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Han J, Liu X, Wang J, Tang M, Xu J, Tan S, Liu X, Wu G. Prognostic value of body composition in patients with digestive tract cancers: A prospective cohort study of 8,267 adults from China. Clin Nutr ESPEN 2024; 62:192-198. [PMID: 38901941 DOI: 10.1016/j.clnesp.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 03/05/2024] [Accepted: 04/27/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND & AIMS The characterization and prognostic value of body composition parameter/phenotype based on computed tomography (CT) in patients with digestive tract cancers remain incomplete. This study aimed to investigate the relationship between parameter/phenotype and clinical outcomes in patients with digestive tract cancers. METHODS In this prospective cohort study, 8267 patients with digestive tract cancers were assessed using CT scans to determine body composition. Body composition data, including areas of skeletal muscle (SM), subcutaneous adipose tissue (SAT), and visceral adipose tissue (VAT), were collected at the third lumbar level on CT images obtained within 30 days before surgery. Body composition phenotypes (sarcopenia, cancer cachexia, sarcopenic obesity) were determined based on SM, SAT, and VAT areas. The primary endpoint was overall survival, obtained from electronic medical records and telephone follow-up surveys. Kaplan-Meier and log-rank analyses were employed to compare unadjusted survival, while multivariate survival analyses were conducted using a proportional hazards model adjusted for age, gender, and cancer-node-metastasis (TNM) stages. RESULTS Adjusted hazard ratios (HRs) for all-cause mortality were calculated for the second (Q2), third (Q3), and fourth (Q4) quantiles relative to the first quantile (Q1) for SM areas, revealing adjusted summary HRs of 0.575 (95% CI, 0.361-0.916), 0.419 (95% CI, 0.241-0.729), and 0.384 (95% CI, 0.203-0.726), respectively. Sarcopenia-adjusted summary HRs were 1.795 (95% CI: 1.012-3.181) for male patients and 1.925 (95% CI: 1.065-3.478) for female patients. Cancer cachexia-adjusted summary HRs were 1.542 (95% CI: 1.023-2.324) for male patients and 1.569 (95% CI: 0.820-3.001) for female patients. Sarcopenic obesity-adjusted summary HRs were 1.122 (95% CI: 0.759-1.657) for male patients and 1.303 (95% CI: 0.623-2.725) for female patients. Subgroup analyses indicated varying prognostic values of body composition parameter/phenotype among different cancer types. CONCLUSIONS Our findings suggest a large SM area is a favorable prognostic indicator, while cancer cachexia and sarcopenia signify poor prognosis in patients with digestive tract cancers. These findings have important implications for the personalized preoperative assessment of body composition in patients with digestive tract cancers.
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Affiliation(s)
- Jun Han
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Clinical Nutrition Research Center, Shanghai, China
| | - Xinyang Liu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Junjie Wang
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Min Tang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiahao Xu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shanjun Tan
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Clinical Nutrition Research Center, Shanghai, China
| | - Xin Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China.
| | - Guohao Wu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Clinical Nutrition Research Center, Shanghai, China.
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Chen W, Yuan Q, Li X, Yao J, Yuan L, Chen X, Gao B. The role of sarcopenic obesity for the prediction of prognosis of patients with gastrointestinal cancer. Cancer Med 2024; 13:e7452. [PMID: 38953401 PMCID: PMC11217812 DOI: 10.1002/cam4.7452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 05/28/2024] [Accepted: 06/24/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Sarcopenic obesity (SO) in patients with gastrointestinal cancer is associated with a poor prognosis. We aimed to investigate the prognostic impact of SO in patients with gastrointestinal cancer, as well as the diagnostic cut-off value of SO in patients with gastrointestinal cancer among Chinese population. METHODS We conducted a consecutive cohort study. Between January 2017 and January 2019, 289 patients diagnosed with gastrointestinal cancer were included in our study. Skeletal muscle area, total fat area, and subcutaneous fat area were measured by CT scan. All patients were followed up for 5 years. Receiver operating characteristic curves (ROC) were adopted to determine the cut-off values of visceral fat obesity for the prediction of sarcopenia. Based on the cut-off values, patients with sarcopenia combined with visceral fat obesity were divided into the SO group, and the others were divided into the non-sarcopenic obesity (NSO) group. Kaplan-Meier curves and univariate and multivariate Cox proportional hazard models were employed to explore the associations of body composition profiles with 5-year overall survival and disease-specific survival. RESULTS Obtained from Youden's Index for ROC for the prediction of 5-year survival, skeletal muscle mass index (SMI) ≤40.02 cm2/m2 with VFA ≥ 126.30 cm2 in men and SMI ≤32.05 cm2/m2 with VFA ≥72.42 cm2 in women indicate a risk of poor prognosis in patients diagnosed with gastrointestinal cancer. Patients with SO had poorer 5-year overall survival (OS) than patients with NSO (6.74% vs. 82.84%, p < 0.001), and poorer 5-year DFS (6.74% vs. 81.82%, p < 0.001). In multivariate analysis, we found that the long-term mortality risk was approximately 13-fold higher among patients in the SO group compared to those with no conditions. CONCLUSIONS Preoperative assessment of SO is useful not only for monitoring nutritional status but also for predicting 5-year OS in gastrointestinal cancer patients.
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Affiliation(s)
- Wenqing Chen
- Department of Clinical Nutrition, Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjingJiangsuChina
| | - Qinggang Yuan
- Department of General SurgeryNanjing Drum Tower Hospital Clinical College of Xuzhou Medical UniversityNanjingJiangsuChina
| | - Xiangrui Li
- Department of Clinical Nutrition, Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjingJiangsuChina
| | - Jiashu Yao
- Department of Clinical Nutrition, Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjingJiangsuChina
| | - Lihua Yuan
- Department of Interventional Radiology, Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjingJiangsuChina
| | - Xiaotian Chen
- Department of Clinical Nutrition, Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjingJiangsuChina
| | - Bo Gao
- Department of Clinical Nutrition, Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjingJiangsuChina
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Viddeleer AR, Vedder IR, Dob R, Bokkers RPH. Objective comparison of commonly used computed tomography body composition analysis software. Nutrition 2024; 123:112421. [PMID: 38581847 DOI: 10.1016/j.nut.2024.112421] [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: 01/23/2024] [Revised: 02/13/2024] [Accepted: 03/05/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVES Sarcopenia is defined as an age-related, involuntary loss of skeletal muscle mass and strength. This condition is increasingly gaining clinical attention, as it has proved a predictor of complications and unfavorable outcomes in several diseases. For analysis of body composition on computed tomography images, several different software packages are used. Extensive research is being conducted globally to establish general cutoff values for different patient groups by combining the results of different studies with meta-analysis. Therefore, it is important that the measurements are independent of the software used. However, clinical software comparisons suggest there are differences between analysis packages, which would complicate establishment of cutoff values. For this study, we compared the eight most used analysis software programs in an objective manner, using a phantom image, to assess if their results can be readily compared. METHODS Eight software packages (sliceOmatic, OsiriX, ImageJ/Fiji, Mimics, CoreSlicer, SarcoMeas, 3D Slicer, and Aquarius iNtuition) were objectively evaluated, by performing measurements in a standardized synthetic image, containing fixed muscle and fat compartments with homogeneous radiodensities. For all programs, the measured areas and radiodensities of the regions of interest were assessed. RESULTS For sliceOmatic, OsiriX, ImageJ/Fiji, Mimics, CoreSlicer, SarcoMeas, and 3D Slicer, identical results were found, all reporting correct values for muscle and fat areas as well as correct radiodensity values, whereas values reported by Aquarius iNtuition deviated ≤ 5% for area measurements and had slight variation in radiodensity measurements. CONCLUSIONS Seven of eight software packages (sliceOmatic, OsiriX, ImageJ/Fiji, Mimics, CoreSlicer, SarcoMeas, and 3D Slicer) perform identically, so their results can be readily compared and combined when assessing body composition in computed tomography images. Area measurements acquired with Aquarius iNtuition may differ slightly (≤ 5%) from the other packages.
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Affiliation(s)
- Alain R Viddeleer
- Medical Imaging Center, Department of Radiology, University Medical Center Groningen, Groningen, Netherlands.
| | - Issi R Vedder
- Medical Imaging Center, Department of Radiology, University Medical Center Groningen, Groningen, Netherlands
| | - Ronald Dob
- Medical Imaging Center, Department of Radiology, University Medical Center Groningen, Groningen, Netherlands
| | - Reinoud P H Bokkers
- Medical Imaging Center, Department of Radiology, University Medical Center Groningen, Groningen, Netherlands
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Feng H, Zhang Z, Lyu W, Kong X, Li J, Zhou H, Wei P. The Effects of Appropriate Perioperative Exercise on Perioperative Neurocognitive Disorders: a Narrative Review. Mol Neurobiol 2024; 61:4663-4676. [PMID: 38110646 PMCID: PMC11236851 DOI: 10.1007/s12035-023-03864-0] [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: 07/12/2023] [Accepted: 12/06/2023] [Indexed: 12/20/2023]
Abstract
Perioperative neurocognitive disorders (PNDs) are now considered the most common neurological complication in older adult patients undergoing surgical procedures. A significant increase exists in the incidence of post-operative disability and mortality in patients with PNDs. However, no specific treatment is still available for PNDs. Recent studies have shown that exercise may improve cognitive dysfunction-related disorders, including PNDs. Neuroinflammation is a key mechanism underlying exercise-induced neuroprotection in PNDs; others include the regulation of gut microbiota and mitochondrial and synaptic function. Maintaining optimal skeletal muscle mass through preoperative exercise is important to prevent the occurrence of PNDs. This review summarizes current clinical and preclinical evidence and proposes potential molecular mechanisms by which perioperative exercise improves PNDs, providing a new direction for exploring exercise-mediated neuroprotective effects on PNDs. In addition, it intends to provide new strategies for the prevention and treatment of PNDs.
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Affiliation(s)
- Hao Feng
- Department of Anesthesiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, People's Republic of China
| | - Zheng Zhang
- Department of Anesthesiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, People's Republic of China
| | - Wenyuan Lyu
- Department of Anesthesiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, People's Republic of China
| | - Xiangyi Kong
- Department of Anesthesiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, People's Republic of China
| | - Jianjun Li
- Department of Anesthesiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, People's Republic of China
| | - Haipeng Zhou
- Department of Anesthesiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, People's Republic of China.
| | - Penghui Wei
- Department of Anesthesiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, People's Republic of China.
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Ying T, Borrelli P, Edenbrandt L, Enqvist O, Kaboteh R, Trägårdh E, Ulén J, Kjölhede H. AI-based fully automatic image analysis: Optimal abdominal and thoracic segmentation volumes for estimating total muscle volume on computed tomography scans. Osteoporos Sarcopenia 2024; 10:78-83. [PMID: 39035229 PMCID: PMC11260007 DOI: 10.1016/j.afos.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 04/04/2024] [Accepted: 04/09/2024] [Indexed: 07/23/2024] Open
Abstract
Objectives Evaluation of sarcopenia from computed tomography (CT) is often based on measuring skeletal muscle area on a single transverse slice. Automatic segmentation of muscle volume has a lower variance and may be a better proxy for the total muscle volume than single-slice areas. The aim of the study was to determine which abdominal and thoracic anatomical volumes were best at predicting the total muscle volume. Methods A cloud-based artificial intelligence tool (recomia.org) was used to segment all skeletal muscle of the torso of 994 patients who had performed whole-torso CT 2008-2020 for various clinical indications. Linear regression models for several anatomical volumes and single-slice areas were compared with regard to predicting the total torso muscle volume. Results The muscle volume from the tip of the coccyx and 25 cm cranially was the best of the abdominal volumes and was significantly better than the L3 slice muscle area (R2 0.935 vs 0.830, P < 0.0001). For thoracic volumes, the muscle volume between the top of the sternum to the lower bound of the Th12 vertebra showed the best correlation with the total volume, significantly better than the Th12 slice muscle area (R2 0.892 vs 0.775, P < 0.0001). Adjusting for body height improved the correlation slightly for all measurements but did not significantly change the ordering. Conclusions We identified muscle volumes that can be reliably segmented by automated image analysis which is superior to single slice areas in predicting total muscle volume.
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Affiliation(s)
- Thomas Ying
- Department of Urology, Sahlgrenska University Hospital, Blå Stråket 5, 41345, Gothenburg, Sweden
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 3, 40530, Gothenburg, Sweden
| | - Pablo Borrelli
- Department of Clinical Physiology, Sahlgrenska University Hospital, Blå Stråket 5, 41345, Gothenburg, Sweden
| | - Lars Edenbrandt
- Department of Clinical Physiology, Sahlgrenska University Hospital, Blå Stråket 5, 41345, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 3, 40530, Gothenburg, Sweden
| | - Olof Enqvist
- Eigenvision AB, Bredgatan 4, 21130, Malmö, Sweden
| | - Reza Kaboteh
- Department of Clinical Physiology, Sahlgrenska University Hospital, Blå Stråket 5, 41345, Gothenburg, Sweden
| | - Elin Trägårdh
- Department of Translational Medicine and Wallenberg Centre for Molecular Medicine, Lund University, Margaretavägen 1 A, 22240, Lund, Sweden
- Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Carl-Bertil Laurells Gata 9, 21428, Malmö, Sweden
| | | | - Henrik Kjölhede
- Department of Urology, Sahlgrenska University Hospital, Blå Stråket 5, 41345, Gothenburg, Sweden
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 3, 40530, Gothenburg, Sweden
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Yao J, Zhang Y, Gao B, Zhou M. Associations of Preoperative Nutritional Status and Sarcopenia With Mortality in Patients With Abdominal Aortic Aneurysm After Open and Endovascular Abdominal Aortic Aneurysm Repair: A Retrospective Study. J Cardiothorac Vasc Anesth 2024; 38:1337-1346. [PMID: 38521631 DOI: 10.1053/j.jvca.2024.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/21/2024] [Accepted: 02/27/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE The effect of preoperative malnutrition and sarcopenia on outcomes in patients with abdominal aortic aneurysm (AAA) after open surgical repair (OSR) and endovascular abdominal aortic aneurysm repair is undefined. The authors conducted the study to address this issue in this population. DESIGN A retrospective observational study. SETTING A large tertiary hospital. PARTICIPANTS Patients with AAA who underwent OSR and endovascular aneurysm repair (EVAR). INTERVENTIONS Evaluation of nutritional status (Nutritional Risk Screening 2002 [NRS 2002] and the Controlling Nutritional Status [CONUT] scores), muscle size (skeletal muscle index), and postoperative parameters. MEASUREMENTS AND MAIN RESULTS A total of 199 patients were reviewed from January 2020 to December 2022. Patients weew categorized into group A (CONUT <4) and group B (CONUT ≥4) based on whether their CONUT scores were less than 4. The mortality (p = 0.004) and the incidence of Clavien-Dindo class III complications (p = 0.007) in group B were higher than those in group A. CONUT score was an independent risk factor for midterm mortality (hazard ratio 1.329; 95% CI, 1.104-1.697; p = 0.002) and Clavien-Dindo class III complications (odds ratio 1.225; 95% CI, 1.012-1.482; p = 0.037) according to univariate and multivariate analyses, whereas NRS 2002 score and sarcopenia were not. Kaplan-Meier curves showed a lower midterm survival rate in group B (log-rank p < 0.001). CONCLUSION In patients with AAA undergoing OSR or EVAR, a CONUT score ≥4 was associated with increased Clavien-Dindo class III complications and mortality. Preoperative nutritional status should be evaluated and optimized in this high-risk population.
