Medical CollegeNew Taipei CityTaiwan
| | - Ya‐Ting Jan
- Department of RadiologyMacKay Memorial HospitalTaipeiTaiwan
| | - Tze‐Chien Chen
- Department of Obstetrics and GynecologyMacKay Memorial HospitalTaipeiTaiwan
| | - Jie Lee
- Department of MedicineMacKay Medical CollegeNew Taipei CityTaiwan
- Department of Radiation OncologyMacKay Memorial HospitalTaipeiTaiwan
| |
Collapse
|
155
|
Sheean P, O'Connor P, Joyce C, Wozniak A, Vasilopoulos V, Formanek P. Applying the Global Leadership Initiative on Malnutrition criteria in patients admitted with SARS-CoV-2 infection using computed tomography imaging. Nutr Clin Pract 2023; 38:1009-1020. [PMID: 37312258 DOI: 10.1002/ncp.11024] [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: 01/26/2023] [Revised: 04/26/2023] [Accepted: 05/10/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Patients with low muscle mass and acute SARS-CoV-2 infection meet the Global Leadership Initiative on Malnutrition (GLIM) etiologic and phenotypic criteria to diagnose malnutrition, respectively. However, available cut-points to classify individuals with low muscle mass are not straightforward. Using computed tomography (CT) to determine low muscularity, we assessed the prevalence of malnutrition using the GLIM framework and associations with clinical outcomes. METHODS A retrospective cohort was conducted gathering patient data from various clinical resources. Patients admitted to the COVID-19 unit (March 2020 to June 2020) with appropriate/evaluable CT studies (chest or abdomen/pelvis) within the first 5 days of admission were considered eligible. Sex- and vertebral-specific skeletal muscle indices (SMI; cm2 /m2 ) from healthy controls were used to determine low muscle mass. Injury-adjusted SMI were derived, extrapolated from cancer cut-points and explored. Descriptive statistics and mediation analyses were completed. RESULTS Patients (n = 141) were 58.2 years of age and racially diverse. Obesity (46%), diabetes (40%), and cardiovascular disease (68%) were prevalent. Using healthy controls and injury-adjusted SMI, malnutrition prevalence was 26% (n = 36/141) and 50% (n = 71/141), respectively. Mediation analyses demonstrated a significant reduction in the effect of malnutrition on outcomes in the presence of Acute Physiology and Chronic Health Evaluation II, supporting the mediating effects of severity of illness intensive care unit (ICU) admission, ICU length of stay, mechanical ventilation, complex respiratory support, discharge status (all P values = 0.03), and 28-day mortality (P = 0.04). CONCLUSIONS Future studies involving the GLIM criteria should consider these collective findings in their design, analyses, and implementation.
Collapse
Affiliation(s)
- Patricia Sheean
- Parkinson School of Health Sciences and Public Health, Maywood, Illinois, USA
| | - Paula O'Connor
- Parkinson School of Health Sciences and Public Health, Maywood, Illinois, USA
| | - Cara Joyce
- Clinical Research Office, Loyola University Chicago, Maywood, Illinois, USA
| | - Amy Wozniak
- Clinical Research Office, Loyola University Chicago, Maywood, Illinois, USA
| | - Vasilios Vasilopoulos
- Department of Radiology (3D lab), Loyola University Medical Center, Maywood, Illinois, USA
| | - Perry Formanek
- Department of Medicine, Loyola University Medical Center, Maywood, Illinois, USA
| |
Collapse
|
156
|
Mandl J, Baumer S, Holtzem B, Theurer R, Zorger N, Pech O. [Sarcopenia in patients with pancreatic cancer, an independant prognostic factor]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:1365-1370. [PMID: 36482058 DOI: 10.1055/a-1959-2894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pancreatic cancer is despite modern diagnostic tools and treatment regimen associated with poor outcome. Many patients show cachexia and sarcopenia. METHODS In a retrospective analysis the SMI (cm²/m²) was measured by determining the skelettal muscle area in a computed tomography image at lumbar vertebrae 3. Further clinical parameters were measured to determine the outcome. RESULTS The mean survival after diagnosis in the population with sarcopenia was significantly lower (14,4 vs 17,7 months, p=0,046). Significantly shorter survival was also seen for higher age (p=0,006), no tumor resection (p=0,004), metastases (p=0,002) and high CA19-9 level (p=0,002) CONCLUSION: Sarcopenia is an indipendant prognostic factor in patients with pancreatic cancer. SMI should be measured clinical practice and further studies are necessary to asses a potential therapeutic strategy.
Collapse
Affiliation(s)
- Johanna Mandl
- Klinik für Gastroenterologie und interventionelle Endoskopie, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Sebastian Baumer
- Klinik für Gastroenterologie und interventionelle Endoskopie, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Bernadette Holtzem
- Klinik für Gastroenterologie und interventionelle Endoskopie, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Rainer Theurer
- Institut für Radiologie, Neuroradiologie und Nuklearmedizin, Krankenhaus Barmherzige Bruder Regensburg, Regensburg, Germany
| | - Niels Zorger
- Institut für Radiologie, Neuroradiologie und Nuklearmedizin, Krankenhaus Barmherzige Bruder Regensburg, Regensburg, Germany
| | - Oliver Pech
- Klinik für Gastroenterologie und interventionelle Endoskopie, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| |
Collapse
|
157
|
Klassen PN, Mazurak VC, Thorlakson J, Servais S. Call for standardization in assessment and reporting of muscle and adipose change using computed tomography analysis in oncology: A scoping review. J Cachexia Sarcopenia Muscle 2023; 14:1918-1931. [PMID: 37675809 PMCID: PMC10570077 DOI: 10.1002/jcsm.13318] [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: 02/06/2023] [Revised: 07/07/2023] [Accepted: 07/24/2023] [Indexed: 09/08/2023] Open
Abstract
Investigators are increasingly measuring skeletal muscle (SM) and adipose tissue (AT) change during cancer treatment to understand impact on patient outcomes. Recent meta-analyses have reported high heterogeneity in this literature, representing uncertainty in the resulting estimates. Using the setting of palliative-intent chemotherapy as an exemplar, we aimed to systematically summarize the sources of variability among studies evaluating SM and AT change during cancer treatment and propose standards for future studies to enable reliable meta-analysis. Studies that measured computed tomography-defined SM and/or AT change in adult patients during palliative-intent chemotherapy for solid tumours were included, with no date or geographical limiters. Of 2496 publications screened by abstract/title, 83 were reviewed in full text and 38 included for extraction, representing 34 unique cohorts across 8 tumour sites. The timing of baseline measurement was frequently defined as prior to treatment, while endpoint timing ranged from 6 weeks after treatment start to time of progression. Fewer than 50% specified the actual time interval between measurements. Measurement error was infrequently discussed (8/34). A single metric (cm2 /m2 , cm2 or %) was used to describe SM change in 18/34 cohorts, while multiple metrics were presented for 10/34 and no descriptive metrics for 6/34. AT change metrics and sex-specific reporting were available for 10/34 cohorts. Associations between SM loss and overall survival were evaluated in 24 publications, with classification of SM loss ranging from any loss to >14% loss over variable time intervals. Age and sex were the most common covariates, with disease response in 50% of models. Despite a wealth of data and effort, heterogeneity in study design, reporting and statistical analysis hinders evidence synthesis regarding the severity and outcomes of SM and AT change during cancer treatment. Proposed standards for study design include selection of homogenous cohorts, clear definition of baseline/endpoint timing and attention to measurement error. Standard reporting should include baseline SM and AT by sex, actual scan interval, SM and AT change using multiple metrics and visualization of the range of change observed. Reporting by sex would advance understanding of sexual dimorphism in SM and AT change. Evaluating the impact of tissue change on outcomes requires adjustment for relevant covariates and concurrent disease response. Adoption of these standards by researchers and publishers would alter the current paradigm to enable meta-analysis of future studies and move the field towards meaningful application of SM and AT change to clinical care.
Collapse
Affiliation(s)
- Pamela N. Klassen
- Department of Agricultural, Food and Nutritional ScienceUniversity of AlbertaEdmontonABCanada
| | - Vera C. Mazurak
- Department of Agricultural, Food and Nutritional ScienceUniversity of AlbertaEdmontonABCanada
| | | | - Stephane Servais
- Department of Agricultural, Food and Nutritional ScienceUniversity of AlbertaEdmontonABCanada
- Faculté de MédecineInserm UMR1069 Nutrition Croissance et Cancer, Université de ToursTours CedexFrance
| |
Collapse
|
158
|
Polyzos SA, Vachliotis ID, Mantzoros CS. Sarcopenia, sarcopenic obesity and nonalcoholic fatty liver disease. Metabolism 2023; 147:155676. [PMID: 37544590 DOI: 10.1016/j.metabol.2023.155676] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 08/08/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD), sarcopenia and sarcopenic obesity (SO) are highly prevalent conditions that may coexist, especially in the aging population, without any approved pharmacologic treatment for all of them. There are multiple pathophysiologic mechanisms suggested to explain an association between NAFLD and sarcopenia or SO, including alterations in the adipokines, cytokines, hepatokines and myokines, which may interplay with other factors, such as aging, diet and physical inactivity. In clinical terms, most observational studies support an association between NAFLD and sarcopenia or SO; importantly, there are few cohort studies indicating higher mortality in patients with NAFLD and sarcopenia. Their association also bears some treatment considerations: for example, pioglitazone or vitamin E, suggested as off label treatment for selected patients with nonalcoholic steatohepatitis, may be recommended in the coexistence of sarcopenia or SO, since limited evidence did not show adverse effects of them on sarcopenia and abdominal obesity. In this review, evidence linking sarcopenia and SO with NAFLD is summarized, with a special focus on clinical data. A synopsis of the major pathophysiological links between NAFLD and sarcopenia/SO is initially presented, followed by selected clinical studies and, finally, treatment considerations in patients with NAFLD and sarcopenia or SO are discussed.
Collapse
Affiliation(s)
- Stergios A Polyzos
- First Department of Pharmacology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Ilias D Vachliotis
- First Department of Pharmacology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christos S Mantzoros
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Internal Medicine, Boston VA Healthcare System, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
159
|
Renman D, van Guelpen B, Anderson F, Axelsson J, Riklund K, Strigård K, Palmqvist R, Gunnarsson U, Gylling B. Association of pre-diagnostic physical exercise and peri-diagnostic body composition with mortality in non-metastatic colorectal cancer. Int J Colorectal Dis 2023; 38:239. [PMID: 37755537 PMCID: PMC10533590 DOI: 10.1007/s00384-023-04536-0] [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] [Accepted: 09/18/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE Sarcopenia and myosteatosis, quantified via computed tomography (CT), are associated with poor colorectal cancer outcomes. These body composition estimates can be influenced by physical exercise. We explored the correlation between pre-diagnostic physical exercise, body composition close to diagnosis, and the combined prognosis impact of these factors. METHODS We studied 519 stage I-III colorectal cancer (CRC) cases diagnosed 2000-2016 with pre-diagnostic self-reported recreational physical exercise data collected in the prospective, population-based Northern Sweden Health and Disease Study, and CT-estimated skeletal muscle index (SMI) or skeletal muscle density (SMD). Risk estimates were calculated by multivariable logistic regression and Cox proportional hazards models. RESULTS No association was seen between low pre-diagnostic physical exercise and sarcopenia/myosteatosis in the multivariable model adjusted for age, sex, educational level, tumor stage, and tumor location. In multivariable Cox regression models, the combination of low pre-diagnostic physical exercise and either sarcopenia or myosteatosis at the time of diagnosis was associated with cancer-specific mortality compared to the reference group of high physical exercise combined with no sarcopenia/myosteatosis (adjusted HR 1.94 95% CI 1.00-3.76 for sarcopenia and adjusted HR 2.39 95% CI 1.16-4.94 for myosteatosis). CONCLUSIONS The combined presence of low pre-diagnostic physical exercise and sarcopenia or myosteatosis was associated with increased CRC-specific mortality. Despite the positive effect on prognosis, physical exercise did not alter body composition estimates at diagnosis, which could indicate attenuation from other factors.
Collapse
Affiliation(s)
- David Renman
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.
| | - Bethany van Guelpen
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
- Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Fredrick Anderson
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Jan Axelsson
- Department of Radiation Sciences, Radiation Physics, Umeå University, Umeå, Sweden
| | - Katrine Riklund
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, Umeå, Sweden
| | - Karin Strigård
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Richard Palmqvist
- Department of Medical Biosciences Pathology, Umeå University, Umeå, Sweden
| | - Ulf Gunnarsson
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Björn Gylling
- Department of Medical Biosciences Pathology, Umeå University, Umeå, Sweden
| |
Collapse
|
160
|
Morelli C, Formica V, Bossi P, Rofei M, Guerriero S, Riondino S, Argirò R, Pucci N, Cenci T, Savino L, Rinaldi CG, Garaci F, Orlandi A, D’Angelillo RM, Arkenau HT, Roselli M. Untailored vs. Gender- and Body-Mass-Index-Tailored Skeletal Muscle Mass Index (SMI) to Assess Sarcopenia in Advanced Head and Neck Squamous Cell Carcinoma (HNSCC). Cancers (Basel) 2023; 15:4716. [PMID: 37835410 PMCID: PMC10571960 DOI: 10.3390/cancers15194716] [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: 08/01/2023] [Revised: 09/13/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023] Open
Abstract
(1) Background: Sarcopenia lasting >1 year might be considered a chronic condition in many HNSCC patients. CT-scan-derived Skeletal Muscle Mass Index (SMI) is an established surrogate of sarcopenia; yet, the cut-off reported in the literature (literature-based, lb-SMI < 43.2) is mainly based on the risk of chemoradiotherapy-induced toxicity, and the optimal value to discriminate OS is under-investigated. (2) Methods: The effect on OS of the lb-SMI cutoff was compared with an untailored OS-oriented SMI cutoff obtained in a cohort of consecutive advanced HNSCC patients treated with primary chemoradiotherapy, bio-chemotherapy or chemo-immunotherapy (cohort-specific, cs-SMI cutoff). Gender- and BMI-tailored (gt-SMI and bt-SMI) cut-offs were also evaluated. Cutoff values were identified by using the maximally selected rank statistics for OS. (3) Results: In 115 HNSCC patients, the cs-SMI cutoff was 31.50, which was lower compared to the lb-SMI reported cut-off. The optimal cut-off separately determined in females, males, overweight and non-overweight patients were 46.02, 34.37, 27.32 and 34.73, respectively. gt-SMI categorization had the highest effect on survival (p < 0.0001); its prognostic value was independent of the treatment setting or the primary location and was retained in a multivariate cox-regression analysis for OS including other HNSCC-specific prognostic factors (p = 0.0004). (4) Conclusions: A tailored SMI assessment would improve clinical management of sarcopenia in chemoradiotherapy-, bio-chemotherapy- or chemo-immunotherapy-treated HNSCC patients. Gender-based SMI could be used for prognostication in HNSCC patients.
Collapse
Affiliation(s)
- Cristina Morelli
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, 00133 Rome, Italy; (C.M.); (M.R.); (S.G.); (S.R.); (M.R.)
| | - Vincenzo Formica
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, 00133 Rome, Italy; (C.M.); (M.R.); (S.G.); (S.R.); (M.R.)
| | - Paolo Bossi
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, “ASST Spedali Civili di Brescia”, University of Brescia, 25123 Brescia, Italy;
| | - Michela Rofei
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, 00133 Rome, Italy; (C.M.); (M.R.); (S.G.); (S.R.); (M.R.)
| | - Simona Guerriero
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, 00133 Rome, Italy; (C.M.); (M.R.); (S.G.); (S.R.); (M.R.)
| | - Silvia Riondino
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, 00133 Rome, Italy; (C.M.); (M.R.); (S.G.); (S.R.); (M.R.)
| | - Renato Argirò
- Interventional Radiology Unit, Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Noemi Pucci
- Neuroradiology Unit, Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy; (N.P.); (F.G.)
| | - Tonia Cenci
- Anatomic Pathology, Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy; (T.C.); (L.S.); (A.O.)
| | - Luca Savino
- Anatomic Pathology, Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy; (T.C.); (L.S.); (A.O.)
| | - Carla G. Rinaldi
- Radiation Oncology, Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00152 Rome, Italy; (C.G.R.); (R.M.D.)
| | - Francesco Garaci
- Neuroradiology Unit, Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy; (N.P.); (F.G.)
| | - Augusto Orlandi
- Anatomic Pathology, Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy; (T.C.); (L.S.); (A.O.)
| | - Rolando M. D’Angelillo
- Radiation Oncology, Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00152 Rome, Italy; (C.G.R.); (R.M.D.)
| | | | - Mario Roselli
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, 00133 Rome, Italy; (C.M.); (M.R.); (S.G.); (S.R.); (M.R.)
| |
Collapse
|
161
|
Xiao YZ, Wen XT, Ying YY, Zhang XY, Li LY, Wang ZC, Su MG, Zheng XW, Miao SL. The psoas muscle density as a predictor of postoperative complications in elderly patients undergoing rectal cancer resection. Front Oncol 2023; 13:1189324. [PMID: 37781186 PMCID: PMC10539580 DOI: 10.3389/fonc.2023.1189324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
Background Muscle depletion that impairs normal physiological function in elderly patients leads to poor prognosis. This study aimed to evaluate the association between total abdominal muscle area (TAMA), total psoas area (TPA), psoas muscle density (PMD), and short-term postoperative complications in elderly patients with rectal cancer. Methods All elderly patients underwent rectal cancer resection with perioperative abdominal computed tomography (CT). Complications were assessed according to the Clavien-Dindo classification. Severe complications were defined as grade III-V following the Clavien-Dindo classification. Univariate and multivariate analyses were performed to evaluate risk factors of short-term severe postoperative complications. Results The cohort consisted of 191 patients with a mean age of 73.60 ± 8.81 years. Among them, 138 (72.25%) patients had Clavien-Dindo 0- II, 53 (27.75%) patients had severe postoperative complications (Clavien-Dindo III-V), and 1(0.52%) patient died within 30 days of surgery. PMD was significantly higher in the Clavien-Dindo 0-II cohort compared to the Clavien-Dindo III-V cohort (p=0.004). Nevertheless, TAMA and TPA failed to exhibit significant differences. Moreover, the multivariate regression analysis implied that advanced age [OR 1.07 95%CI (1.02-1.13) p=0.013], male [OR 5.03 95%CI (1.76-14.41) p=0.003], high charlson comorbidity index (CCI) score [OR 3.60 95%CI (1.44-9.00) p=0.006], and low PMD [OR 0.94 95%CI (0.88-0.99) p=0.04] were independent risk factors of Clavien-Dindo III-V. Conclusion Preoperative assessment of the PMD on CT can be a simple and practical method for identifying elderly patients with rectal cancer at risk for severe postoperative complications.
