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Becerra-Tomás N, Markozannes G, Cariolou M, Balducci K, Vieira R, Kiss S, Aune D, Greenwood DC, Dossus L, Copson E, Renehan AG, Bours M, Demark-Wahnefried W, Hudson MM, May AM, Odedina FT, Skinner R, Steindorf K, Tjønneland A, Velikova G, Baskin ML, Chowdhury R, Hill L, Lewis SJ, Seidell J, Weijenberg MP, Krebs J, Cross AJ, Tsilidis KK, Chan DSM. Post-diagnosis adiposity and colorectal cancer prognosis: A Global Cancer Update Programme (CUP Global) systematic literature review and meta-analysis. Int J Cancer 2024; 155:400-425. [PMID: 38692659 DOI: 10.1002/ijc.34905] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 12/15/2023] [Accepted: 01/17/2024] [Indexed: 05/03/2024]
Abstract
The adiposity influence on colorectal cancer prognosis remains poorly characterised. We performed a systematic review and meta-analysis on post-diagnosis adiposity measures (body mass index [BMI], waist circumference, waist-to-hip ratio, weight) or their changes and colorectal cancer outcomes. PubMed and Embase were searched through 28 February 2022. Random-effects meta-analyses were conducted when at least three studies had sufficient information. The quality of evidence was interpreted and graded by the Global Cancer Update Programme (CUP Global) independent Expert Committee on Cancer Survivorship and Expert Panel. We reviewed 124 observational studies (85 publications). Meta-analyses were possible for BMI and all-cause mortality, colorectal cancer-specific mortality, and cancer recurrence/disease-free survival. Non-linear meta-analysis indicated a reverse J-shaped association between BMI and colorectal cancer outcomes (nadir at BMI 28 kg/m2). The highest risk, relative to the nadir, was observed at both ends of the BMI distribution (18 and 38 kg/m2), namely 60% and 23% higher risk for all-cause mortality; 95% and 26% for colorectal cancer-specific mortality; and 37% and 24% for cancer recurrence/disease-free survival, respectively. The higher risk with low BMI was attenuated in secondary analyses of RCTs (compared to cohort studies), among studies with longer follow-up, and in women suggesting potential methodological limitations and/or altered physiological state. Descriptively synthesised studies on other adiposity-outcome associations of interest were limited in number and methodological quality. All the associations were graded as limited (likelihood of causality: no conclusion) due to potential methodological limitations (reverse causation, confounding, selection bias). Additional well-designed observational studies and interventional trials are needed to provide further clarification.
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Affiliation(s)
- Nerea Becerra-Tomás
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Georgios Markozannes
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - Margarita Cariolou
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Katia Balducci
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Rita Vieira
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Sonia Kiss
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Nutrition, Oslo New University College, Oslo, Norway
- Department of Research, The Cancer Registry of Norway, Oslo, Norway
| | - Darren C Greenwood
- Leeds Institute for Data Analytics, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Laure Dossus
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Ellen Copson
- Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Andrew G Renehan
- The Christie NHS Foundation Trust, Manchester Cancer Research Centre, NIHR Manchester Biomedical Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Martijn Bours
- Department of Epidemiology, GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Wendy Demark-Wahnefried
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Melissa M Hudson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Roderick Skinner
- Department of Paediatric and Adolescent Haematology/Oncology, Great North Children's Hospital and Translational and Clinical Research Institute, and Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Diet, Cancer and Health, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Galina Velikova
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | | | - Rajiv Chowdhury
- Department of Global Health, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Lynette Hill
- World Cancer Research Fund International, London, UK
| | - Sarah J Lewis
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jaap Seidell
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Matty P Weijenberg
- Department of Epidemiology, GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - John Krebs
- Department of Biology, University of Oxford, Oxford, UK
| | - Amanda J Cross
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Konstantinos K Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - Doris S M Chan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
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Molenaar-Kuijsten L, Pieters TT, Veldhuis WB, Moeskops P, Rijkhorst EJ, Dorlo TPC, Beijnen JH, Steeghs N, Rookmaaker MB, Huitema ADR. Optimizing carboplatin dosing by an improved prediction of carboplatin clearance using a CT-enhanced estimate of renal function. Br J Clin Pharmacol 2023; 89:3016-3025. [PMID: 37194167 DOI: 10.1111/bcp.15789] [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: 08/15/2022] [Revised: 04/27/2023] [Accepted: 05/05/2023] [Indexed: 05/18/2023] Open
Abstract
AIMS Carboplatin is generally dosed based on a modified Calvert formula, in which the Cockcroft-Gault-based creatinine clearance (CRCL) is used as proxy for the glomerular filtration rate (GFR). The Cockcroft-Gault formula (CG) overpredicts CRCL in patients with an aberrant body composition. The CT-enhanced estimate of RenAl FuncTion (CRAFT) was developed to compensate for this overprediction. We aimed to evaluate whether carboplatin clearance is better predicted by CRCL based on the CRAFT compared to the CG. METHODS Data of four previously conducted trials was used. The CRAFT was divided by serum creatinine to derive CRCL. The difference between CRAFT- and CG-based CRCL was assessed by population pharmacokinetic modelling. Furthermore, the difference in calculated carboplatin dose was assessed in a heterogeneous dataset. RESULTS In total, 108 patients were included in the analysis. Addition of the CRAFT- and CG-based CRCL as covariate on carboplatin clearance led, respectively, to an improved model fit with a 26-point drop in objective function value and a worsened model fit with an increase of 8 points. In 19 subjects with serum creatinine <50 μmol/L, the calculated carboplatin dose was 233 mg higher using the CG. CONCLUSIONS Carboplatin clearance is better predicted by CRAFT vs. CG-based CRCL. In subjects with low serum creatinine, the calculated carboplatin dose using CG exceeds the dose using CRAFT, which might explain the need for dose capping when using the CG. Therefore, the CRAFT might be an alternative for dose capping while still dosing accurately.