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Affiliation(s)
- Jiashu Yao
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Yepeng Zhang
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Bo Gao
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
| | - Min Zhou
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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Warmerdam BW, van Rijswijk CS, Droop A, Lucassen CJ, Hamming JF, van Schaik J, van der Vorst JR. The association between sarcopenia and adverse outcomes after complex endovascular aortic repair. THE JOURNAL OF CARDIOVASCULAR SURGERY 2024; 65:256-264. [PMID: 37987737 DOI: 10.23736/s0021-9509.23.12821-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
BACKGROUND Sarcopenia is identified as a predictive factor for adverse outcomes after complex endovascular aortic repair (complex EVAR). Consensus on preferred parameters for sarcopenia is not yet reached. The current study compares three CT-assessed parameters on their association with adverse outcomes after complex EVAR. METHODS This was a single-center retrospective cohort study. Psoas Muscle Index (PMI), Skeletal Muscle Index (SMI), and lean psoas muscle area (LPMA) were examined by CT-segmentation. PMI, SMI, and LPMA were analyzed as continuous variables. In addition, cut-off values from previous research were used to diagnose patients as sarcopenic or non-sarcopenic. Outcomes were: all-cause mortality, major adverse events (MAE), length of hospital stay, and non-home discharge. A sub-analysis was made for severe sarcopenia; sarcopenia combined with low physical performance (gait speed, Time Up and Go test, Metabolic Equivalent of Task-score). RESULTS We included 101 patients. A higher PMI (HR=0.590, CI: 0.374-0.930, P=0.023), SMI (HR=0.453, CI: 0.267-0.768, P=0.003), and LPMA (HR=0.559, CI: 0.333-0.944, P=0.029) were associated with a lower risk of mortality. Sarcopenia based on cut-off values for PMI and LPMA was not significantly associated with survival. Sarcopenia based on SMI did present a higher mortality risk (P=0.017). A sub-analysis showed that severely sarcopenic patients were at even higher risk of mortality (P=0.036). None of the parameters were significantly associated with the other outcomes. CONCLUSIONS SMI had a slightly stronger association with mortality compared to PMI and LPMA. High-risk patients were selected by adding physical performance scores. Future research could focus on complex EVAR-specific PMI and LPMA cut-off values.
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Affiliation(s)
- Britt W Warmerdam
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Carla S van Rijswijk
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Anneke Droop
- Department of Dietetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Claudia J Lucassen
- Department of Dietetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Jaap F Hamming
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan van Schaik
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
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Takenoshita M, Weir McCall JR, Barker AP, Suresh S, Celik H, Vuylsteke A. Association between body composition and mortality in patients requiring extracorporeal membrane oxygenation support. Clin Radiol 2024; 79:272-278. [PMID: 38278741 DOI: 10.1016/j.crad.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 11/16/2023] [Accepted: 12/14/2023] [Indexed: 01/28/2024]
Abstract
AIM To ascertain the association between body composition, including muscle mass and adiposity, and patient mortality in those requiring extracorporeal membrane oxygenation (ECMO) for acute respiratory failure. MATERIALS AND METHODS A retrospective study was undertaken of all patients with acute respiratory failure requiring veno-venous (VV) ECMO between January 2015 and December 2019. Automated image segmentation software was used to quantify the cross-sectional area and average radiodensity (in Hounsfield units) of different muscle and fat compartments at the L3 level of whole-body computed tomography (CT) images taken within 48 h of initiation of ECMO support. The primary endpoint was 30-day post-ECMO initiation all-cause mortality. Logistic regression was used to analyse the correlation between CT measurements, co-morbidities, and 30-day survival. RESULTS The study included 189 patients (age = 43.8 ± 14.6, sex = 42.3% female). There was no significant association between 30-day survival status and cross-sectional area of muscle or fat. Muscle attenuation (psoas, long spine, and abdominal muscles respectively) at the L3 level were significantly lower in those who died within 30 days of ECMO cannulation (p<0.05). On multivariable analysis including age, sex, and pre-existing respiratory comorbidities, psoas muscle attenuation was an independent predictor of survival at 30 days (OR 0.97; 95% CI 0.94 to 1.00; p=0.047). CONCLUSIONS Reduced psoas muscle attenuation is associated with poorer survival outcomes at 30 days post-ECMO cannulation in patients who received VV ECMO support for respiratory failure. Cross-sectional areas of muscle and fat compartments did not correlate with survival outcomes at 30 days even when corrected for height and sex.
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Affiliation(s)
- M Takenoshita
- Department of Radiology, Royal Papworth Hospital, Cambridge, UK
| | - J R Weir McCall
- Department of Radiology, Royal Papworth Hospital, Cambridge, UK.
| | - A P Barker
- Department of Radiology, Royal Papworth Hospital, Cambridge, UK
| | - S Suresh
- Department of Radiology, Royal Papworth Hospital, Cambridge, UK
| | - H Celik
- University of Massachusetts Chan Medical School, Massachusetts, USA
| | - A Vuylsteke
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, UK
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Ma M, Luo M, Liu Q, Zhong D, Liu Y, Zhang K. Influence of abdominal fat distribution and inflammatory status on post-operative prognosis in non-small cell lung cancer patients: a retrospective cohort study. J Cancer Res Clin Oncol 2024; 150:111. [PMID: 38431748 PMCID: PMC10908607 DOI: 10.1007/s00432-024-05633-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/26/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE To evaluate the influence of visceral fat area (VFA), subcutaneous fat area (SFA), the systemic immune-inflammation index (SII) and total inflammation-based systemic index (AISI) on the postoperative prognosis of non-small cell lung cancers (NSCLC) patients. METHODS 266 NSCLC patients received surgery from two academic medical centers were included. To assess the effect of abdominal fat measured by computed tomography (CT) imaging and inflammatory indicators on patients' overall survival (OS) and progression-free survival (PFS), Kaplan-Meier survival analysis and Cox proportional hazards models were used. RESULTS Kaplan-Meier analysis showed the OS and PFS of patients in high-VFA group was better than low-VFA group (p < 0.05). AISI and SII were shown to be risk factors for OS and PFS (p < 0.05) after additional adjustment for BMI (Cox regression model II). After further adjustment for VFA (Cox regression model III), low-SFA group had longer OS (p < 0.05). Among the four subgroups based on VFA (high/low) and SFA (high/low) (p < 0.05), the high-VFA & low-SFA group had the longest median OS (108 months; 95% CI 74-117 months) and PFS (85 months; 95% CI 65-117 months), as well as the lowest SII and AISI (p < 0.05). Low-SFA was a protective factor for OS with different VFA stratification (p < 0.05). CONCLUSION VFA, SFA, SII and AISI may be employed as significant prognostic markers of postoperative survival in NSCLC patients. Moreover, excessive SFA levels may encourage systemic inflammation decreasing the protective impact of VFA, which may help to provide targeted nutritional support and interventions for postoperative NSCLC patients with poor prognosis.
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Affiliation(s)
- Mengtian Ma
- Department of Radiology, The First Hospital of Hunan University of Chinese Medicine, Changsha, 410007, Hunan Province, People's Republic of China
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan Province, People's Republic of China
| | - Muqing Luo
- Department of Radiology, The First Hospital of Hunan University of Chinese Medicine, Changsha, 410007, Hunan Province, People's Republic of China
| | - Qianyun Liu
- Department of Medical Imaging, Yueyang Central Hospital, Yueyang, 414000, Hunan Province, People's Republic of China
| | - Dong Zhong
- Department of Nuclear Medicine, XiangYa Hospital CentralSouth University, Changsha, 410005, Hunan Province, People's Republic of China
| | - Yinqi Liu
- Department of Radiology, The First Hospital of Hunan University of Chinese Medicine, Changsha, 410007, Hunan Province, People's Republic of China
| | - Kun Zhang
- Department of Radiology, The First Hospital of Hunan University of Chinese Medicine, Changsha, 410007, Hunan Province, People's Republic of China.
- College of Integrated Traditional Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, 410208, People's Republic of China.
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Yao L, Petrosyan A, Chaudhari AJ, Lenchik L, Boutin RD. Clinical, functional, and opportunistic CT metrics of sarcopenia at the point of imaging care: analysis of all-cause mortality. Skeletal Radiol 2024; 53:515-524. [PMID: 37684434 PMCID: PMC10841085 DOI: 10.1007/s00256-023-04438-w] [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: 05/28/2023] [Revised: 08/23/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023]
Abstract
PURPOSE This study examines clinical, functional, and CT metrics of sarcopenia and all-cause mortality in older adults undergoing outpatient imaging. METHODS The study included outpatients ≥ 65 years of age undergoing CT or PET/CT at a tertiary care institution. Assessments included screening questionnaires for sarcopenia (SARC-F) and frailty (FRAIL scale), and measurements of grip strength and usual gait speed (6 m course). Skeletal muscle area (SMA), index (SMI, area/height2) and density (SMD) were measured on CT at T12 and L3. A modified SMI was also examined (SMI-m, area/height). Mortality risk was studied with Cox proportional hazard analysis. RESULTS The study included 416 patients; mean age 73.8 years [sd 6.2]; mean follow-up 2.9 years (sd 1.34). Abnormal grip, SARC-F, and FRAIL scale assessments were associated with higher mortality risk (HR [95%CI] = 2.0 [1.4-2.9], 1.6 [1.1-2.3], 2.0 [1.4-2.8]). Adjusting for age, higher L3-SMA, T12-SMA, T12-SMI and T12-SMI-m were associated with lower mortality risk (HR [95%CI] = 0.80 [0.65-0.90], 0.76 [0.64-0.90], 0.84 [0.70-1.00], and 0.80 [0.67-0.90], respectively). T12-SMD and L3-SMD were not predictive of mortality. After adjusting for abnormal grip strength and FRAIL scale assessments, T12-SMA and T12-SMI-m remained predictive of mortality risk (HR [95%CI] = 0.83 [0.70-1.00] and 0.80 [0.67-0.97], respectively). CONCLUSION CT areal metrics were weaker predictors of all-cause mortality than clinical and functional metrics of sarcopenia in our older patient cohort; a CT density metric (SMD) was not predictive. Of areal CT metrics, SMI (area/height2) appeared to be less effective than non-normalized SMA or SMA normalized by height1.
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Affiliation(s)
- Lawrence Yao
- Radiology and Imaging Sciences/CC/NIH, 10 Center Drive, Bethesda, MD, 20892, USA.
| | | | - Abhijit J Chaudhari
- University of California, Davis 4860 Y Street, Suite 3100, Sacramento, CA, 95817, USA
| | - Leon Lenchik
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Robert D Boutin
- Stanford University School of Medicine, 300 Pasteur Drive, MC-5105, Stanford, CA, 94305, USA
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11
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Ruiz-Margáin A, Macías-Rodríguez RU, Flores-García NC, Román Calleja BM, Fierro-Angulo OM, González-Regueiro JA. Assessing nutrition status, sarcopenia, and frailty in adult transplant recipients. Nutr Clin Pract 2024; 39:14-26. [PMID: 38097210 DOI: 10.1002/ncp.11107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/15/2023] [Accepted: 11/15/2023] [Indexed: 01/13/2024] Open
Abstract
The assessment of nutrition status, sarcopenia, and frailty holds significant relevance in the context of adult transplantation, as these factors are associated with an unfavorable prognosis; thus, transplant candidates must undergo a full nutrition assessment. Screening tools may be used to prioritize patients, this can be done using the Nutrition Risk Screening 2002 or Royal Free Hospital-Nutritional Prioritizing Tool. Subsequently, a thorough nutrition-focused physical examination should be conducted to evaluate clinical signs of nutrition deficiencies, fat and muscle loss, and fluid overload; dietary history and current intake must also be assessed. Apart from physical examination, specific testing for sarcopenia and frailty are recommended. For sarcopenia assessment, specifically for muscle quantification, the gold standard is the cross-sectional measurement of the muscle at L3 obtained from a computed tomography scan or magnetic resonance imaging; dual-energy x-ray absorptiometry is also a good tool especially when appendicular skeletal muscle index is calculated. Other more readily available options include phase angle from bioelectrical impedance or bioimpedance spectroscopy. In the sarcopenia assessment, muscle function evaluation is required, handgrip strength stands as the primary test for this purpose; this test is also part of the subjective global assessment and is included in some frailty scores. Finally, for frailty assessment, the Short Physical Performance Battery is useful for evaluating physical frailty, and for a multidimensional evaluation, the Fried frailty phenotype can be used. Specifically for liver transplant candidates, the use of Liver Frailty Index is recommended.
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Affiliation(s)
- Astrid Ruiz-Margáin
- Division of Hepatology, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ricardo U Macías-Rodríguez
- Division of Hepatology, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Nayelli C Flores-García
- Division of Hepatology, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Berenice M Román Calleja
- Division of Hepatology, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Oscar M Fierro-Angulo
- Division of Hepatology, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - José A González-Regueiro
- Division of Hepatology, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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12
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Zhu Z, Gong H, Gu J, Dai Y, Yang C, Mao M, Song A, Feng F. Development and validation of a preoperative CT-based risk scoring system for predicting recurrence-free survival in patients undergoing curative surgery for gastric cancer. Eur J Radiol 2024; 171:111303. [PMID: 38215532 DOI: 10.1016/j.ejrad.2024.111303] [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: 11/11/2023] [Revised: 12/30/2023] [Accepted: 01/07/2024] [Indexed: 01/14/2024]
Abstract
PURPOSE The objective of this study was to establish and validate a preoperative risk scoring system that incorporated both clinical and computed tomography(CT) variables to predict recurrence-free survival (RFS) in gastric cancer(GC) patients who underwent curative resection. METHOD We retrospectively included consecutive patients with surgically confirmed GC who underwent preoperative CT scans between October 2017 and January 2022. Multivariate Cox regression analysis was employed in the derivation set to identify clinical and CT variables associated with RFS and to construct a risk score. This risk score was subsequently validated in an independent test set. RESULTS A total of 346 patients were included in the study, with 213 in the derivation set and 133 in the test set. Five variables, namely ctEMVI, ctBorrmann, visceral obesity, sarcopenia, and NLR, were independently associated with RFS. In the test set, the preoperative risk score exhibited a c-index of 0.741, which outperformed the predictive accuracy of pathological tumor staging (c-index of 0.673, p = 0.021) at various time points. The preoperative risk score effectively stratified patients into low and high-risk groups. CONCLUSION The developed preoperative risk scoring system demonstrated the ability to predict RFS following curative resection in GC patients.
