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Li Y, Sheng Q, Li J, Liu W, Ma L, Han L, He J, Zhao T, Chu Y. Sarcopenia is a prognostic factor in lymphoma patients: a systematic review and meta-analysis. Leuk Lymphoma 2024:1-14. [PMID: 39086237 DOI: 10.1080/10428194.2024.2371500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 06/12/2024] [Accepted: 06/18/2024] [Indexed: 08/02/2024]
Abstract
Findings regarding the relationship between sarcopenia and lymphoma have been inconsistent across studies. This study investigated the association between sarcopenia and lymphoma. We systematically searched the Embase, Science Direct, Cochrane Library, and PubMed databases from inception to 31 March 2024 to identify relevant studies. Two researchers independently extracted and evaluated studies that met inclusion and exclusion criteria. Twenty-six studies with 3659 participants were included. Sarcopenic lymphoma patients had poor overall survival (OS) (HR = 1.88; 95% CI: 1.47-2.41; p < 0.001). The heterogeneity was high (I2=80%). However, the result of the Egger test indicated a significant publication bias (p < 0.001). After employing the trim and fill method to adjust for this bias, the HR of OS became non-significant (p > 0.05). The progression-free survival (PFS) was worse in sarcopenic patients (HR = 1.77; 95% CI: 1.37-2.29; p < 0.001; I2=70%). There was no significant publication bias (p > 0.05). In the subgroup analyses, sarcopenia was a negative predictor of OS in lymphoma patients who undergo hematopoietic cell transplantation (HCT) (HR = 1.61;95% CI: 1.19-2.18; I2=30%). Male lymphoma patients with sarcopenia had a significantly worse OS (HR = 2.29; 95% CI:1.24-4.24; p = 0.009). Among patients with primary central nervous system lymphoma (PCNSL), those with sarcopenia defined by temporal muscle thickness (TMT) exhibited significantly worse OS (HR = 2.20; 95% CI:1.04-4.65; p = 0.039; I2=68%). Sarcopenia is associated with worse PFS in lymphoma patients. Subgroup analyses indicate that sarcopenia is a negative predictor of OS after HCT, and male lymphoma patients who suffer from sarcopenia have higher mortality. Sarcopenia defined by TMT is also a negative predictor of OS for patients with PCNSL.
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Affiliation(s)
- Yixuan Li
- Department of Endocrinology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Qi Sheng
- Department of Clinical Nutrition, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jiayao Li
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Wenyu Liu
- Department of Clinical Nutrition, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Li Ma
- Department of Clinical Nutrition, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Lei Han
- Department of Clinical Nutrition, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Juan He
- Department of Clinical Nutrition, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Ting Zhao
- Department of Clinical Nutrition, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yuning Chu
- Department of Clinical Nutrition, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Anabtawi NM, Pasala MS, Grimshaw AA, Kharel P, Bal S, Godby K, Siwakoti A, Buford TW, Bhatia S, Costa LJ, Williams GR, Giri S. Low skeletal muscle mass and treatment outcomes among adults with haematologic malignancies: A systematic review and meta-analysis. J Cachexia Sarcopenia Muscle 2024; 15:1084-1093. [PMID: 38558541 PMCID: PMC11154774 DOI: 10.1002/jcsm.13446] [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: 01/18/2023] [Revised: 11/21/2023] [Accepted: 02/08/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Low skeletal muscle mass (LSMM) and/or, function associated with an increased risk of treatment-related toxicities and inferior overall survival (OS) among adults with solid malignancies. However, the association between LSMM and treatment-related toxicities among adults with haematologic malignancies remains unclear. METHODS Using a pre-published protocol (CRD42020197814), we searched seven bibliographic databases from inception to 08/2021 for studies reporting the impact of LSMM among adults ≥18 years with a known haematologic malignancy. The primary outcome of interest was OS, and secondary outcomes included progression free survival (PFS) and non-relapse mortality (NRM). These effect sizes were quantified in terms of hazards ratio (HR) along with 95% confidence interval (CI) and pooled across studies using a DerSimonian-Laird random-effects model. Heterogeneity was assessed using the Cochran's Q and the I2 statistic. All hypothesis testing was two-sided with an alpha of 0.05. RESULTS Of 3791 studies screened, we identified 20 studies involving 3468 patients with a mean age of 60 years; 44% were female and the most common malignancy was diffuse large B-cell lymphoma (42%). Most studies measured muscle mass using single slice computed tomography imaging at the L3 level. The presence of LSMM was associated with worse OS (pooled HR = 1.81, 95% CI = 1.48-2.22, P < 0.001) with moderate heterogeneity (Cochran's Q, I2 = 60.4%), PFS (pooled HR = 1.61, 95% CI = 1.28-2.02, P < 0.001) with moderate heterogeneity (Cochran's Q, I2 = 66.0%). Similarly, LSMM was associated with worse NRM (HR = 1.72, 95% CI = 1.34-2.22, P < 0.001) with little evidence of heterogeneity (Cochran's Q, I2 = 0.0%). CONCLUSIONS LSMM is associated with worse survival outcomes among adults with haematologic malignancies. Further research into understanding the underlying mechanism of this association and mitigating the negative effects of LSMM among adults with haematologic malignancies is needed.