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Affiliation(s)
- Laura Molenaar-Kuijsten
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Tobias T Pieters
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Wouter B Veldhuis
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Erik Jan Rijkhorst
- Department of Medical Physics and Technology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Thomas P C Dorlo
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Jos H Beijnen
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Neeltje Steeghs
- Department of Medical Oncology and Clinical Pharmacology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Maarten B Rookmaaker
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Alwin D R Huitema
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Pharmacology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Wiebe N, Lloyd A, Crumley ET, Tonelli M. Associations between body mass index and all-cause mortality: A systematic review and meta-analysis. Obes Rev 2023; 24:e13588. [PMID: 37309266 DOI: 10.1111/obr.13588] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/12/2023] [Accepted: 05/22/2023] [Indexed: 06/14/2023]
Abstract
Fasting insulin and c-reactive protein confound the association between mortality and body mass index. An increase in fat mass may mediate the associations between hyperinsulinemia, hyperinflammation, and mortality. The objective of this study was to describe the "average" associations between body mass index and the risk of mortality and to explore how adjusting for fasting insulin and markers of inflammation might modify the association of BMI with mortality. MEDLINE and EMBASE were searched for studies published in 2020. Studies with adult participants where BMI and vital status was assessed were included. BMI was required to be categorized into groups or parametrized as non-first order polynomials or splines. All-cause mortality was regressed against mean BMI squared within seven broad clinical populations. Study was modeled as a random intercept. β coefficients and 95% confidence intervals are reported along with estimates of mortality risk by BMIs of 20, 30, and 40 kg/m2 . Bubble plots with regression lines are drawn, showing the associations between mortality and BMI. Splines results were summarized. There were 154 included studies with 6,685,979 participants. Only five (3.2%) studies adjusted for a marker of inflammation, and no studies adjusted for fasting insulin. There were significant associations between higher BMIs and lower mortality risk in cardiovascular (unadjusted β -0.829 [95% CI -1.313, -0.345] and adjusted β -0.746 [95% CI -1.471, -0.021]), Covid-19 (unadjusted β -0.333 [95% CI -0.650, -0.015]), critically ill (adjusted β -0.550 [95% CI -1.091, -0.010]), and surgical (unadjusted β -0.415 [95% CI -0.824, -0.006]) populations. The associations for general, cancer, and non-communicable disease populations were not significant. Heterogeneity was very large (I2 ≥ 97%). The role of obesity as a driver of excess mortality should be critically re-examined, in parallel with increased efforts to determine the harms of hyperinsulinemia and chronic inflammation.
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Affiliation(s)
- Natasha Wiebe
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Anita Lloyd
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Ellen T Crumley
- Rowe School of Business, Dalhousie University, Halifax, Nova Scotia, Canada
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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.
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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
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Surov A, Strobel A, Borggrefe J, Wienke A. Low skeletal muscle mass predicts treatment response in oncology: a meta-analysis. Eur Radiol 2023; 33:6426-6437. [PMID: 36929392 DOI: 10.1007/s00330-023-09524-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/24/2022] [Accepted: 02/04/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVES Low skeletal muscle mass (LSMM) predicts relevant clinical outcomes in oncologic patients. The purpose of this study was to perform a meta-analysis of data regarding associations between LSMM and treatment response (TR) in oncology. METHODS MEDLINE, Cochrane, and SCOPUS databases were screened for relationships between LSMM and TR in oncologic patients up to November 2022. Overall, 35 studies met the inclusion criteria. The meta-analysis was performed using RevMan 5.4 software. RESULTS The collected 35 studies comprised 3858 patients. In 1682 patients (43.6%), LSMM was diagnosed. In the overall sample, LSMM predicted a negatively objective response rate (ORR), OR = 0.70, 95% CI = (0.54-0.91), p = 0.007, and disease control rate (DCR), OR = 0.69, 95% CI = (0.50-0.95), p = 0.02. In the curative setting, LSMM predicted a negatively ORR, OR = 0.24, 95% CI = (0.12-0.50), p = 0.0001, but not DCR, OR = 0.60, 95% CI = (0.31-1.18), p = 0.14. In palliative treatment with conventional chemotherapies, LSMM did not predict ORR: OR = 0.94, 95% CI (0.57-1.55), p = 0.81, and DCR: OR = 1.13, 95% CI (0.38-3.40), p = 0.82. In palliative treatment with tyrosine kinase inhibitors (TKI), LSMM did not predict TR: ORR, OR = 0.74, 95% CI (0.44-1.26), p = 0.27, and DCR, OR = 1.04, 95% CI (0.53-2.05), p = 0.90. In palliative immunotherapy, LSMM tended to predict ORR, OR = 0.74, 95% CI = (0.54-1.01), p = 0.06, and predicted DCR, OR = 0.53, 95% CI = (0.37-0.76), p = 0.0006. CONCLUSION LSMM is a risk factor for poor TR in curative chemotherapy in the adjuvant and/or neoadjuvant setting. LSMM is a risk factor for treatment failure in treatment with immunotherapy. Finally, LSMM does not influence TR in palliative treatment with conventional chemotherapy and/or TKIs. KEY POINTS • Low skeletal muscle mass (LSMM) predicts treatment response (TR) to chemotherapy in the adjuvant and/or neoadjuvant setting. • LSMM predicts TR in immunotherapy. • LSMM does not influence TR in palliative chemotherapy.
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Affiliation(s)
- Alexey Surov
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University, Bochum, Germany.
| | - Alexandra Strobel
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Jan Borggrefe
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University, Bochum, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
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Borrelli A, Pecoraro M, Del Giudice F, Cristofani L, Messina E, Dehghanpour A, Landini N, Roberto M, Perotti S, Muscaritoli M, Santini D, Catalano C, Panebianco V. Standardization of Body Composition Status in Patients with Advanced Urothelial Tumors: The Role of a CT-Based AI-Powered Software for the Assessment of Sarcopenia and Patient Outcome Correlation. Cancers (Basel) 2023; 15:cancers15112968. [PMID: 37296930 DOI: 10.3390/cancers15112968] [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: 03/25/2023] [Revised: 05/26/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Sarcopenia is a well know prognostic factor in oncology, influencing patients' quality of life and survival. We aimed to investigate the role of sarcopenia, assessed by a Computed Tomography (CT)-based artificial intelligence (AI)-powered-software, as a predictor of objective clinical benefit in advanced urothelial tumors and its correlations with oncological outcomes. METHODS We retrospectively searched patients with advanced urothelial tumors, treated with systemic platinum-based chemotherapy and an available total body CT, performed before and after therapy. An AI-powered software was applied to CT to obtain the Skeletal Muscle Index (SMI-L3), derived from the area of the psoas, long spine, and abdominal muscles, at the level of L3 on CT axial images. Logistic and Cox-regression modeling was implemented to explore the association of sarcopenic status and anthropometric features to the clinical benefit rate and survival endpoints. RESULTS 97 patients were included, 66 with bladder cancer and 31 with upper-tract urothelial carcinoma. Clinical benefit outcomes showed a linear positive association with all the observed body composition variables variations. The chances of not experiencing disease progression were positively associated with ∆_SMI-L3, ∆_psoas, and ∆_long spine muscle when they ranged from ~10-20% up to ~45-55%. Greater survival chances were matched by patients achieving a wider ∆_SMI-L3, ∆_abdominal and ∆_long spine muscle. CONCLUSIONS A CT-based AI-powered software body composition and sarcopenia analysis provide prognostic assessments for objective clinical benefits and oncological outcomes.