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Affiliation(s)
- Zhengqi Zhu
- Radiology Department, Jiangsu Province Nantong City Cancer Hospital, Nantong 226300, Jiangsu Province, China
| | - Haipeng Gong
- Radiology Department, Jiangsu Province Nantong City Cancer Hospital, Nantong 226300, Jiangsu Province, China
| | - Jianan Gu
- Radiology Department, Jiangsu Province Nantong City Cancer Hospital, Nantong 226300, Jiangsu Province, China
| | - Yongfeng Dai
- Radiology Department, Jiangsu Province Nantong City Cancer Hospital, Nantong 226300, Jiangsu Province, China
| | - Chunyan Yang
- Radiology Department, Jiangsu Province Nantong City Cancer Hospital, Nantong 226300, Jiangsu Province, China
| | - Mimi Mao
- Radiology Department, Jiangsu Province Nantong City Cancer Hospital, Nantong 226300, Jiangsu Province, China
| | - Anyi Song
- Radiology Department, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Feng Feng
- Radiology Department, Jiangsu Province Nantong City Cancer Hospital, Nantong 226300, Jiangsu Province, China.
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Cereda M, Bernasconi DP, Uggeri F, Ippolito D, Di Lucca G, Maino C, Gandola D, Braga M, Sandini M, Gianotti L. Association of chronic statin use, myopenia, myosteatosis and major morbidity in surgical patients with upper gastrointestinal cancer. Updates Surg 2023; 75:2297-2303. [PMID: 37202600 PMCID: PMC10710384 DOI: 10.1007/s13304-023-01543-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/15/2023] [Indexed: 05/20/2023]
Abstract
Derangements of body composition affect surgical outcomes. Chronic statin use may induce muscle wasting and impair muscle tissue quality. Aim of this study was to evaluate the association of chronic statin use, skeletal muscle area (SMA), myosteatosis and major postoperative morbidity. Between 2011 and 2021, patients undergoing pancreatoduodenectomy or total gastrectomy for cancer, and using statins since at least 1 year, were retrospective studied. SMA and myosteatosis were measured at CT scan. The cut-off for SMA and myosteatosis were determined using ROC curve and considering severe complications as the binary outcome. The presence of myopenia was defined when SMA was lower that the cut-off. A multivariable logistic regression was applied to assess the association between several factors and severe complications. After a matching procedure (1:1) for key baseline risk factors (ASA; age; Charlson comorbidity index; tumor site; intraoperative blood loss), a final sample of 104 patients, of which 52 treated and 52 not treated with statins, was obtained. The median age was 75 years, with an ASA score ≥ 3 in 63% of the cases. SMA (OR 5.119, 95% CI 1.053-24.865) and myosteatosis (OR 4.234, 95% CI 1.511-11.866) below the cut-off values were significantly associated with major morbidity. Statin use was predictive of major complication only in patients with preoperative myopenia (OR 5.449, 95% CI 1.054-28.158). Myopenia and myosteatosis were independently associated with an increased risk of severe complications. Statin use was associated with a higher risk of having major morbidity only in the subgroup of patients with myopenia.
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Affiliation(s)
- Marco Cereda
- HPB Unit, Department of Surgery, IRCCS San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, Italy
| | - Davide Paolo Bernasconi
- Bicocca Bioinformatics Biostatistics and Bioimaging Centre-B4, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Fabio Uggeri
- HPB Unit, Department of Surgery, IRCCS San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Davide Ippolito
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Diagnostic Radiology, School of Medicine and Surgery, IRCCS San Gerardo Hospital, Monza, Italy
| | - Gabriele Di Lucca
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Cesare Maino
- Diagnostic Radiology, School of Medicine and Surgery, IRCCS San Gerardo Hospital, Monza, Italy
| | - Davide Gandola
- Diagnostic Radiology, School of Medicine and Surgery, IRCCS San Gerardo Hospital, Monza, Italy
| | - Marco Braga
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Marta Sandini
- Department of Medicine, Surgery, and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Luca Gianotti
- HPB Unit, Department of Surgery, IRCCS San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, Italy.
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
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14
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Lin WL, Wu LM, Huang WT, Guo HR, Chen JJ. Age as a modifier of the effects of sarcopenia on survival among colon cancer patients after surgery. J Surg Oncol 2023; 128:1121-1132. [PMID: 37592877 DOI: 10.1002/jso.27405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/06/2023] [Accepted: 07/16/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Studies have been conducted to evaluate whether sarcopenia is a predictor for survival in patients with colon cancer postsurgery, but findings have been inconsistent, and effects of age were seldom evaluated. METHODS We recruited 133 patients with resectable colon cancer who underwent surgery between January 2014 and December 2017 at a teaching hospital to evaluate the effects of sarcopenia on survival, after adjusting for age and other potential predictors, including visceral adiposity (VA). RESULTS Preoperative sarcopenia was associated with worse overall survival (OS: 62.3% vs. 83.8%, p = 0.04) and longer hospital stay (20.6 vs. 14.9 days, p < 0.01) while VA was not. Cox proportional hazards regressions showed that sarcopenia was associated with an adjusted hazard ratio (HR) of 2.91 (95% confidence interval [CI]: 1.08-7.86) after adjustment for other independent risk factors, but was not associated with disease free survival. In stratified analyses, we found that sarcopenia was an independent factor for worse OS (adjusted HR = 1.94; 95% CI: 1.11-3.38) among patients >70 years, but not among patients ≤70 years (HR = 0.48; 95% CI: 0.55-4.55). CONCLUSIONS Age appeared to be a modifier of the effects of sarcopenia on OS among colon cancer patients postsurgery.
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Affiliation(s)
- Wen-Li Lin
- Center for Quality Management, Chi Mei Hospital, Liouying, Tainan, Taiwan
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Li-Min Wu
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wen-Tsung Huang
- Division of Hematology and Oncology, Chi Mei Hospital, Liouying, Tainan, Taiwan
| | - How-Ran Guo
- Department of Environmental and Occupational Health, National Cheng Kung University, Tainan, Taiwan
- Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Jyh-Jou Chen
- Division of Gastroenterology and Hepatology, Chi Mei Hospital, Liouying, Tainan, Taiwan
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15
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Ogon I, Takashima H, Morita T, Fukushi R, Takebayashi T, Teramoto A. Association of central sensitization, visceral fat, and surgical outcomes in lumbar spinal stenosis. J Orthop Surg Res 2023; 18:886. [PMID: 37990264 PMCID: PMC10662108 DOI: 10.1186/s13018-023-04376-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/15/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Controversy remains regarding predictors of surgical outcomes for patients with lumbar spinal stenosis (LSS). Pain sensitization may be an underlying mechanism contributing to LSS surgical outcomes. Further, obesity is associated with dissatisfaction and poorer outcomes after surgery for LSS. Therefore, this study aimed to examine the relationship between central sensitization (CS), visceral fat, and surgical outcomes in LSS. METHODS Patients with LSS were categorized based on their central sensitization inventory (CSI) scores into low- (CSI < 40) and high- (CSI ≥ 40) CSI subgroups. The participants completed clinical outcome assessments preoperatively and 12 months postoperatively. RESULTS Overall, 60 patients were enrolled in the study (28 men, 32 women; mean age: 62.1 ± 2.8 years). The high-CSI group had significantly higher mean low back pain (LBP), leg pain, and leg numbness visual analogue scale (VAS) scores than the low-CSI group (p < 0.01). The high-CSI group had a significantly higher mean visceral fat area than the low-CSI group (p < 0.01). Postoperatively, LBP VAS score was significantly worse in the high-CSI group. Relative to preoperatively, postoperative leg pain and leg numbness improved significantly in both groups. CONCLUSIONS We believe that neuro decompression can be effective for LSS surgical outcomes in patients with CS; nonetheless, it should be approached with caution owing to the potential for worsening LBP. Additionally, visceral fat is an important indicator suggesting the involvement of CS.
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Affiliation(s)
- Izaya Ogon
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, 291, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan.
| | - Hiroyuki Takashima
- Faculty of Health Sciences, Hokkaido University, North-12, West-5, Kitaku, Sapporo, 060-0812, Japan
| | - Tomonori Morita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, 291, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Ryunosuke Fukushi
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, 291, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Tsuneo Takebayashi
- Department of Orthopaedic Surgery, Sapporo Maruyama Orthopaedic Hospital, 1-3, North-7, West-27, Chuo-ku, Sapporo, 060-0007, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, 291, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
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Uno K, Yoshikawa N, Kitami K, Mori S, Shibata T, Iyoshi S, Fujimoto H, Mogi K, Yoshihara M, Tamauchi S, Ikeda Y, Yokoi A, Kato K, Hoshiba T, Oguchi H, Kajiyama H. The sarcopenia index measured using the lumbar paraspinal muscle is associated with prognosis in endometrial cancer. Jpn J Clin Oncol 2023; 53:942-949. [PMID: 37519058 DOI: 10.1093/jjco/hyad086] [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: 05/07/2023] [Accepted: 07/11/2023] [Indexed: 08/01/2023] Open
Abstract
OBJECTIVE The number of type-II endometrial cancer patients has been increasing and the prognosis is not favorable. We aim to investigate whether sarcopenia index in any of several different muscles could serve as a novel biomarker of prognosis in patients with type-II endometrial cancer. METHODS We retrospectively investigated a total of 194 patients at four hospitals. Ninety patients were treated as derivation set and the other 104 patients as validation set. Using preoperative computed tomography images, we measured the horizontal cross-sectional area at the third lumbar spine level: the (i) psoas major, (ii) iliac and (iii) paraspinal muscle. The clinical information including recurrence-free survival and overall survival were retrospectively collected. These results were validated with external data sets of three hospitals. RESULTS The median values of the sarcopenia index (cm2/m2) ± standard deviation with the first data of 90 patients using the psoas, iliac and paraspinal muscle were 3.4 ± 1.0, 1.7 ± 0.6 and 12.6 ± 3.2, respectively. In univariate analyses, the sarcopenia indexes measured using the psoas or paraspinal muscle were associated with recurrence-free survival and overall survival. On the other hand, in multivariate analyses, only the sarcopenia index using paraspinal muscle was significantly related to recurrence-free survival (hazard ratio = 3.78, 95% confidence intervals = 1.29-5.97, P = 0.009) and overall survival (hazard ratio = 3.13, 95% confidence interval = 1.18-8.26, P = 0.022). Paraspinal sarcopenia index was also related to overall survival (hazard ratio = 3.74, 95% confidence interval = 1.31-10.72, P = 0.014) even in patients with advanced stage. Serum albumin was significantly correlated with the sarcopenia index (P = 0.012). Within the analysis of the validation set, sarcopenia index using paraspinal muscle was related to recurrence-free survival (hazard ratio = 2.06, P = 0.045) in multivariate analysis and recurrence-free survival (P = 0.009) in patients with advanced stage. CONCLUSIONS The sarcopenia index using the paraspinal muscle, not psoas, could be a suitable index to predict recurrence-free survival and overall survival in patients with type-II endometrial cancer even in advanced stage.
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Affiliation(s)
- Kaname Uno
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Nobuhisa Yoshikawa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuhisa Kitami
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Obstetrics and Gynecology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Sho Mori
- Department of Obstetrics and Gynecology, TOYOTA Memorial Hospital, Toyota, Japan
| | - Takahiro Shibata
- Department of Obstetrics and Gynecology, TOYOTA Memorial Hospital, Toyota, Japan
- Department of Obstetrics and Gynecology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Shohei Iyoshi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Spemann Graduate School of Biology and Medicine, University of Freiburg, Freiburg, Germany
| | - Hiroki Fujimoto
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Discipline of Obstetrics and Gynecology, Adelaide Medical School, Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Kazumasa Mogi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masato Yoshihara
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Tamauchi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshiki Ikeda
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akira Yokoi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuyoshi Kato
- Department of Obstetrics and Gynecology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Tsutomu Hoshiba
- Department of Obstetrics and Gynecology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Hidenori Oguchi
- Department of Obstetrics and Gynecology, TOYOTA Memorial Hospital, Toyota, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Ballinger TJ, Marques HS, Xue G, Hoffman R, Gatsonis C, Zhao F, Miller KD, Sparano J, Connolly RM. Impact of Muscle Measures on Outcome in Patients Receiving Endocrine Therapy for Metastatic Breast Cancer: Analysis of ECOG-ACRIN E2112. J Natl Compr Canc Netw 2023; 21:915-923.e1. [PMID: 37673107 PMCID: PMC10594540 DOI: 10.6004/jnccn.2023.7045] [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] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/06/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Observational data investigating the relationship between body habitus and outcomes in breast cancer have been variable and inconsistent, largely centered in the curative setting and focused on weight-based metrics. This study evaluated the impact of muscle measures on outcomes in patients with metastatic breast cancer receiving endocrine-based therapy. METHODS Baseline CT scans were collected from ECOG-ACRIN E2112, a randomized phase III placebo-controlled study of exemestane with or without entinostat. A CT cross-sectional image at the L3 level was extracted to obtain skeletal muscle mass and attenuation. Low muscle mass (LMM) was defined as skeletal muscle index <41 cm2/m2 and low muscle attenuation (LMA) as muscle density <25 HU or <33 HU if overweight/obese by body mass index (BMI). Multivariable Cox proportional hazard models determined the association between LMM or LMA and progression-free survival (PFS) and overall survival (OS). Correlations between LMM, LMA, and patient-reported outcomes were determined using 2-sample t tests. RESULTS Analyzable CT scans and follow-up data were available for 540 of 608 patients. LMM was present in 39% (n=212) of patients and LMA in 56% (n=301). Those with LMA were more likely to have obesity and worse performance status. LMM was not associated with survival (PFS hazard ratio [HR]: 1.13, P=.23; OS HR: 1.05, P=.68), nor was LMA (PFS HR: 1.01, P=.93; OS HR: 1.00, P=.99). BMI was not associated with survival. LMA, but not LMM, was associated with increased frequency of patient-reported muscle aches. CONCLUSIONS Both low muscle mass and density are prevalent in patients with hormone receptor-positive metastatic breast cancer. Muscle measures correlated with obesity and performance status; however, neither muscle mass nor attenuation were associated with prognosis. Further work is needed to refine body composition measurements and select optimal cutoffs with meaningful endpoints in specific breast cancer populations, particularly those living with metastatic disease.