Collapse
Affiliation(s)
- Yun-Zhou Xiao
- Department of Radiology, PingYang Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiao-Ting Wen
- Department of Obstetrics, PingYang Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ying-Ying Ying
- Department of Radiology, PingYang Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiao-Yan Zhang
- Department of Radiology, PingYang Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Lu-Yao Li
- Department of Radiology, PingYang Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhong-Chu Wang
- Department of Radiology, PingYang Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Miao-Guang Su
- Department of Radiology, PingYang Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiang-Wu Zheng
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shou-Liang Miao
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| |
Collapse
|
162
|
Yang Z, Choi I, Choi J, Jung J, Ryu M, Yong HS. Deep learning-based pectoralis muscle volume segmentation method from chest computed tomography image using sagittal range detection and axial slice-based segmentation. PLoS One 2023; 18:e0290950. [PMID: 37669295 PMCID: PMC10479911 DOI: 10.1371/journal.pone.0290950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 08/19/2023] [Indexed: 09/07/2023] Open
Abstract
The pectoralis muscle is an important indicator of respiratory muscle function and has been linked to various parenchymal biomarkers, such as airflow limitation severity and diffusing capacity for carbon monoxide, which are widely used in diagnosing parenchymal diseases, including asthma and chronic obstructive pulmonary disease. Pectoralis muscle segmentation is a method for measuring muscle volume and mass for various applications. The segmentation method is based on deep-learning techniques that combine a muscle area detection model and a segmentation model. The training dataset for the detection model comprised multichannel images of patients, whereas the segmentation model was trained on 7,796 cases of the computed tomography (CT) image dataset of 1,841 patients. The dataset was expanded incrementally through an active learning process. The performance of the model was evaluated by comparing the segmentation results with manual annotations by radiologists and the volumetric differences between the CT image datasets of the same patients. The results indicated that the machine learning model is promising in segmenting the pectoralis major muscle, with good agreement between the automatic segmentation and manual annotations by radiologists. The training accuracy and loss values of the validation set were 0.9954 and 0.0725, respectively, and for segmentation, the loss value was 0.0579. This study shows the potential clinical usefulness of the machine learning model for pectoralis major muscle segmentation as a quantitative biomarker for various parenchymal and muscular diseases.
Collapse
Affiliation(s)
- Zepa Yang
- Department of Radiology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Insung Choi
- Department of Radiology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Juwhan Choi
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Jongha Jung
- Department of Radiology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Minyeong Ryu
- Department of Radiology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Hwan Seok Yong
- Department of Radiology, Korea University Guro Hospital, Seoul, Republic of Korea
| |
Collapse
|
163
|
Shi Y, Guo J, Jiang Y, Zhao J, Li J, Shen J, Jin G, Bai X, Li Q. Myelosuppression Caused by Nanoparticle Albumin-Bound Paclitaxel in the Northern Chinese Population and the Role of Body Composition. J Clin Pharmacol 2023; 63:1009-1016. [PMID: 37128692 DOI: 10.1002/jcph.2259] [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: 03/08/2023] [Accepted: 04/25/2023] [Indexed: 05/03/2023]
Abstract
The aim of this study was to examine the relationship between lean body mass (LBM) and the incidence and severity of neutropenia in patients with malignant tumors from Northern China who have received nanoparticle albumin-bound paclitaxel. Twenty-six patients with pathologically confirmed malignant tumors were prospectively included in this study. These 26 patients were divided into Group A (sarcopenia) and Group B (nonsarcopenia). Group A comprised 50% (13/26) of the patients, while Group B comprised the other 50% (13/26). There was no statistically significant difference between both groups in terms of body surface area (P = .052). The incidence of neutropenia in Group A was 76.9% compared to 61.5% in Group B (P = .0673). The incidence of Grade 3 and severe neutropenia was 76.9% versus 61.5% in Groups A and B, respectively (P = .645). These 26 patients were divided into Groups 1 and 2 based on the administered nab-paclitaxel dose per kilogram of LBM, with both groups receiving a body surface area dose of 260 mg/m2 . Group 1 received a nab-paclitaxel dose of 14.19 mg/kg of LBM, whereas Group 2 received 11.37 mg/kg of LBM. In Group 1, the incidence of neutropenia was 71.4%, whereas it was 66.7% in Group 2. Grade 3 or higher neutropenia incidence was 28.6% in Group 1 versus 16.7% in Group 2. Patients with sarcopenia in northern China experienced a higher incidence of severe neutropenia after receiving nab-paclitaxel than patients without sarcopenia. Higher drug dose intensity per unit of LBM may be a contributing factor.
Collapse
Affiliation(s)
- Yongzhi Shi
- Ordos Clinical College, Baotou Medical College, Ordos, People's Republic of China
| | - Jiayuan Guo
- Ordos Clinical College, Inner Mongolia Medical University, Ordos, People's Republic of China
| | - Ying Jiang
- Department of Medical Oncology, Ordos Central Hospital, Ordos, People's Republic of China
| | - Juan Zhao
- Department of Medical Oncology, Ordos Central Hospital, Ordos, People's Republic of China
| | - Jiaxuan Li
- Ordos Clinical College, Inner Mongolia Medical University, Ordos, People's Republic of China
| | - Jing Shen
- Ordos Clinical College, Baotou Medical College, Ordos, People's Republic of China
| | - Gaowa Jin
- Department of Medical Oncology, Ordos Central Hospital, Ordos, People's Republic of China
| | - Xiaojun Bai
- Department of Medical Oncology, Ordos Central Hospital, Ordos, People's Republic of China
| | - Quanfu Li
- Department of Medical Oncology, Ordos Central Hospital, Ordos, People's Republic of China
| |
Collapse
|
164
|
Tram NK, Chou TH, Janse SA, Bobbey AJ, Audino AN, Onofrey JA, Stacy MR. Deep learning of image-derived measures of body composition in pediatric, adolescent, and young adult lymphoma: association with late treatment effects. Eur Radiol 2023; 33:6599-6607. [PMID: 36988714 DOI: 10.1007/s00330-023-09587-z] [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: 08/26/2022] [Revised: 02/07/2023] [Accepted: 02/17/2023] [Indexed: 03/30/2023]
Abstract
OBJECTIVES The objective of this study was to translate a deep learning (DL) approach for semiautomated analysis of body composition (BC) measures from standard of care CT images to investigate the prognostic value of BC in pediatric, adolescent, and young adult (AYA) patients with lymphoma. METHODS This 10-year retrospective, single-site study of 110 pediatric and AYA patients with lymphoma involved manual segmentation of fat and muscle tissue from 260 CT imaging datasets obtained as part of routine imaging at initial staging and first therapeutic follow-up. A DL model was trained to perform semiautomated image segmentation of adipose and muscle tissue. The association between BC measures and the occurrence of 3-year late effects was evaluated using Cox proportional hazards regression analyses. RESULTS DL-guided measures of BC were in close agreement with those obtained by a human rater, as demonstrated by high Dice scores (≥ 0.95) and correlations (r > 0.99) for each tissue of interest. Cox proportional hazards regression analyses revealed that patients with elevated subcutaneous adipose tissue at baseline and first follow-up, along with patients who possessed lower volumes of skeletal muscle at first follow-up, have increased risk of late effects compared to their peers. CONCLUSIONS DL provides rapid and accurate quantification of image-derived measures of BC that are associated with risk for treatment-related late effects in pediatric and AYA patients with lymphoma. Image-based monitoring of BC measures may enhance future opportunities for personalized medicine for children with lymphoma by identifying patients at the highest risk for late effects of treatment. KEY POINTS • Deep learning-guided CT image analysis of body composition measures achieved high agreement level with manual image analysis. • Pediatric patients with more fat and less muscle during the course of cancer treatment were more likely to experience a serious adverse event compared to their clinical counterparts. • Deep learning of body composition may add value to routine CT imaging by offering real-time monitoring of pediatric, adolescent, and young adults at high risk for late effects of cancer treatment.
Collapse
Affiliation(s)
- Nguyen K Tram
- Center for Regenerative Medicine, The Research Institute at Nationwide Children's Hospital, 575 Children's Crossroad, WB4133, Columbus, OH, 43215, USA
| | - Ting-Heng Chou
- Center for Regenerative Medicine, The Research Institute at Nationwide Children's Hospital, 575 Children's Crossroad, WB4133, Columbus, OH, 43215, USA
| | - Sarah A Janse
- Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Adam J Bobbey
- Department of Radiology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Anthony N Audino
- Division of Hematology/Oncology/BMT, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - John A Onofrey
- Department of Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
- Department of Urology, Yale University School of Medicine, New Haven, CT, USA
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Mitchel R Stacy
- Center for Regenerative Medicine, The Research Institute at Nationwide Children's Hospital, 575 Children's Crossroad, WB4133, Columbus, OH, 43215, USA.
- Interdisciplinary Biophysics Graduate Program, The Ohio State University, Columbus, OH, USA.
- Division of Vascular Diseases and Surgery, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA.
| |
Collapse
|
165
|
Ma Z, Liu R, Liu H, Zheng L, Zheng X, Li Y, Cui H, Qin C, Hu J. New scoring system combining computed tomography body composition analysis and inflammatory-nutritional indicators to predict postoperative complications in stage II-III colon cancer. J Gastroenterol Hepatol 2023; 38:1520-1529. [PMID: 37202867 DOI: 10.1111/jgh.16214] [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: 12/10/2022] [Revised: 04/07/2023] [Accepted: 04/28/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND AND AIM Postoperative complications are important clinical outcomes for colon cancer patients. This study aimed to investigate the predictive value of inflammatory-nutritional indicators combined with computed tomography body composition on postoperative complications in patients with stage II-III colon cancer. METHODS We retrospectively collected data from patients with stage II-III colon cancer admitted to our hospital from 2017 to 2021, including 198 patients in the training cohort and 50 patients in the validation cohort. Inflammatory-nutritional indicators and body composition were included in the univariate and multivariate analyses. Binary regression was used to develop a nomogram and evaluate its predictive value. RESULTS In the multivariate analysis, the monocyte-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), nutritional risk score (NRS), skeletal muscle index (SMI), and visceral fat index (VFI) were independent risk factors for postoperative complications of stage II-III colon cancer. In the training cohort, the area under the receiver operating characteristic curve of the predictive model was 0.825 (95% confidence interval [CI] 0.764-0.886). In the validation cohort, it was 0.901 (95% CI 0.816-0.986). The calibration curve showed that the prediction results were in good agreement with the observational results. Decision curve analysis showed that colon cancer patients could benefit from the predictive model. CONCLUSIONS A nomogram combining MLR, SII, NRS, SMI, and VFI with good accuracy and reliability in predicting postoperative complications in patients with stage II-III colon cancer was established, which can help guide treatment decisions.
Collapse
Affiliation(s)
- Zheng Ma
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Ruiqing Liu
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Huasheng Liu
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Longbo Zheng
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xuefeng Zheng
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yinling Li
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Haoyu Cui
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Chen Qin
- The Affiliated Qingdao Central Hospital of Qingdao University, Qingdao, Shandong, China
- The Second Affiliated Hospital of Medical College of Qingdao University, Qingdao, Shandong, China
| | - Jilin Hu
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| |
Collapse
|
166
|
Harada T, Tsuji T, Ueno J, Hijikata N, Ishikawa A, Kotani D, Kojima T, Fujita T. Association of sarcopenia with relative dose intensity of neoadjuvant chemotherapy in older patients with locally advanced esophageal cancer: A retrospective cohort study. J Geriatr Oncol 2023; 14:101580. [PMID: 37478514 DOI: 10.1016/j.jgo.2023.101580] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/28/2023] [Accepted: 06/29/2023] [Indexed: 07/23/2023]
Abstract
INTRODUCTION Sarcopenia impacts the toxicity of chemotherapy in patients with cancer, but there is little information on the association of sarcopenia with the relative dose intensity (RDI) of chemotherapy. We investigated the association of sarcopenia with RDI of neoadjuvant chemotherapy (NAC) in older patients with locally advanced esophageal cancer (LAEC). MATERIALS AND METHODS This was a single-center retrospective cohort study of patients aged ≥65 years who underwent curative esophagectomy after NAC for LAEC between 2016 and 2020. Skeletal muscle mass index (SMI) was calculated from computed tomography images at the L3 level. Sarcopenia was defined using the Youden index of SMI. Average RDI was calculated from delivered-dose intensity and standard-dose intensity of all drugs. The cutoff point of low average RDI was defined as <85%. The multivariate logistic regression model was used for the endpoint. RESULTS We analyzed 188 patients with a mean age of 71.3 years. The cutoff points of sarcopenia for low average RDI were defined as 42.81 cm2/m2 in males and 37.48 cm2/m2 in females. Sarcopenia significantly affected low average RDI, adjusted for age, sex, body mass index, drug regimen, clinical stage, and creatinine clearance (adjusted odds ratio: 2.195, 95% confidence interval: 1.107-4.411, p = 0.024). Compared with the non-sarcopenia patients, the sarcopenia patients with low average RDI had a higher rate of dose reduction, delayed, or discontinuation after the first cycle because of neutropenia (45% vs. 38%), and decreased performance status (11% vs. 0%). DISCUSSION Sarcopenia predicted low average RDI (<85%) of NAC in older patients with LAEC. In the future, the information about the mechanism of association of sarcopenia with RDI will progress the development of intervention strategy and novel supportive care.
Collapse
Affiliation(s)
- Tsuyoshi Harada
- Department of Rehabilitation Medicine, National Cancer Center Hospital East, Kashiwa, Chiba, Japan; Department of Rehabilitation Medicine, Keio University Graduate School, Shinjuku, Tokyo, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, National Cancer Center Hospital East, Kashiwa, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan.
| | - Junya Ueno
- Department of Rehabilitation Medicine, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Nanako Hijikata
- Department of Rehabilitation Medicine, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Aiko Ishikawa
- Department of Rehabilitation Medicine, National Cancer Center Hospital East, Kashiwa, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Daisuke Kotani
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Takashi Kojima
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Takeo Fujita
- Department of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| |
Collapse
|
167
|
Saino Y, Kawase F, Nagano A, Ueshima J, Kobayashi H, Murotani K, Inoue T, Nagami S, Suzuki M, Maeda K. Diagnosis and prevalence of sarcopenic obesity in patients with colorectal cancer: A scoping review. Clin Nutr 2023; 42:1595-1601. [PMID: 37480796 DOI: 10.1016/j.clnu.2023.06.025] [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: 04/27/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND & AIMS Sarcopenic obesity (SO) is associated with worse outcomes in patients with colorectal cancer (CRC); however, the diagnostic methods and prevalence of SO vary among studies. Therefore, we conducted this scoping review to investigate the diagnosis of SO in CRC, identify the associated problems, and determine its prevalence. METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews reporting guidelines. A literature search was performed by two independent reviewers on studies that diagnosed SO in CRC using the MEDLINE, EMBASE, CINAHL, CENTRAL, Web of Science, and Ichushi-Web (in Japanese) databases. Observational, longitudinal, cross-sectional, and clinical trials written in English or Japanese as of July 2022 were included. Studies that did not define SO were excluded from the analysis. The study protocol was pre-registered in Figshare. RESULTS In total, 670 studies were identified, 22 of which were included. Eighteen studies used sarcopenia in combination with obesity to diagnose SO. Sarcopenia was mainly diagnosed using skeletal muscle mass index (SMI), and only one combined with grip strength or gait speed. Obesity was diagnosed based on the body mass index (BMI; n = 11), followed by visceral fat area (VFA; n = 5). The overall prevalence of SO in patients with CRC was 15% (95%CI, 11-21%). The prevalence of SO in surgical resection and colorectal cancer liver metastases was 18% (95%CI, 12-25%) and 11% (95%CI, 3-36%), respectively. CONCLUSIONS SO in patients with CRC was mainly diagnosed based on a combination of SMI and BMI, and muscle strength and body composition were rarely evaluated. The prevalence of SO was approximately 15%, depending on the diagnostic methods used. Since SO in patients with CRC is associated with poor prognosis, further research on diagnostic methods for the early detection of SO and its clinical outcomes is needed.