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Affiliation(s)
- Nadia M. Anabtawi
- School of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
| | - Monica Sai Pasala
- School of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
| | - Alyssa A. Grimshaw
- Harvey Cushing/John Hay Whitney Medical LibraryYale UniversityNew HavenCTUSA
| | - Prakash Kharel
- Department of Hospital MedicineGeisinger Health System, GeisingerDanvillePAUSA
| | - Susan Bal
- Department of Medicine, Division of Hematology and OncologyUniversity of Alabama at BirminghamBirminghamALUSA
| | - Kelly Godby
- Department of Medicine, Division of Hematology and OncologyUniversity of Alabama at BirminghamBirminghamALUSA
| | | | - Thomas W. Buford
- Department of Medicine, Division of Gerontology, Geriatrics & Palliative CareUniversity of Alabama at BirminghamBirminghamALUSA
- Birmingham/Atlanta VA GRECCBirmingham VA Medical CenterBirminghamALUSA
| | - Smita Bhatia
- Institute for Cancer Outcomes and SurvivorshipUniversity of Alabama at BirminghamBirminghamALUSA
| | - Luciano J. Costa
- Department of Medicine, Division of Hematology and OncologyUniversity of Alabama at BirminghamBirminghamALUSA
| | - Grant R. Williams
- Department of Medicine, Division of Hematology and OncologyUniversity of Alabama at BirminghamBirminghamALUSA
- Institute for Cancer Outcomes and SurvivorshipUniversity of Alabama at BirminghamBirminghamALUSA
| | - Smith Giri
- Department of Medicine, Division of Hematology and OncologyUniversity of Alabama at BirminghamBirminghamALUSA
- Institute for Cancer Outcomes and SurvivorshipUniversity of Alabama at BirminghamBirminghamALUSA
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Zhao Z, Bo Z, Ye N, Dong Y, Xu Y, Wang B, Yang F, Liu L, Liu Z. Impact of sarcopenia on postoperative outcomes after hepatectomy in older patients with intrahepatic cholangiocarcinoma: A multicentre cohort study. Liver Int 2024; 44:155-168. [PMID: 37804070 DOI: 10.1111/liv.15757] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 08/24/2023] [Accepted: 09/22/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND AND AIMS Sarcopenia is associated with poor prognosis, but its role in older patients with intrahepatic cholangiocarcinoma (ICC) is unclear. We aimed to evaluate the impact of sarcopenia on the prognosis of older patients with ICC undergoing hepatectomy. METHODS A total of 363 patients with ICC following hepatectomy from 2015 to 2021 were retrospectively reviewed at five institutions. Sarcopenia was evaluated using skeletal muscle index by computed tomography images. Patients were divided into four subgroups according to sarcopenia and age. Postoperative outcomes including complication, overall survival (OS) and recurrence-free survival (RFS) were evaluated. Risk factors were identified through univariate and multivariate Cox regression analyses. RESULTS 302 patients were included in the analysis. The median age was 63 years and there were 128 patients (42.4%) aged over 65 years. 192 patients (63.6%) were diagnosed with sarcopenia, while 180 patients (59.6%) experienced myosteatosis. Older patients experienced a higher incidence of sarcopenia and myosteatosis, and worse postoperative outcomes than younger patients. In the subgroup of patients with sarcopenia, older patients experienced a significant shorter OS than younger patients, which was not observed in patients without sarcopenia. According to the multivariate Cox regression analysis, lymphatic metastasis (p < .001), blood transfusion (p = .004), low serum albumin (p = .051), sarcopenia (p = .024), and myosteatosis (p = .004) were identified as independent risk factors of OS in older patients, meanwhile tumour size (p = .013) and lymphatic metastasis (p < .001) were independent risk factors of RFS. CONCLUSIONS Sarcopenia and myosteatosis have a significant adverse impact on postoperative outcomes in older patients with ICC undergoing hepatectomy.