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Affiliation(s)
| | | | - Gloria Xue
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Richard Hoffman
- Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Fengmin Zhao
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kathy D. Miller
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Joseph Sparano
- Icahn School of Medicine at Mount Sinai, New York, New York
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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.
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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
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19
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Beumer BR, Takagi K, Buettner S, Umeda Y, Yagi T, Fujiwara T, van Vugt JL, IJzermans JN. Impact of sarcopenia on clinical outcomes for patients with resected hepatocellular carcinoma: a retrospective comparison of Eastern and Western cohorts. Int J Surg 2023; 109:2258-2266. [PMID: 37204461 PMCID: PMC10442104 DOI: 10.1097/js9.0000000000000458] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/01/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Patient fitness is important for guiding treatment. Muscle mass, as a reflection thereof, can be objectively measured. However, the role of East-West differences remains unclear. Therefore, we compared the impact of muscle mass on clinical outcomes after liver resection for hepatocellular carcinoma (HCC) in a Dutch [the Netherlands (NL)] and Japanese [Japan (JP)] setting and evaluated the predictive performance of different cutoff values for sarcopenia. METHOD In this multicenter retrospective cohort study, patients with HCC undergoing liver resection were included. The skeletal muscle mass index (SMI) was determined on computed tomography scans obtained within 3 months before surgery. The primary outcome measure was overall survival (OS). Secondary outcome measures were: 90-day mortality, severe complications, length of stay, and recurrence-free survival. The predictive performance of several sarcopenia cutoff values was studied using the concordance index (C-index) and area under the curve. Interaction terms were used to study the geographic effect modification of muscle mass. RESULTS Demographics differed between NL and JP. Gender, age, and body mass index were associated with SMI. Significant effect modification between NL and JP was found for BMI. The predictive performance of sarcopenia for both short-term and long-term outcomes was higher in JP compared to NL (maximum C-index: 0.58 vs. 0.55, respectively). However, differences between cutoff values were small. For the association between sarcopenia and OS, a strong association was found in JP [hazard ratio (HR) 2.00, 95% CI [1.230-3.08], P =0.002], where this was not found in NL (0.76 [0.42-1.36], P =0.351). The interaction term confirmed that this difference was significant (HR 0.37, 95% CI [0.19-0.73], P =0.005). CONCLUSIONS The impact of sarcopenia on survival differs between the East and West. Clinical trials and treatment guidelines using sarcopenia for risk stratification should be validated in race-dependent populations prior to clinical adoption.
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Affiliation(s)
- Berend R. Beumer
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC Transplant Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Kosei Takagi
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan Okayama University Hospital, Okayama, Japan
| | - Stefan Buettner
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC Transplant Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Yuzo Umeda
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan Okayama University Hospital, Okayama, Japan
| | - Takahito Yagi
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan Okayama University Hospital, Okayama, Japan
| | - Toshiyoshi Fujiwara
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan Okayama University Hospital, Okayama, Japan
| | - Jeroen L.A. van Vugt
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC Transplant Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Jan N.M. IJzermans
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC Transplant Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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20
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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.
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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
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21
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Ravaioli F, De Maria N, Di Marco L, Pivetti A, Casciola R, Ceraso C, Frassanito G, Pambianco M, Pecchini M, Sicuro C, Leoni L, Di Sandro S, Magistri P, Menozzi R, Di Benedetto F, Colecchia A. From Listing to Recovery: A Review of Nutritional Status Assessment and Management in Liver Transplant Patients. Nutrients 2023; 15:2778. [PMID: 37375682 DOI: 10.3390/nu15122778] [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: 05/22/2023] [Revised: 06/04/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Liver transplantation (LT) is a complex surgical procedure requiring thorough pre- and post-operative planning and care. The nutritional status of the patient before, during, and after LT is crucial to surgical success and long-term prognosis. This review aims to assess nutritional status assessment and management before, during, and after LT, with a focus on patients who have undergone bariatric surgery. We performed a comprehensive topic search on MEDLINE, Ovid, In-Process, Cochrane Library, EMBASE, and PubMed up to March 2023. It identifies key factors influencing the nutritional status of liver transplant patients, such as pre-existing malnutrition, the type and severity of liver disease, comorbidities, and immunosuppressive medications. The review highlights the importance of pre-operative nutritional assessment and intervention, close nutritional status monitoring, individualised nutrition care plans, and ongoing nutritional support and monitoring after LT. The review concludes by examining the effect of bariatric surgery on the nutritional status of liver transplant recipients. The review offers valuable insights into the challenges and opportunities for optimising nutritional status before, during, and after LT.
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Affiliation(s)
- Federico Ravaioli
- Gastroenterology Unit, Department of Medical Specialties, University Hospital of Modena, University of Modena & Reggio Emilia, 41121 Modena, Italy
| | - Nicola De Maria
- Gastroenterology Unit, Department of Medical Specialties, University Hospital of Modena, University of Modena & Reggio Emilia, 41121 Modena, Italy
| | - Lorenza Di Marco
- Gastroenterology Unit, Department of Medical Specialties, University Hospital of Modena, University of Modena & Reggio Emilia, 41121 Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Alessandra Pivetti
- Gastroenterology Unit, Department of Medical Specialties, University Hospital of Modena, University of Modena & Reggio Emilia, 41121 Modena, Italy
| | - Riccardo Casciola
- Gastroenterology Unit, Department of Medical Specialties, University Hospital of Modena, University of Modena & Reggio Emilia, 41121 Modena, Italy
| | - Carlo Ceraso
- Gastroenterology Unit, Department of Medical Specialties, University Hospital of Modena, University of Modena & Reggio Emilia, 41121 Modena, Italy
| | - Gabriella Frassanito
- Gastroenterology Unit, Department of Medical Specialties, University Hospital of Modena, University of Modena & Reggio Emilia, 41121 Modena, Italy
| | - Martina Pambianco
- Gastroenterology Unit, Department of Medical Specialties, University Hospital of Modena, University of Modena & Reggio Emilia, 41121 Modena, Italy
| | - Maddalena Pecchini
- Gastroenterology Unit, Department of Medical Specialties, University Hospital of Modena, University of Modena & Reggio Emilia, 41121 Modena, Italy
| | - Chiara Sicuro
- Gastroenterology Unit, Department of Medical Specialties, University Hospital of Modena, University of Modena & Reggio Emilia, 41121 Modena, Italy
| | - Laura Leoni
- Division of Metabolic Diseases and Clinical Nutrition, Department of Specialistic Medicines, University Hospital of Modena and Reggio Emilia, Largo del Pozzo 71, 41125 Modena, Italy
| | - Stefano Di Sandro
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University Hospital of Modena "Policlinico", University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Paolo Magistri
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University Hospital of Modena "Policlinico", University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Renata Menozzi
- Division of Metabolic Diseases and Clinical Nutrition, Department of Specialistic Medicines, University Hospital of Modena and Reggio Emilia, Largo del Pozzo 71, 41125 Modena, Italy
| | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University Hospital of Modena "Policlinico", University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Antonio Colecchia
- Gastroenterology Unit, Department of Medical Specialties, University Hospital of Modena, University of Modena & Reggio Emilia, 41121 Modena, Italy
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Liu Y, Ji F, Nguyen MH. Sarcopenia in cirrhosis: epidemiology, diagnosis, management and prognosis. Curr Opin Gastroenterol 2023; 39:131-139. [PMID: 37144530 DOI: 10.1097/mog.0000000000000922] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE OF REVIEW With the development of many international guidelines, research on sarcopenia has increased rapidly, showing that sarcopenia is predictive of adverse outcomes, including increased mortality and impaired mobility, in patients with cirrhosis. The purpose of this article is to review the current evidence concerning the epidemiology, diagnosis, management and predictive value of sarcopenia on the prognosis of patients with cirrhosis. RECENT FINDINGS Sarcopenia is a frequent and lethal complication of cirrhosis. Currently, abdominal computed tomography imaging is the most commonly used method to diagnose sarcopenia. In clinical practice, assessing muscle strength and physical performance, such as by measuring handgrip strength and gait speed, is of increasing interest. In addition to the necessary pharmacological therapy, adequate intake of protein, energy and micronutrients, as well as regular moderate-intensity exercise, can help to minimize sarcopenia. Sarcopenia has been shown to be a strong predictor of prognosis in patients with severe liver disease. SUMMARY A global consensus is needed on the definition and operational parameters for the diagnosis of sarcopenia. Further research should focus on developing standardized screening, management and treatment protocols for sarcopenia. Adding sarcopenia to existing models may better exploit the effect of sarcopenia on prognosis in patients with cirrhosis, which should be investigated further.
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Affiliation(s)
- Yi Liu
- Department of Infectious Diseases, the Second Affiliated Hospital of Xi'an Jiaotong University
| | - Fanpu Ji
- Department of Infectious Diseases, the Second Affiliated Hospital of Xi'an Jiaotong University
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, the Second Affiliated Hospital of Xi'an Jiaotong University
- Shaanxi Clinical Research Center of Infectious Diseases
- Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education of China, Xi'an, PRC
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology
- Department of Epidemiology and Population Health, Stanford University Medical Center, Palo Alto, California, USA
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23
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Han J, Liu X, Tang M, Yang F, Ding Z, Wu G. Abdominal fat and muscle distributions in different stages of colorectal cancer. BMC Cancer 2023; 23:279. [PMID: 36978044 PMCID: PMC10044362 DOI: 10.1186/s12885-023-10736-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND The purpose of this study is to explore the difference of abdominal fat and muscle composition, especially subcutaneous and visceral adipose tissue, in different stages of colorectal cancer (CRC). MATERIALS AND METHODS Patients were divided into 4 groups: healthy controls (patients without colorectal polyp), polyp group (patients with colorectal polyp), cancer group (CRC patients without cachexia), and cachexia group (CRC patients with cachexia). Skeletal muscle (SM), subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and intermuscular adipose tissue (IMAT) were assessed at the third lumbar level on computed tomography images obtained within 30 days before colonoscopy or surgery. One-way ANOVA and linear regression were used to analyze the difference of abdominal fat and muscle composition in different stages of CRC. RESULTS A total of 1513 patients were divided into healthy controls, polyp group, cancer group, and cachexia group, respectively. In the development of CRC from normal mucosa to polyp and cancer, the VAT area of the polyp group was significantly higher than that of the healthy controls both in male (156.32 ± 69.71 cm2 vs. 141.97 ± 79.40 cm2, P = 0.014) and female patients (108.69 ± 53.95 cm2 vs. 96.28 ± 46.70 cm2, P = 0.044). However, no significant differences were observed of SAT area between polyp group and healthy controls in both sexes. SAT area decreased significantly in the male cancer group compared with the polyp group (111.16 ± 46.98 cm2 vs. 126.40 ± 43.52 cm2, P = 0.001), while no such change was observed in female patients. When compared with healthy controls, the SM, IMAT, SAT, and VAT areas of cachexia group was significantly decreased by 9.25 cm2 (95% CI: 5.39-13.11 cm2, P < 0.001), 1.93 cm2 (95% CI: 0.54-3.32 cm2, P = 0.001), 28.84 cm2 (95% CI: 17.84-39.83 cm2, P < 0.001), and 31.31 cm2 (95% CI: 18.12-44.51 cm2, P < 0.001) after adjusting for age and gender. CONCLUSION Abdominal fat and muscle composition, especially SAT and VAT, was differently distributed in different stages of CRC. It is necessary to pay attention to the different roles of subcutaneous and visceral adipose tissue in the development of CRC.
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Affiliation(s)
- Jun Han
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- Shanghai Clinical Nutrition Research Center, Shanghai, China
| | - Xinyang Liu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Min Tang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Fan Yang
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Zuoyou Ding
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Guohao Wu
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
- Shanghai Clinical Nutrition Research Center, Shanghai, China.
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24
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Stehlé T, Morel A, Ouamri Y, Pigneur F. Comment on 'Allograft function and muscle mass evolution after kidney transplantation' by Gaillard et al. J Cachexia Sarcopenia Muscle 2023; 14:1139-1141. [PMID: 36869595 PMCID: PMC10067480 DOI: 10.1002/jcsm.13203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Affiliation(s)
- Thomas Stehlé
- 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
| | - 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 Néphrologie et Transplantation, Fédération Hospitalo-Universitaire "Innovative Therapy for Immune Disorders", Créteil, France
| | - 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
| | - 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
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25
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Pellegrini M, Besutti G, Ottone M, Canovi S, Bonelli E, Venturelli F, Farì R, Damato A, Bonelli C, Pinto C, Ligabue G, Pattacini P, Giorgi Rossi P, El Ghoch M. Abdominal Fat Characteristics and Mortality in Rectal Cancer: A Retrospective Study. Nutrients 2023; 15:nu15020374. [PMID: 36678245 PMCID: PMC9864407 DOI: 10.3390/nu15020374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 01/14/2023] Open
Abstract
The aim of this study was to evaluate the association of adipose tissue characteristics with survival in rectal cancer patients. All consecutive patients, diagnosed with stage II-IV rectal cancer between 2010-2016 using baseline unenhanced Computed Tomography (CT), were included. Baseline total, subcutaneous and visceral adipose tissue areas (TAT, SAT, VAT) and densities (TATd, SATd, VATd) at third lumbar vertebra (L3) were retrospectively measured. The association of these tissues with cancer-specific and progression-free survival (CCS, PFS) was assessed by using competitive risk models adjusted by age, sex and stage. Among the 274 included patients (median age 70 years, 41.2% females), the protective effect of increasing adipose tissue area on survival could be due to random fluctuations (e.g., sub-distribution hazard ratio-SHR for one cm2 increase in SAT = 0.997; 95%confidence interval-CI = 0.994-1.000; p = 0.057, for CSS), while increasing density was associated with poorer survival (e.g., SHR for one Hounsfield Unit-HU increase in SATd = 1.03, 95% CI = 1.01-1.05, p = 0.002, for CSS). In models considering each adipose tissue area and respective density, the association with CSS tended to disappear for areas, while it did not change for TATd and SATd. No association was found with PFS. In conclusion, adipose tissue density influenced survival in rectal cancer patients, raising awareness on a routinely measurable variable that requires more research efforts.