Collapse
Affiliation(s)
- Yoko Saino
- Department of Clinical Nutrition, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto, Tokyo 135-8550, Japan; Department of Nutrition and Metabolism, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.
| | - Fumiya Kawase
- Department of Nutrition, Asuke Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, 20 Nakata, Yagami-cho, Toyota, Aichi 444-2351, Japan.
| | - Ayano Nagano
- Department of Nursing, Nishinomiya Kyoritsu Neurosurgical Hospital, 11-1 Imazuyamanaka-cho, Nishinomiya, Hyogo 663-8211, Japan.
| | - Junko Ueshima
- Department of Nutritional Service, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa, Tokyo 141-8625, Japan.
| | - Haruko Kobayashi
- General Incorporated Association Manabi Public Library, 306 Wakabadai, Meito, Nagoya, Aichi 465-0015, Japan.
| | - Kenta Murotani
- Biostatistics Center, Kurume University. 67, Asahimachi, Kurume, Fukuoka 830-0011, Japan.
| | - Tatsuro Inoue
- Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimami, Kita-ku, Niigata 950-3198, Japan.
| | - Shinsuke Nagami
- Department of Speech-Language Pathology and Audiology, Faculty of Rehabilitation, Kawasaki University of Medical Welfare, 288 Matsushima, Kurashiki, Okayama 701-0193, Japan.
| | - Mizue Suzuki
- Department of Rehabilitation, Faculty of Allied Health Sciences, Yamato University, 2-5-1 Katayama, Suita, Osaka 564-0082, Japan.
| | - Keisuke Maeda
- Nutrition Therapy Support Center, Aichi Medical University Hospital1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan; Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, Aichi 474-8511, Japan.
| |
Collapse
|
168
|
Masuda S, Yamakawa K, Masuda A, Toyama H, Sofue K, Nanno Y, Komatsu S, Omiya S, Sakai A, Kobayashi T, Tanaka T, Tsujimae M, Ashina S, Gonda M, Abe S, Uemura H, Kohashi S, Inomata N, Nagao K, Harada Y, Miki M, Irie Y, Juri N, Kanzawa M, Itoh T, Fukumoto T, Kodama Y. Association of Sarcopenia with a Poor Prognosis and Decreased Tumor-Infiltrating CD8-Positive T Cells in Pancreatic Ductal Adenocarcinoma: A Retrospective Analysis. Ann Surg Oncol 2023; 30:5776-5787. [PMID: 37191859 PMCID: PMC10409680 DOI: 10.1245/s10434-023-13569-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/27/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Sarcopenia, defined as a loss of skeletal muscle mass and quality, is found in 30-65% of patients with pancreatic ductal adenocarcinoma (PDAC) at diagnosis, and is a poor prognostic factor. However, it is yet to be evaluated why sarcopenia is associated with poor prognosis. Therefore, this study elucidated the tumor characteristics of PDAC with sarcopenia, including driver gene alterations and tumor microenvironment. PATIENTS AND METHODS We retrospectively analyzed 162 patients with PDAC who underwent pancreatic surgery between 2008 and 2017. We defined sarcopenia by measuring the skeletal muscle mass at the L3 level using preoperative computed tomography images and evaluated driver gene alteration (KRAS, TP53, CDKN2A/p16, and SMAD4) and tumor immune (CD4+, CD8+, and FOXP3+) and fibrosis status (stromal collagen). RESULTS In localized-stage PDAC (stage ≤ IIa), overall survival (OS) and recurrence-free survival were significantly shorter in the sarcopenia group than in the non-sarcopenia group (2-year OS 89.7% versus 59.1%, P = 0.03; 2-year RFS 74.9% versus 50.0%, P = 0.02). Multivariate analysis revealed that sarcopenia was an independent poor prognostic factor in localized-stage PDAC. Additionally, tumor-infiltrating CD8+ T cells in the sarcopenia group were significantly less than in the non-sarcopenia group (P = 0.02). However, no difference was observed in driver gene alteration and fib.rotic status. These findings were not observed in advanced-stage PDAC (stage ≥ IIb). CONCLUSIONS Sarcopenia was associated with a worse prognosis and decreased tumor-infiltrating CD8+ T cells in localized-stage PDAC. Sarcopenia may worsen a patient's prognosis by suppressing local tumor immunity.
Collapse
Affiliation(s)
- Shigeto Masuda
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kohei Yamakawa
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Atsuhiro Masuda
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
| | - Hirochika Toyama
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Keitaro Sofue
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yoshihide Nanno
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Shohei Komatsu
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Satoshi Omiya
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Arata Sakai
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takashi Kobayashi
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takeshi Tanaka
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Masahiro Tsujimae
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Shigeto Ashina
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Masanori Gonda
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Shohei Abe
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Hisahiro Uemura
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Shinya Kohashi
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Noriko Inomata
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kae Nagao
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yoshiyuki Harada
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Mika Miki
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yosuke Irie
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Noriko Juri
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Maki Kanzawa
- Division of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoo Itoh
- Division of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takumi Fukumoto
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yuzo Kodama
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| |
Collapse
|
169
|
Wu C, Hsu P, Chang JW, Chang C, Huang C, Yang C, Kuo CS, Fang Y, Wu C. Comprehensive assessment of pretreatment sarcopenia impacts on patients with EGFR-mutated NSCLC treated with afatinib. Thorac Cancer 2023; 14:2548-2557. [PMID: 37525557 PMCID: PMC10481145 DOI: 10.1111/1759-7714.15017] [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: 04/14/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND This study aimed to comprehensively evaluate the efficacy and toxicity of afatinib in patients with sarcopenia, an important prognostic factor for treatment efficacy and toxicity in patients with cancer. METHODS The clinical features of patients with advanced NSCLC treated with frontline afatinib between 2014 and 2018 at a medical center in Taiwan were retrospectively reviewed. Sarcopenia was evaluated based on the total cross-sectional area of skeletal muscles assessed by computed tomography (CT) imaging at the L3 level. Baseline characteristics, response rates, survival rates, and adverse events (AEs) were compared between sarcopenic and nonsarcopenic patients. RESULTS A total of 176 patients evaluated for sarcopenia by CT and treated with afatinib were enrolled in the current study. Sarcopenia was significantly associated with good performance status, low body mass index (BMI), low body surface area (BSA), and low total mass area (TMA). Sarcopenia did not influence the response rate (69.2% vs. 72.0%, p = 0.299), progression-free survival (median 15.9 vs. 14.9 months, p = 0.791), or overall survival (median 26.5 vs. 27.2 months, p = 0.441). However, BSA ≤ 1.7 and the 40 mg afatinib dose were associated with dose reduction. TMA was the only independent factor for afatinib discontinuation due to AEs. CONCLUSION Sarcopenia was not associated with treatment efficacy or toxicity among patients with NSCLC harboring common mutations treated with afatinib, indicating sarcopenic patients should not be excluded from afatinib treatment. Other factors, such as BSA and TMA, were associated with dose reduction and afatinib discontinuation, respectively, which may require additional evaluations in future studies.
Collapse
Affiliation(s)
- Chen‐Te Wu
- Department of Medical Imaging and InterventionChang Gung Memorial Hospital at Linkou, Chang Gung University College of MedicineTaoyuanTaiwan
| | - Ping‐Chih Hsu
- Division of Thoracic Oncology, Department of Thoracic MedicineChang Gung Memorial Hospital at Linkou, Chang Gung University College of MedicineTaoyuanTaiwan
| | - John Wen‐Cheng Chang
- Division of Hematology‐Oncology, Department of Internal MedicineChang Gung Memorial Hospital at Linkou, Chang Gung University College of MedicineTaoyuanTaiwan
| | - Ching‐Fu Chang
- Division of Hematology‐Oncology, Department of Internal MedicineChang Gung Memorial Hospital at Linkou, Chang Gung University College of MedicineTaoyuanTaiwan
| | - Chen‐Yang Huang
- Division of Hematology‐Oncology, Department of Internal MedicineChang Gung Memorial Hospital at Linkou, Chang Gung University College of MedicineTaoyuanTaiwan
| | - Cheng‐Ta Yang
- Division of Thoracic Oncology, Department of Thoracic MedicineChang Gung Memorial Hospital at Linkou, Chang Gung University College of MedicineTaoyuanTaiwan
| | - Chih‐Hsi Scott Kuo
- Division of Thoracic Oncology, Department of Thoracic MedicineChang Gung Memorial Hospital at Linkou, Chang Gung University College of MedicineTaoyuanTaiwan
| | - Yueh‐Fu Fang
- Division of Thoracic Oncology, Department of Thoracic MedicineChang Gung Memorial Hospital at Linkou, Chang Gung University College of MedicineTaoyuanTaiwan
| | - Chiao‐En Wu
- Division of Hematology‐Oncology, Department of Internal MedicineChang Gung Memorial Hospital at Linkou, Chang Gung University College of MedicineTaoyuanTaiwan
| |
Collapse
|
170
|
Yerli M, Yüce A, Ayaz MB, Bayraktar TO, Erkurt N, Dedeoğlu SS, İmren Y, Gürbüz H. Effect of psoas and gluteus medius muscles attenuation on hip fracture type. Hip Int 2023; 33:952-957. [PMID: 35658691 DOI: 10.1177/11207000221101169] [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] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Sarcopenia is defined as a progressive loss of muscle mass and function with increased age. The measurement of muscle mass and attenuation on the axial computed tomography (CT) scan has been reported to be a good indicator for sarcopenia in previous literature. This study aimed to compare muscle mass between the intertrochanteric fracture and femoral neck fracture groups by accurately measuring muscle mass around the hip joint using a CT scan. METHODS The cases were matched according to age and gender on a 1-to-1 basis. As a result, a total of 400 patients, 200 patients in each group with the same age and gender characteristics, were included in the study. At the disc of L4-L5 level, the cross-sectional area (CSA) of the psoas muscle was evaluated, and at the disc of L5-S1 level, the CSA of the psoas, iliacus and gluteus medius muscles were evaluated. In addition, attenuation was evaluated using the average Hounsfield Unit (HU) for the specific area. RESULTS The mean age of 400 patients (262 females, 138 male) included in the study was 78.49 ± 7.67 years. It was observed that the mean HU values of the patients in the femoral neck fracture group were significantly higher than the intertrochanteric fracture group (p < 0.001, p = 0.008; respectively). At the same time, the mean HU values of the gluteus medius muscle were higher in the femoral neck fracture group (p < 0.001), but in contrast with the psoas muscle, the CSA values of gluteus medius muscle were significantly higher in the intertrochanteric fracture group (p = 0.017). CONCLUSIONS Fatty degeneration of the psoas muscle among the muscles around the hip may affect the type of hip fracture. Elderly patients with strong psoas muscles may experience femoral neck fracture due to contraction and torsion during falling.
Collapse
Affiliation(s)
- Mustafa Yerli
- Department of Orthopaedics and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Ali Yüce
- Department of Orthopaedics and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Mustafa B Ayaz
- Department of Orthopaedics and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Tahsin O Bayraktar
- Department of Orthopaedics and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Nazım Erkurt
- Department of Orthopaedics and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Süleyman S Dedeoğlu
- Department of Orthopaedics and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Yunus İmren
- Department of Orthopaedics and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Hakan Gürbüz
- Department of Orthopaedics and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| |
Collapse
|
171
|
Vasilevska Nikodinovska V, Ivanoski S. Sarcopenia, More Than Just Muscle Atrophy: Imaging Methods for the Assessment of Muscle Quantity and Quality. ROFO-FORTSCHR RONTG 2023; 195:777-789. [PMID: 37160148 DOI: 10.1055/a-2057-0205] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND Sarcopenia, a progressive reduction of muscle mass and function, is associated with adverse outcomes in the elderly. Sarcopenia and muscle atrophy are not equal processes. Low muscle strength in association with muscle quantity/quality reduction is currently the optimal method for assessing sarcopenia. There is a practical need for indirect measurement of muscle strength using state-of-the-art imaging techniques. METHODS The following provides a narrative, broad review of all current imaging techniques for evaluating muscles and identifying sarcopenia, including DEXA, CT, MRI, and high-resolution ultrasound, their main strengths, weaknesses, and possible solutions to problems regarding each technique. RESULTS AND CONCLUSION Well-recognized imaging methods for the assessment of muscle mass are explained, including evaluation with DEXA, CT, and MRI muscle quantity assessment, ultrasound evaluation of muscle thickness and CSA, and their correlations with established muscle mass calculation methods. A special focus is on imaging methods for muscle quality evaluation. Several innovative and promising techniques that are still in the research phase but show potential in the assessment of different properties of muscle quality, including MRI DIXON sequences, MRI spectroscopy, Diffusion Tensor Imaging, ultrasound echo intensity, ultrasound elastography, and speed-of-sound ultrasound imaging are briefly mentioned. KEY POINTS · Sarcopenia definition includes low muscle strength and low muscle quantity/quality.. · DEXA is a low-radiation method for whole-body composition measurement in a single image.. · CT has established cut-off values for muscle quality/quantity evaluation and sarcopenia diagnosis.. · MRI is the most sophisticated muscle quality assessment method capable of evaluating myosteatosis, myofibrosis, and microstructure.. · Ultrasound can evaluate muscle quality, including tissue architecture, and elasticity with excellent spatial resolution.. CITATION FORMAT · Vasilevska Nikodinovska V, Ivanoski S, . Sarcopenia, More Than Just Muscle Atrophy: Imaging Methods for the Assessment of Muscle Quantity and Quality. Fortschr Röntgenstr 2023; 195: 777 - 789.
Collapse
Affiliation(s)
| | - Slavcho Ivanoski
- Diagnostic Radiology, St. Erasmo Hospital, Ohrid, North Macedonia
| |
Collapse
|
172
|
Klassen PN, Baracos V, Ghosh S, Martin L, Sawyer MB, Mazurak VC. Muscle and Adipose Wasting despite Disease Control: Unaddressed Side Effects of Palliative Chemotherapy for Pancreatic Cancer. Cancers (Basel) 2023; 15:4368. [PMID: 37686641 PMCID: PMC10486774 DOI: 10.3390/cancers15174368] [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: 07/12/2023] [Revised: 08/21/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Muscle and adipose wasting during chemotherapy for advanced pancreatic cancer (aPC) are associated with poor outcomes. We aimed to quantify the contributions of chemotherapy regimen and tumour progression to muscle and adipose wasting and evaluate the prognostic value of each tissue loss. Of all patients treated for aPC from 2013-2019 in Alberta, Canada (n = 504), computed-tomography (CT)-defined muscle and adipose tissue index changes (∆SMI, ∆ATI, cm2/m2) were measured for patients with CT images available both prior to and 12 ± 4 weeks after chemotherapy initiation (n = 210). Contributions of regimen and tumour response to tissue change were assessed with multivariable linear regression. Survival impacts were assessed with multivariable Cox's proportional hazards models. Tissue changes varied widely (∆SMI: -17.8 to +7.3 cm2/m2, ∆ATI: -106.1 to +37.7 cm2/m2) over 116 (27) days. Tumour progression contributed to both muscle and adipose loss (-3.2 cm2/m2, p < 0.001; -12.4 cm2/m2, p = 0.001). FOLFIRINOX was associated with greater muscle loss (-1.6 cm2/m2, p = 0.013) and GEM/NAB with greater adipose loss (-11.2 cm2/m2, p = 0.002). The greatest muscle and adipose losses were independently associated with reduced survival (muscle: HR 1.72, p = 0.007; adipose: HR 1.73, p = 0.012; tertile 1 versus tertile 3). Muscle and adipose losses are adverse effects of chemotherapy and may require regimen-specific management strategies.