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Affiliation(s)
- Zhengxiao Zhao
- Department of Oncology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhiyuan Bo
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ni Ye
- Department of General Practice, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yulong Dong
- Department of Oncology, The Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Yingfei Xu
- Department of Oncology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Binbin Wang
- Department of Oncology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Facai Yang
- Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Sichuan, China
| | - Liwei Liu
- Department of Pediatric, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhendong Liu
- Department of Oncology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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Zeng X, Zhang L, Zhang Y, Jia S, Lin T, Zhao X, Huang X. Prevalence and prognostic value of baseline sarcopenia in hematologic malignancies: a systematic review. Front Oncol 2023; 13:1308544. [PMID: 38162495 PMCID: PMC10755879 DOI: 10.3389/fonc.2023.1308544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
Background The correlation between sarcopenia and hematological malignancy prognosis is still controversial. Design: A systematic review and meta-analysis. Objectives: To explore sarcopenia's prevalence and prognostic value in hematologic malignancies. Data sources and methods We searched Embase, MEDLINE, and Cochrane Library through Ovid SP using an appropriate search strategy on August 28, 2022, and updated the search results on January 9, 2023. Study quality was assessed using the Newcastle-Ottawa scale. The pooled prevalence of sarcopenia was calculated with a 95% confidence interval (CI). Relationships between sarcopenia and prognostic value were expressed as hazard ratio (HR) and 95% CI. HR means the probability of something undesirable, i.e., death or disease progression. Results The search identified more than 3992 studies, and 21 (3354 patients, median or mean age ranging from 36 to 78 years) were finally included. The risk of bias in the studies was low to medium. All included studies were diagnosed based on low muscle mass (LMM). Muscle mass was assessed mainly through imaging technologies, and different cut-offs were applied to determine LMM. The prevalence of sarcopenia was 44.5%, which could fluctuate by age. Subgroup analysis showed that older people had a higher sarcopenic rate than the non-elderly group. Sarcopenia resulted in an inferior prognosis [overall survival: HR 1.821, 95% CI 1.415-2.343; progression-free survival: HR 1.703, 95% CI 1.128-2.571). Conclusion Sarcopenia has a prevalence of over 30% in malignant hematologic patients and is associated with a poorer prognosis. Future studies with a standardized sarcopenia diagnostic criterion were needed to investigate sarcopenia's prevalence and prognostic effects in hematologic malignancies.