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Affiliation(s)
- Massimo Pellegrini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Giulia Besutti
- Radiology Unit, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy
- Correspondence: ; Tel.: +39-0522296369
| | - Marta Ottone
- Epidemiology Unit, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Simone Canovi
- Clinical Chemistry and Endocrinology Laboratory, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Efrem Bonelli
- Radiology Unit, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
- Clinical Chemistry and Endocrinology Laboratory, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Francesco Venturelli
- Epidemiology Unit, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Roberto Farì
- Radiology Unit, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Angela Damato
- Oncology Department, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Candida Bonelli
- Oncology Department, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Carmine Pinto
- Oncology Department, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Guido Ligabue
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Pierpaolo Pattacini
- Radiology Unit, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Marwan El Ghoch
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, Riad El Solh, Beirut 11072809, Lebanon
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26
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Surci N, Bassi C, Salvia R, Marchegiani G, Casetti L, Deiro G, Bergmann C, Walenta K, Tamandl D, Schindl M, Sahora K, Mühlbacher J. Long-Term Follow-Up after Surgery for Chronic Pancreatitis: A Bicentric Retrospective Experience. Dig Surg 2023; 39:169-175. [PMID: 35917792 PMCID: PMC9909709 DOI: 10.1159/000526263] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 06/30/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION The impact of surgery on nutritional status, pancreatic function, and symptoms of patients affected by chronic pancreatitis (CP) has not been unequivocally determined. This study aimed to evaluate clinical follow-up after surgery for CP in an Italian-Austrian population. MATERIALS AND METHODS Patients operated for CP at two high-volume centers between 2000 and 2018 were analyzed. The following parameters were compared between the pre- and postoperative period: nutritional status, endocrine and exocrine pancreatic functions, and chronic pain. RESULTS Overall, 186 patients underwent surgery for CP. Among these, 68 (40%) answered a specific follow-up questionnaire. The body mass index showed a significant increase between pre- and postoperative assessments (21.1 vs. 22.5 p = 0.003). Furthermore, a 60% decrease in the prevalence of chronic pain (81 vs. 21%, p < 0.001) was observed. On the contrary, both exocrine and endocrine pancreatic functions pointed toward a worsening after surgery, with consistent higher rates of patients presenting with diabetes mellitus, as well as patients requiring insulin therapy and oral intake of pancreatic enzymes. The analysis of body composition performed on 40 (24%) patients with a complete imaging pack revealed no significant change in the nutritional status after surgery. DISCUSSION/CONCLUSION Despite the good results observed in terms of pain relief, the surgical approach led to a consistent worsening of the global pancreatic function. No significant influence of surgery on the nutritional status of patients was detected.
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Affiliation(s)
- Niccolò Surci
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria,Department of General and Pancreatic Surgery, Pancreas Institute, University and Hospital Trust of Verona, “GB Rossi” Hospital, Verona, Italy
| | - Claudio Bassi
- Department of General and Pancreatic Surgery, Pancreas Institute, University and Hospital Trust of Verona, “GB Rossi” Hospital, Verona, Italy
| | - Roberto Salvia
- Department of General and Pancreatic Surgery, Pancreas Institute, University and Hospital Trust of Verona, “GB Rossi” Hospital, Verona, Italy
| | - Giovanni Marchegiani
- Department of General and Pancreatic Surgery, Pancreas Institute, University and Hospital Trust of Verona, “GB Rossi” Hospital, Verona, Italy
| | - Luca Casetti
- Department of General and Pancreatic Surgery, Pancreas Institute, University and Hospital Trust of Verona, “GB Rossi” Hospital, Verona, Italy
| | - Giacomo Deiro
- Department of General and Pancreatic Surgery, Pancreas Institute, University and Hospital Trust of Verona, “GB Rossi” Hospital, Verona, Italy
| | - Christina Bergmann
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria
| | - Klaus Walenta
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria
| | - Dietmar Tamandl
- Department of Radiology, Medical University of Vienna, General Hospital, Vienna, Austria
| | - Martin Schindl
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria
| | - Klaus Sahora
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria
| | - Jakob Mühlbacher
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria,*Jakob Mühlbacher, jakob.muehlbacherMühlbachermeduniwien.ac.at
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Benmassaoud A, Roccarina D, Arico FM, Cilla M, Donghia R, Leandro G, Prat LI, Zuhair M, North M, Kearney O, Ryan J, Tsochatzis EA. Sex is a major effect modifier between body composition and mortality in patients with cirrhosis assessed for liver transplantation. Liver Int 2023; 43:160-169. [PMID: 35567758 DOI: 10.1111/liv.15293] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 04/13/2022] [Accepted: 05/09/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS Body composition predicts mortality in patients with cirrhosis. The impact of sex on this association is unknown. We investigated the impact of sex on this association in patients with cirrhosis assessed for liver transplantation. METHODS This single-centre retrospective cohort study included adults assessed for liver transplantation. Nutritional status was assessed using the Royal Free Hospital-Global Assessment (RFH-GA). Body composition at the third lumbar vertebrae was determined. SarcopeniaSMI was defined as Skeletal Muscle Index <50 cm2 /m2 in males and <39 cm2 /m2 in females. SarcopeniaPMI was defined as the sex-specific 25th percentile of the Psoas Muscle Index. Patients were assessed for the occurrence of liver transplantation and death. Analyses were stratified by sex. RESULTS The cohort comprised 628 patients, including 199 females and 429 males. Both groups were similar in terms of baseline liver disease severity by Model for End-stage Liver Disease (MELD) (p = .98) and nutritional status (p = .24). SarcopeniaSMI was present in 41% of males compared to 27% of females (p < .001). In the male cohort, when adjusted for age and MELD, sarcopeniaPMI (aHR 1.74, 95% CI 1.08-2.80) and RFH-GA (aHR 1.40, 95% CI 1.03-1.90) remained independent predictors of mortality. Adipose tissue had no impact on outcomes in males. In female patients, adipose tissue (TATI or VATI depending on the multivariable model) was independently associated with mortality, whereas sarcopenia and malnutrition were not. CONCLUSIONS This study demonstrates that male patients were susceptible to low muscle mass, whereas female patients were not. Future research in this patient population should minimize sex-related bias and present data for both groups separately.
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Affiliation(s)
- Amine Benmassaoud
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Canada
- The Royal Free Sheila Sherlock Liver Centre, Royal Free London NHS Trust, London, UK
- UCL Institute for Liver and Digestive Health, University College of London, London, UK
| | - Davide Roccarina
- The Royal Free Sheila Sherlock Liver Centre, Royal Free London NHS Trust, London, UK
- UCL Institute for Liver and Digestive Health, University College of London, London, UK
| | - Francesco Marcello Arico
- The Royal Free Sheila Sherlock Liver Centre, Royal Free London NHS Trust, London, UK
- UCL Institute for Liver and Digestive Health, University College of London, London, UK
| | - Marta Cilla
- The Royal Free Sheila Sherlock Liver Centre, Royal Free London NHS Trust, London, UK
- UCL Institute for Liver and Digestive Health, University College of London, London, UK
| | - Rossella Donghia
- National Institute of Gastroenterology, S. De Bellis Research Hospital, Castellana Grotte, Italy
| | - Gioacchino Leandro
- National Institute of Gastroenterology, S. De Bellis Research Hospital, Castellana Grotte, Italy
| | - Laura Iogna Prat
- The Royal Free Sheila Sherlock Liver Centre, Royal Free London NHS Trust, London, UK
- UCL Institute for Liver and Digestive Health, University College of London, London, UK
| | - Mohamed Zuhair
- The Royal Free Sheila Sherlock Liver Centre, Royal Free London NHS Trust, London, UK
| | - Matthew North
- The Royal Free Sheila Sherlock Liver Centre, Royal Free London NHS Trust, London, UK
| | - Orla Kearney
- The Royal Free Sheila Sherlock Liver Centre, Royal Free London NHS Trust, London, UK
| | - John Ryan
- Hepatology Unit, Beaumont Hospital / Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Emmanuel A Tsochatzis
- The Royal Free Sheila Sherlock Liver Centre, Royal Free London NHS Trust, London, UK
- UCL Institute for Liver and Digestive Health, University College of London, London, UK
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28
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Ten Cate C, Huijs SMH, Willemsen ACH, Pasmans RCOS, Eekers DBP, Zegers CML, Ackermans L, Beckervordersandforth J, van Raak EPM, Anten MHME, Hoeben A, Postma AA, Broen MPG. Correlation of reduced temporal muscle thickness and systemic muscle loss in newly diagnosed glioblastoma patients. J Neurooncol 2022; 160:611-618. [PMID: 36394717 PMCID: PMC9758090 DOI: 10.1007/s11060-022-04180-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/21/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE Reduced temporal muscle thickness (TMT) has recently been postulated as a prognostic imaging marker and an objective tool to assess patients frailty in glioblastoma. Our aim is to investigate the correlation of TMT and systemic muscle loss to confirm that TMT is an adequate surrogate marker of sarcopenia in newly diagnosed glioblastoma patients. METHODS TMT was assessed on preoperative MR-images and skeletal muscle area (SMA) was assessed at the third lumbar vertebra on preoperative abdominal CT-scans. Previous published TMT sex-specific cut-off values were used to classify patients as 'patient at risk of sarcopenia' or 'patient with normal muscle status'. Correlation between TMT and SMA was assessed using Spearman's rank correlation coefficient. RESULTS Sixteen percent of the 245 included patients were identified as at risk of sarcopenia. The mean SMA of glioblastoma patients at risk of sarcopenia (124.3 cm2, SD 30.8 cm2) was significantly lower than the mean SMA of patients with normal muscle status (146.3 cm2, SD 31.1 cm2, P < .001). We found a moderate association between TMT and SMA in the patients with normal muscle status (Spearman's rho 0.521, P < .001), and a strong association in the patients at risk of sarcopenia (Spearman's rho 0.678, P < .001). CONCLUSION Our results confirm the use of TMT as a surrogate marker of total body skeletal muscle mass in glioblastoma, especially in frail patients at risk of sarcopenia. TMT can be used to identify patients with muscle loss early in the disease process, which enables the implementation of adequate intervention strategies.
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Affiliation(s)
- Cecil Ten Cate
- Master of Science in Medicine and Clinical Research, Maastricht University, Maastricht, The Netherlands
| | - Sandra M H Huijs
- Department of Neurology Zuyderland Medical Center, Heerlen, The Netherlands
| | - Anna C H Willemsen
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Daniëlle B P Eekers
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Catharina M L Zegers
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Linda Ackermans
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jan Beckervordersandforth
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Department of Pathology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Elisabeth P M van Raak
- Department of Neurology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Monique H M E Anten
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Department of Neurology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Ann Hoeben
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Alida A Postma
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Martinus P G Broen
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands.
- Department of Neurology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
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29
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Beumer BR, van Vugt JLA, Sapisochin G, Yoon P, Bongini M, Lu D, Xu X, De Simone P, Pintore L, Golse N, Nowosad M, Bennet W, Tsochatzis E, Koutli E, Abbassi F, Claasen MPAW, Merli M, O'Rourke J, Gambato M, Benito A, Majumdar A, Tan EK, Ebadi M, Montano-Loza AJ, Berenguer M, Metselaar HJ, Polak WG, Mazzaferro V, IJzermans JNM, Salinas‐Miranda E, Bhoori S, Rossi P, Remiszewski P, Korzeniowski K, Arico F, Toso C, Ferri F, Shah T, Puchades L, Herreras J, De Man RA, Van Klaveren D. Impact of muscle mass on survival of patients with hepatocellular carcinoma after liver transplantation beyond the Milan criteria. J Cachexia Sarcopenia Muscle 2022; 13:2373-2382. [PMID: 36622940 PMCID: PMC9530497 DOI: 10.1002/jcsm.13053] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/31/2022] [Accepted: 06/25/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Access to the liver transplant waitlist for patients with hepatocellular carcinoma (HCC) depends on tumour presentation, biology, and response to treatments. The Milan Criteria (MC) represent the benchmark for expanded criteria that incorporate additional prognostic factors. The purpose of this study was to determine the added value of skeletal muscle index (SMI) in HCC patients beyond the MC. METHOD Patients with HCC that were transplanted beyond the MC were included in this retrospective multicentre study. SMI was quantified using the Computed Tomography (CT) within 3 months prior to transplantation. Cox regression models were used to identify predictors of overall survival (OS). The discriminative performance of SMI extended Metroticket 2.0 and AFP models was also assessed. RESULTS Out of 889 patients transplanted outside the MC, 528 had a CT scan within 3 months prior to liver transplantation (LT), of whom 176 (33%) were classified as sarcopenic. The median time between assessment of the SMI and LT was 1.8 months (IQR: 0.77-2.67). The median follow-up period was 5.1 95% CI [4.7-5.5] years, with a total of 177 recorded deaths from any cause. In a linear regression model with SMI as the dependent variable, only male gender (8.55 95% CI [6.51-10.59], P < 0.001) and body mass index (0.74 95% CI [0.59-0.89], P < 0.001) were significant. Univariable survival analysis of patients with sarcopenia versus patients without sarcopenia showed a significant difference in OS (HR 1.44 95% CI [1.07 - 1.94], P = 0.018). Also the SMI was significant (HR 0.98 95% CI [0.96-0.99], P = 0.014). The survival difference between the lowest SMI quartile versus the highest SMI quartile was significant (log-rank: P = 0.005) with 5 year OS of 57% and 71%, respectively. Data from 423 patients, describing 139 deaths, was used for multivariate analysis. Both sarcopenia (HR 1.45 95% CI [1.02 - 2.05], P = 0.036) and SMI were (HR 0.98 95% CI [0.95-0.99], P = 0.035) significant. On the survival scale this translates to a 5 year OS difference of 11% between sarcopenia and no sarcopenia. Whereas for SMI, this translates to a survival difference of 8% between first and third quartiles for both genders. CONCLUSIONS Overall, we can conclude that higher muscle mass contributes to a better long-term survival. However, for individual patients, low muscle mass should not be considered an absolute contra-indication for LT as its discriminatory performance was limited.