Collapse
Affiliation(s)
- Pamela N. Klassen
- Department of Agricultural, Food & Nutritional Sciences, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Vickie Baracos
- Department of Oncology, University of Alberta, Edmonton, AB T6G 2P5, Canada
| | - Sunita Ghosh
- Department of Oncology, University of Alberta, Edmonton, AB T6G 2P5, Canada
| | - Lisa Martin
- Nutrition Services, Alberta Health Services, Edmonton, AB T5J 3E4, Canada
| | - Michael B. Sawyer
- Department of Oncology, University of Alberta, Edmonton, AB T6G 2P5, Canada
| | - Vera C. Mazurak
- Department of Agricultural, Food & Nutritional Sciences, University of Alberta, Edmonton, AB T6G 2R3, Canada
| |
Collapse
|
173
|
Dandache C, Confavreux CB, Gavoille A, Massy E, Chambard L, Rambaud J, Geye M, Brevet M, Girard N, Subtil F, Pialat JB. Peripheral but not axial muscle mass is associated with early mortality in bone metastatic lung cancer patients at diagnosis. Joint Bone Spine 2023; 90:105613. [PMID: 37442335 DOI: 10.1016/j.jbspin.2023.105613] [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: 01/23/2023] [Revised: 05/22/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVES Identification of sarcopenia is a key issue in oncology. Several methods may be used to evaluate muscle mass in patients. Routine cancer follow-up computed tomography (CT) provides axial muscle mass whereas whole-body densitometry (DEXA) measures appendicular lean mass (ALM). Up to now, no studies have assessed, in cancer patients, the correlation between CT and DEXA muscle mass indicators and compared their prognostic value. METHODS We included patients with synchronous bone metastases from lung adenocarcinoma at diagnosis. Diagnosis was confirmed by bone biopsy. Skeletal muscle area was determined semi-automatically on initial CT scan at the T7, T12, and L3 vertebral level using Osirix® software. The skeletal muscle index (SMI) was calculated as the ratio of muscle area to height squared. Standardised ALM/height squared data were obtained by DEXA assessment within a 30-day window of CT. RESULTS A total of 65 patients were included; 47 (72%) were male. Mean±SD age was 65±11.4years. DEXA was available for 46 patients. The performance status was good (<1) for 39 patients. SMI indicators were significantly correlated with each other (rho from 0.3 to 0.7) but moderately correlated with ALM (rho from 0.1 to 0.7). ALM had a good discriminatory ability on 6-month survival (AUC 0.87 [0.76; 0.97]). ALM was associated with early mortality (<6months) (HR=0.29, 95% CI [0.15; 0.57]; P<0.001) but not with later mortality (>6months). In contrast, no significant effect was found for SMI. CONCLUSIONS Peripheral muscle mass (standardized ALM by DEXA) but not axial muscle mass (SMI assessed by CT) was associated with early mortality (<6months) suggesting that cancer-induced muscle loss would affect differently appendicular muscles and axial muscles.
Collapse
Affiliation(s)
- Célia Dandache
- Département de Radiologie, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; Département de Radiologie, Hôpital Édouard-Herriot, Hospices Civils de Lyon, 69003 Lyon, France; Université Claude-Bernard Lyon 1, Université de Lyon, 69100 Lyon, France; CREATIS, CNRS UMR 5220, Inserm 1206 Unit, Université Lyon 1, INSA Lyon, 69100 Villeurbanne, France
| | - Cyrille B Confavreux
- Université Claude-Bernard Lyon 1, Université de Lyon, 69100 Lyon, France; Département de Rhumatologie, Centre Expert des Métastases Osseuses (CEMOS), Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; Inserm UMR1033, LYOS, Université de Lyon, 69003 Lyon, France.
| | - Antoine Gavoille
- Université Claude-Bernard Lyon 1, Université de Lyon, 69100 Lyon, France; Service de Biostatistiques, Hospices Civils de Lyon, 69003 Lyon, France
| | - Emmanuel Massy
- Université Claude-Bernard Lyon 1, Université de Lyon, 69100 Lyon, France; Département de Rhumatologie, Centre Expert des Métastases Osseuses (CEMOS), Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; Inserm UMR1033, LYOS, Université de Lyon, 69003 Lyon, France
| | - Lauriane Chambard
- Département de Rhumatologie, Centre Expert des Métastases Osseuses (CEMOS), Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
| | - Julien Rambaud
- Département de Radiologie, Hôpital Édouard-Herriot, Hospices Civils de Lyon, 69003 Lyon, France; Université Claude-Bernard Lyon 1, Université de Lyon, 69100 Lyon, France; CREATIS, CNRS UMR 5220, Inserm 1206 Unit, Université Lyon 1, INSA Lyon, 69100 Villeurbanne, France
| | - Madiane Geye
- Université Claude-Bernard Lyon 1, Université de Lyon, 69100 Lyon, France; Département de Rhumatologie, Centre Expert des Métastases Osseuses (CEMOS), Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
| | - Marie Brevet
- Université Claude-Bernard Lyon 1, Université de Lyon, 69100 Lyon, France; Département d'Anatomopathologie, Groupement Hospitalier Est, Hospices Civils de Lyon, 69003 Lyon, France
| | - Nicolas Girard
- Institut du Thorax Curie-Montsouris, Institut Curie, 75014 Paris, France
| | - Fabien Subtil
- CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR 5558, 69100 Villeurbanne, France; Service de Biostatistiques, Hospices Civils de Lyon, 69003 Lyon, France
| | - Jean-Baptiste Pialat
- Département de Radiologie, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; Université Claude-Bernard Lyon 1, Université de Lyon, 69100 Lyon, France; CREATIS, CNRS UMR 5220, Inserm 1206 Unit, Université Lyon 1, INSA Lyon, 69100 Villeurbanne, France
| |
Collapse
|
174
|
Jung SY, Lee MJ, Lee SY. Analysis of the Relationship Between Lower leg Muscle Mass and Preservation of Lower Extremity in Patients with Diabetic Foot Ulcer. INT J LOW EXTR WOUND 2023; 22:503-508. [PMID: 34096804 DOI: 10.1177/15347346211024493] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to determine how the muscle mass of the lower leg affects the preservation of the lower extremities in patients with diabetic foot ulcer. This study analyzed patients with diabetic foot ulcer between January 2014 and June 2018 with a follow-up of at least 2 years. Of these 181 patients whose ulcer is located distal to the metatarsophalangeal joint, which was categorized as grade ≤2 by the Wagner classification were classified into 4 grades: grade 0 (treated without amputation), grade 1 (amputation distal to the metatarsophalangeal joint), grade 2 (Ray, transmetatarsal, Lisfranc, and Chopart amputation), and grade 3 (Syme, below-knee, and above-knee amputation) according to the final amputation degree. The muscles of the lower leg were classified into 4 compartments: anterior, lateral, deep posterior, and superficial posterior. The cross-sectional area and attenuation to estimate the muscle volume and density were measured at the axial image of computed tomography (CT) angiography. No significant differences were observed in the sex ratio and mean age among the grades (P = .966 and .962). The cross-sectional area of the anterior, lateral, and posterior compartments demonstrated no significant differences, but that of the superficial posterior compartment exhibited significant differences among the grades (P < .001). Moreover, the attenuation of the anterior, lateral, and deep posterior compartments showed no significant differences, but that of the posterior compartment showed significant differences among the grades (P = .003). The muscle mass of the superficial posterior compartment of the lower leg could be a good indicator of the preservation of the lower extremity in patients with diabetic foot ulcer. Therefore, a strengthening exercise for the triceps surae and plantaris muscles in the early stage could help preserve as much of the lower extremities as possible.
Collapse
Affiliation(s)
- Sung Y Jung
- Department of Orthopedic Surgery, College of Medicine, Dong-A University, Busan, Korea
| | - Myoung J Lee
- Department of Orthopedic Surgery, College of Medicine, Dong-A University, Busan, Korea
| | - Sang Y Lee
- Department of Orthopedic Surgery, College of Medicine, Dong-A University, Busan, Korea
| |
Collapse
|
175
|
Brown LR, Laird BJA, Wigmore SJ, Skipworth RJE. Longitudinal characterisation of cachexia in patients undergoing surgical resection for cancer. Curr Opin Support Palliat Care 2023; 17:172-176. [PMID: 37389614 DOI: 10.1097/spc.0000000000000660] [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: 07/01/2023]
Abstract
PURPOSE OF REVIEW The complexity of the cancer cachexia phenotype has undoubtedly hindered researchers' understanding of this devastating syndrome. The presence and magnitude of host-tumour interactions are rarely considered during clinical decision-making within the current staging paradigm. Furthermore, treatment options for those patients who are identified as suffering from cancer cachexia remain extremely limited. RECENT FINDINGS Previous attempts to characterise cachexia have largely focussed on individual surrogate disease markers, often studied across a limited timeframe. While the adverse prognostic value of clinical and biochemical features is evident, the relationships between these are less clear. Investigation of patients with earlier-stage disease could allow researchers to identify markers of cachexia that precede the refractory stage of the wasting process. Appreciation of the cachectic phenotype within 'curative' populations may aid our understanding of the syndrome's genesis and provide potential routes for prevention, rather than treatment. SUMMARY Holistic, longitudinal characterisation of cancer cachexia, across all at-risk and affected populations, is of vital importance for future research in the field. This paper presents the protocol for an observational study aiming to create a robust and holistic characterisation of surgical patients with, or at risk of, cancer cachexia.
Collapse
Affiliation(s)
- Leo R Brown
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh
| | - Barry J A Laird
- St Columba's Hospice
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, Scotland, UK
| | - Stephen J Wigmore
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh
| | | |
Collapse
|
176
|
Park SJ, Yoon JH, Joo I, Lee JM. Newly developed sarcopenia after liver transplantation, determined by a fully automated 3D muscle volume estimation on abdominal CT, can predict post-transplant diabetes mellitus and poor survival outcomes. Cancer Imaging 2023; 23:73. [PMID: 37528480 PMCID: PMC10394977 DOI: 10.1186/s40644-023-00593-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/12/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Loss of muscle mass is the most common complication of end-stage liver disease and negatively affects outcomes for liver transplantation (LT) recipients. We aimed to determine the prognostic value of a fully automated three-dimensional (3D) muscle volume estimation using deep learning algorithms on abdominal CT in patients who underwent liver transplantation (LT). METHODS This retrospective study included 107 patients who underwent LT from 2014 to 2015. Serial CT scans, including pre-LT and 1- and 2-year follow-ups were performed. From the CT scans, deep learning-based automated body composition segmentation software was used to calculate muscle volumes in 3D. Sarcopenia was calculated by dividing average skeletal muscle area by height squared. Newly developed-(ND) sarcopenia was defined as the onset of sarcopenia 1 or 2 years after LT in patients without a history of sarcopenia before LT. Patients' clinical characteristics, including post-transplant diabetes mellitus (PTDM) and Model for end-stage liver disease score, were compared according to the presence or absence of sarcopenia after LT. A subgroup analysis was performed in the post-LT sarcopenic group. The Kaplan-Meier method was used for overall survival (OS). RESULTS Patients with ND-sarcopenia had poorer OS than those who did not (P = 0.04, hazard ratio [HR], 3.34; 95% confidence interval [CI] 1.05 - 10.7). In the subgroup analysis for post-LT sarcopenia (n = 94), 34 patients (36.2%) had ND-sarcopenia. Patients with ND-sarcopenia had significantly worse OS (P = 0.002, HR 7.12; 95% CI 2.00 - 25.32) and higher PTDM occurrence rates (P = 0.02, HR 4.93; 95% CI 1.18 - 20.54) than those with sarcopenia prior to LT. CONCLUSION ND-sarcopenia determined by muscle volume on abdominal CT can predict poor survival outcomes and the occurrence of PTDM for LT recipients.
Collapse
Affiliation(s)
- Sae-Jin Park
- Department of Radiology, SMG - SNU Boramae Medical Center, Seoul, Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
| |
Collapse
|
177
|
Morton M, Patterson J, Sciuva J, Perni J, Backes F, Nagel C, O'Malley DM, Chambers LM. Malnutrition, sarcopenia, and cancer cachexia in gynecologic cancer. Gynecol Oncol 2023; 175:142-155. [PMID: 37385068 DOI: 10.1016/j.ygyno.2023.06.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/14/2023] [Accepted: 06/18/2023] [Indexed: 07/01/2023]
Abstract
Patients with gynecologic cancers are at risk for malnutrition, cancer cachexia, and sarcopenia. Accumulating data supports that malnourished patients with gynecologic cancer have worse overall survival, increased healthcare utilization and costs, and a higher incidence of postoperative complications and treatment toxicity than those who are not malnourished. Malnutrition is defined as insufficient energy intake, leading to altered body composition and subsequent impaired physical and cognitive function, and can result in sarcopenia and cachexia, defined as the loss of lean body mass and loss of body weight respectively. The etiology of cancer-related malnutrition is complex, resulting from a systemic pro-inflammatory state of malignancy with upregulation of muscle degradation pathways and metabolic derangements, including lipolysis and proteolysis, that may not respond to nutritional repletion alone. Numerous validated scoring systems and radiographic measures have been described to define and quantify the severity of malnutrition and muscle loss in both clinical and research settings. "Prehabilitation" and optimization of nutrition and functional status early in therapy may combat the development or worsening of malnutrition and associated syndromes and ultimately improve oncologic outcomes, but limited data exist in the context of gynecologic cancer. Multi-modality nutrition and physical activity interventions have been proposed to combat the biophysical losses related to malnutrition. Several trials are underway in gynecologic oncology patients to address these aims, but significant gaps in knowledge persist. Pharmacologic interventions and potential immune targets for combating cachexia related to malignancy are discussed in this review and may provide opportunities to target disease and cachexia. This article reviews currently available data regarding the implications, diagnostics, physiology, and intervention strategies for gynecologic oncology patients with malnutrition and its associated conditions.
Collapse
Affiliation(s)
- Molly Morton
- Division of Gynecologic Oncology; The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute, Starling Loving Hall, M210, 320 W. 10(th) Avenue, Columbus, OH 43210, United States of America.
| | - Jenna Patterson
- Department of Obstetrics and Gynecology; The Ohio State University Wexner Medical Center, 456 W 10(th) Avenue, Columbus, OH 43210, United States of America
| | - Jessica Sciuva
- The Ohio State University College of Medicine; 370 W. 9(th) Ave, Columbus, OH 43210, United States of America
| | - Jaya Perni
- The Ohio State University; 281 W Lane Ave, Columbus, OH 43210, United States of America
| | - Floor Backes
- Division of Gynecologic Oncology; The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute, Starling Loving Hall, M210, 320 W. 10(th) Avenue, Columbus, OH 43210, United States of America
| | - Christa Nagel
- Division of Gynecologic Oncology; The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute, Starling Loving Hall, M210, 320 W. 10(th) Avenue, Columbus, OH 43210, United States of America
| | - David M O'Malley
- Division of Gynecologic Oncology; The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute, Starling Loving Hall, M210, 320 W. 10(th) Avenue, Columbus, OH 43210, United States of America
| | - Laura M Chambers
- Division of Gynecologic Oncology; The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute, Starling Loving Hall, M210, 320 W. 10(th) Avenue, Columbus, OH 43210, United States of America
| |
Collapse
|
178
|
Kiss N, Prado CM, Daly RM, Denehy L, Edbrooke L, Baguley BJ, Fraser SF, Khosravi A, Abbott G. Low muscle mass, malnutrition, sarcopenia, and associations with survival in adults with cancer in the UK Biobank cohort. J Cachexia Sarcopenia Muscle 2023; 14:1775-1788. [PMID: 37212184 PMCID: PMC10401543 DOI: 10.1002/jcsm.13256] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/23/2023] [Accepted: 04/15/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND Low muscle mass (MM) is a common component of cancer-related malnutrition and sarcopenia, conditions that are all independently associated with an increased risk of mortality. This study aimed to (1) compare the prevalence of low MM, malnutrition, and sarcopenia and their association with survival in adults with cancer from the UK Biobank and (2) explore the influence of different allometric scaling (height [m2 ] or body mass index [BMI]) on low MM estimates. METHODS Participants in the UK Biobank with a cancer diagnosis within 2 years of the baseline assessment were identified. Low MM was estimated by appendicular lean soft tissue (ALST) from bioelectrical impedance analysis derived fat-free mass. Malnutrition was determined using the Global Leadership in Malnutrition criteria. Sarcopenia was defined using the European Working Group on Sarcopenia in Older People criteria (version 2). All-cause mortality was determined from linked national mortality records. Cox-proportional hazards models were fitted to estimate the effect of low MM, malnutrition, and sarcopenia on all-cause mortality. RESULTS In total, 4122 adults with cancer (59.8 ± 7.1 years; 49.2% male) were included. Prevalence of low MM (8.0% vs. 1.7%), malnutrition (11.2% vs. 6.2%), and sarcopenia (1.4% vs. 0.2%) was higher when MM was adjusted using ALST/BMI compared with ALST/height2 , respectively. Low MM using ALST/BMI identified more cases in participants with obesity (low MM 56.3% vs. 0%; malnutrition 50% vs. 18.5%; sarcopenia 50% vs. 0%). During a median 11.2 (interquartile range: 10.2, 12.0) years of follow up, 901 (21.7%) of the 4122 participants died, and of these, 744 (82.6%) deaths were cancer-specific All conditions were associated with a higher hazard of mortality using either method of MM adjustment: low MM (ALST/height2 : HR 1.9 [95% CI 1.3, 2.8], P = 0.001; ALST/BMI: HR 1.3 [95% CI 1.1, 1.7], P = 0.005; malnutrition (ALST/height2 : HR 2.5 [95% CI 1.1, 1.7], P = 0.005; ALST/BMI: HR 1.3 [95% CI 1.1, 1.7], P = 0.005; sarcopenia (ALST/height2 : HR 2.9 [95% CI 1.3, 6.5], P = 0.013; ALST/BMI: HR 1.6 [95% CI 1.0, 2.4], P = 0.037). CONCLUSIONS In adults with cancer, malnutrition was more common than low MM or sarcopenia, although all conditions were associated with a higher mortality risk, regardless of the method of adjusting for MM. In contrast, adjustment of low MM for BMI identified more cases of low MM, malnutrition, and sarcopenia overall and in participants with obesity compared with height adjustment, suggesting it is the preferred adjustment.