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Affiliation(s)
- Xiaofeng Zeng
- The Center of Gerontology and Geriatrics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Liying Zhang
- The Center of Gerontology and Geriatrics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Zhang
- Sichuan University Library, Sichuan University, Chengdu, China
| | - Shuli Jia
- The Center of Gerontology and Geriatrics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Taiping Lin
- The Center of Gerontology and Geriatrics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Xuman Zhao
- The Center of Gerontology and Geriatrics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoli Huang
- The Center of Gerontology and Geriatrics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
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Abdallah NH, Nagayama H, Takahashi N, Gonsalves W, Fonder A, Dispenzieri A, Dingli D, Buadi FK, Lacy MQ, Hobbs M, Gertz MA, Binder M, Kapoor P, Warsame R, Hayman SR, Kourelis T, Hwa YL, Lin Y, Kyle RA, Rajkumar SV, Broski SM, Kumar SK. Muscle and fat composition in patients with newly diagnosed multiple myeloma. Blood Cancer J 2023; 13:185. [PMID: 38086801 PMCID: PMC10716405 DOI: 10.1038/s41408-023-00934-3] [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: 03/14/2023] [Revised: 08/13/2023] [Accepted: 10/24/2023] [Indexed: 12/18/2023] Open
Abstract
Measures of muscle and adipose tissue mass have been associated with outcomes in several malignancies, but studies in multiple myeloma (MM) are inconsistent. The aim of this study was to evaluate the association between muscle and fat areas and radiodensity, and overall survival (OS) in patients with newly diagnosed MM. We included 341 patients diagnosed with MM from 2010-2019 who had an 18F-fluorodeoxyglucose positron emission tomography/computed tomography at diagnosis. A cross-sectional image at the third lumbar vertebrae was segmented into muscle and fat components. Median follow up was 5.7 years. There was no association between sarcopenia and baseline disease characteristics or OS. Low muscle radiodensity was associated with higher disease stage, anemia, and renal failure. OS was 5.6 vs. 9.0 years in patients with muscle radiodensity in the lower vs. middle/upper tertiles, respectively (P = 0.02). High subcutaneous adipose tissue (SAT) radiodensity was associated with higher stage, anemia, thrombocytopenia, hypercalcemia, renal failure, and high LDH. OS was 5.4 years vs. not reached in patients with SAT radiodensity in the upper vs. middle/lower tertiles, respectively (P = 0.001). In conclusion, sarcopenia was not associated with OS in MM patients. High SAT radiodensity and low muscle radiodensity were associated with advanced disease stage and adverse laboratory characteristics.
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Affiliation(s)
| | | | | | | | - Amie Fonder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Martha Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Miriam Hobbs
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Moritz Binder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Rahma Warsame
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Yi L Hwa
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Robert A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Shaji K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
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6
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Xu T, Li Y, Liu Y, Ning B, Wu H, Wei Y. Clinical and prognostic role of sarcopenia based on masticatory muscle index on MR images in patients with extranodal natural killer/T cell lymphoma, nasal type. Ann Hematol 2023; 102:3521-3532. [PMID: 37702822 DOI: 10.1007/s00277-023-05436-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 09/04/2023] [Indexed: 09/14/2023]
Abstract
Sarcopenia is known to be associated with an increased risk of adverse outcomes in a variety of malignancies, but its impact in extranodal natural killer/T cell lymphoma, nasal type (ENKTL-NT) is unknown. The aim of this study was to explore the prognostic relevance of sarcopenia defined by MRI-based masticatory muscle index in ENKTL-NT patients. A total of 112 patients with newly diagnosed ENKTL-NT who underwent cranial magnetic resonance imaging (MRI) were enrolled. The masticatory skeletal muscle index (M-SMI) was measured based on T2-weighted MR images and sarcopenia was defined by M-SMI<5.5 cm2/ m2. The median M-SMI was 5.47 (4.91-5.96) cm2/m2; 58 were identified with sarcopenia in this cohort. On multivariate analyses, sarcopenia was the only independently risk factor predicting overall survival (HR, 4.590; 95% CI, 1.657-12.715; p = 0.003), progression-free survival (HR, 3.048; 95% CI, 1.515-6.130; p = 0.002), and treatment response (HR, 0.112; 95% CI, 0.042-0.301; p < 0.001). In addition, we found that integrating sarcopenia into prognostic indices could improve the discriminative power of the corresponding original model. Stratification analysis showed that sarcopenia was able to further identify survival differences in patients that could not be distinguished by prognostic models. In summary, our study suggests that sarcopenia defined by MRI-based M-SMI represents a new and routinely applicable prognostic indicator of clinical outcome or predictor of treatment response in ENKTL-NT patients, and may aid in risk stratification and treatment decisions.
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Affiliation(s)
- Tianzi Xu
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, 430071, China
| | - Yi Li
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, 430071, China
| | - Yixin Liu
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, 430071, China
| | - Biao Ning
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, 430071, China
| | - Huijing Wu
- Department of Lymphoma Medicine (Breast Cancer & Soft Tissue Tumor Medicine), Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430079, China.
| | - Yongchang Wei
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, 430071, China.