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Affiliation(s)
- Berend R Beumer
- Erasmus MC Transplant Institute, Department of Surgery, Division of HPB & Transplant Surgery, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Jeroen L A van Vugt
- Erasmus MC Transplant Institute, Department of Surgery, Division of HPB & Transplant Surgery, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Gonzalo Sapisochin
- Multi Organ Transplant Program, University Health Network, University of Toronto, Toronto, Canada
| | - Peter Yoon
- Multi Organ Transplant Program, University Health Network, University of Toronto, Toronto, Canada.,Department of Surgery, Westmead Hospital, Sydney, Australia
| | - Marco Bongini
- Gastrointestinal Surgery and Liver Transplantation, National Cancer Institute of Milan, Department of Oncology, University of Milan, Milan, Italy
| | - Di Lu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiao Xu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Paolo De Simone
- Hepatobiliary Surgery and Liver Transplantation, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Lorenzo Pintore
- Hepatobiliary Surgery and Liver Transplantation, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Nicolas Golse
- Centre Hépato-Biliaire, Hôpital Paul Brousse, Université Paris-Sud, Villejuif, France
| | - Malgorzata Nowosad
- Department of General Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - William Bennet
- Transplant Institute, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg, Sweden
| | - Emmanouil Tsochatzis
- Royal Free Sheila Sherlock Liver Centre, Royal Free Hospital and UCL Institute of Liver and Digestive Health, London, UK
| | - Evangelia Koutli
- Royal Free Sheila Sherlock Liver Centre, Royal Free Hospital and UCL Institute of Liver and Digestive Health, London, UK
| | - Fariba Abbassi
- Division of Digestive Surgery, University Hospitals of Geneva, Genève, Switzerland
| | - Marco P A W Claasen
- Erasmus MC Transplant Institute, Department of Surgery, Division of HPB & Transplant Surgery, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Multi Organ Transplant Program, University Health Network, University of Toronto, Toronto, Canada
| | - Manuela Merli
- Section of Gastroenterology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Joanne O'Rourke
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Martina Gambato
- Section of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Alberto Benito
- Section of Radiology, Clinica Universidad de Navarra, Pamplona, Spain
| | - Avik Majumdar
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | - Ek Khoon Tan
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - Maryam Ebadi
- Division of Gastroenterology and Liver Unit, Zeidler Ledcor Centre, University of Alberta, Edmonton, Canada
| | - Aldo J Montano-Loza
- Division of Gastroenterology and Liver Unit, Zeidler Ledcor Centre, University of Alberta, Edmonton, Canada
| | - Marina Berenguer
- Hepatology & Liver Transplantation Unit and Ciberehd and ISS La Fe, Hospital Universitario y Politécnico La Fe, University of Valencia, Valencia, Spain
| | - Herold J Metselaar
- Erasmus MC Transplant Institute, Department of Gastroenterology and Hepatology, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Wojciech G Polak
- Erasmus MC Transplant Institute, Department of Surgery, Division of HPB & Transplant Surgery, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Vincenzo Mazzaferro
- Gastrointestinal Surgery and Liver Transplantation, National Cancer Institute of Milan, Department of Oncology, University of Milan, Milan, Italy
| | - Jan N M IJzermans
- Erasmus MC Transplant Institute, Department of Surgery, Division of HPB & Transplant Surgery, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | | | - Emmanuel Salinas‐Miranda
- Joint Department of Medical Imaging, University Health Network Sinai Health System and University of Toronto Toronto Canada
| | - Sherrie Bhoori
- Gastrointestinal Surgery and Liver Transplantation, National Cancer Institute of Milan, Department of Oncology University of Milan Milan Italy
| | - Piercarlo Rossi
- Department of Radiology Azienda Ospedaliero‐Universitaria Pisana Pisa Italy
| | - Piotr Remiszewski
- Department of General, Endocrine and Transplant Surgery Medical University of Gdansk Gdansk Poland
| | - Krzysztof Korzeniowski
- Department of General Transplant and Liver Surgery Medical University of Warsaw Warsaw Poland
| | - Francesco Arico
- Royal Free Sheila Sherlock Liver Centre Royal Free Hospital and UCL Institute of Liver and Digestive Health London UK
| | - Christian Toso
- Division of Digestive Surgery University Hospitals of Geneva Genève Switzerland
| | - Flaminia Ferri
- Division of Digestive Surgery University Hospitals of Geneva Genève Switzerland
| | - Tahir Shah
- The Liver Unit Queen Elizabeth Hospital Birmingham Birmingham UK
| | - Lorena Puchades
- Hepatology & Liver Transplantation Unit and Ciberehd and ISS La Fe, Hospital Universitario y Politécnico La Fe University of Valencia Valencia Spain
| | - Julia Herreras
- Hepatology & Liver Transplantation Unit and Ciberehd and ISS La Fe, Hospital Universitario y Politécnico La Fe University of Valencia Valencia Spain
| | - Rob A. De Man
- Erasmus MC Transplant Institute, Department of Gastroenterology and Hepatology University Medical Centre Rotterdam Rotterdam The Netherlands
| | - David Van Klaveren
- Department of Public Health University Medical Centre Rotterdam Rotterdam The Netherlands
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30
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Miki M, Lee L, Hisano T, Sugimoto R, Furukawa M. Loss of adipose tissue or skeletal muscle during first-line gemcitabine/nab-paclitaxel therapy is associated with worse survival after second-line therapy of advanced pancreatic cancer. Asia Pac J Clin Oncol 2022; 18:e297-e305. [PMID: 34818466 PMCID: PMC9541259 DOI: 10.1111/ajco.13669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/17/2021] [Indexed: 12/18/2022]
Abstract
AIM Progression of cachexia indicated by decreased body weight and composition is associated with poor survival of advanced pancreatic cancer (APC). There are limited data concerning the prognostic effect of cachexia on second-line chemotherapy (L2). We aimed to assess the impact of cachexia progression during first-line therapy (L1) on survival after L2. METHODS We reviewed patients with gemcitabine/nab-paclitaxel (GEM/nabPTX)-refractory APC who underwent L2 with modified FOLFIRINOX or S-1 between 2015 and 2019 in our institution. We determined clinicopathological data including body composition parameters: subcutaneous fat area (SFA), visceral fat area (VFA), and skeletal muscle index (SMI). Correlations of changes in these parameters, as well as their effect on overall survival after L2 (OS2), were examined. RESULTS Median rates of change in SMI, SFA, and VFA were 0.19%, -4.17%, and -18.39%, respectively, in 59 patients during L1. Although there was moderate correlation in rate of change between SFA and VFA, there was no correlation between SMI and other parameters. We defined loss of SFA, VFA, and SMI as decreases greater than 8.5%, 34.1%, and 8.7%, respectively. Median OS2 of patients with loss in any of these parameters was significantly shorter than in patients without loss (3.83 vs. 8.73 months). Multivariate analysis revealed that loss in any parameters, performance status, and C-reactive protein/albumin ratio were independent negative prognostic factors. CONCLUSION Loss of adipose tissue or skeletal muscle during L1 had a considerable impact on OS2 in APC refractory to GEM/nabPTX.
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Affiliation(s)
- Masami Miki
- Department of Hepato‐Biliary‐PancreatologyNational Hospital Organization Kyushu Cancer CenterFukuokaJapan
| | - Lingaku Lee
- Department of Hepato‐Biliary‐PancreatologyNational Hospital Organization Kyushu Cancer CenterFukuokaJapan
| | - Terumasa Hisano
- Department of Hepato‐Biliary‐PancreatologyNational Hospital Organization Kyushu Cancer CenterFukuokaJapan
| | - Rie Sugimoto
- Department of Hepato‐Biliary‐PancreatologyNational Hospital Organization Kyushu Cancer CenterFukuokaJapan
| | - Masayuki Furukawa
- Department of Hepato‐Biliary‐PancreatologyNational Hospital Organization Kyushu Cancer CenterFukuokaJapan
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Ogon I, Teramoto A, Takashima H, Terashima Y, Yoshimoto M, Emori M, Iba K, Takebayashi T, Yamashita T. Associations between visceral fat chronic low back pain and central sensitization in patients with lumbar spinal stenosis. J Back Musculoskelet Rehabil 2022; 35:1035-1041. [PMID: 35213342 DOI: 10.3233/bmr-210124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Pain sensitization may be one of the mechanisms contributing to chronic low back pain (CLBP). OBJECTIVE To evaluate the association between visceral fat, CLBP, and central sensitization (CS); describe the relationship between low back pain (LBP) intensity and CS; and identify possible correlation between visceral fat and LBP intensity. METHODS Patients with CLBP were divided using their CS inventory (CSI) scores into low- (CSI < 40) and high-CSI (CSI ⩾ 40) subgroups. We compared computed tomography (CT) measurements and scores for association with pain according to the visual analogue scale (VAS) between the two groups. RESULTS The low-CSI and the high-CSI groups had 47 patients (67.1%; 21 men, 26 women) and 23 patients (32.9%; 11 men and 12 women), respectively. The high-CSI group had a significantly higher mean VAS score (p< 0.01) and estimated mean visceral fat area (p< 0.05) than the low-CSI group. There was a moderate positive correlation between VAS score and visceral fat (standardised partial regression coefficient: 0.659, p< 0.01) in the high-CSI group according to multiple linear regression analysis adjusted for age and sex. CONCLUSIONS Visceral fat is associated with CLBP, regardless of sex or age, and may be a potential therapeutic target for CLBP with CS.
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Affiliation(s)
- Izaya Ogon
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiroyuki Takashima
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yoshinori Terashima
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Mitsunori Yoshimoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Makoto Emori
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kousuke Iba
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tsuneo Takebayashi
- Department of Orthopaedic Surgery, Sapporo Maruyama Orthopaedic Hospital, Sapporo, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
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Wang Y, Wang Y, Li G, Zhang H, Yu H, Xiang J, Wang Z, Jiang X, Yan G, Liu Y, Wang C, Xiong H, Wang G, Shi H, Liu M. Associations of intermuscular adipose tissue and total muscle wasting score in PG-SGA with low muscle radiodensity and mass in nonmetastatic colorectal cancer: A two-center cohort study. Front Nutr 2022; 9:967902. [PMID: 36091250 PMCID: PMC9452825 DOI: 10.3389/fnut.2022.967902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundsThe patient-generated subjective global assessment (PG-SGA) is one of the screening criteria for malnutrition, the skeletal muscle radiodensity (SMD) and skeletal muscle mass index (SMI) are associated with survival in colorectal cancer patients. Body composition parameters can be easily assessed; however, few studies have examined the association between total muscle wasting scores in PG-SGA and body composition parameters and two muscle abnormalities.MethodsThis cohort study included 1,637 stage I-III CRC patients from 2 clinical centers in China, who were enrolled in the training cohort (n = 1,005) and validation cohort (n = 632). Baseline data were collected prospectively from patients including age, BMI, staging, gait speed, hand grip strength (HGS), peak expiratory flow (PEF), neutrophil-lymphocyte ratio (NLR), intermuscular adipose tissue (IMAT), visceral fat area (VFA) and total muscle wasting score in PG-SGA. Relevant risk factors were subjected to logistic regression analysis and Cox regression analysis to identify characteristics associated with muscle abnormalities and survival. Based on the logistic model results, normograms were established to predict muscle abnormalities, and its discrimination and calibration were assessed using the receiver operating characteristic (ROC) curve and calibration curve. The Kaplan-Meier curves were used to assess the survival of colorectal cancer patients with malnutrition or sarcopenia in an inflammatory state (assessed by NLR).ResultsThe mean age of all participants was 57.7 ± 10.6 years (56.9% males) and the prevalence of low SMD and low SMI was 32.2 and 39.5%, respectively. Low SMD rate was significantly associated with age, TNM stage, BMI, IMAT, walking speed, total muscle wasting score and NRS2002 score by logistic regression analysis (p < 0.05). Low SMI rate was significantly correlated with age, NLR, BMI, PEF, handgrip strength, calf circumference, walking speed, total muscle wasting score and NRS2002 score (p < 0.05). The AUCs of the diagnostic nomograms were 0.859 (95% CI, 0.831–0.886) for low SMD and 0.843 (95% CI, 0.813–0.871) for low SMI in the validation cohort. We also found that patients with colorectal cancer with malnutrition or sarcopenia had a worse prognosis when NLR ≥3.5.ConclusionMuscle abnormalities and malnutrition are strongly associated with mortality in patients with non-metastatic colorectal cancer. Early identification and intervention of the associated risk factors may offer new ways to improve patient prognosis.
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Affiliation(s)
- Yang Wang
- Cancer Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yuliuming Wang
- Cancer Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guodong Li
- Department of General Surgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hao Zhang
- Cancer Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hang Yu
- Cancer Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jun Xiang
- Cancer Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zitong Wang
- Cancer Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xia Jiang
- Cancer Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guoqing Yan
- Cancer Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yunxiao Liu
- Cancer Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Chunlin Wang
- Cancer Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Huan Xiong
- Cancer Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guiyu Wang
- Cancer Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hanping Shi
- Departments of Gastrointestinal Surgery and Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Ming Liu
- Cancer Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- *Correspondence: Ming Liu
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Tram NK, Chou TH, Ettefagh LN, Deep K, Bobbey AJ, Audino AN, Stacy MR. Quantification of chemotherapy-induced changes in body composition in pediatric, adolescent, and young adult lymphoma using standard of care CT imaging. Eur Radiol 2022; 32:7270-7277. [PMID: 35947147 DOI: 10.1007/s00330-022-09048-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: 01/27/2022] [Revised: 05/17/2022] [Accepted: 07/13/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objective of this study was to use computed tomography (CT) imaging to quantify chemotherapy-induced changes in body composition (BC) in pediatric, adolescent, and young adult (AYA) patients with lymphoma and to compare image-derived changes in BC measures to changes in traditional body mass index (BMI) measures. METHODS Skeletal muscle (SkM), subcutaneous adipose tissue (SAT), and visceral adipose tissue (VAT) volumes were manually segmented using low-dose CT images acquired from a 10-year retrospective, single-site cohort of 110 patients with lymphoma. CT images and BMI percentiles (BMI%) were acquired from baseline and first therapeutic follow-up. CT image segmentation was performed at vertebral level L3 using 5 consecutive axial CT images. RESULTS CT imaging detected significant treatment-induced changes in BC measures from baseline to first follow-up time points, with SAT and VAT significantly increasing and SkM significantly decreasing. BMI% measures did not change from baseline to first follow-up and were not significantly correlated with changes in image-derived BC measures. Patients who were male, younger than 12 years old, diagnosed with non-Hodgkin's lymphoma, and presented with stage 3 or 4 disease gained more adipose tissue and lost more SkM in response to the first cycle of treatment compared to their clinical counterparts. CONCLUSIONS Standard of care CT imaging can quantify treatment-induced changes in BC that are not reflected by traditional BMI assessment. Image-based monitoring of BC parameters may offer personalized approaches to lymphoma treatment for pediatric and AYA patients by guiding cancer treatment recommendations and subsequently enhance clinical outcomes. KEY POINTS • Standard of care low-dose CT imaging quantifies chemotherapy-induced changes in body composition in pediatric, adolescent, and young adults with lymphoma. • Body mass index could not detect changes in body composition during treatment that were quantified by CT imaging. • Pediatric and AYA patients who were male, younger than 12 years old, and diagnosed with non-Hodgkin's lymphoma, and presented with stage 3 or 4 disease gained more adipose tissue and lost more skeletal muscle tissue in response to the first cycle of treatment compared to their clinical counterparts.
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Affiliation(s)
- Nguyen K Tram
- Center for Regenerative Medicine, The Research Institute at Nationwide Children's Hospital, 575 Children's Crossroad, WB4131, Columbus, OH, 43215, USA
| | - Ting-Heng Chou
- Center for Regenerative Medicine, The Research Institute at Nationwide Children's Hospital, 575 Children's Crossroad, WB4131, Columbus, OH, 43215, USA
| | - Laila N Ettefagh
- Center for Regenerative Medicine, The Research Institute at Nationwide Children's Hospital, 575 Children's Crossroad, WB4131, Columbus, OH, 43215, USA
| | - Kyra Deep
- Center for Regenerative Medicine, The Research Institute at Nationwide Children's Hospital, 575 Children's Crossroad, WB4131, Columbus, OH, 43215, 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
| | - Mitchel R Stacy
- Center for Regenerative Medicine, The Research Institute at Nationwide Children's Hospital, 575 Children's Crossroad, WB4131, Columbus, OH, 43215, USA.