Collapse
Affiliation(s)
- Nicole Kiss
- Institute for Physical Activity and NutritionDeakin UniversityGeelongAustralia
- Department of Health Services ResearchPeter MacCallum Cancer CentreMelbourneAustralia
| | - Carla M. Prado
- Department of Agricultural, Food and Nutrition ScienceUniversity of AlbertaEdmontonCanada
| | - Robin M. Daly
- Institute for Physical Activity and NutritionDeakin UniversityGeelongAustralia
| | - Linda Denehy
- Department of Health Services ResearchPeter MacCallum Cancer CentreMelbourneAustralia
- Melbourne School of Health SciencesUniversity of MelbourneParkvilleAustralia
| | - Lara Edbrooke
- Department of Health Services ResearchPeter MacCallum Cancer CentreMelbourneAustralia
- Department of PhysiotherapyUniversity of MelbourneParkvilleAustralia
| | - Brenton J. Baguley
- Institute for Physical Activity and NutritionDeakin UniversityGeelongAustralia
| | - Steve F. Fraser
- Institute for Physical Activity and NutritionDeakin UniversityGeelongAustralia
| | - Abbas Khosravi
- Institute for Intelligent Systems Research and InnovationDeakin UniversityGeelongAustralia
| | - Gavin Abbott
- Institute for Physical Activity and NutritionDeakin UniversityGeelongAustralia
| |
Collapse
|
179
|
van Bakel SIJ, Gietema HA, Stassen PM, Gosker HR, Gach D, van den Bergh JP, van Osch FHM, Schols AMWJ, Beijers RJHCG. CT Scan-Derived Muscle, But Not Fat, Area Independently Predicts Mortality in COVID-19. Chest 2023; 164:314-322. [PMID: 36894133 PMCID: PMC9990885 DOI: 10.1016/j.chest.2023.02.048] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/28/2023] [Accepted: 02/28/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND COVID-19 has demonstrated a highly variable disease course, from asymptomatic to severe illness and eventually death. Clinical parameters, as included in the 4C Mortality Score, can predict mortality accurately in COVID-19. Additionally, CT scan-derived low muscle and high adipose tissue cross-sectional areas (CSAs) have been associated with adverse outcomes in COVID-19. RESEARCH QUESTION Are CT scan-derived muscle and adipose tissue CSAs associated with 30-day in-hospital mortality in COVID-19, independent of 4C Mortality Score? STUDY DESIGN AND METHODS This was a retrospective cohort analysis of patients with COVID-19 seeking treatment at the ED of two participating hospitals during the first wave of the pandemic. Skeletal muscle and adipose tissue CSAs were collected from routine chest CT-scans at admission. Pectoralis muscle CSA was demarcated manually at the fourth thoracic vertebra, and skeletal muscle and adipose tissue CSA was demarcated at the first lumbar vertebra level. Outcome measures and 4C Mortality Score items were retrieved from medical records. RESULTS Data from 578 patients were analyzed (64.6% men; mean age, 67.7 ± 13.5 years; 18.2% 30-day in-hospital mortality). Patients who died within 30 days demonstrated lower pectoralis CSA (median, 32.6 [interquartile range (IQR), 24.3-38.8] vs 35.4 [IQR, 27.2-44.2]; P = .002) than survivors, whereas visceral adipose tissue CSA was higher (median, 151.1 [IQR, 93.6-219.7] vs 112.9 [IQR, 63.7-174.1]; P = .013). In multivariate analyses, low pectoralis muscle CSA remained associated with 30-day in-hospital mortality when adjusted for 4C Mortality Score (hazard ratio, 0.98; 95% CI, 0.96-1.00; P = .038). INTERPRETATION CT scan-derived low pectoralis muscle CSA is associated significantly with higher 30-day in-hospital mortality in patients with COVID-19 independently of the 4C Mortality Score.
Collapse
Affiliation(s)
- Sophie I J van Bakel
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Hester A Gietema
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; Grow School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Patricia M Stassen
- Section Acute Medicine, Division of General Internal Medicine, Department of Internal Medicine, CARIM School for Cardiovascular Diseases, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Harry R Gosker
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Debbie Gach
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, the Netherlands
| | - Joop P van den Bergh
- Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Internal Medicine, VieCuri Medical Centre, Venlo, the Netherlands
| | - Frits H M van Osch
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, 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
| | - Rosanne J H C G Beijers
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, the Netherlands.
| |
Collapse
|
180
|
de Leeuw SP, Pruis MA, Sikkema BJ, Mohseni M, Veerman GDM, Paats MS, Dumoulin DW, Smit EF, Schols AMWJ, Mathijssen RHJ, van Rossum EFC, Dingemans AMC. Analysis of Serious Weight Gain in Patients Using Alectinib for ALK-Positive Lung Cancer. J Thorac Oncol 2023; 18:1017-1030. [PMID: 37001858 DOI: 10.1016/j.jtho.2023.03.020] [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: 11/17/2022] [Revised: 03/08/2023] [Accepted: 03/25/2023] [Indexed: 03/31/2023]
Abstract
INTRODUCTION Alectinib is a standard-of-care treatment for metastatic ALK+ NSCLC. Weight gain is an unexplored side effect reported in approximately 10%. To prevent or intervene alectinib-induced weight gain, more insight in its extent and etiology is needed. METHODS Change in body composition was analyzed in a prospective series of 46 patients with ALK+ NSCLC, treated with alectinib. Waist circumference, visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and skeletal muscle were quantified using sliceOmatic software on computed tomography images at baseline, 3 months (3M), and 1 year (1Y). To investigate an exposure-toxicity relationship, alectinib plasma concentrations were quantified. Four patients with more than 10 kg weight gain were referred to Erasmus MC Obesity Center CGG for in-depth analysis (e.g., assessments of appetite, dietary habits, other lifestyle, medical and psychosocial factors, and extensive metabolic and endocrine assessments, including resting energy expenditure). RESULTS Mean increase in waist circumference was 9 cm (9.7%, p < 0.001) in 1Y with a 40% increase in abdominal obesity (p = 0.014). VAT increased to 10.8 cm2 (15.0%, p = 0.003) in 3M and 35.7 cm2 (39.0%, p < 0.001) in 1Y. SAT increased to 18.8 cm2 (12.4%, p < 0.001) in 3M and 45.4 cm2 (33.3%, p < 0.001) in 1Y. The incidence of sarcopenic obesity increased from 23.7% to 47.4% during 1Y of treatment. Baseline waist circumference was a positive predictor of increase in VAT (p = 0.037). No exposure-toxicity relationship was found. In-depth analysis (n = 4) revealed increased appetite in two patients and metabolic syndrome in all four patients. CONCLUSIONS Alectinib may cause relevant increased sarcopenic abdominal obesity, with increases of both VAT and SAT, quickly after initiation. This may lead to many serious metabolic, physical, and mental disturbances in long-surviving patients.
Collapse
Affiliation(s)
- Simon P de Leeuw
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Melinda A Pruis
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Barend J Sikkema
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mostafa Mohseni
- Department of Internal Medicine, Division of Endocrinology and Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - G D Marijn Veerman
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marthe S Paats
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Daphne W Dumoulin
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Egbert F Smit
- Department of Pulmonary Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Annemie M W J Schols
- School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ron H J Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Elisabeth F C van Rossum
- Department of Internal Medicine, Division of Endocrinology and Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Anne-Marie C Dingemans
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| |
Collapse
|
181
|
Ford KL, Pichard C, Sawyer MB, Trottier CF, Disi IR, Purcell SA, Ghosh S, Siervo M, Deutz NE, Prado CM. Total energy expenditure assessed by 24-h whole-room indirect calorimeter in patients with colorectal cancer: baseline findings from the PRIMe study. Am J Clin Nutr 2023; 118:422-432. [PMID: 37290740 DOI: 10.1016/j.ajcnut.2023.06.002] [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: 01/03/2023] [Revised: 05/19/2023] [Accepted: 06/05/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Total energy expenditure (TEE) determines energy requirements, but objective data in patients with cancer are limited. OBJECTIVES We aimed to characterize TEE, investigate its predictors, and compare TEE with cancer-specific predicted energy requirements. METHODS This cross-sectional analysis included patients with stages II-IV colorectal cancer from the Protein Recommendation to Increase Muscle (PRIMe) trial. TEE was assessed by 24-h stay in a whole-room indirect calorimeter before dietary intervention and compared with cancer-specific predicted energy requirements (25-30 kcal/kg). Generalized linear models, paired-samples t tests, and Pearson correlation were applied. RESULTS Thirty-one patients (56 ± 10 y; body mass index [BMI]: 27.9 ± 5.5 kg/m2; 68% male) were included. Absolute TEE was higher in males (mean difference: 391 kcal/d; 95% CI: 167, 616 kcal/d; P < 0.001), patients with colon cancer (mean difference: 279 kcal/d; 95% CI: 73, 485 kcal/d; P = 0.010), and patients with obesity (mean difference: 393 kcal/d; 95% CI: 182, 604 kcal/d; P < 0.001). Appendicular lean soft tissue (β: 46.72; 95% CI: 34.27, 59.17; P < 0.001) and tumor location (colon-β: 139.69; 95% CI: 19.44, 259.95; P = 0.023) independently predicted TEE when adjusted for sex. Error between measured TEE and energy requirements predicted by 25 kcal/kg (mean difference: 241 kcal/d; 95% CI: 76, 405 kcal/d; P = 0.010) or 30 kcal/kg (mean difference: 367 kcal/d; 95% CI: 163, 571 kcal/d; P < 0.001) was higher for patients with obesity, and proportional error was observed (25 kcal/kg: r = -0.587; P < 0.001; and 30 kcal/kg: r = -0.751; P < 0.001). TEE (mean difference: 25 kcal/kg; 95% CI: 24, 27 kcal/kg) was below predicted requirements using 30 kcal/kg (-430 ± 322 kcal/d; P < 0.001). CONCLUSIONS This is the largest study to assess TEE of patients with cancer using whole-room indirect calorimeter and highlights the need for improved assessment of energy requirements in this population. Energy requirements predicted using 30 kcal/kg overestimated TEE by 1.44 times in a controlled sedentary environment and TEE was outside of the predicted requirement range for most. Special considerations are warranted when determining TEE of patients with colorectal cancer, such as BMI, body composition, and tumor location. This is a baseline cross-sectional analysis from a clinical trial registered at clinicaltrials.gov as NCT02788955 (https://clinicaltrials.gov/ct2/show/NCT02788955).
Collapse
Affiliation(s)
- Katherine L Ford
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Canada
| | - Claude Pichard
- Clinical Nutrition, Geneva University Hospital, Geneva, Switzerland
| | | | - Claire F Trottier
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Canada
| | - Ilana Roitman Disi
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Canada; Department of Anesthesia, University of Sao Paulo, Sao Paulo, Brazil
| | - Sarah A Purcell
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Canada; Department of Medicine, University of British Columbia, Vancouver, Canada; Department of Biology, University of British Columbia Okanagan, Kelowna, Canada
| | - Sunita Ghosh
- Department of Oncology, University of Alberta, Edmonton, Canada
| | - Mario Siervo
- School of Population Health, Curtin University, Perth, Australia; Curtin Dementia Centre of Excellence, enAble Institute, Curtin University, Perth, Australia
| | - Nicolaas Ep Deutz
- Center for Translational Research in Aging and Longevity, Texas A&M University, College Station, United States
| | - Carla M Prado
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Canada.
| |
Collapse
|
182
|
Khan M, Parshad S, Naimi MF, Sidhu AK, Lyons F, Hardisty MR, Whyne CM, Smoragiewicz M, Phillips CM, Briones J, Emmenegger U. Sarcopenia in Men With Bone-Predominant Metastatic Castration-Resistant Prostate Cancer Undergoing Ra-223 Therapy. Clin Genitourin Cancer 2023; 21:e228-e235.e1. [PMID: 36849325 DOI: 10.1016/j.clgc.2023.01.009] [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: 06/24/2022] [Revised: 01/19/2023] [Accepted: 01/21/2023] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Osteosarcopenia is the progressive loss of musculoskeletal structure and functionality, contributing to disability and mortality. Despite complex interactions between bone and muscle, osteosarcopenia prevention and treatment in men with metastatic castration-resistant prostate cancer (mCRPC) focuses predominantly on bone health. It is unknown whether Radium-223 (Ra-223) therapy affects sarcopenia. METHODS We identified 52 patients with mCRPC who had received Ra-223 and had a baseline plus ≥1 follow-up abdominopelvic CT scan. The total contour area (TCA) and averaged Hounsfield units (HU) of the left and right psoas muscles were obtained at the inferior L3 endplate, and the psoas muscle index (PMI) was calculated therefrom. Intrapatient musculoskeletal changes were analyzed across various time points. RESULTS TCA and PMI gradually declined over the study period (P = .002, P = .003, respectively), but Ra-223 therapy did not accelerate sarcopenia, nor the decline of HU compared to the pre-Ra-223 period. The median overall survival of patients with baseline sarcopenia was numerically worse (14.93 vs. 23.23 months, HR 0.612, P = .198). CONCLUSIONS Ra-223 does not accelerate sarcopenia. Thus, worsening muscle parameters in men with mCRPC undergoing Ra-223 therapy are attributable to other factors. Further research is needed to determine whether baseline sarcopenia predicts poor overall survival in such patients.
Collapse
Affiliation(s)
- Maira Khan
- Sunnybrook Research Institute and Odette Cancer Centre, Toronto, Ontario, Canada
| | - Shruti Parshad
- Sunnybrook Research Institute and Odette Cancer Centre, Toronto, Ontario, Canada
| | - Mahdi F Naimi
- Sunnybrook Research Institute and Odette Cancer Centre, Toronto, Ontario, Canada
| | - Amanjot K Sidhu
- Sunnybrook Research Institute and Odette Cancer Centre, Toronto, Ontario, Canada
| | - Frank Lyons
- Department of Orthopaedic Surgery, Mater University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland
| | - Michael R Hardisty
- Sunnybrook Research Institute and Odette Cancer Centre, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Cari M Whyne
- Sunnybrook Research Institute and Odette Cancer Centre, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Martin Smoragiewicz
- Sunnybrook Research Institute and Odette Cancer Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Cameron M Phillips
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Medical Oncology, Niagara Health Systems, St. Catharines, Ontario, Canada
| | - Juan Briones
- Sunnybrook Research Institute and Odette Cancer Centre, Toronto, Ontario, Canada
| | - Urban Emmenegger
- Sunnybrook Research Institute and Odette Cancer Centre, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
183
|
Yamagishi S, Okamura Y, Kang W, Shindate M, Kochi M, Mitsuka Y, Watabe M, Yoshida N, Ikarashi M, Yamazaki S, Aramaki O, Nakayama H, Moriguchi M, Higaki T, Yamashita H. Impact of Sarcopenic Obesity on Severe Postoperative Complications in Patients with Gastric Cancer Undergoing Gastrectomy. Dig Surg 2023; 40:143-152. [PMID: 37527628 DOI: 10.1159/000531797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/15/2023] [Indexed: 08/03/2023]
Abstract
INTRODUCTION Several studies have indicated that sarcopenia affects the short- and long-term outcomes of cancer patients, including those with gastric cancer. In recent years, sarcopenic obesity and its effects have been reported in cancer patients. This study aimed to evaluate the impact of sarcopenic obesity on postoperative complications in patients with gastric cancer undergoing gastrectomy. METHODS This single-center, retrospective study included 155 patients who underwent curative gastrectomy for gastric cancer from January 2015 to July 2021. Sarcopenia was defined by the psoas muscle index (<6.36 cm2/m2 in men and <3.92 cm2/m2 in women), which measures the iliopsoas muscle area at the lumbar L3 level using computed tomography. Obesity was defined by body mass index (≥25). Patients with both sarcopenia and obesity were defined as the sarcopenic obesity group and others as the non-sarcopenic obesity group. Severe postoperative complications were defined as Clavien-Dindo classification grade IIIa or higher. RESULTS Of the 155 patients, 26 (16.8%) had sarcopenic obesity. The incidence of severe postoperative complications was significantly higher in the sarcopenic obesity group (30.8% vs. 10.9%; p = 0.014). Multivariate analysis indicated that sarcopenic obesity was an independent risk factor for severe postoperative complications (odds ratio, 3.950; 95% confidence interval, 1.390-11.200; p = 0.010). CONCLUSION Sarcopenic obesity is an independent risk factor for severe postoperative complications.