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Affiliation(s)
- Antonella Borrelli
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161 Rome, Italy
| | - Martina Pecoraro
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161 Rome, Italy
| | - Francesco Del Giudice
- Department of Maternal Infant and Urologic Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Leonardo Cristofani
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161 Rome, Italy
| | - Emanuele Messina
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161 Rome, Italy
| | - Ailin Dehghanpour
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161 Rome, Italy
| | - Nicholas Landini
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161 Rome, Italy
| | - Michela Roberto
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161 Rome, Italy
| | - Stefano Perotti
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161 Rome, Italy
| | - Maurizio Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Daniele Santini
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161 Rome, Italy
| | - Carlo Catalano
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161 Rome, Italy
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00161 Rome, Italy
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Gu YJ, Chen LM, Gu ME, Xu HX, Li J, Wu LY. Body mass index-based predictions and personalized clinical strategies for colorectal cancer in the context of PPPM. EPMA J 2022; 13:615-632. [PMID: 36505896 PMCID: PMC9727065 DOI: 10.1007/s13167-022-00306-0] [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: 08/13/2022] [Accepted: 11/07/2022] [Indexed: 12/03/2022]
Abstract
Currently colorectal cancer (CRC) is the third most prevalent cancer worldwide. Body mass index (BMI) is frequently used in CRC screening and risk assessment to quantitatively evaluate weight. However, the impact of BMI on clinical strategies for CRC has received little attention. Within the framework of the predictive, preventive, and personalized medicine (3PM/PPPM), we hypothesized that BMI stratification would affect the primary, secondary, and tertiary care options for CRC and we conducted a critical evidence-based review. BMI dynamically influences CRC outcomes, which helps avoiding adverse treatment effects. The outcome of surgical and radiation treatment is adversely affected by overweight (BMI ≥ 30) or underweight (BMI < 20). A number of interventions, such as enhanced recovery after surgery and robotic surgery, can be applied to CRC at all levels of BMI. BMI-controlling modalities such as exercise, diet control, nutritional therapy, and medications may be potentially beneficial for patients with CRC. Patients with overweight are advised to lose weight through diet, medication, and physical activity while patients suffering of underweight require more focus on nutrition. BMI assists patients with CRC in better managing their weight, which decreases the incidence of adverse prognostic events during treatment. BMI is accessible, noninvasive, and highly predictive of clinical outcomes in CRC. The cost-benefit of the PPPM paradigm in developing countries can be advanced, and the clinical benefit for patients can be improved with the promotion of BMI-based clinical strategy models for CRC.
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Affiliation(s)
- Yun-Jia Gu
- grid.412540.60000 0001 2372 7462Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No.110 Ganhe Road, Shanghai, 200437 China ,grid.412540.60000 0001 2372 7462Shanghai Qigong Research Institute, Shanghai University of Traditional Chinese Medicine, No. 650 South Wanping Road, Shanghai, 200030 China
| | - Li-Ming Chen
- grid.412540.60000 0001 2372 7462Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No.110 Ganhe Road, Shanghai, 200437 China
| | - Mu-En Gu
- grid.412540.60000 0001 2372 7462Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No.110 Ganhe Road, Shanghai, 200437 China
| | - Hong-Xiao Xu
- grid.412540.60000 0001 2372 7462Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No.110 Ganhe Road, Shanghai, 200437 China
| | - Jing Li
- grid.412540.60000 0001 2372 7462Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No.110 Ganhe Road, Shanghai, 200437 China
| | - Lu-Yi Wu
- grid.412540.60000 0001 2372 7462Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No.110 Ganhe Road, Shanghai, 200437 China
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In vitro chemotherapy-associated muscle toxicity is attenuated with nutritional support, while treatment efficacy is retained. Oncotarget 2022; 13:1094-1108. [PMID: 36242541 PMCID: PMC9564364 DOI: 10.18632/oncotarget.28279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose: Muscle-wasting and treatment-related toxicities negatively impact prognosis of colorectal cancer (CRC) patients. Specific nutritional composition might support skeletal muscle and enhance treatment support. In this in vitro study we assess the effect of nutrients EPA, DHA, L-leucine and vitamin D3, as single nutrients or in combination on chemotherapy-treated C2C12-myotubes, and specific CRC-tumor cells. Materials and Methods: Using C2C12-myotubes, the effects of chemotherapy (oxaliplatin, 5-fluorouracil, oxaliplatin+5-fluorouracil and irinotecan) on protein synthesis, cell-viability, caspase-3/7-activity and LDH-activity were assessed. Addition of EPA, DHA, L-leucine and vitamin D3 and their combination (SNCi) were studied in presence of above chemotherapies. Tumor cell-viability was assessed in oxaliplatin-treated C26 and MC38 CRC cells, and in murine and patient-derived CRC-organoids. Results: While chemotherapy treatment of C2C12-myotubes decreased protein synthesis, cell-viability and increased caspase-3/7 and LDH-activity, SNCi showed improved protein synthesis and cell viability and lowered LDH activity. The nutrient combination SNCi showed a better overall performance compared to the single nutrients. Treatment response of tumor models was not significantly affected by addition of nutrients. Conclusions: This in vitro study shows protective effect with specific nutrition composition of C2C12-myotubes against chemotherapy toxicity, which is superior to the single nutrients, while treatment response of tumor cells remained.
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Massaad E, Bridge CP, Kiapour A, Fourman MS, Duvall JB, Connolly ID, Hadzipasic M, Shankar GM, Andriole KP, Rosenthal M, Schoenfeld AJ, Bilsky MH, Shin JH. Evaluating frailty, mortality, and complications associated with metastatic spine tumor surgery using machine learning-derived body composition analysis. J Neurosurg Spine 2022; 37:263-273. [PMID: 35213829 DOI: 10.3171/2022.1.spine211284] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/05/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Cancer patients with spinal metastases may undergo surgery without clear assessments of prognosis, thereby impacting the optimal palliative strategy. Because the morbidity of surgery may adversely impact recovery and initiation of adjuvant therapies, evaluation of risk factors associated with mortality risk and complications is critical. Evaluation of body composition of cancer patients as a surrogate for frailty is an emerging area of study for improving preoperative risk stratification. METHODS To examine the associations of muscle characteristics and adiposity with postoperative complications, length of stay, and mortality in patients with spinal metastases, the authors designed an observational study of 484 cancer patients who received surgical treatment for spinal metastases between 2010 and 2019. Sarcopenia, muscle radiodensity, visceral adiposity, and subcutaneous adiposity were assessed on routinely available 3-month preoperative CT images by using a validated deep learning methodology. The authors used k-means clustering analysis to identify patients with similar body composition characteristics. Regression models were used to examine the associations of sarcopenia, frailty, and clusters with the outcomes of interest. RESULTS Of 484 patients enrolled, 303 had evaluable CT data on muscle and adiposity (mean age 62.00 ± 11.91 years; 57.8% male). The authors identified 2 clusters with significantly different body composition characteristics and mortality risks after spine metastases surgery. Patients in cluster 2 (high-risk cluster) had lower muscle mass index (mean ± SD 41.16 ± 7.99 vs 50.13 ± 10.45 cm2/m2), lower subcutaneous fat area (147.62 ± 57.80 vs 289.83 ± 109.31 cm2), lower visceral fat area (82.28 ± 48.96 vs 239.26 ± 98.40 cm2), higher muscle radiodensity (35.67 ± 9.94 vs 31.13 ± 9.07 Hounsfield units [HU]), and significantly higher risk of 1-year mortality (adjusted HR 1.45, 95% CI 1.05-2.01, p = 0.02) than individuals in cluster 1 (low-risk cluster). Decreased muscle mass, muscle radiodensity, and adiposity were not associated with a higher rate of complications after surgery. Prolonged length of stay (> 7 days) was associated with low muscle radiodensity (mean 30.87 vs 35.23 HU, 95% CI 1.98-6.73, p < 0.001). CONCLUSIONS Body composition analysis shows promise for better risk stratification of patients with spinal metastases under consideration for surgery. Those with lower muscle mass and subcutaneous and visceral adiposity are at greater risk for inferior outcomes.