- Division of Vascular Surgery and Diseases, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA.
- Interdisciplinary Biophysics Graduate Program, The Ohio State University, Columbus, OH, USA.
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Visceral Obesity in Non-Small Cell Lung Cancer. Cancers (Basel) 2022; 14:cancers14143450. [PMID: 35884508 PMCID: PMC9315749 DOI: 10.3390/cancers14143450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 02/04/2023] Open
Abstract
While obesity measured by body mass index (BMI) has been paradoxically associated with reduced risk and better outcome for lung cancer, recent studies suggest that the harm of obesity becomes apparent when measured as visceral adiposity. However, the prevalence of visceral obesity and its associations with demographic and tumor features are not established. We therefore conducted an observational study of visceral obesity in 994 non-small cell lung cancer (NSCLC) patients treated during 2008-2020 at our institution. Routine computerized tomography (CT) images of the patients, obtained within a year of tumor resection or biopsy, were used to measure cross-sectional abdominal fat areas. Important aspects of the measurement approach such as inter-observer variability and time stability were examined. Visceral obesity was semi-quantified as visceral fat index (VFI), the fraction of fat area that was visceral. VFI was found to be higher in males compared to females, and in former compared to current or never smokers. There was no association of VFI with tumor histology or stage. A gene expression-based measure of tumor immunogenicity was negatively associated with VFI but had no bearing with BMI. Visceral obesity is appraisable in routine CT and can be an important correlate in lung cancer studies.
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Preoperative Body Composition Combined with Tumor Metabolism Analysis by PET/CT Is Associated with Disease-Free Survival in Patients with NSCLC. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:7429319. [PMID: 35935304 PMCID: PMC9300276 DOI: 10.1155/2022/7429319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/08/2022] [Accepted: 06/14/2022] [Indexed: 11/17/2022]
Abstract
Objective. To evaluate the relationship between preoperative primary tumor metabolism and body composition in patients with NSCLC and analyze their effects on DFS. Method. A retrospective study was conducted on 154 patients with NSCLC. All patients were scanned by baseline 18F-FDG PET/CT. SUVmax (maximum standard uptake value) of primary tumor, liver SUVmean (mean standard uptake value), and spleen SUVmean were measured by AW workstation. The skeletal muscle area (SMA), skeletal muscle mass index (SMI), skeletal muscle radiation density (SMD), visceral fat area (VFA), visceral adipose tissue index (VATI), and skeletal muscle visceral fat ratio (SVR) were measured by ImageJ software. Kaplan–Meier survival analysis was used to evaluate the impact of the above parameters on DFS. Results. Compared with the low SUVmax group of primary tumors, the mean values of SMA, VFA, and VATI in the high SUVmax group were significantly higher. In addition, there were obvious differences in histopathological type, pathological differentiation, AJCC stage, and T stage between the two groups. Univariate analysis of DFS showed that VFA, VATI, pathological differentiation, tumor SUVmax, AJCC stage, tumor T stage, and N stage all affected the DFS of patients except for the parameters reflecting skeletal muscle content. Multivariate regression analysis showed that only VFA and SUVmax were associated with DFS. Kaplan–Meier survival analysis showed that high SUVmax, low VFA, high T stage, and high N stage were related to the decrease of DFS. Conclusion:Preoperative 18F-FDG PET/CT could comprehensively evaluate the primary tumor SUVmax, skeletal muscle, and visceral fat in patients with NSCLC. The combination of primary tumor SUVmax and visceral fat area can well evaluate the prognosis of patients with NSCLC.
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Relationship between the creatinine/cystatin C ratio and muscle mass measured by CT-scan in cancer patients. Clin Nutr ESPEN 2022; 51:412-418. [DOI: 10.1016/j.clnesp.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 07/19/2022] [Indexed: 11/19/2022]
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Chargi N, Bril SI, Smid EJ, de Jong PA, de Bree R. Cut-off values for low skeletal muscle mass at the level of the third cervical vertebra (C3) in patients with head and neck cancer. Quant Imaging Med Surg 2022; 12:3024-3033. [PMID: 35655816 PMCID: PMC9131345 DOI: 10.21037/qims-21-911] [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: 09/11/2021] [Accepted: 01/19/2022] [Indexed: 11/19/2023]
Abstract
BACKGROUND Low skeletal muscle mass is associated with adverse outcomes in patients with cancer. For patients with head and neck cancer (HNC), skeletal muscle mass is often assessed at the third cervical vertebra on head and neck imaging. Due to the unavailability of standardized cut-off values for low skeletal muscle mass in patients with head and cancer, there is heterogeneousness of cut-off values for low skeletal muscle mass described in literature. Therefore, we aim to provide standardized cut-off values for low skeletal muscle mass in HNC patients. METHODS A retrospective cohort study was performed. Between 2008 and 2018, HNC patients with head and neck imaging were included. Skeletal muscle area (SMA) was manually delineated at the level of the third cervical vertebra and corrected for patients squared height to obtain the cervical skeletal muscle mass index. Gender and body-mass index specific cut-off values for low skeletal muscle mass were calculated based on mean cervical skeletal muscle mass index minus 2 standard deviations as suggested in literature. RESULTS Of the 1,415 included patients, the majority was male (69.8%) and had a body mass index below 25 kg/m2 (59.2%). A primary tumor localization in the oropharynx (35.3%) and a tumor, node, metastasis stage IV tumor (60.5%) were most frequently observed. Cervical skeletal muscle mass index was significantly correlated with gender (r2=0.4, P<0.01) and body mass index (r2=0.4, P<0.01). For male patients with a body mass index <25 and ≥25 kg/m2, a cervical skeletal muscle mass index of respectively ≤6.8 and ≤8.5 cm2/m2 was defined for low skeletal muscle mass. For female patients with a body mass index <25 and ≥25 kg/m2, a cervical skeletal muscle mass index of respectively ≤5.3 and ≤6.4 cm2/m2 was defined for low skeletal muscle mass. CONCLUSIONS This study is the first to provide standardized cut-off values for low skeletal muscle mass at the level of the third cervical vertebra in patients with HNC. This information may aid in the uniformity of low skeletal muscle mass definition in research.
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Affiliation(s)
- Najiba Chargi
- Department of Head and Neck Surgical Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sandra I. Bril
- Department of Head and Neck Surgical Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ernst J. Smid
- Department of Radiation Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pim A. de Jong
- Department of Radiology and Nuclear Medicine, Division of Imaging and Oncology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
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CT-Derived Body Composition Assessment as a Prognostic Tool in Oncologic Patients: From Opportunistic Research to Artificial Intelligence-Based Clinical Implementation. AJR Am J Roentgenol 2022; 219:671-680. [PMID: 35642760 DOI: 10.2214/ajr.22.27749] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
CT-based body composition measures are well established in research settings as prognostic markers in oncologic patients. Numerous retrospective studies have shown the role of objective measurements extracted from abdominal CT images of skeletal muscle, abdominal fat, and bone mineral density in providing more accurate assessments of frailty and cancer cachexia in comparison with traditional clinical methods. Quantitative CT-based measurements of liver fat and aortic atherosclerotic calcification have received relatively less attention in cancer care but also provide prognostic information. Patients with cancer routinely undergo serial CT scans for staging, treatment response, and surveillance, providing the opportunity for performing quantitative body composition assessment as part of routine clinical care. The emergence of fully automated artificial intelligence-based segmentation and quantification tools to replace earlier time-consuming manual and semi-automated methods for body composition analysis will allow these opportunistic measures to transition from the research realm to clinical practice. With continued investigation, the measurements may ultimately be applied to achieve more precise risk stratification as a component of personalized oncologic care.
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Dietz MV, van Kooten JP, van Vugt JLA, Brandt-Kerkhof ARM, Verhoef C, Madsen EVE. The Impact of Low Skeletal Muscle Mass on Short- and Long-Term Outcomes After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 2022; 29:5830-5841. [PMID: 35650370 PMCID: PMC9356922 DOI: 10.1245/s10434-022-11941-2] [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: 11/29/2021] [Accepted: 05/10/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is a potentially curative treatment for peritoneal metastases from colorectal cancer (CRC) or pseudomyxoma peritonei (PMP). Because of the considerable morbidity of this treatment, optimal patient selection is key. This study aimed to assess the impact of low skeletal muscle mass (SMM) on outcomes after CRS-HIPEC. METHODS Patients who underwent CRS-HIPEC between 2014 and 2020 at a tertiary center were included. SMM was measured on computed tomography by means of the L3 muscle index. Postoperative complications and survival outcomes were compared between groups by use of logistic regression and Kaplan-Meier survival analyses. RESULTS Of 284 included patients, 149 had low SMM. Occurrence of severe postoperative complications did not differ between groups (28.9% for patients with low vs. 34.1% for patients with normal SMM). Low SMM was not associated with postoperative complications (p = 0.344). For CRC patients, no significant differences were observed in disease-free (DFS) or overall survival (OS) between patients with low (median DFS 7 months [IQR 4-14], median OS 33 months [IQR 14-NR]) and patients with normal SMM (median DFS 8 months [IQR 5-20], median OS 35 months [IQR 18-NR]). Regarding PMP, survival outcomes did not significantly differ between groups (3-year DFS 47.3% for patients with low SMM vs. 54.5% for patients with normal SMM, p = 0.676; 3-year OS 70.8% vs. 90.9% respectively, p = 0.172). CONCLUSIONS Low SMM could not be identified as a predictor of severe complications or survival outcomes after CRS-HIPEC.
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Affiliation(s)
- Michelle V Dietz
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | - Job P van Kooten
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Jeroen L A van Vugt
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Eva V E Madsen
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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Wang PH, Gow CH, Chiu YL, Li TC. Determination of Low Muscle Mass by Muscle Surface Index of the First Lumbar Vertebra Using Low-Dose Computed Tomography. J Clin Med 2022; 11:jcm11092429. [PMID: 35566554 PMCID: PMC9103630 DOI: 10.3390/jcm11092429] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 04/23/2022] [Accepted: 04/25/2022] [Indexed: 11/16/2022] Open
Abstract
The muscle index of the first vertebra (L1MI) derived from computed tomography (CT) is an indicator of total skeletal muscle mass. Nevertheless, the cutoff value and utility of L1MI derived from low-dose chest CT (LDCT) remain unclear. Adults who received LDCT for health check-ups in 2017 were enrolled. The cutoff values of L1MI were established in subjects aged 20-60 years. The cutoff values were used in chronic obstructive pulmonary disease (COPD) patients to determine muscle quantity. A total of 1780 healthy subjects were enrolled. Subjects (n = 1393) aged 20-60 years were defined as the reference group. The sex-specific cutoff values of L1MI were 26.2 cm2/m2 for males and 20.9 cm2/m2 for females. Six subjects in the COPD group (6/44, 13.6%) had low L1MI. COPD subjects with low L1MI had lower forced expiratory volume in one second (0.81 ± 0.17 vs. 1.30 ± 0.55 L/s, p = 0.046) and higher COPD assessment test scores (19.5 ± 2.6 vs. 15.0 ± 4.9, p = 0.015) than those with normal L1MI. In conclusion, LDCT in health assessments may provide additional information on sarcopenia.
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Affiliation(s)
- Ping-Huai Wang
- Division of Pulmonology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan;
- Department of Nursing, Asia Eastern University of Science and Technology, New Taipei City 220, Taiwan
| | - Chien-Hung Gow
- Division of Pulmonology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan;
- Department of Healthcare Information and Management, Ming-Chuan University, Taoyuan 333, Taiwan
- Correspondence: ; Tel.: +886-2-772815
| | - Yen-Ling Chiu
- Graduate Institute of Medicine and Graduate Program in Biomedical Informatics, Yuan Ze University, Taoyuan 320, Taiwan;
- Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Tien-Chi Li
- Department of Radiology, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan;
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Visceral Adipose Tissue Influence on Health Problem Development and Its Relationship with Serum Biochemical Parameters in Middle-Aged and Older Adults: A Literature Review. J Aging Res 2022; 2022:8350527. [PMID: 35492380 PMCID: PMC9042620 DOI: 10.1155/2022/8350527] [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: 07/02/2021] [Revised: 08/28/2021] [Accepted: 03/29/2022] [Indexed: 11/24/2022] Open
Abstract
Background The amount of visceral adipose tissue (VAT) tends to increase with age and is associated with several health problems, such as cardiometabolic diseases, increased infections, and overall mortality. Objectives This review provides a general assessment of how visceral adiposity correlates with the development of health problems and changes in serum biochemical parameters in middle-aged and older adults. Methods We searched specific terms in the Virtual Health Library (VHL) databases for VAT articles published in the English language between 2009 and 2019 related to older adults. Results The search found twenty-three publications in this period, of which nine were excluded. The publications had a population aged between 42 and 83 years and correlated the VAT area ratio with several comorbidities (such as pancreatitis, depression, cancer, and coronary heart disease) and serum biochemical parameters. Conclusion Further research on the association between visceral obesity and the emergence of health problems and the relationship between VAT and changes in serum biochemical parameters in older individuals should deepen the understanding of this connection and develop preventive actions.
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Sarcopenia in Children with Solid Organ Tumors: An Instrumental Era. Cells 2022; 11:cells11081278. [PMID: 35455957 PMCID: PMC9024674 DOI: 10.3390/cells11081278] [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: 02/04/2022] [Revised: 03/22/2022] [Accepted: 04/05/2022] [Indexed: 11/17/2022] Open
Abstract
Sarcopenia has recently been studied in both adults and children and was found to be a prognostic marker for adverse outcome in a variety of patient groups. Our research showed that sarcopenia is a relevant marker in predicting outcome in children with solid organ tumors, such as hepatoblastoma and neuroblastoma. This was especially true in very ill, high-risk groups. Children with cancer have a higher likelihood of ongoing loss of skeletal muscle mass due to a mismatch in energy intake and expenditure. Additionally, the effects of cancer therapy, hormonal alterations, chronic inflammation, multi-organ dysfunction, and a hypermetabolic state all contribute to a loss of skeletal muscle mass. Sarcopenia seems to be able to pinpoint this waste to a high degree in a new and objective way, making it an additional tool in predicting and improving outcome in children. This article focuses on the current state of sarcopenia in children with solid organ tumors. It details the pathophysiological mechanisms behind sarcopenia, highlighting the technical features of the available methods for measuring muscle mass, strength, and function, including artificial intelligence (AI)-based techniques. It also reviews the latest research on sarcopenia in children, focusing on children with solid organ tumors.