Collapse
Affiliation(s)
- Shunsuke Yamagishi
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan,
| | - Yukiyasu Okamura
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Woodae Kang
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare, Ichikawa Hospital, Chiba, Japan
| | - Masataka Shindate
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Mitsugu Kochi
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Yusuke Mitsuka
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Megumu Watabe
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Nao Yoshida
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Masahito Ikarashi
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Shintaro Yamazaki
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Osamu Aramaki
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Hisashi Nakayama
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Masamichi Moriguchi
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Tokio Higaki
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroharu Yamashita
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| |
Collapse
|
184
|
Stehlé T, Ouamri Y, Morel A, Vidal-Petiot E, Fellahi S, Segaux L, Prié D, Grimbert P, Luciani A, Audard V, Haymann JP, Mulé S, De Kerviler E, Peraldi MN, Boutten A, Matignon M, Canouï-Poitrine F, Flamant M, Pigneur F. Development and validation of a new equation based on plasma creatinine and muscle mass assessed by CT scan to estimate glomerular filtration rate: a cross-sectional study. Clin Kidney J 2023; 16:1265-1277. [PMID: 37529645 PMCID: PMC10387393 DOI: 10.1093/ckj/sfad012] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Indexed: 08/03/2023] Open
Abstract
Background Inter-individual variations of non-glomerular filtration rate (GFR) determinants of serum creatinine, such as muscle mass, account for the imperfect performance of estimated GFR (eGFR) equations. We aimed to develop an equation based on creatinine and total lumbar muscle cross-sectional area measured by unenhanced computed tomography scan at the third lumbar vertebra. Methods The muscle mass-based eGFR (MMB-eGFR) equation was developed in 118 kidney donor candidates (iohexol clearance) using linear regression. Validation cohorts included 114 healthy subjects from another center (51Cr-EDTA clearance, validation population 1), 55 patients with chronic diseases (iohexol, validation population 2), and 60 patients with highly discordant creatinine and cystatin C-based eGFR, thus presumed to have atypical non-GFR determinants of creatinine (51Cr-EDTA, validation population 3). Mean bias was the mean difference between eGFR and measured GFR, precision the standard deviation (SD) of the bias, and accuracy the percentage of eGFR values falling within 20% and 30% of measured GFR. Results In validation population 1, performance of MMB-eGFR was not different from those of CKD-EPICr2009 and CKD-EPICr2021. In validation population 2, MMB-eGFR was unbiased and displayed better precision than CKD-EPICr2009, CKD-EPICr2021 and EKFC (SD of the biases: 13.1 vs 16.5, 16.8 and 15.9 mL/min/1.73 m2). In validation population 3, MMB-eGFR had better precision and accuracy {accuracy within 30%: 75.0% [95% confidence interval (CI) 64.0-86.0] vs 51.5% (95% CI 39.0-64.3) for CKD-EPICr2009, 43.3% (95% CI 31.0-55.9) for CKD-EPICr2021, and 53.3% (95% CI 40.7-66.0) for EKFC}. Difference in bias between Black and white subjects was -2.1 mL/min/1.73 m2 (95% CI -7.2 to 3.0), vs -8.4 mL/min/1.73 m2 (95% CI -13.2 to -3.6) for CKD-EPICr2021. Conclusion MMB-eGFR displayed better performances than equations based on demographics, and could be applied to subjects of various ethnic backgrounds.
Collapse
Affiliation(s)
| | - Yaniss Ouamri
- Univ. Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri-Mondor, Service d'Imagerie Médicale, Créteil, France
| | - Antoine Morel
- Univ. Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri-Mondor, Service de Santé Publique, Créteil, France
| | - Emmanuelle Vidal-Petiot
- Université Paris Cité, Institut National de la Santé et de la Recherche Médicale (INSERM), U1149, Paris, France
- Assistance Publique des Hôpitaux de Paris (AP-HP), Département de Physiologie-Explorations Fonctionnelles, Hôpital Bichat, Paris, France
| | - Soraya Fellahi
- Université Pierre et Marie Curie Paris 6, Hôpital Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (APHP), Paris, France
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Département de Biochimie, Créteil, France
| | - Lauriane Segaux
- Univ. Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri-Mondor, Service de Santé Publique, Créteil, France
| | - Dominique Prié
- Université de Paris Cité, Faculté de Médecine, Institut National de la Santé et de la Recherche Médicale (INSERM) U1151, Paris, France
- Assistance Publique des Hôpitaux de Paris (AP-HP), Groupe Hospitalier Necker Enfants Malades, Service de Physiologie et Explorations Fonctionnelles, Paris, France
| | - Philippe Grimbert
- Univ. Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Fédération Hospitalo-Universitaire « Innovative therapy for immune disorders », Créteil, France
| | - Alain Luciani
- Univ. Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri-Mondor, Service d'Imagerie Médicale, Créteil, France
| | - Vincent Audard
- Univ. Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Fédération Hospitalo-Universitaire « Innovative therapy for immune disorders », Créteil, France
| | - Jean Philippe Haymann
- Univ. Paris Diderot, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale (INSERM), U1155
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux de Paris, hôpital Tenon, Département de Physiologie-Explorations Fonctionnelles, Paris, France
| | - Sébastien Mulé
- Univ. Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri-Mondor, Service d'Imagerie Médicale, Créteil, France
| | - Eric De Kerviler
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux de Paris, Hôpital Tenon, Département de Physiologie-Explorations Fonctionnelles, Paris, France
| | - Marie-Noëlle Peraldi
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Saint Louis, Service de Néphrologie, Paris, France
| | - Anne Boutten
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux de Paris, hôpital Bichat, Département de Biochimie Clinique, Paris, France
| | - Marie Matignon
- Univ. Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Fédération Hospitalo-Universitaire « Innovative therapy for immune disorders », Créteil, France
| | - Florence Canouï-Poitrine
- Univ. Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri-Mondor, Service de Santé Publique, Créteil, France
| | - Martin Flamant
- Université Paris Cité, Institut National de la Santé et de la Recherche Médicale (INSERM), U1149, Paris, France
- Assistance Publique des Hôpitaux de Paris (AP-HP), Département de Physiologie-Explorations Fonctionnelles, Hôpital Bichat, Paris, France
| | - Frédéric Pigneur
- Univ. Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri-Mondor, Service d'Imagerie Médicale, Créteil, France
| |
Collapse
|
185
|
An J, Choi SP, Oh JH, Zhu JH, Kim SW, Kim SH. The Association between the L3 Skeletal Muscle Index Derived from Computed Tomography and Clinical Outcomes in Patients with Urinary Tract Infection in the Emergency Department. J Clin Med 2023; 12:5024. [PMID: 37568426 PMCID: PMC10420275 DOI: 10.3390/jcm12155024] [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: 05/25/2023] [Revised: 07/28/2023] [Accepted: 07/29/2023] [Indexed: 08/13/2023] Open
Abstract
The occurrence of a critical event during a urinary tract infection (UTI) can have a significant impact on mortality. This study aimed to investigate the association between the skeletal muscle index (SMI) and critical events in patients with a UTI. From April 2019 to March 2022, a total of 478 patients who met the diagnostic criteria of a UTI and underwent an abdominal CT were included in this study. Multivariate binary logistic regression analysis was used to assess independent predictors of critical events. The primary outcome was any critical event, defined as the initiation of dialysis, invasive ventilation, initiation of vasoactive medications, cardiac arrest, or death. The UTI patients were divided into two groups: those with a low SMI (n = 93) and those with a high SMI (n = 385). In multivariate analysis, a low SMI, diabetes mellitus, altered mentality, lactate levels, and creatinine levels were identified as significant predictors of critical events. A low SMI is an independent factor associated with the occurrence of critical events in UTI patients during hospitalization. Patients with a low SMI, indicating muscle wasting, may have less resilience to infections and a higher risk of experiencing severe complications. Considering the SMI along with other clinical factors can help health care providers assess and manage UTI patients.
Collapse
Affiliation(s)
- Jinjoo An
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea;
| | - Seung Pill Choi
- Department of Emergency, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea; (S.P.C.); (J.H.O.); (J.H.Z.); (S.W.K.)
| | - Jae Hun Oh
- Department of Emergency, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea; (S.P.C.); (J.H.O.); (J.H.Z.); (S.W.K.)
| | - Jong Ho Zhu
- Department of Emergency, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea; (S.P.C.); (J.H.O.); (J.H.Z.); (S.W.K.)
| | - Sung Wook Kim
- Department of Emergency, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea; (S.P.C.); (J.H.O.); (J.H.Z.); (S.W.K.)
| | - Soo Hyun Kim
- Department of Emergency, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea; (S.P.C.); (J.H.O.); (J.H.Z.); (S.W.K.)
| |
Collapse
|
186
|
Vandoni G, D'Amico F, Fabbrini M, Mariani L, Sieri S, Casirati A, Di Guardo L, Del Vecchio M, Anichini A, Mortarini R, Sgambelluri F, Celano G, Serale N, De Angelis M, Brigidi P, Gavazzi C, Turroni S. Gut Microbiota, Metabolome, and Body Composition Signatures of Response to Therapy in Patients with Advanced Melanoma. Int J Mol Sci 2023; 24:11611. [PMID: 37511376 PMCID: PMC10380337 DOI: 10.3390/ijms241411611] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/11/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
Despite the recent breakthroughs in targeted and immunotherapy for melanoma, the overall survival rate remains low. In recent years, considerable attention has been paid to the gut microbiota and other modifiable patient factors (e.g., diet and body composition), though their role in influencing therapeutic responses has yet to be defined. Here, we characterized a cohort of 31 patients with unresectable IIIC-IV-stage cutaneous melanoma prior to initiation of targeted or first-line immunotherapy via the following methods: (i) fecal microbiome and metabolome via 16S rRNA amplicon sequencing and gas chromatography/mass spectrometry, respectively, and (ii) anthropometry, body composition, nutritional status, physical activity, biochemical parameters, and immunoprofiling. According to our data, patients subsequently classified as responders were obese (i.e., with high body mass index and high levels of total, visceral, subcutaneous, and intramuscular adipose tissue), non-sarcopenic, and enriched in certain fecal taxa (e.g., Phascolarctobacterium) and metabolites (e.g., anethole), which were potentially endowed with immunostimulatory and oncoprotective activities. On the other hand, non-response was associated with increased proportions of Streptococcus, Actinomyces, Veillonella, Dorea, Fusobacterium, higher neutrophil levels (and a higher neutrophil-to-lymphocyte ratio), and higher fecal levels of butyric acid and its esters, which also correlated with decreased survival. This exploratory study provides an integrated list of potential early prognostic biomarkers that could improve the clinical management of patients with advanced melanoma, in particular by guiding the design of adjuvant therapeutic strategies to improve treatment response and support long-term health improvement.
Collapse
Affiliation(s)
- Giulia Vandoni
- Clinical Nutrition Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Federica D'Amico
- Microbiomics Unit, Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
- Unit of Microbiome Science and Biotechnology, Department of Pharmacy and Biotechnology, University of Bologna, 40126 Bologna, Italy
| | - Marco Fabbrini
- Microbiomics Unit, Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
- Unit of Microbiome Science and Biotechnology, Department of Pharmacy and Biotechnology, University of Bologna, 40126 Bologna, Italy
| | - Luigi Mariani
- Data Science Unit, Fondazione IRCCS Istituito Nazionale dei Tumori, 20133 Milan, Italy
| | - Sabina Sieri
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Amanda Casirati
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Lorenza Di Guardo
- Melanoma Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Michele Del Vecchio
- Melanoma Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Andrea Anichini
- Human Tumors Immunobiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Roberta Mortarini
- Human Tumors Immunobiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Francesco Sgambelluri
- Human Tumors Immunobiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Giuseppe Celano
- Department of Soil, Plant and Food Science (DiSSPA), University of Bari Aldo Moro, 70126 Bari, Italy
| | - Nadia Serale
- Department of Soil, Plant and Food Science (DiSSPA), University of Bari Aldo Moro, 70126 Bari, Italy
| | - Maria De Angelis
- Department of Soil, Plant and Food Science (DiSSPA), University of Bari Aldo Moro, 70126 Bari, Italy
| | - Patrizia Brigidi
- Microbiomics Unit, Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Cecilia Gavazzi
- Clinical Nutrition Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Silvia Turroni
- Unit of Microbiome Science and Biotechnology, Department of Pharmacy and Biotechnology, University of Bologna, 40126 Bologna, Italy
| |
Collapse
|
187
|
Zhi J, Jiāo B, Qing S, Liang L. Factors associated with low skeletal muscle index among patients with Crohn's disease. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20221606. [PMID: 37466589 DOI: 10.1590/1806-9282.20221606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/28/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE Disease-related skeletal muscle loss is highly prevalent among patients with Crohn's disease. Low skeletal muscle mass lead to disability and interventions to prevent skeletal mass loss as an effective strategy to prevent disability. The aim of this article was to identify the factor associated with skeletal muscle loss of Crohn's disease and seek for management target for the prevention of sarcopenia-related disability. METHODS Patients with Crohn's disease were divided into low and normal skeletal muscle mass groups based on L3 skeletal muscle index using abdominal CT scans. The clinical and laboratory parameters and colonoscopy were compared between the two groups. Univariate and multivariate regression logistic models were built to identify the prognostic markers of Crohn's disease-associated muscle loss. RESULTS A total of 191 Crohn's disease patients were enrolled in this study, of whom 116 (60.73%) were detected to have low L3 skeletal muscle index, including 71 (68.26%) males. The multivariate logistic regression analysis showed that age (OR: 1.031, 95%CI: 1.006-1.057), female gender (OR: 2.939, 95%CI: 1.386-6.233), disease duration (OR: 0.988, 95%CI: 0.980-0.996), endoscopic disease activity (simple endoscopic score for Crohn's disease) (OR: 0.923, 95%CI: 0.855-0.996), serum albumin (OR: 1.079, 95%CI: 1.009-1.154), and serum creatinine (OR: 1.037, 95%CI: 1.011-1.063) were associated with L3 skeletal muscle index among Crohn's disease patients. CONCLUSION The gender, age, and duration of disease were uncontrollable factors associated with muscle loss of Crohn's disease. The treatment target of mucosal healing and improved nutritional status may be beneficial for maintaining muscle mass among Crohn's disease patients.
Collapse
Affiliation(s)
- Jiehua Zhi
- Yangzhou University, The Affiliated Hospital of Yangzhou University, Department of Gastroenterology - Yangzhou, China
| | - Bing Jiāo
- Yangzhou University, The Affiliated Hospital of Yangzhou University, Department of Gastroenterology - Yangzhou, China
| | - Shan Qing
- Yangzhou University, The Affiliated Hospital of Yangzhou University, Department of Geriatric - Yangzhou, China
| | - Lanyu Liang
- Yangzhou University, The Affiliated Hospital of Yangzhou University, Department of Geriatric - Yangzhou, China
| |
Collapse
|
188
|
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.
Collapse
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
| |
Collapse
|
189
|
Galvez T, Berkane I, Thézenas S, Eberlé MC, Flori N, Guillemard S, Ilonca AD, Santoro L, Kotzki PO, Senesse P, Deshayes E. Identification of 18F-FDG PET/CT Parameters Associated with Weight Loss in Patients with Esophageal Cancer. Nutrients 2023; 15:3042. [PMID: 37447367 DOI: 10.3390/nu15133042] [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: 05/08/2023] [Revised: 06/16/2023] [Accepted: 07/01/2023] [Indexed: 07/15/2023] Open
Abstract
18F-FDG PET-CT is routinely performed as part of the initial staging of numerous cancers. Other than having descriptive, predictive and prognostic values for tumors, 18F-FDG PET-CT provides full-body data, which could inform on concurrent pathophysiological processes such as malnutrition. To test this hypothesis, we measured the 18F-FDG uptake in several organs and evaluated their association with weight loss in patients at diagnosis of esophageal cancer. Forty-eight patients were included in this retrospective monocentric study. 18F-FDG uptake quantification was performed in the brain, the liver, the spleen, bone marrow, muscle and the esophageal tumor itself and was compared between patients with different amounts of weight loss. We found that Total Lesion Glycolysis (TLG) and peak Standardized Uptake Values (SUVpeak) measured in the brain correlated with the amount of weight loss: TLG was, on average, higher in patients who had lost more than 5% of their usual weight, whereas brain SUVpeak were, on average, lower in patients who had lost more than 10% of their weight. Higher TLG and lower brain SUVpeak were associated with worse OS in the univariate analysis. This study reports a new and significant association between 18F-FDG uptake in the brain and initial weight loss in patients with esophageal cancer.