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Affiliation(s)
- Elie Massaad
- 1Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Christopher P Bridge
- 2Massachusetts General Hospital and Brigham and Women's Hospital Center for Clinical Data Science, Harvard Medical School, Boston
- 4Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Ali Kiapour
- 1Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Mitchell S Fourman
- 3Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Julia B Duvall
- 1Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Ian D Connolly
- 1Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Muhamed Hadzipasic
- 1Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Ganesh M Shankar
- 1Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Katherine P Andriole
- 2Massachusetts General Hospital and Brigham and Women's Hospital Center for Clinical Data Science, Harvard Medical School, Boston
- 4Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Michael Rosenthal
- 4Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston
- 5Department of Radiology, Dana Farber Cancer Institute, Boston
| | - Andrew J Schoenfeld
- 6Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - Mark H Bilsky
- 7Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - John H Shin
- 1Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston
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10
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Xu Q, Li J, Wu Y, Zhou W, Xu Z. Colorectal Cancer Chemotherapy Drug Bevacizumab May Induce Muscle Atrophy Through CDKN1A and TIMP4. Front Oncol 2022; 12:897495. [PMID: 35847900 PMCID: PMC9283830 DOI: 10.3389/fonc.2022.897495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/04/2022] [Indexed: 11/21/2022] Open
Abstract
The muscle in the organism has the function of regulating metabolism. Long-term muscle inactivity or the occurrence of chronic inflammatory diseases are easy to induce muscle atrophy. Bevacizumab is an antiangiogenic drug that prevents the formation of neovascularization by inhibiting the activation of VEGF signaling pathway. It is used in the first-line treatment of many cancers in clinic. Studies have shown that the use of bevacizumab in the treatment of tumors can cause muscle mass loss and may induce muscle atrophy. Based on bioinformatics analysis, this study sought the relationship and influence mechanism between bevacizumab and muscle atrophy. The differences of gene and sample expression between bevacizumab treated group and control group were studied by RNA sequencing. WGCNA is used to find gene modules related to bevacizumab administration and explore biological functions through metascape. Differential analysis was used to analyze the difference of gene expression between the administration group and the control group in different muscle tissues. The key genes timp4 and CDKN1A were obtained through Venn diagram, and then GSEA was used to explore their biological functions in RNA sequencing data and geo chip data. This study studied the role of bevacizumab in muscle through the above methods, preliminarily determined that timp4 and CDKN1A may be related to muscle atrophy, and further explored their functional mechanism in bevacizumab myotoxicity.
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11
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Surov A, Wienke A. Prevalence of sarcopenia in patients with solid tumors A meta analysis based on 81 814 patients. JPEN J Parenter Enteral Nutr 2022; 46:1761-1768. [PMID: 35633306 DOI: 10.1002/jpen.2415] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 05/24/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND The purpose of the present meta-analysis was to analyze the prevalence of sarcopenia on staging computed tomography (CT) in patients with different malignant solid tumors and in different oncologic settings based on a large sample. METHODS MEDLINE, Cochrane, and SCOPUS databases were screened for prevalence of sarcopenia in oncologic patients up to December 2021. Overall, 280 studies met the inclusion criteria. The methodological quality of the involved studies was checked according to the QUADAS instrument. The meta-analysis was undertaken by using RevMan 5.4 software. DerSimonian and Laird random-effects models with inverse-variance weights were used. RESULTS The included 280 studies comprised 81814 patients with different tumors. The prevalence of sarcopenia over all included studies was 35.3%. A prevalence of sarcopenia over 50% was identified in esophageal cancer, urothelial cancer, cholangiocarcinoma, prostate cancer, sarcomas and thyroid cancer. In head and neck squamous cell carcinoma, pancreatic cancer, lung cancer, renal cell cancer, and ovarian cancer, the prevalence of sarcopenia varied between 35% and 50%. In colorectal cancer, gastric cancer, hepatocellular cancer, and breast cancer, the prevalence of LSMM was below 35%. In curative setting, the prevalence of sarcopenia was 39.6% and in palliative setting, it was 49.2% (p<0.001). CONCLUSIONS Sarcopenia is a frequent condition in oncology with a prevalence of 35.3%. The prevalence of sarcopenia is higher in palliative setting vs curative setting. The prevalence of sarcopenia is also different in different tumors. CLINICAL RELEVANCY STATEMENT This article is the first report regarding the prevalence of sarcopenia on staging CT in oncology based on a large sample. It provides evident data about prevalence of sarcopenia in palliative and curative settings in different malignant tumors. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Alexey Surov
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Magdeburg, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany and Profile Area Clinical Studies & Biostatistics
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12
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Clinical Relevance of Myopenia and Myosteatosis in Colorectal Cancer. J Clin Med 2022; 11:jcm11092617. [PMID: 35566740 PMCID: PMC9100218 DOI: 10.3390/jcm11092617] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/28/2022] [Accepted: 05/04/2022] [Indexed: 02/01/2023] Open
Abstract
Sarcopenia was initially described as a decrease in muscle mass associated with aging and subsequently also as a consequence of underlying disease, including advanced malignancy. Accumulating evidence shows that sarcopenia has clinically significant effects in patients with malignancy, including an increased risk of adverse events associated with medical treatment, postoperative complications, and a poor survival outcome. Colorectal cancer (CRC) is one of the most common cancers worldwide, and several lines of evidence suggest that preoperative sarcopenia negatively impacts various outcomes in patients with CRC. In this review, we summarize the current evidence in this field and the clinical relevance of sarcopenia in patients with CRC from three standpoints, namely, the adverse effects of medical treatment, postoperative infectious complications, and oncological outcomes.