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Xiong J, Chen K, Huang W, Huang M, Cao F, Wang Y, Chen Q. Prevalence and effect on survival of pre-treatment sarcopenia in patients with hematological malignancies: a meta-analysis. Front Oncol 2023; 13:1249353. [PMID: 37869092 PMCID: PMC10587577 DOI: 10.3389/fonc.2023.1249353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/11/2023] [Indexed: 10/24/2023] Open
Abstract
Background & aims Evidence regarding the prevalence of pre-treatment sarcopenia and its impact on survival in patients with hematological malignancies (HM) varies across studies. We conducted a systematic review and meta-analysis to summarize this discrepancy. Methods PubMed, Embase and Cochrane library were systematically searched for relevant studies. Outcomes assessed were: prevalence of pre-treatment sarcopenia, overall survival (OS), progression-free survival (PFS) and complete response (CR). Weighted mean proportion, odds ratios (ORs) and hazard ratios (HRs) were estimated using a fixed-effects and a random-effects model. Results A total of 27 retrospective cohort studies involving 4,991 patients were included in this study. The prevalence of pre-treatment sarcopenia was 37.0% (95% CI: 32.0%-42.0%) in HM patients <60 years and 51.0% (95% CI: 45.0%-57.0%) in≥60 years. Patients with leukemia had the lowest prevalence, compared with those with other HM (38.0%; 95% CI: 33.0%-43.0%; P = 0.010). The presence of sarcopenia was independently associated with poor OS (HR = 1.57, 95% CI = 1.41-1.75) and PFS (HR = 1.50, 95% CI = 1.22-1.83) throughout treatment period, which may be partially attributed to decreased CR (OR = 0.54, 95% CI = 0.41-0.72), particularly for BMI ≥ 25 (P = 0.020) and males (P = 0.020). Conclusion Sarcopenia is highly prevalent in patients with HM and an adverse prognostic factor for both survival and treatment efficacy. HM and sarcopenia can aggravate each other. We suggest that in future clinical work, incorporating sarcopenia into risk scores will contribute to guide patient stratification and therapeutic strategy, particularly for the elderly. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier (CRD42023392550).
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Affiliation(s)
- Jianzhu Xiong
- Department of Public Health, Shaoxing Seventh People's Hospital, Shaoxing, China
| | - Kangkang Chen
- Department of Non-communicable Diseases Control and Prevention, Shaoxing Center for Disease Control and Prevention, Shaoxing, China
| | - Wen Huang
- Department of Non-communicable Diseases Control and Prevention, Shaoxing Center for Disease Control and Prevention, Shaoxing, China
| | - Mingang Huang
- Department of Non-communicable Diseases Control and Prevention, Shaoxing Center for Disease Control and Prevention, Shaoxing, China
| | - Feiyan Cao
- Dispatch Division of Shaoxing Emergency Medical Services, Shaoxing Center for Emergency, Shaoxing, China
| | - Yiwen Wang
- Department of Non-communicable Diseases Control and Prevention, Shaoxing Center for Disease Control and Prevention, Shaoxing, China
| | - Qifeng Chen
- Department of Non-communicable Diseases Control and Prevention, Shaoxing Center for Disease Control and Prevention, Shaoxing, China
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8
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Chen Y, Chen Z, Tan X, Zhang Q, Zhou Y, Yuan H, Jiang L. Role of body composition and metabolic parameters extracted from baseline 18F-FDG PET/CT in patients with diffuse large B-cell lymphoma. Ann Hematol 2023; 102:2779-2789. [PMID: 37530853 DOI: 10.1007/s00277-023-05379-z] [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: 04/04/2023] [Accepted: 07/19/2023] [Indexed: 08/03/2023]
Abstract
This study aimed to clarify the clinical and prognostic role of body composition and metabolic parameters extracted from baseline 18F-FDG PET/CT in patients with diffuse large B-cell lymphoma (DLBCL). We retrospectively collected the clinicopathological and 18F-FDG PET/CT parameters of 181 DLBCL patients. The indexes of skeletal muscle, subcutaneous adipose tissue, and visceral adipose tissue were calculated using the area measured at the 3rd lumbar level normalized for height. Additionally, the metabolic activity of corresponding muscle and adipose tissue, and maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of all lesions were measured. Survival endpoints included progression-free survival (PFS) and overall survival (OS). We identified 75 (41.4%) patients