Collapse
Affiliation(s)
- Thierry Galvez
- Department of Nuclear Medicine, Institut du Cancer de Montpellier, Université de Montpellier, 34298 Montpellier, Cedex 5, France
- Department of Endocrinology, Diabetes and Nutrition, CHU de Montpellier, Université de Montpellier, 34295 Montpellier, France
| | - Ikrame Berkane
- Department of Nuclear Medicine, Institut du Cancer de Montpellier, Université de Montpellier, 34298 Montpellier, Cedex 5, France
| | - Simon Thézenas
- Biometry Unit, Institut du Cancer de Montpellier, Université de Montpellier, 34298 Montpellier, Cedex 5, France
| | - Marie-Claude Eberlé
- Department of Nuclear Medicine, Institut du Cancer de Montpellier, Université de Montpellier, 34298 Montpellier, Cedex 5, France
| | - Nicolas Flori
- Department of Clinical Nutrition and Gastroenterology, Institut du Cancer de Montpellier, Université de Montpellier, 34298 Montpellier, Cedex 5, France
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, 34298 Montpellier, France
| | - Sophie Guillemard
- Department of Nuclear Medicine, Institut du Cancer de Montpellier, Université de Montpellier, 34298 Montpellier, Cedex 5, France
| | - Alina Diana Ilonca
- Department of Nuclear Medicine, Institut du Cancer de Montpellier, Université de Montpellier, 34298 Montpellier, Cedex 5, France
| | - Lore Santoro
- Department of Nuclear Medicine, Institut du Cancer de Montpellier, Université de Montpellier, 34298 Montpellier, Cedex 5, France
| | - Pierre-Olivier Kotzki
- Department of Nuclear Medicine, Institut du Cancer de Montpellier, Université de Montpellier, 34298 Montpellier, Cedex 5, France
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, 34298 Montpellier, France
| | - Pierre Senesse
- Department of Clinical Nutrition and Gastroenterology, Institut du Cancer de Montpellier, Université de Montpellier, 34298 Montpellier, Cedex 5, France
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, 34298 Montpellier, France
| | - Emmanuel Deshayes
- Department of Nuclear Medicine, Institut du Cancer de Montpellier, Université de Montpellier, 34298 Montpellier, Cedex 5, France
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, 34298 Montpellier, France
| |
Collapse
|
190
|
Ali S, Lee YR, Park SY, Tak WY, Jung SK. Abdominal CT Segmentation for Body Composition Assessment Using Network Consistency Learning. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38082821 DOI: 10.1109/embc40787.2023.10340476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Estimating skeletal muscle (SM) and adipose tissues is an invaluable prognostic indicator in cancer treatment, major surgeries, and general health screening. Body composition is usually measured with abdominal computed tomography (CT) scans acquired in clinical settings. The whole-body SM volume is correlated with the estimated SM based on the measurement of a single two-dimensional vertebral slice. It is necessary to label a CT image at the pixel level to estimate SM, known as semantic segmentation. In this work, we trained a segmentation model using the labeled abdominal CT slices and the additional unlabeled slices. In particular, we trained two identical segmentation networks with differently initialized weights. Network Consistency Learning (NCL) allowed learning from unlabeled images by forcing the predictions from both networks to be the same. We segmented abdominal CT images from a newly created in-house dataset. The proposed approach gained 10% better performance in terms of Dice similarity score (DSC) than that obtained by a standard supervised network demonstrating the effectiveness of NCL in exploiting unlabeled images.Clinical relevance- An efficient and cost-effective method is proposed for assessing body composition from limited labeled and abundant unlabeled CT images to facilitate fast diagnosis, prognosis, and interventions.
Collapse
|
191
|
Urakawa H, Sato K, Vaishnav AS, Lee R, Chaudhary C, Mok JK, Virk S, Sheha E, Katsuura Y, Kaito T, Gang CH, Qureshi SA. Preoperative cross-sectional area of psoas muscle correlates with short-term functional outcomes after posterior lumbar surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:2326-2335. [PMID: 37010611 DOI: 10.1007/s00586-023-07533-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 09/26/2022] [Accepted: 01/09/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE To determine the optimal level for the measurement of psoas cross-sectional area and examine the correlation with short-term functional outcomes of posterior lumbar surgery. METHODS Patients who underwent minimally invasive posterior lumbar surgery were included in this study. The cross-sectional area of psoas muscle was measured at each intervertebral level on T2-weighted axial images of preoperative MRI. Normalized total psoas area (NTPA) (mm2/m2) was calculated as total psoas area normalized to patient height. Intraclass Correlation Coefficient (ICC) was calculated for the analysis of inter-rater reliability. Patient reported outcome measures including Oswestry disability index (ODI), visual analog scale (VAS), short form health survey (SF-12) and patient-reported outcomes measurement information system were collected. A multivariate analysis was performed to elucidate independent predictors associated with failure to reach minimal clinically important difference (MCID) in each functional outcome at 6 months. RESULTS The total of 212 patients were included in this study. ICC was highest at L3/4 [0.992 (95% CI: 0.987-0.994)] compared to the other levels [L1/2 0.983 (0.973-0.989), L2/3 0.991 (0.986-0.994), L4/5 0.928 (0.893-0.952)]. Postoperative PROMs were significantly worse in patients with low NTPA. Low NTPA was an independent predictor of failure to reach MCID in ODI (OR = 2.68; 95% CI: 1.26-5.67; p = 0.010) and VAS leg (OR = 2.43; 95% CI: 1.13-5.20; p = 0.022). CONCLUSION Decreased psoas cross-sectional area on preoperative MRI correlated with functional outcomes after posterior lumbar surgery. NTPA was highly reliable, especially at L3/4.
Collapse
Affiliation(s)
- Hikari Urakawa
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Kosuke Sato
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Avani S Vaishnav
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Ryan Lee
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Chirag Chaudhary
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Jung Kee Mok
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Sohrab Virk
- North Shore University Hospital, 300 Community Dr, Manhasset, NY, USA
- Long Island Jewish Medical Center, 825 Northern Blvd, Great Neck, NY, USA
| | - Evan Sheha
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
- Weill Cornell Medical College, 1300 York Ave, New York, NY, USA
| | | | - Takashi Kaito
- Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | | | - Sheeraz A Qureshi
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA.
- Weill Cornell Medical College, 1300 York Ave, New York, NY, USA.
| |
Collapse
|
192
|
Pénichoux J, Lanic H, Thill C, Ménard AL, Camus V, Stamatoullas A, Lemasle E, Leprêtre S, Lenain P, Contentin N, Kraut-Tauzia J, Fruchart C, Kammoun L, Damaj G, Farge A, Delette C, Modzelewski R, Vaudaux S, Pépin LF, Tilly H, Jardin F. Prognostic relevance of sarcopenia, geriatric, and nutritional assessments in older patients with diffuse large B-cell lymphoma: results of a multicentric prospective cohort study. Ann Hematol 2023; 102:1811-1823. [PMID: 37058153 PMCID: PMC10260702 DOI: 10.1007/s00277-023-05200-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 03/23/2023] [Indexed: 04/15/2023]
Abstract
This prospective study aimed to investigate the prognostic effect of sarcopenia, geriatric, and nutritional status in older patients with diffuse large B-cell lymphoma (DLBCL). Ninety-five patients with DLBCL older than 70 years who were treated with immunochemotherapy were included. The lumbar L3 skeletal muscle index (L3-SMI) was measured by computed tomography at baseline, and sarcopenia was defined as low L3-SMI. Geriatric assessment included G8 score, CIRS-G scale, Timed Up and Go test, and instrumental activity of daily living. Nutritional status was assessed using the Mini Nutritional Assessment and the body mass index, and several scores used in the literature incorporating nutritional and inflammatory biomarkers, namely the Nutritional and inflammatory status (NIS), Geriatric Nutritional Risk Index, Prognostic Nutritional Index, and Glasgow Prognostic Score.Fifty-three patients were considered sarcopenic. Sarcopenic patients displayed higher levels of inflammation markers and lower levels of prealbumin than non-sarcopenic patients. Sarcopenia was associated with NIS, but was not associated with severe adverse events and treatment disruptions. They were, however, more frequent among patients with elevated NIS. Sarcopenia did not appear in this study as a prognostic factor for progression-free survival (PFS) or overall survival (OS). However, NIS emerged as predictive of the outcome with a 2-year PFS rate of 88% in the NIS ≤ 1 group and 49% in the NIS > 1 group and a significant effect in a multivariate analysis for both PFS (p = 0.049) and OS (HR = 9.61, CI 95% = [1.03-89.66], p = 0.04). Sarcopenia was not associated with adverse outcomes, but was related to NIS, which appeared to be an independent prognostic factor.
Collapse
Affiliation(s)
- Juliette Pénichoux
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France.
| | - Hélène Lanic
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
| | - Caroline Thill
- Department of Statistics, Rouen University Hospital, Rouen, France
| | - Anne-Lise Ménard
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
| | - Vincent Camus
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
- INSERM U1245 Unit, Team "Genetic and Biomarkers in Lymphoma and Solid Tumors", Rouen University, Centre Henri Becquerel, Rouen, France
| | - Aspasia Stamatoullas
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
- INSERM U1245 Unit, Team "Genetic and Biomarkers in Lymphoma and Solid Tumors", Rouen University, Centre Henri Becquerel, Rouen, France
| | - Emilie Lemasle
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
| | - Stéphane Leprêtre
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
| | - Pascal Lenain
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
| | - Nathalie Contentin
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
| | | | | | - Leila Kammoun
- Department of Oncology-Hematology, Eure-Seine Hospital Center, Evreux, France
| | - Gandhi Damaj
- Institute of Hematology, Caen University Hospital, Caen, France
| | - Agathe Farge
- Institute of Hematology, Caen University Hospital, Caen, France
| | - Caroline Delette
- Department of Clinical Hematology, Amiens University Hospital, Amiens, France
| | | | - Sandrine Vaudaux
- Clinical Research Unit, Henri Becquerel Cancer Center, Rouen, France
| | | | - Hervé Tilly
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
- INSERM U1245 Unit, Team "Genetic and Biomarkers in Lymphoma and Solid Tumors", Rouen University, Centre Henri Becquerel, Rouen, France
| | - Fabrice Jardin
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
- INSERM U1245 Unit, Team "Genetic and Biomarkers in Lymphoma and Solid Tumors", Rouen University, Centre Henri Becquerel, Rouen, France
| |
Collapse
|
193
|
Ngo-Huang AT, Parker NH, Xiao L, Schadler KL, Petzel MQB, Prakash LR, Kim MP, Tzeng CWD, Lee JE, Ikoma N, Wolff RA, Javle MM, Koay EJ, Pant SD, Folloder JP, Wang X, Cotto AM, Ju YR, Garg N, Wang H, Bruera ED, Basen-Engquist KM, Katz MHG. Effects of a Pragmatic Home-based Exercise Program Concurrent With Neoadjuvant Therapy on Physical Function of Patients With Pancreatic Cancer: The PancFit Randomized Clinical Trial. Ann Surg 2023; 278:22-30. [PMID: 37026453 PMCID: PMC10330108 DOI: 10.1097/sla.0000000000005878] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
OBJECTIVE To determine the effects of a preoperative, home-based exercise program on fitness and physical function in patients with pancreatic cancer. BACKGROUND We previously established a well-tolerated preoperative exercise program after finding a high frequency of sarcopenia and frailty in patients with pancreatic cancer. METHODS In this randomized, controlled trial (NCT03187951), patients with pancreatic cancer were randomized to Arm A: enhanced usual care or Arm B: prescribed aerobic and resistance exercise during neoadjuvant therapy. Patients received nutrition counseling and activity trackers. The primary endpoint was a 6-minute walk distance (6MWD; ≥14 meters improvement was clinically meaningful). Secondary endpoints included additional physical function tests, health-related quality of life, and clinical outcomes. RESULTS One hundred fifty-one patients were randomized. Objectively measured weekly activity (153.2±135.6 and 159.8±122.8 min in Arm A and B, respectively, P =0.62) and self-reported weekly moderate-to-strenuous physical activity (107.4±160.4 and 129.6±161.6 min in Arm A and Arm B, respectively, P =0.49) were similar, but weekly strength training sessions increased more in Arm B (by 1.8±1.8 vs 0.1±2.4 sessions, P <0.001). 6MWD improved in both Arm A (mean change 18.6±56.8 m, P =0.01) and Arm B (27.3±68.1 m, P =0.002). Quality of life and clinical outcomes did not significantly differ between arms. Pooling patients in both study groups, exercise, and physical activity was favorably associated with physical performance and clinical outcomes. CONCLUSIONS In this randomized trial of prescribed exercise versus enhanced usual care during neoadjuvant therapy for pancreatic cancer, a high volume of physical activity and increased exercise capacity were observed in both arms, highlighting the importance of activity among patients preparing for surgery.
Collapse
Affiliation(s)
- An T Ngo-Huang
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nathan H Parker
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | - Lianchun Xiao
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Keri L Schadler
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Maria Q B Petzel
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Laura R Prakash
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael P Kim
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ching-Wei D Tzeng
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeffrey E Lee
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Naruhiko Ikoma
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Robert A Wolff
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Milind M Javle
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eugene J Koay
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Shubham D Pant
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Justin P Folloder
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Xuemei Wang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Alicia M Cotto
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | - Ye Rang Ju
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Naveen Garg
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Huamin Wang
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eduardo D Bruera
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Karen M Basen-Engquist
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Matthew H G Katz
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
194
|
Bedrikovetski S, Traeger L, Vather R, Sammour T, Moore JW. Does Sarcopenia Predict Local Response Rates After Chemoradiotherapy for Locally Advanced Rectal Cancer? Dis Colon Rectum 2023; 66:965-972. [PMID: 36538702 DOI: 10.1097/dcr.0000000000002451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The predictive value of sarcopenia for tumor response to neoadjuvant chemoradiotherapy is unclear. OBJECTIVE This study aimed to investigate the association between sarcopenia and pathological tumor regression grade after neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer. DESIGN Retrospective cohort study from a prospectively collected database. Univariate logistic regression was performed to assess the association between sarcopenia and tumor response. SETTINGS This study was conducted at 2 tertiary care centers. PATIENTS Participants were patients undergoing neoadjuvant chemoradiotherapy for locally advanced rectal cancer (T3/4, N0/+) between 2007 and 2018. INTERVENTION Sarcopenia was diagnosed using sex-specific cutoffs of lean muscle mass. Using the initial staging CT, lean muscle mass was estimated using the cross-sectional area of the psoas muscle at the level of the third lumbar vertebra, normalized for patient height. MAIN OUTCOME MEASURES The primary end point was pathological tumor regression grade, defined as good (tumor regression grade 0/1) vs poor (tumor regression grade 2/3). RESULTS The study included 167 patients with locally advanced rectal cancer with a median age of 60 (20-91) years, with 132 in the nonsarcopenia group and 35 in the sarcopenia group. Eighty-nine percent of patients had stage 3 cancer. Nine patients (5.4%) had a complete clinical response, 1 patient did not respond to treatment and opted for nonoperative management, and the remaining 157 patients (94.0%) proceeded to surgery. Pathological data revealed no significant difference between good tumor regression grade patients in the sarcopenia group compared with the nonsarcopenia group. Univariate analysis revealed BMI ≥25 kg/m 2 to be a risk factor for good tumor regression grade ( p = 0.002). LIMITATIONS This study was limited by its retrospective design and small sample size. CONCLUSIONS Sarcopenia is not a predictor of poor neoadjuvant chemoradiotherapy response in patients with locally advanced rectal cancer. Increasing BMI was associated with good tumor regression grade. Future multicentered studies are warranted to validate this finding. See Video Abstract at http://links.lww.com/DCR/C78 . LA SARCOPENIA PREDICE LAS TASAS DE RESPUESTA LOCAL DESPUS DE LA QUIMIORRADIOTERAPIA PARA EL CNCER DE RECTO LOCALMENTE AVANZADO ANTECEDENTES:El valor predictivo de la sarcopenia para la respuesta tumoral a la quimiorradioterapia neoadyuvante no está claro.OBJETIVO:Este estudio investiga la asociación entre la sarcopenia y el grado de regresión tumoral patológica después de la quimiorradioterapia neoadyuvante en pacientes con cáncer de recto localmente avanzado.DISEÑO:Estudio de cohorte retrospectivo a partir de una base de datos recolectada prospectivamente. Se realizó una regresión logística univariante para evaluar la asociación entre la sarcopenia y la respuesta tumoral.ENTORNO CLINICO:Este estudio se realizó en dos centros de atención terciaria.PACIENTES:Pacientes sometidos a quimiorradioterapia neoadyuvante por cáncer de recto localmente avanzado (T3/4, N0/+) entre 2007-2018.INTERVENCIÓNES:La sarcopenia se diagnosticó utilizando puntos de corte de masa muscular magra específicos por género. Utilizando la tomografía computarizada de estadificación inicial, se estimó la masa muscular magra utilizando el área transversal del músculo psoas a nivel de la tercera vértebra lumbar, normalizada para la altura del paciente.PRINCIPALES MEDIDAS DE VALORACIÓN:El criterio principal de valoración fue el grado de regresión tumoral patológica, definido como bueno (grado de regresión tumoral 0/1) frente a malo (grado de regresión tumoral 2/3).RESULTADOS:El estudio incluyó a 167 pacientes con cáncer de recto localmente avanzado con una mediana de edad de 60 años (20-91), 132 en el grupo sin sarcopenia y 35 en el grupo con sarcopenia. Ochenta y nueve por ciento estaban en etapa III. Seis pacientes (5,4%) tuvieron respuesta clínica completa sostenida, un paciente no respondió al tratamiento y optó por manejo conservador, los 157 restantes (94,0%) procedieron a cirugía. Los datos patológicos no revelaron diferencias significativas entre los pacientes con buen grado de regresión tumoral en el grupo de sarcopenia en comparación con el grupo sin sarcopenia. El análisis univariado reveló que un IMC ≥25 kg/m2 era un factor de riesgo para un buen grado de regresión tumoral (p = 0,002).LIMITACIONES:Este estudio estuvo limitado por su diseño retrospectivo y tamaño de muestra pequeño.CONCLUSIÓNES:La sarcopenia no es un predictor de mala respuesta a la quimiorradioterapia neoadyuvante en pacientes con cáncer de recto localmente avanzado. El aumento del IMC se asoció con un buen grado de regresión tumoral. Se justifican futuros estudios multicéntricos para validar este hallazgo. Consulte Video Resumen en http://links.lww.com/DCR/C78 . (Traducción-Dr. Ingrid Melo ).