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13
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Clifford B, Koizumi S, Wewege MA, Leake HB, Ha L, Macdonald E, Fairman CM, Hagstrom AD. The Effect of Resistance Training on Body Composition During and After Cancer Treatment: A Systematic Review and Meta-Analysis. Sports Med 2021; 51:2527-2546. [PMID: 34499338 DOI: 10.1007/s40279-021-01542-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Changes in body composition during cancer treatments have been linked with poorer outcomes, and increased morbidity and mortality. The effect of resistance training (RT) on body composition in cancer cohorts is debated. OBJECTIVE We conducted a systematic review and meta-analysis to determine the effect of RT on body composition during and after treatment. METHODS We searched five electronic databases for articles up to 1 February 2021 and included randomized controlled trials that compared RT with a non-exercise control in adults with cancer. Risk of bias was assessed using the RoB 2 tool. Pairwise, random-effects meta-analysis was used to synthesize the available data. RESULTS Overall, we included 15 studies (n = 1368). After treatment (11 studies), RT increased lean mass with moderate heterogeneity {0.41 kg [95% confidence interval (CI) 0.05, 0.76], p = 0.029; I2 = 47.1%, p = 0.02} and decreased fat mass with substantial heterogeneity (- 0.59 kg [95% CI - 1.05, - 0.12], p = 0.019; I2 = 69.1%, p < 0.001). During treatment (4 studies), RT did not increase lean mass (0.71 kg [95% CI - 0.04, 1.45], p = 0.05; I2 = 0.0%, p = 0.75) or reduce fat mass (0.00 kg [95% CI - 5.31, 5.30], p = 0.99; I2 = 0.0%, p = 0.62), both with no heterogeneity. CONCLUSION Modest improvements in body composition were observed following RT after cancer treatment; however, no changes were observed during treatment. These adaptations are markedly lower than those observed in healthy cohorts but may be clinically meaningful for the cancer survivorship population. At present it is unclear if these diminished adaptations are due to ineffective exercise prescriptions in cancer cohorts or due to an innate anabolic resistance as a result of cancer and its treatments. STUDY REGISTRATION Open Science Framework (osf.io/x6z72).
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Affiliation(s)
- Briana Clifford
- Department of Exercise Physiology, School of Health Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Sean Koizumi
- Department of Exercise Physiology, School of Health Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Michael A Wewege
- Department of Exercise Physiology, School of Health Sciences, University of New South Wales, Sydney, NSW, Australia.,Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Hayley B Leake
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia.,IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
| | - Lauren Ha
- Department of Exercise Physiology, School of Health Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Eliza Macdonald
- Department of Exercise Physiology, School of Health Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Ciaran M Fairman
- Exercise Science Department, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Amanda D Hagstrom
- Department of Exercise Physiology, School of Health Sciences, University of New South Wales, Sydney, NSW, Australia.
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14
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Myosteatosis at diagnosis is adversely associated with 2-year survival in women with estrogen receptor-negative metastatic breast cancer. Breast Cancer Res Treat 2021; 190:121-132. [PMID: 34389926 DOI: 10.1007/s10549-021-06358-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/06/2021] [Indexed: 01/04/2023]
Abstract
PURPOSE To examine the relationship between skeletal muscle (SM) and cancer-specific outcomes for women with estrogen receptor-negative (ER-) metastatic breast cancer (MBC). METHODS For this retrospective cohort, females (≥ 18 years) with histologically confirmed ER- MBC and computerized tomography (CT) imaging were screened. Demographic, anthropometric, and clinical data were collected uniformly from the electronic medical record. CT images inclusive of the third lumbar region (L3) at diagnosis, 6 and 12 months, were used to classify sarcopenia (≤ 41 cm2/m2) and myosteatosis (< 41 or 33 Hounsfield Units, adjusted for body mass index (BMI)) and to evaluate changes in SM and total adipose tissue (TAT) over time. Kaplan-Meier curves, Cox Proportional Hazards (PH), and restricted mean survival time (RMST) estimates were generated to examine the relationship between sarcopenia and myosteatosis and time to tumor progression (TTP), treatment toxicity and 2-year survival, adjusting for covariates. RESULTS Participants were 58.0 (15.0) years of age, ethnically diverse (55% non-Hispanic white, 31% Black, 11% Hispanic), post-menopausal (73%, n = 111), and classified as overweight (BMI 29.4 (7.6)). At diagnosis, 40% (n = 61) were sarcopenic, 49% had myosteatosis, and 28% (n = 42) had both. While Cox PH modeling and RMST analysis reveal no significant relationship between sarcopenia at diagnosis and 2-year survival (RMST difference - 1.6 (1.4) months, HR 1.35 (0.88-2.08)), these analyses support a significant, adverse association between myosteatosis at diagnosis and 2-year survival (RMST difference - 2.4 (1.5) months, HR 1.72 (1.09-2.72)). Incident sarcopenia was 11% (n = 5/45) and 2.5% (n = 1/40), respectively, while incident myosteatosis was 19% (n = 8/42) and 15% (n = 5/34) at 6 and 12 months, respectively. TTP and treatment toxicities did not appear to be related to diagnostic SM or body composition changes over time. CONCLUSION Targeted interventions initiated within the first year of diagnosis to preserve or improve SM quality seem warranted for women with ER-MBC.
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15
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Molenaar-Kuijsten L, Jacobs BAW, Kurk SA, May AM, Dorlo TPC, Beijnen JH, Steeghs N, Huitema ADR. Worse capecitabine treatment outcome in patients with a low skeletal muscle mass is not explained by altered pharmacokinetics. Cancer Med 2021; 10:4781-4789. [PMID: 34121365 PMCID: PMC8290233 DOI: 10.1002/cam4.4038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 05/03/2021] [Accepted: 05/09/2021] [Indexed: 12/26/2022] Open
Abstract
Background A low skeletal muscle mass (SMM) has been associated with increased toxicity and shorter survival in cancer patients treated with capecitabine, an oral prodrug of 5‐fluorouracil (5‐FU). Capecitabine and its metabolites are highly water‐soluble and, therefore, more likely to distribute to lean tissues. The pharmacokinetics (PK) in patients with a low SMM could be changed, for example, by reaching higher maximum plasma concentrations. In this study, we aimed to examine whether the association between a low SMM and increased toxicity and shorter survival could be explained by altered PK of capecitabine and its metabolites. Methods Previously, a population PK model of capecitabine and metabolites in patients with solid tumors was developed. In our analysis, we included patients from this previous analysis for which evaluable abdominal computed tomography (CT)‐scans were available. SMM was measured on CT‐scans, by single slice evaluation at the third lumbar vertebra, using the Slice‐o‐Matic software. The previously developed population PK model was extended with SMM as a covariate, to assess the association between SMM and capecitabine and metabolite PK. Results PK and SMM data were available from 151 cancer patients with solid tumors. From the included patients, 55% had a low SMM. No relevant relationships were found between SMM and the PK parameters of capecitabine and, the active and toxic metabolite, 5‐FU. SMM only correlated with the PK of the, most hydrophilic, but inactive and non‐toxic, metabolite α‐fluoro‐β‐alanine (FBAL). Patients with a low SMM had a smaller apparent volume of distribution and lower apparent clearance of FBAL. Conclusions No alterations in PK of capecitabine and the active and toxic metabolite 5‐FU were observed in patients with a low SMM. Therefore, the previously identified increased toxicity and shorter survival in patients with a low SMM, could not be explained by changes in pharmacokinetic characteristics of capecitabine and metabolites.