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Low skeletal muscle index and myosteatosis as predictors of mortality in critically ill surgical patients. Nutrition 2022; 101:111687. [DOI: 10.1016/j.nut.2022.111687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/15/2022] [Accepted: 04/04/2022] [Indexed: 11/16/2022]
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Monaco-Ferreira DV, Magro DO, Coy CSR. Evaluation of different tools for body composition assessment in colorectal cancer - a systematic review. ARQUIVOS DE GASTROENTEROLOGIA 2022; 59:296-303. [PMID: 35830044 DOI: 10.1590/s0004-2803.202202000-52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/28/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The nutritional status of patients with colorectal cancer (CRC) impacts on treatment response and morbidity. An effective evaluation of the body composition includes the measurements of fat and visceral fat-free mass and is currently being used in the diagnosis of the nutritional status. The better understanding regarding nutritional tools for body composition evaluation in CRC patients may impact on the outcome. METHODS Systematic review conducted according to Preferred Items of Reports for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A literature search was performed using the BVS (LILACS), PubMed, Embase, Cochrane, Scopus, and Web of Science databases. RESULTS For the initial search, 97 studies were selected and 51 duplicate manuscripts were excluded. Thus, 46 were reviewed and seven studies included with a total of 4,549 patients. Among them were one clinical trial, one prospective study (cohort), two retrospective cohort and two cross-sectional studies. All studies included body composition evaluated by computed tomography, one with bioelectrical impedance, one with handgrip strength, and two employed mid-arm muscle circumference and body mass index. CONCLUSION Current evidence suggests that computed tomography has better accuracy in the diagnosis of sarcopenia, visceral fat, and myopenia among individuals with CRC. Further studies are needed to identify cutoff points for these changes aggravated by CRC.
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Aziz MH, van Dongen JC, Saida L, Suker M, van Vugt JLA, van Putten Y, Sideras K, Groen JV, Mieog JSD, Lucassen CJ, Droop A, Mauff K, Shahbazi Feshtali S, Groot Koerkamp B, Mustafa DAM, van Eijck CJ. High Systemic Immune Inflammation Index Is Associated With Low Skeletal Muscle Quantity in Resectable Pancreatic Ductal Adenocarcinoma. Front Oncol 2022; 12:827755. [PMID: 35296013 PMCID: PMC8919513 DOI: 10.3389/fonc.2022.827755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/02/2022] [Indexed: 12/12/2022] Open
Abstract
Background and Aims Failing immune surveillance in pancreatic ductal adenocarcinoma (PDAC) is related to poor prognosis. PDAC is also characterized by its substantial alterations to patients’ body composition. Therefore, we investigated associations between the host systemic immune inflammation response and body composition in patients with resected PDAC. Methods Patients who underwent a pancreatectomy for PDAC between 2004 and 2016 in two tertiary referral centers were included. Skeletal muscle mass quantity and muscle attenuation, as well as subcutaneous and visceral adipose tissue at the time of diagnosis, were determined by CT imaging measured transversely at the third lumbar vertebra level. Baseline clinicopathological characteristics, laboratory values including the systemic immune inflammation index (SIII), postoperative, and survival outcomes were collected. Results A total of 415 patients were included, and low skeletal muscle mass quantity was found in 273 (65.7%) patients. Of the body composition indices, only low skeletal muscle mass quantity was independently associated with a high (≥900) SIII (OR 7.37, 95% CI 2.31-23.5, p=0.001). The SIII was independently associated with disease-free survival (HR 1.86, 95% CI 1.12-3.04), and cancer-specific survival (HR 2.21, 95% CI 1.33-3.67). None of the body composition indices were associated with survival outcomes. Conclusion This study showed a strong association between preoperative low skeletal muscle mass quantity and elevated host systemic immune inflammation in patients with resected PDAC. Understanding how systemic inflammation may contribute to changes in body composition or whether reversing these changes may affect the host systemic immune inflammation response could expose new therapeutic possibilities for improving patients’ survival outcomes.
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Affiliation(s)
- Mohammad Hosein Aziz
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Jelle C van Dongen
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Lawlaw Saida
- Department of Pathology, The Tumor Immuno-Pathology Laboratory, Erasmus, University Medical Center, Rotterdam, Netherlands
| | - Mustafa Suker
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Jeroen L A van Vugt
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Yordi van Putten
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Kostandinos Sideras
- Divisions of Medical Oncology and Hematology, Mayo Clinic, Rochester, MN, United States
| | - Jesse V Groen
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - J Sven D Mieog
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Claudia J Lucassen
- Department of Dietetics, Leiden University Medical Center, Leiden, Netherlands
| | - Anneke Droop
- Department of Dietetics, Leiden University Medical Center, Leiden, Netherlands
| | - Katya Mauff
- Department of Biostatistics, Erasmus University Medical Centre, Rotterdam, Netherlands
| | | | - Bas Groot Koerkamp
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Dana A M Mustafa
- Department of Pathology, The Tumor Immuno-Pathology Laboratory, Erasmus, University Medical Center, Rotterdam, Netherlands
| | - Casper J van Eijck
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Pathology, The Tumor Immuno-Pathology Laboratory, Erasmus, University Medical Center, Rotterdam, Netherlands
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Computed Tomography Assessment of Sarcopenic Myosteatosis for Predicting Overall Survival in Colorectal Carcinoma: Systematic Review. J Comput Assist Tomogr 2022; 46:157-162. [PMID: 35297571 DOI: 10.1097/rct.0000000000001281] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND As the US population ages, cancer incidence and prevalence are projected to increase. In the last decade, there has been an increased interest in the opportunistic use of computed tomography (CT) scan data to predict cancer prognosis and inform treatment based on body composition measures, especially muscle measures for sarcopenia. OBJECTIVE This article aimed to perform a systematic review of current literature related to CT assessment of muscle attenuation values for myosteatosis in colorectal cancer (CRC) survival prediction. RESULTS Initial broad search of CT and CRC yielded 4234 results. A more focused search strategy narrowed this to 129 research papers, and 13 articles met the final inclusion criteria. Twelve of 13 studies found a statistically significant decrease in overall survival according to Hounsfield unit (HU)-based sarcopenia, with hazard ratios ranging from 1.36 to 2.94 (mean, 1.78). However, the specific criteria used to define myosteatosis by CT varied widely, with attenuation thresholds ranging from 22.5 to 47.3 HU, often further subdivided by sex and/or body mass index. CONCLUSIONS Current evidence suggests that a strong association between CT-based muscle attenuation values for myosteatosis assessment correlates with overall survival in CRC. However, more research is needed to verify these findings and determine appropriate threshold values for more diverse patient populations. Because CRC patients are staged and followed by CT, the opportunity exists for routine objective myosteatosis assessment in the clinical setting.
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Giani A, Famularo S, Fogliati A, Riva L, Tamini N, Ippolito D, Nespoli L, Braga M, Gianotti L. Skeletal muscle wasting and long-term prognosis in patients undergoing rectal cancer surgery without neoadjuvant therapy. World J Surg Oncol 2022; 20:51. [PMID: 35216606 PMCID: PMC8881874 DOI: 10.1186/s12957-021-02460-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/29/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Derangement of body composition has been associated with dismal long-term survival in several gastrointestinal cancers including rectal tumors treated with neoadjuvant therapies. The role of specific preoperative anthropometric indexes on the oncologic outcomes of patients undergoing upfront surgery for rectal cancer has not been investigated. The aim of the study is to evaluate the association of body composition and overall survival in this specific cohort. METHODS Lumbar computed tomography images, obtained within the 30 days previous to surgery, between January 2009 and December 2016, were used to calculate population-specific thresholds of muscle mass (sarcopenia), subcutaneous and visceral adiposity, visceral obesity, sarcopenic obesity, and myosteatosis. These body composition variables were related with overall survival (OS), tumor-specific survival (TSS), and disease-free survival (DFS). OS, TSS, and DFS were evaluated by the Kaplan-Meier method. Cox regression analysis was used to identify independent predictors of mortality, tumor-specific mortality, and recurrence, and data were presented as hazard ratio (HR) and 95% confidence interval (CI). RESULTS During the study period, 411 patients underwent rectal resection for cancer, and among these, 129 were without neoadjuvant chemoradiation. The median follow-up was 96.7 months. At the end of the follow-up, 41 patients (31.8%) had died; of these, 26 (20.1%) died for tumor-related reasons, and 36 (27.1%) experienced disease recurrence. One-, three-, and five-year OS was 95.7%, 86.0%, and 76.8% for non-sarcopenic patients versus 82.4%, 58.8%, and 40.0% for sarcopenic ones respectively (p < 0.001). Kaplan-Meier survival curves comparing sarcopenic and non-sarcopenic patients showed a significant difference in terms of OS (log-rank < 0.0001). Through multivariate Cox regression, overall mortality risk was associated only with sarcopenia (HR 1.96; 95%CI 1.03-3.74; p = 0.041). Disease stage IV and III (HR 13.75; 95% CI 2.89-65.6; p < 0.001 and HR 4.72; 95% CI 1.06-21.1; p = 0.043, respectively) and sarcopenia (HR 2.62; 95% CI 1.22-5.6; p = 0.013) were independently associated with TSS. The other body composition indexes investigated showed no significant association with prognosis. CONCLUSIONS These results support the inclusion of body composition assessment for prognostic stratification of rectal cancer patients undergoing upfront resection.
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Affiliation(s)
- Alessandro Giani
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Surgery, San Gerardo Hospital, Monza, Italy
| | - Simone Famularo
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Surgery, San Gerardo Hospital, Monza, Italy
| | - Alessandro Fogliati
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Surgery, San Gerardo Hospital, Monza, Italy
| | - Luca Riva
- Department of Radiology, San Gerardo Hospital Via Pergolesi 33, 20900, Monza, Italy
| | - Nicolò Tamini
- Department of Surgery, San Gerardo Hospital, Monza, Italy
| | - Davide Ippolito
- Department of Radiology, San Gerardo Hospital Via Pergolesi 33, 20900, Monza, Italy
| | - Luca Nespoli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Surgery, San Gerardo Hospital, Monza, Italy
| | - Marco Braga
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Surgery, San Gerardo Hospital, Monza, Italy
| | - Luca Gianotti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
- Department of Surgery, San Gerardo Hospital, Monza, Italy.
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Nagayama T, Fujiwara SI, Kikuchi T, Onda K, Murahashi R, Nakashima H, Ikeda T, Matsuoka S, Kawaguchi SI, Toda Y, Ito S, Ban T, Umino K, Minakata D, Nakano H, Yamasaki R, Morita K, Ashizawa M, Yamamoto C, Hatano K, Sato K, Oh I, Ohmine K, Kanda Y. Impact of muscle mass loss assessed by computed tomography on the outcome of allogeneic stem cell transplantation. Leuk Lymphoma 2022; 63:1694-1700. [DOI: 10.1080/10428194.2022.2034159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Takashi Nagayama
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Shin-ichiro Fujiwara
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Tomohiro Kikuchi
- Division of Radiology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Kaoru Onda
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Rui Murahashi
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Hirotomo Nakashima
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Takashi Ikeda
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Sae Matsuoka
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Shin-ichiro Kawaguchi
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Yumiko Toda
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Shoko Ito
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Tetsuaki Ban
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Kento Umino
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Daisuke Minakata
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Hirofumi Nakano
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Ryoko Yamasaki
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Kaoru Morita
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Masahiro Ashizawa
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Chihiro Yamamoto
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Kaoru Hatano
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Kazuya Sato
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Iekuni Oh
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Ken Ohmine
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
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Martin L, Tom M, Basualdo-Hammond C, Baracos V, Gramlich L. Piloting a training program in computed tomography (CT) skeletal muscle assessment for Registered Dietitians. JPEN J Parenter Enteral Nutr 2022; 46:1317-1325. [PMID: 35147237 DOI: 10.1002/jpen.2348] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/25/2022] [Accepted: 02/04/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Consensus definitions for disease-associated malnutrition and sarcopenia include reduced skeletal muscle mass as a diagnostic criterion. There is a need to develop and validate techniques to assess skeletal muscle in clinical practice. Skeletal muscle mass can be precisely quantified from computed tomography (CT) images. This pilot study aimed to train Registered Dietitians (RD) to complete precise skeletal muscle measurements using CT. METHODS Purposive sampling identified RDs employed in clinical areas where CT scans are routinely performed. CT training included: 1) a 3-day training session focused on manual segmentation of skeletal muscle cross-sectional areas (cm2 ) from abdominal CT images at the third lumber (L3) vertebra, using SliceOmatic® software, and 2) a precision assessment to quantify the intra- and inter-observer precision error of repeated skeletal muscle measurements (30 images in duplicate). Precision error is reported as the root mean standard deviation (cm2 ) and % coefficient of variation (%CV), our primary performance indicator was defined as a precision error <2%. RESULTS Five RDs completed CT training. RDs were from three clinical areas (cancer care (N=1), surgery (N=2), and critical care (N=1). RDs precision error was low and below the minimal acceptable error of <2%; intra-observer error was ≤1.8 cm2 (range 0.8 - 1.8 cm2 ) or ≤1.5% (range 0.8 - 1.5%) and inter-observer error was 1.2 cm2 or 1.1%. CONCLUSION RDs can be trained to perform precise CT skeletal muscle measurements. Increasing capacity to assess skeletal muscle is a first step toward developing this technique for use in clinical practice. CLINICAL RELEVANCE STATEMENT There is significant interest from both researchers and clinicians to undertake the measurement of skeletal muscle. Reduced skeletal muscle mass places individuals at risk of experiencing adverse outcomes and is a diagnostic criterion for disease-associated malnutrition and sarcopenia. In this study we piloted a training program in computed tomography (CT)-skeletal muscle assessments for RDs, and demonstrated after completion of the program RDs were able to perform CT skeletal muscle measurements with high precision. The addition of new tools to the comprehensive nutrition assessment tool box may benefit clinical practice in multiple ways including improved identification of patients with reduced skeletal muscle mass, individualization of interventions, and monitoring effectiveness of interventions over time. Other clinicians may also benefit from knowing about their patients' skeletal muscle mass to help identify risk and make treatment decisions. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Lisa Martin
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mei Tom
- Alberta Health Services, Edmonton, Alberta, Canada
| | | | - Vickie Baracos
- Department of Oncology, University of Alberta. Edmonton, Alberta, Canada
| | - Leah Gramlich
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Ackermans LL, Rabou J, Basrai M, Schweinlin A, Bischoff S, Cussenot O, Cancel-Tassin G, Renken R, Gómez E, Sánchez-González P, Rainoldi A, Boccia G, Reisinger K, Ten Bosch JA, Blokhuis TJ. Screening, Diagnosis and Monitoring of Sarcopenia: when to use which tool? Clin Nutr ESPEN 2022; 48:36-44. [DOI: 10.1016/j.clnesp.2022.01.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 11/18/2021] [Accepted: 01/23/2022] [Indexed: 10/19/2022]
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