with low skeletal muscle index (sarcopenia), presenting risk factors including male, high β2-microglobulin, low BMI, high visceral adipose tissue index, low SUVmax of skeletal muscle, and high SUVmax of visceral adipose tissue. Male, low BMI, low visceral adipose tissue index, and high SUVmax of subcutaneous adipose tissue were risk factors for low subcutaneous adipose tissue index diagnosed in 105 (58.0%) patients. In total, 132 (79.2%) patients represented low visceral adipose tissue index, associated with younger age, B symptoms, and low BMI. Eastern Cooperative Oncology Group (ECOG) status, sarcopenia, and visceral adipose tissue index were found independently predictive of PFS and OS, while β2-microglobulin was independently predictive of OS. In conclusion, body composition indexes were correlated with both clinical characteristics and 18F-FDG PET/CT metabolic parameters, significantly impacting survival, such that sarcopenia and high visceral adipose tissue index were powerful predictors of poor DLBCL outcomes.
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Affiliation(s)
- Yang Chen
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Zhijian Chen
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Xiaoyue Tan
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Qing Zhang
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Yongrong Zhou
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Hui Yuan
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China.
| | - Lei Jiang
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China.
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China.
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Colloca GF, Bellieni A, Di Capua B, Iervolino M, Bracci S, Fusco D, Tagliaferri L, Landi F, Valentini V. Sarcopenia Diagnosis and Management in Hematological Malignancies and Differences with Cachexia and Frailty. Cancers (Basel) 2023; 15:4600. [PMID: 37760569 PMCID: PMC10527381 DOI: 10.3390/cancers15184600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/31/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
Sarcopenia is a geriatric syndrome characterized by a progressive loss of systemic muscle mass and decreased muscle strength or physical function. Several conditions have a role in its pathogenesis, significantly impacting adverse outcomes such as falls, functional decline, frailty, disability, multiple hospitalizations, and mortality. In the oncological setting, sarcopenia is associated with an increased risk of treatment toxicity, postoperative complications, and a higher mortality rate related to other causes (e.g., pneumonia). In the hematological field, even more so, sarcopenia predicts toxicity and response to treatments. In patients with hematologic malignancy, low muscle mass is associated with adverse outcomes and is a predictor of overall survival and non-relapse mortality. Therefore, it is essential to correctly recognize sarcopenia, evaluate the risk factors and their impact on the patient's trajectory, and effectively treat sarcopenia. Sarcopenia is a reversible condition. The most effective intervention for reversing it is physical exercise combined with nutrition. The objective of clinical assessment focused on sarcopenia is to be able to carry out a "tailor-made treatment".
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Affiliation(s)
- Giuseppe Ferdinando Colloca
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.F.C.); (S.B.); (V.V.)
| | - Andrea Bellieni
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.F.C.); (S.B.); (V.V.)
| | - Beatrice Di Capua
- Centro di Eccellenza Oncologia Radioterapica e Medica e Radioterapia, Ospedale Fatebenefratelli Isola Tiberina—Gemelli Isola, 00186 Rome, Italy
| | - Marialuisa Iervolino
- Dipartimento Universitario di Scienze Geriatriche ed Ortopediche, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Serena Bracci
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.F.C.); (S.B.); (V.V.)
| | - Domenico Fusco
- Dipartimento di Scienze dell’Invecchiamento, Ortopediche e Reumatologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (D.F.); (F.L.)
| | - Luca Tagliaferri
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.F.C.); (S.B.); (V.V.)
| | - Francesco Landi
- Dipartimento di Scienze dell’Invecchiamento, Ortopediche e Reumatologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (D.F.); (F.L.)
| | - Vincenzo Valentini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.F.C.); (S.B.); (V.V.)