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Affiliation(s)
- Laura Molenaar-Kuijsten
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Bart Albertus Wilhelmus Jacobs
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Sophie Alberdine Kurk
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Anne Maria May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Thomas Petrus Catharina Dorlo
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Jacob Hendrik Beijnen
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands.,Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Neeltje Steeghs
- Department of Medical Oncology and Clinical Pharmacology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Alwin Dagmar Redmar Huitema
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands.,Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Pharmacology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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16
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Wijler LA, Raats DAE, Elias SG, Dijk FJ, Quirindongo H, May AM, Furber MJW, Dorresteijn B, van Dijk M, Kranenburg O. Specialized nutrition improves muscle function and physical activity without affecting chemotherapy efficacy in C26 tumour-bearing mice. J Cachexia Sarcopenia Muscle 2021; 12:796-810. [PMID: 33956410 PMCID: PMC8200448 DOI: 10.1002/jcsm.12703] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/04/2021] [Accepted: 03/18/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Skeletal muscle wasting and fatigue are commonly observed in cancer patients receiving chemotherapy and associated with reduced treatment outcome and quality of life. Nutritional support may mitigate these side effects, but potential interference with chemotherapy efficacy could be of concern. Here, we investigated the effects of an ω-3 polyunsaturated fatty acid (eicosapentaenoic acid and docosahexaenoic acid), leucine-enriched, high-protein (100% whey), additional vitamin D, and prebiotic fibres 'specific nutritional composition' (SNC) and chemotherapy on state-of-the-art tumour organoids and muscle cells and studied muscle function, physical activity, systemic inflammation, and chemotherapy efficacy in a mouse model of aggressive colorectal cancer (CRC). METHODS Tumour-bearing mice received a diet with or without SNC. Chemotherapy treatment consisted of oxaliplatin and 5-fluorouracil. Tumour formation was monitored by calliper measurements. Physical activity was continuously monitored by infrared imaging. Ex vivo muscle performance was determined by myography, muscle fatty acid composition by gas chromatography, and plasma cytokine levels by Luminex xMAP technology. Patient-derived CRC organoids and C2C12 myotubes were used to determine whether SNC affects chemotherapy sensitivity in vitro. RESULTS Specific nutritional composition increased muscle contraction capacity of chemotherapy-treated tumour-bearing mice (P < 0.05) and enriched ω-3 fatty acid composition in muscle without affecting treatment efficacy (P < 0.0001). Mice receiving SNC maintained physical activity after chemotherapy and showed decreased systemic inflammation. Therapeutic response of CRC organoids was unaffected by SNC nutrients, while cell viability and protein synthesis of muscle cells significantly improved. CONCLUSIONS The results show that specialized nutritional support can be used to maintain muscle function and physical activity levels during chemotherapy without increasing tumour viability. Therefore, nutritional strategies have potential value in promoting cancer and chemotherapy tolerance.
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Affiliation(s)
- Liza A Wijler
- Laboratory of Translational Oncology, Division of Imaging and Cancer, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Danielle A E Raats
- Laboratory of Translational Oncology, Division of Imaging and Cancer, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sjoerd G Elias
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | | | - Anne M May
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | | | | | - Onno Kranenburg
- Laboratory of Translational Oncology, Division of Imaging and Cancer, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.,Utrecht Platform for Organoid Technology, Utrecht University, Utrecht, The Netherlands
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17
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Maddalena C, Ponsiglione A, Camera L, Santarpia L, Pasanisi F, Bruzzese D, Panico C, Fiore G, Camardella S, Caramia T, Farinaro A, De Placido S, Carlomagno C. Prognostic role of sarcopenia in metastatic colorectal cancer patients during first-line chemotherapy: A retrospective study. World J Clin Oncol 2021; 12:355-366. [PMID: 34131567 PMCID: PMC8173330 DOI: 10.5306/wjco.v12.i5.355] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 01/31/2021] [Accepted: 03/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Sarcopenia is a condition characterized by decreased skeletal muscle mass due to physiological ageing or to a concomitant disease such as neoplasia. In cancer patients, a low lean body mass is suggested to be a negative prognostic factor for survival and for the development of dose-limiting chemotherapy toxicities irrespective of disease stage.
AIM To evaluate the prognostic role of sarcopenia in patients with metastatic colorectal cancer (mCRC) undergoing first-line chemotherapy.
METHODS Our retrospective analysis included 56 mCRC patients who received first-line chemotherapy from 2014 to 2017 at the Medical Oncology Unit of our hospital. Computerized scans were performed before starting chemotherapy and at the first disease reassessment. Sarcopenia was assessed using the skeletal mass index = muscle area in cm2/(height in m2) calculated at the L3 vertebra. Overall survival and objective response rate were evaluated. Toxicities were analyzed during the first four cycles of therapy and graded according to Common Terminology Criteria for Adverse Events version 4.0. A loss of skeletal muscle mass ≥ 5% was considered indicative of deterioration in muscle condition.
RESULTS Median age was 67 years and 35.7% of patients were ≥ 70 years old. Fourteen patients (25%) were sarcopenic at baseline computed tomography (CT) scan (7/33 men; 7/23 women); 5/14 sarcopenic patients were ≥ 70 years old. Median follow-up was 26.8 mo (3.8-66.8 mo) and median overall survival was 27.2 mo (95%CI: 23.3-37.3). Sarcopenia was not correlated to overall survival (P = 0.362), to higher toxicities reported during the first 4 cycles of chemotherapy (P = 1.0) or to response to treatment (P = 0.221). At the first disease reassessment, a skeletal muscle loss (SML) ≥ 5% was found in 17 patients (30.3%) 3 of whom were already sarcopenic at baseline CT scan, while 7 patients became sarcopenic. SML was not correlated to overall survival (P = 0.961). No statistically significant correlation was found between baseline sarcopenia and age (P = 1.0), body mass index (P = 0.728), stage at diagnosis (P = 0.355) or neutrophil/lymphocyte ratio (P = 0.751).
CONCLUSION Neither baseline sarcopenia nor SML affected survival. In addition, baseline sarcopenia was not related to worse treatment toxicity. However, these results must be interpreted with caution due to the limited sample size.