Collapse
Affiliation(s)
- Sergei Bedrikovetski
- Discipline of Surgery, Faculty of Health and Medical Sciences, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Luke Traeger
- Discipline of Surgery, Faculty of Health and Medical Sciences, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Ryash Vather
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Tarik Sammour
- Discipline of Surgery, Faculty of Health and Medical Sciences, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - James W Moore
- Discipline of Surgery, Faculty of Health and Medical Sciences, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| |
Collapse
|
195
|
Topcu A, Yurtsever I, Isleyen ZS, Besiroglu M, Yasin AI, Topcu ZA, Shbair AT, Toluk O, Simsek M, Seker M, Turk HM. The correlation between skeletal muscle index and anxiety in patients with lung cancer on the first day of chemotherapy. Future Oncol 2023. [PMID: 37367530 DOI: 10.2217/fon-2022-1200] [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: 06/28/2023] Open
Abstract
Aim: To evaluate the relationship between anxiety and skeletal muscle index (SMI) levels in lung cancer patients on the first day of chemotherapy. Materials & methods: This cross-sectional study included 108 patients. We analyzed patient characteristics, SMI levels, pain status and predicted anxiety factors. Results: Anxiety was detected in 61% of patients. SMI levels were significantly lower in the high anxiety group than the low anxiety group (p < 0.001). A significant correlation was observed between anxiety and SMI levels (r = -0.292; p = 0.002). Anxiety levels were significantly correlated with trait anxiety (r = 0.618; p < 0.001) and visual analog scale-pain (r = 0.364; p < 0.001). SMI (odds ratio: 0.94), trait anxiety (odds ratio: 1.12) and visual analog scale pain (odds ratio: 1.28) were independent risk factors for anxiety after adjusting for sex, stage and Eastern Cooperative Oncology Group performance status. Conclusion: Our study highlighted that higher anxiety scores were significantly correlated with lower SMI levels. We found that SMI, pain and trait anxiety were independent risk factors for anxiety.
Collapse
Affiliation(s)
- Atakan Topcu
- Department of Medical Oncology, Bezmialem Vakif University, Istanbul, 34093, Turkey
| | - Ismail Yurtsever
- Department of Radiology, Bezmialem Vakif University, Istanbul, 34093, Turkey
| | | | - Mehmet Besiroglu
- Department of Medical Oncology, Bezmialem Vakif University, Istanbul, 34093, Turkey
| | - Ayse Irem Yasin
- Department of Medical Oncology, Bezmialem Vakif University, Istanbul, 34093, Turkey
| | - Zeynep Alaca Topcu
- Department of Medical Oncology, Istanbul Medeniyet University, Istanbul, 34722, Turkey
| | - Abdallah Tm Shbair
- Department of Medical Oncology, Bezmialem Vakif University, Istanbul, 34093, Turkey
| | - Ozlem Toluk
- Department of Biostatistics, Bezmialem Vakif University, Istanbul, 34093, Turkey
| | - Melih Simsek
- Department of Medical Oncology, Bezmialem Vakif University, Istanbul, 34093, Turkey
| | - Mesut Seker
- Department of Medical Oncology, Bezmialem Vakif University, Istanbul, 34093, Turkey
| | - Haci Mehmet Turk
- Department of Medical Oncology, Bezmialem Vakif University, Istanbul, 34093, Turkey
| |
Collapse
|
196
|
Palmas F, Ciudin A, Guerra R, Eiroa D, Espinet C, Roson N, Burgos R, Simó R. Comparison of computed tomography and dual-energy X-ray absorptiometry in the evaluation of body composition in patients with obesity. Front Endocrinol (Lausanne) 2023; 14:1161116. [PMID: 37455915 PMCID: PMC10345841 DOI: 10.3389/fendo.2023.1161116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/17/2023] [Indexed: 07/18/2023] Open
Abstract
Objective a) To evaluate the accuracy of the pre-existing equations (based on cm2 provided by CT images), to estimate in kilograms (Kg) the body composition (BC) in patients with obesity (PwO), by comparison with Dual-energy X-ray absorptiometry (DXA). b) To evaluate the accuracy of a new approach (based on both cm2 and Hounsfield Unit parameters provided by CT images), using an automatic software and artificial intelligence to estimate the BC in PwO, by comparison with DXA. Methods Single-centre cross-sectional study including consecutive PwO, matched by gender with subjects with normal BMI. All the subjects underwent BC assessment by Dual-energy X-ray absorptiometry (DXA) and skeletal-CT at L3 vertebrae. CT images were processed using FocusedON-BC software. Three different models were tested. Model 1 and 2, based on the already existing equations, estimate the BC in Kg based on the tissue area (cm2) in the CT images. Model 3, developed in this study, includes as additional variables, the tissue percentage and its average Hounsfield unit. Results 70 subjects (46 PwO and 24 with normal BMI) were recruited. Significant correlations for BC were obtained between the three models and DXA. Model 3 showed the strongest correlation with DXA (r= 0.926, CI95% [0.835-0.968], p<0.001) as well as the best agreement based on Bland - Altman plots. Conclusion This is the first study showing that the BC assessment based on skeletal CT images analyzed by automatic software coupled with artificial intelligence, is accurate in PwO, by comparison with DXA. Furthermore, we propose a new equation that estimates both the tissue quantity and quality, that showed higher accuracy compared with those currently used, both in PwO and subjects with normal BMI.
Collapse
Affiliation(s)
- Fiorella Palmas
- Endocrinology and Nutrition Department, Hospital Universitari Vall D´Hebron, Barcelona, Spain
| | - Andreea Ciudin
- Endocrinology and Nutrition Department, Hospital Universitari Vall D´Hebron, Barcelona, Spain
- Diabetes and Metabolism Research Unit, Vall d’Hebron Institut De Recerca (VHIR), Barcelona, Spain
- Department of Medicine, Universitat Autònoma De Barcelona, Barcelona, Spain
- Centro De Investigación Biomédica En Red De Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto De Salud Carlos III (ISCIII), Madrid, Spain
| | | | - Daniel Eiroa
- Department of Radiology, Institut De Diagnòstic Per La Imatge (IDI), Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Carina Espinet
- Nuclear Medicine Deparment, Vall Hebron Hospital, Barcelona, Spain
| | - Nuria Roson
- Department of Radiology, Institut De Diagnòstic Per La Imatge (IDI), Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Rosa Burgos
- Endocrinology and Nutrition Department, Hospital Universitari Vall D´Hebron, Barcelona, Spain
- Diabetes and Metabolism Research Unit, Vall d’Hebron Institut De Recerca (VHIR), Barcelona, Spain
- Department of Medicine, Universitat Autònoma De Barcelona, Barcelona, Spain
| | - Rafael Simó
- Endocrinology and Nutrition Department, Hospital Universitari Vall D´Hebron, Barcelona, Spain
- Diabetes and Metabolism Research Unit, Vall d’Hebron Institut De Recerca (VHIR), Barcelona, Spain
- Department of Medicine, Universitat Autònoma De Barcelona, Barcelona, Spain
- Centro De Investigación Biomédica En Red De Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto De Salud Carlos III (ISCIII), Madrid, Spain
| |
Collapse
|
197
|
Hanna L, Sellahewa R, Huggins CE, Lundy J, Croagh D. Relationship between circulating tumour DNA and skeletal muscle stores at diagnosis of pancreatic ductal adenocarcinoma: a cross-sectional study. Sci Rep 2023; 13:9663. [PMID: 37316578 DOI: 10.1038/s41598-023-36643-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 06/07/2023] [Indexed: 06/16/2023] Open
Abstract
Low skeletal muscle index (SMI) and low skeletal muscle radiodensity (SMD) are associated with reduced survival time in pancreatic ductal adenocarcinoma (PDAC). The negative prognostic impact of low SMI and low SMD is often reported as independent of cancer stage when using traditional clinical staging tools. Therefore, this study sought to explore the relationship between a novel marker of tumour burden (circulating tumour DNA) and skeletal muscle abnormalities at diagnosis of PDAC. A retrospective cross-sectional study was conducted in patients who had plasma and tumour tissue samples stored in the Victorian Pancreatic Cancer Biobank (VPCB) at diagnosis of PDAC, between 2015 and 2020. Circulating tumour DNA (ctDNA) of patients with G12 and G13 KRAS mutations was detected and quantified. Pre-treatment SMI and SMD derived from analysis of diagnostic computed tomography imaging was tested for its association to presence and concentration of ctDNA, as well as conventional staging, and demographic variables. The study included 66 patients at PDAC diagnosis; 53% female, mean age 68.7 years (SD ± 10.9). Low SMI and low SMD were present in 69.7% and 62.1% of patients, respectively. Female gender was an independent risk factor for low SMI (OR 4.38, 95% CI 1.23-15.55, p = 0.022), and older age an independent risk factor for low SMD (OR 1.066, 95% CI 1.002-1.135, p = 0.044). No association between skeletal muscle stores and concentration of ctDNA (SMI r = - 0.163, p = 0.192; SMD r = 0.097, p = 0.438) or stage of disease according to conventional clinical staging [SMI F(3, 62) = 0.886, p = 0.453; SMD F(3, 62) = 0.717, p = 0.545] was observed. These results demonstrate that low SMI and low SMD are highly prevalent at diagnosis of PDAC, and suggest they are comorbidities of cancer rather than related to the clinical stage of disease. Future studies are needed to identify the mechanisms and risk factors for low SMI and low SMD at diagnosis of PDAC to aid screening and intervention development.
Collapse
Affiliation(s)
- Lauren Hanna
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia.
- Department of Nutrition and Dietetics, Monash Health, Clayton, VIC, Australia.
| | - Rav Sellahewa
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Monash University, Clayton, VIC, Australia
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Department of Upper Gastrointestinal Surgery, Monash Health, Clayton, VIC, Australia
| | - Catherine E Huggins
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Burwood, VIC, Australia
| | - Joanne Lundy
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Department of Molecular and Translational Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Daniel Croagh
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Department of Upper Gastrointestinal Surgery, Monash Health, Clayton, VIC, Australia
| |
Collapse
|
198
|
Imamura T, Fujioka H, Ushijima R, Sobajima M, Fukuda N, Ueno H, Kinugawa K. Prognostic Impact of Psoas Muscle Mass Index following Trans-Catheter Aortic Valve Replacement. J Clin Med 2023; 12:3943. [PMID: 37373637 DOI: 10.3390/jcm12123943] [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: 05/03/2023] [Revised: 06/04/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Psoas muscle mass is a recently featured index of sarcopenia, which has a negative prognostic impact in patients with a variety of diseases. We investigated the prognostic impact of baseline psoas muscle mass in patients receiving a trans-catheter aortic valve replacement (TAVR). METHODS Patients who received TAVR at our center between 2015 and 2022 were included. Patients received computer tomography imaging upon admission as an institutional protocol, and psoas muscle mass was measured, which was indexed by body surface area. Patients were followed for four years or until January 2023. The prognostic impact of psoas muscle mass index on 4-year mortality following index discharge was evaluated. RESULTS A total of 322 patients (85 years, 95 male) were included. Median psoas muscle mass index at baseline was 10.9 (9.0, 13.5) × 10 cm3/m2. A lower psoas muscle mass index tended to be associated with several index of malnutrition and sarcopenia. A psoas muscle mass index was independently associated with 4-year mortality with an adjusted hazard ratio of 0.88 (95% confidence interval 0.79-0.99, p = 0.044). Patients with lower psoas muscle mass index (below the statistically calculated cutoff of 10.7 × 10 cm3/m2, N = 152) had significantly higher cumulative 4-year mortality compared with others (32% versus 13%, p = 0.008). CONCLUSIONS A lower psoas muscle mass index, which is a recently featured objective marker of sarcopenia, was associated with mid-term mortality following TAVR in the elderly cohort with severe aortic stenosis. The measurement of psoas muscle mass index prior to TAVR could have clinical implications for shared decision-making among patients, their relatives, and clinicians.
Collapse
Affiliation(s)
- Teruhiko Imamura
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Hayato Fujioka
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Ryuichi Ushijima
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Mitsuo Sobajima
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Nobuyuki Fukuda
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Hiroshi Ueno
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Koichiro Kinugawa
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan
| |
Collapse
|
199
|
Jang JY, Kim D, Kim ND. Pathogenesis, Intervention, and Current Status of Drug Development for Sarcopenia: A Review. Biomedicines 2023; 11:1635. [PMID: 37371730 DOI: 10.3390/biomedicines11061635] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
Sarcopenia refers to the loss of muscle strength and mass in older individuals and is a major determinant of fall risk and impaired ability to perform activities of daily living, often leading to disability, loss of independence, and death. Owing to its impact on morbidity, mortality, and healthcare expenditure, sarcopenia in the elderly has become a major focus of research and public policy debates worldwide. Despite its clinical importance, sarcopenia remains under-recognized and poorly managed in routine clinical practice, partly owing to the lack of available diagnostic testing and uniform diagnostic criteria. Since the World Health Organization and the United States assigned a disease code for sarcopenia in 2016, countries worldwide have assigned their own disease codes for sarcopenia. However, there are currently no approved pharmacological agents for the treatment of sarcopenia; therefore, interventions for sarcopenia primarily focus on physical therapy for muscle strengthening and gait training as well as adequate protein intake. In this review, we aimed to examine the latest information on the epidemiology, molecular mechanisms, interventions, and possible treatments with new drugs for sarcopenia.
Collapse
Affiliation(s)
- Jung Yoon Jang
- Department of Pharmacy, College of Pharmacy, Research Institute for Drug Development, Pusan National University, Busan 46241, Republic of Korea
| | - Donghwan Kim
- Functional Food Materials Research Group, Korea Food Research Institute, Wanju-gun 55365, Jeollabuk-do, Republic of Korea
| | - Nam Deuk Kim
- Department of Pharmacy, College of Pharmacy, Research Institute for Drug Development, Pusan National University, Busan 46241, Republic of Korea
| |
Collapse
|
200
|
Fatani H, Olaru A, Stevenson R, Alharazi W, Jafer A, Atherton P, Brook M, Moran G. Systematic review of sarcopenia in inflammatory bowel disease. Clin Nutr 2023; 42:1276-1291. [PMID: 37352818 DOI: 10.1016/j.clnu.2023.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 03/10/2023] [Accepted: 05/02/2023] [Indexed: 06/25/2023]
Abstract
INTRODUCTION There is growing evidence of increased muscle atrophy in IBD patients, likely resulting in a higher sarcopenia prevalence in IBD. The aims of this systematic review are A1; to estimate sarcopenia prevalence in IBD patients, A2; to investigate its impact on IBD patients, and A3; the effectiveness of nutritional interventions on muscle mass and/or strength in IBD patients. METHODS On 28 July 2021, three electronic databases were used to identify eligible studies, including peer-reviewed studies (randomised controlled trials [RCTs], non-RCTs, observation studies) in adult (⩾ 18 years) IBD patients. For A1 and A2 only, studies defined low muscle mass and/or strength cut-off points. For A2, studies assessed association between sarcopenia and IBD complication. For A3, studies assessed the nutrition effect among IBD patients. RESULTS 35 studies were included, 34 for A1, 20 for A2, and three for A3. 42% of adult IBD patients have myopenia, 34% have pre-sarcopenia, and 17% sarcopenia. Myopenic IBD was significantly associated with therapy failure including IBD-related surgery risk in six studies, risk of medical therapy failure in four studies, risk of hospitalisation in one study. A significant association existed with postoperative complications risk in IBD patients in four studies, reduction in BMD in two studies, and increased incidence of non-alcoholic fatty liver disease (NAFLD) in one study. Sarcopenia in IBD was significantly associated with a reduction in BMD in one study. Two studies found a personalised nutrition plan (high protein) in IBD patients significantly improved muscle mass. One study found a significant positive association between muscle mass and dietary intake including high protein intake. CONCLUSION Over one third of adult IBD patients have myopenia and pre-sarcopenia, and nearly a fifth have sarcopenia. Myopeninc IBD is significantly associated with increased risk of IBD therapy failure, postoperative complications, and low BMD, with possible association with increased NAFLD risk. Nutritional therapy may play a role in reversing low muscle mass though yet unclear if this is through disease activity reversal. Further studies on adult IBD patients focusing on sarcopenia/myopenia are needed with recommended study designs of 1) standardised population-based definitions with recommended standard methods used to measure skeletal muscle mass, 2) prospective studies with IBD patients stratified by Montreal classification, disease activity, disease duration and concomitant medication to observe muscle changes, 3) mechanistic studies on sarcopenia aetiology, specifically focusing on protein handling atrophy and absorption, 4) properly designed RCT to assess nutrition intervention in sarcopenic IBD patients.
Collapse
Affiliation(s)
- Hala Fatani
- The Nottingham Digestive Diseases Centre (NDDC), School of Medicine, University of Nottingham, Nottingham, UK; MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research & National Institute of Health Research, Nottingham Biomedical Research Centre, University of Nottingham, UK.
| | - Adina Olaru
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Waad Alharazi
- School of Biosciences, University of Nottingham, Nottingham, UK
| | - Ayman Jafer
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Philip Atherton
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research & National Institute of Health Research, Nottingham Biomedical Research Centre, University of Nottingham, UK; Centre Of Metabolism, Ageing & Physiology (COMAP), School of Medicine, University of Nottingham, Derby, UK
| | - Matthew Brook
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research & National Institute of Health Research, Nottingham Biomedical Research Centre, University of Nottingham, UK; Centre of Metabolism, Ageing & Physiology (COMAP), School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Gordon Moran
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research & National Institute of Health Research, Nottingham Biomedical Research Centre, University of Nottingham, UK; Translational Medical Sciences, School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, UK
| |
Collapse
|