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Matsunaga T, Furuya T, Deto T, Masuda H, Nakanishi K. Two Older Hematological Malignancy Patients for Whom Nutrition Rehabilitation Was Effective Against Global Leadership Initiative on Malnutrition-Defined Malnutrition and Sarcopenia. Cureus 2023; 15:e43069. [PMID: 37554378 PMCID: PMC10405756 DOI: 10.7759/cureus.43069] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 08/10/2023] Open
Abstract
The long-term survival rate of hematological malignancy patients with Global Leadership Initiative on Malnutrition (GLIM)-defined malnutrition and sarcopenia is poor, but nutritional rehabilitation effects in such patients are unknown. Here, two cases of older hematological malignancy patients in whom nutritional rehabilitation was effective against GLIM-defined malnutrition and sarcopenia are reported. By undergoing nutritional rehabilitation, the myeloma patient increased her six-meter walking speed and her maintained body mass index (BMI), appendicular skeletal muscle mass (ASM), and hand grip strength, whereas the Hodgkin lymphoma patient regained his hand grip strength and maintained his BMI, ASM, and six-meter walking speed.
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Affiliation(s)
- Takuya Matsunaga
- Department of Hematology, Japan Community Health Care Organization (JCHO) Sapporo Hokushin Hospital, Sapporo, JPN
| | - Tatsunori Furuya
- Department of Rehabilitation, Japan Community Health Care Organization (JCHO) Sapporo Hokushin Hospital, Sapporo, JPN
| | - Tomoko Deto
- Department of Nutrition Management, Japan Community Health Care Organization (JCHO) Sapporo Hokushin Hospital, Sapporo, JPN
| | - Hajime Masuda
- Department of Diabetes, Japan Community Health Care Organization (JCHO) Sapporo Hokushin Hospital, Sapporo, JPN
| | - Katsuya Nakanishi
- Department of Pathology, Japan Community Health Care Organization (JCHO) Sapporo Hokushin Hospital, Sapporo, JPN
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11
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Current Treatment Options and the Role of Functional Status Assessment in Classical Hodgkin Lymphoma in Older Adults: A Review. Cancers (Basel) 2023; 15:cancers15051515. [PMID: 36900306 PMCID: PMC10000520 DOI: 10.3390/cancers15051515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
Along with the fact that classical Hodgkin lymphoma (cHL) in older adults is frequently considered biologically different from cHL in younger patients, its most distinctive feature is its dismal clinical outcome due to the decreased effectiveness and greater toxicity of therapies. Although strategies to mitigate specific toxicities (e.g., cardiological and pulmonary) have obtained some results, in general, reduced-intensity schemes, proposed as an alternative to ABVD, have proved to be less effective. The addition of brentuximab vedotin (BV) to AVD, especially in a sequential scheme, has demonstrated good efficacy. However, the problem of toxicity persists even with this new therapeutic combination, with comorbidities remaining an important prognostic factor. The adequate stratification of functional status is necessary to distinguish between those patients who will benefit from full treatment and those who will benefit from alternative strategies. A simplified geriatric assessment based on the determination of ADL (activity of daily living), IADL (instrumental ADL), and CIRS-G (Cumulative Illness Rating Scale-Geriatric) scores is an easy-to-use tool that permits adequate patient stratification. Other factors of considerable impact on functional status such as sarcopenia and immunosenescence are currently being studied. A fitness-based treatment choice would also be very useful for relapsed or refractory patients, a more frequent and challenging situation than that is found in young cHL patients.