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Affiliation(s)
- Chiara Maddalena
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Andrea Ponsiglione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples 80131, Italy
| | - Luigi Camera
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples 80131, Italy
| | - Lidia Santarpia
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Fabrizio Pasanisi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Dario Bruzzese
- Department of Public Health, University of Naples Federico II, Naples 80131, Italy
| | - Camilla Panico
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples 80131, Italy
| | - Giovanni Fiore
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Simona Camardella
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Tolomeo Caramia
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Alessia Farinaro
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Sabino De Placido
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Chiara Carlomagno
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
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18
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Influence of Postoperative Changes in Sarcopenia on Long-Term Survival in Non-Metastatic Colorectal Cancer Patients. Cancers (Basel) 2021; 13:cancers13102410. [PMID: 34067568 PMCID: PMC8156120 DOI: 10.3390/cancers13102410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary The number of colorectal cancer survivors is increasing due to improvements in oncologic outcomes. Therefore, the risks of metachronous cancer and second cancer are also increased, as well as recurrences. The influence of muscle mass measured as sarcopenia on long-term survival has been studied recently in colorectal cancer patients. Sarcopenia is a factor controllable by lifestyle modification and has gained interest more recently. This study showed an influence of changes in sarcopenia on long-term oncologic outcomes in colorectal cancer and suggests a basis for further investigation of body composition factors, including sarcopenia. Abstract The effect of perioperative sarcopenic changes on prognosis remains unclear. We conducted a retrospective cohort study with 2333 non-metastatic colorectal cancer patients treated between January 2009 and December 2012 at the Asan Medical Center. The body composition at diagnosis was measured via abdominopelvic computed tomography (CT) using Asan-J software. Patients underwent CT scans preoperatively, as well as at 6 months–1 year and 2–3 years postoperatively. The primary outcome was the association between perioperative sarcopenic changes and survival. According to sarcopenic criteria, 1155 (49.5%), 890 (38.2%), and 893 (38.3%) patients had sarcopenia preoperatively, 6 months–1 year, and 2–3 years postoperatively, respectively. The 5-year overall survival (OS) (95.8% vs. 92.1%, hazard ratio (HR) = 2.234, p < 0.001) and 5-year recurrence-free survival (RFS) (93.2% vs. 86.2%, HR = 2.251, p < 0.001) rates were significantly lower in patients with preoperative sarcopenia. Both OS and RFS were lower in patients with persistent sarcopenia 2–3 years postoperatively than in those who recovered (OS: 96.2% vs. 90.2%, p = 0.001; RFS: 91.1% vs. 83.9%, p = 0.002). In multivariate analysis, postoperative sarcopenia was confirmed as an independent factor associated with decreased OS and RFS. Pre- and postoperative sarcopenia and changes in the condition during surveillance were associated with oncological outcomes.
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Chargi N, Wegner I, Markazi N, Smid E, de Jong P, Devriese L, de Bree R. Patterns, Predictors, and Prognostic Value of Skeletal Muscle Mass Loss in Patients with Locally Advanced Head and Neck Cancer Undergoing Cisplatin-Based Chemoradiotherapy. J Clin Med 2021; 10:jcm10081762. [PMID: 33919607 PMCID: PMC8074083 DOI: 10.3390/jcm10081762] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/08/2021] [Accepted: 04/14/2021] [Indexed: 12/15/2022] Open
Abstract
Low skeletal muscle mass (SMM) is associated with toxicities and decreased survival in head and neck cancer (HNC). Chemoradiotherapy (CRT) may exaggerate loss of SMM. We investigated the changes in SMM, their predictors, and prognostic impact of SMM in patients treated with CRT between 2012 and 2018. Skeletal muscle area (SMA) segmentation was performed on pre- and post-CRT imaging. Observed changes in SMM were categorized into: (I) Stable, (II) moderate gain (III), moderate loss, (IV) large gain, and (V) large loss. In total, 235 HNC patients were included, of which 39% had stable SMM, 55% moderate loss, 13% moderate gain, 0.4% large loss, and 0.4% large gain of SMM. After CRT, SMA decreased compared to pre-CRT (31.6 cm2 versus 33.3 cm2, p < 0.01). The key predictor was a body mass index (BMI) of ≥30 kg/m2 (OR 3.6, 95% CI 1.4–9.3, p < 0.01). Low SMM at diagnosis (HR 2.1; 95% CI 1.1–4.1, p = 0.03) and an HPV-positive oropharyngeal tumor (HR 0.1; 95% CI 0.01–0.9, p = 0.04) were prognostic for overall survival. Changes in SMM were not prognostic for survival. Loss of SMM is highly prevalent after CRT and a high BMI before treatment may aid in identifying patients at risk.
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Affiliation(s)
- Najiba Chargi
- Department of Head and Neck Surgical Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; (N.C.); (N.M.)
| | - Inge Wegner
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands;
| | - Navid Markazi
- Department of Head and Neck Surgical Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; (N.C.); (N.M.)
| | - Ernst Smid
- Department of Radiation Oncology and Nuclear Medicine, Division of Imaging and Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands;
| | - Pim de Jong
- Department of Radiology, Division of Imaging and Oncology, University Medical Center Utrecht and Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands;
| | - Lot Devriese
- Department of Medical Oncology, Division of Imaging and Oncology, University Medical Center Utrecht and Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands;
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; (N.C.); (N.M.)
- Correspondence: ; Tel.: +31-88-75-508-19
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20
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Brown JC, Caan BJ, Cespedes Feliciano EM, Xiao J, Weltzien E, Prado CM, Kroenke CH, Castillo A, Kwan ML, Meyerhardt JA. Weight stability masks changes in body composition in colorectal cancer: a retrospective cohort study. Am J Clin Nutr 2021; 113:1482-1489. [PMID: 33668052 PMCID: PMC8168363 DOI: 10.1093/ajcn/nqaa440] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 12/21/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND There is an emerging viewpoint that change in body weight is not sufficiently sensitive to promptly identify clinically meaningful change in body composition, such as skeletal muscle depletion. OBJECTIVES We aimed to determine whether body weight stability is associated with skeletal muscle depletion and whether skeletal muscle depletion is prognostic of death independently of change in body weight. METHODS This retrospective cohort included 1921 patients with stage I-III colorectal cancer. Computed tomography (CT)-based skeletal muscle characteristics and body weight were measured at diagnosis and after a mean 15.0-mo follow-up. Body weight stability was defined as weight change less than ±5% during follow-up. Sarcopenia and myosteatosis were defined using established thresholds for patients with cancer. Multivariable-adjusted logistic and flexible parametric proportional hazards survival models were used to quantify statistical associations. RESULTS At follow-up, 1026 (53.3%) patients were weight stable. Among patients with weight stability, incident sarcopenia and myosteatosis occurred in 8.5% (95% CI: 6.3%, 10.6%) and 13.5% (95% CI: 11.1%, 15.9%), respectively. Men were more likely to be weight stable than were women (56.7% compared with 49.9%; P = 0.04). Weight-stable men were less likely to develop incident sarcopenia (5.4% compared with 15.4%; P = 0.003) and myosteatosis (9.3% compared with 20.8%; P = 0.001) than weight-stable women. Among all patients, the development of incident sarcopenia (HR: 1.40; 95% CI: 1.02, 1.91) and of myosteatosis (HR: 1.41; 95% CI: 1.05, 1.90) were associated with a higher risk of death, independently of change in body weight. Patient sex did not modify the relation between skeletal muscle depletion and death. CONCLUSIONS Body weight stability masks clinically meaningful skeletal muscle depletion. Body composition quantified using clinically acquired CT images may provide a vital sign to identify patients at increased risk of death. These data may inform the design of future cachexia trials.
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Affiliation(s)
| | - Bette J Caan
- Kaiser Permanente Northern California, Oakland, CA, USA
| | | | - Jingjie Xiao
- Covenant Health Palliative Institute, Edmonton, Alberta, Canada
| | - Erin Weltzien
- Kaiser Permanente Northern California, Oakland, CA, USA
| | - Carla M Prado
- Faculty of Arts, University of Alberta, Edmonton, Alberta, Canada
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21
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Nozawa H, Emoto S, Murono K, Shuno Y, Kawai K, Sasaki K, Sonoda H, Ishii H, Iida Y, Yokoyama Y, Anzai H, Ishihara S. Change in skeletal muscle index and its prognostic significance in patients who underwent successful conversion therapy for initially unresectable colorectal cancer: observational study. Therap Adv Gastroenterol 2020; 13:1756284820971197. [PMID: 33240393 PMCID: PMC7672750 DOI: 10.1177/1756284820971197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/12/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Systemic therapy can cause loss of skeletal muscle mass in colorectal cancer (CRC) patients in the neoadjuvant and palliative settings. However, it is unknown how the body composition is changed by chemotherapy rendering unresectable CRC to resectable disease or how it affects the prognosis. This study aimed at elucidating the effects of systemic therapy on skeletal muscles and survival in stage IV CRC patients who underwent conversion therapy. METHODS We reviewed 98 stage IV CRC patients who received systemic therapy in our hospital. According to the treatment setting, patients were divided into the conversion, neoadjuvant chemotherapy (NAC), and palliation groups. The cross-sectional area of skeletal muscles at the third lumbar level and changes in the skeletal muscle index (SMI), defined as the area divided by height squared, during systemic therapy were compared among patient groups. The effects of these parameters on prognosis were analyzed in the conversion group. RESULTS The mean SMI increased by 9.4% during systemic therapy in the conversion group (n = 38), whereas it decreased by 5.9% in the NAC group (n = 18) and 3.7% in the palliation group (n = 42, p < 0.0001). Moreover, patients with increased SMI during systemic therapy had a better overall survival (OS) than those whose SMI decreased in the conversion group (p = 0.025). The increase in SMI was an independent predictor of favorable OS on multivariate analysis (hazard ratio 0.25). CONCLUSIONS Stage IV CRC patients who underwent conversion to resection often had an increased SMI. On the other hand, a decrease in the SMI during systemic therapy was a negative prognostic factor in such patients.
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Affiliation(s)
| | - Shigenobu Emoto
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koji Murono
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasutaka Shuno
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazushige Kawai
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhito Sasaki
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hirofumi Sonoda
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroaki Ishii
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuuki Iida
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuichiro Yokoyama
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Anzai
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Kurk SA, Peeters PHM, Dorresteijn B, de Jong PA, Jourdan M, Creemers GJM, Erdkamp FLG, de Jongh FE, Kint PAM, Poppema BJ, Radema SA, Simkens LHJ, Tanis BC, Tjin-A-Ton MLR, Van Der Velden A, Punt CJA, Koopman M, May AM. Loss of skeletal muscle index and survival in patients with metastatic colorectal cancer: Secondary analysis of the phase 3 CAIRO3 trial. Cancer Med 2019; 9:1033-1043. [PMID: 31850687 PMCID: PMC6997070 DOI: 10.1002/cam4.2787] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 09/20/2019] [Accepted: 11/15/2019] [Indexed: 02/06/2023] Open
Abstract
Background Low skeletal muscle index (SMI) in metastatic colorectal cancer (mCRC) patients is associated with poor outcomes. The prognostic impact of SMI changes during consecutive palliative systemic treatments is unknown. Methods This is a retrospective analysis of the phase 3 CAIRO3 study. The CAIRO3 study randomized 557 patients between maintenance capecitabine + bevacizumab (CAP‐B) or observation, after six cycles capecitabine + oxaliplatin + bevacizumab (CAPOX‐B). Upon first disease progression (PD1), CAPOX‐B was reintroduced until second progression (PD2). SMI was assessed by computed tomography (CT) (total 1355 scans). SMI and body mass index (BMI) changes were analyzed for three time‐periods; p1: during initial CAPOX‐B, p2: randomization to PD1, and p3: PD1 to PD2. The association between absolute and change in SMI and BMI (both per 1 standard deviation) during p1‐p3, with PD1, PD2, and survival was studied by Cox regression models. Results This analysis included 450 of the 557 patients randomized in the CAIRO3 study. Mean SMI decreased during p1: mean −0.6 SMI units [95% CI −1.07;‐0.26] and p3: −2.2 units [−2.7;‐1.8], whereas during p2, SMI increased + 1.2 units [0.8‐1.6]. BMI changes did not reflect changes in SMI. SMI loss during p2 and p3 was significantly associated with shorter survival (HR 1.19 [1.09‐1.35]; 1.54 [1.31‐1.79], respectively). Sarcopenia at PD1 was significantly associated with early PD2 (HR 1.40 [1.10‐1.70]). BMI loss independent of SMI loss was only associated with shorter overall survival during p3 (HR 1.35 [1.14‐1.63]). Conclusions In mCRC patients, SMI loss during palliative systemic treatment was related with early disease progression and reduced survival. BMI did not reflect changes in SMI and could not identify patients at risk of poor outcome during early treatment lines.
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Affiliation(s)
- Sophie A Kurk
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Epidemiology, Julius Center for Health Sciences and Primary Care, Utrecht University, Utrecht, The Netherlands
| | - Petra H M Peeters
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, Utrecht University, Utrecht, The Netherlands
| | - Bram Dorresteijn
- Danone Nutricia Research, Nutricia Advanced Medical Nutrition, Utrecht, The Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marion Jourdan
- Danone Nutricia Research, Nutricia Advanced Medical Nutrition, Utrecht, The Netherlands
| | | | - Frans L G Erdkamp
- Department of Medical Oncology, Zuyderland Hospital, Sittard, The Netherlands
| | - Felix E de Jongh
- Department of Medical Oncology, Ikazia Hospital, Rotterdam, The Netherlands
| | - Peter A M Kint
- Department of Radiology, Amphia Hospital, Breda, The Netherlands
| | - Boelo J Poppema
- Department of Radiology, Department of Medical Oncology, Ommelander Hospital Group, Groningen, The Netherlands
| | - Sandra A Radema
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lieke H J Simkens
- Department of Medical Oncology, Maxima Medical Center, Eindhoven, The Netherlands
| | - Bea C Tanis
- Department of Medical Oncology, Groene Hart Hospital, Gouda, The Netherlands
| | | | | | - Cornelis J A Punt
- Department of Medical Oncology, Amsterdam University Medical Center, University Amsterdam, Amsterdam, The Netherlands
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Anne M May
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, Utrecht University, Utrecht, The Netherlands
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