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12
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Couderc AL, Liuu E, Boudou-Rouquette P, Poisson J, Frelaut M, Montégut C, Mebarki S, Geiss R, ap Thomas Z, Noret A, Pierro M, Baldini C, Paillaud E, Pamoukdjian F. Pre-Therapeutic Sarcopenia among Cancer Patients: An Up-to-Date Meta-Analysis of Prevalence and Predictive Value during Cancer Treatment. Nutrients 2023; 15:nu15051193. [PMID: 36904192 PMCID: PMC10005339 DOI: 10.3390/nu15051193] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/18/2023] [Accepted: 02/21/2023] [Indexed: 03/08/2023] Open
Abstract
This study will address the prevalence of pre-therapeutic sarcopenia (PS) and its clinical impact during cancer treatment among adult cancer patients ≥ 18 years of age. A meta-analysis (MA) with random-effect models was performed via a MEDLINE systematic review, according to the PRISMA statement, focusing on articles published before February 2022 that reported observational studies and clinical trials on the prevalence of PS and the following outcomes: overall survival (OS), progression-free survival (PFS), post-operative complications (POC), toxicities (TOX), and nosocomial infections (NI). A total of 65,936 patients (mean age: 45.7-85 y) with various cancer sites and extensions and various treatment modes were included. Mainly defined by CT scan-based loss of muscle mass only, the pooled prevalence of PS was 38.0%. The pooled relative risks were 1.97, 1.76, 2.70, 1.47, and 1.76 for OS, PFS, POC, TOX, and NI, respectively (moderate-to-high heterogeneity, I2: 58-85%). Consensus-based algorithm definitions of sarcopenia, integrating low muscle mass and low levels of muscular strength and/or physical performance, lowered the prevalence (22%) and heterogeneity (I2 < 50%). They also increased the predictive values with RRs ranging from 2.31 (OS) to 3.52 (POC). PS among cancer patients is prevalent and strongly associated with poor outcomes during cancer treatment, especially when considering a consensus-based algorithm approach.
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Affiliation(s)
- Anne-Laure Couderc
- Internal Medicine Geriatrics and Therapeutic Unit, APHM, 13009 Marseille, France
- CNRS, EFS, ADES, Aix-Marseille University, 13015 Marseille, France
| | - Evelyne Liuu
- Department of Geriatrics, CHU Poitiers, 86000 Poitiers, France
- CIC1402 INSERM Unit, Poitiers University Hospital, 86000 Poitiers, France
| | - Pascaline Boudou-Rouquette
- Ariane Program, Department of Medical Oncology, Cochin Hospital, Paris Cancer Institute CARPEM, APHP, 75014 Paris, France
- INSERM U1016-CNRS UMR8104, Cochin Institute, Paris Cancer Institute CARPEM, Paris Cité University, 75015 Paris, France
| | - Johanne Poisson
- Department of Geriatrics, Georges Pompidou European Hospital, Paris Cancer Institute CARPEM, APHP, 75015 Paris, France
- Faculty of Health, Paris Cité University, 75006 Paris, France
| | - Maxime Frelaut
- Department of Medical Oncology, Gustave Roussy Institute, 94805 Villejuif, France
| | - Coline Montégut
- Internal Medicine Geriatrics and Therapeutic Unit, APHM, 13009 Marseille, France
- Coordination Unit for Geriatric Oncology (UCOG), PACA West, 13009 Marseille, France
| | - Soraya Mebarki
- Department of Geriatrics, Georges Pompidou European Hospital, Paris Cancer Institute CARPEM, APHP, 75015 Paris, France
| | - Romain Geiss
- Department of Medical Oncology, Curie Institute, 92210 Saint-Cloud, France
| | - Zoé ap Thomas
- Department of Cancer Medicine, Gustave Roussy Institute, 94805 Villejuif, France
| | - Aurélien Noret
- Department of Geriatrics, Georges Pompidou European Hospital, Paris Cancer Institute CARPEM, APHP, 75015 Paris, France
| | - Monica Pierro
- Department of Geriatrics, Georges Pompidou European Hospital, Paris Cancer Institute CARPEM, APHP, 75015 Paris, France
| | - Capucine Baldini
- Drug Development Department, Gustave Roussy Institute, 94805 Villejuif, France
| | - Elena Paillaud
- Department of Geriatrics, Georges Pompidou European Hospital, Paris Cancer Institute CARPEM, APHP, 75015 Paris, France
- INSERM, IMRB, Clinical, Epidemiology and Ageing, Université Paris-Est Creteil, 94010 Creteil, France
| | - Frédéric Pamoukdjian
- Department of Geriatrics, Avicenne Hospital, APHP, 93000 Bobigny, France
- INSERM UMR_S942 Cardiovascular Markers in Stressed Conditions MASCOT, Sorbonne Paris Nord University, 93000 Bobigny, France
- Correspondence:
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13
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Longitudinal Body Composition Changes Detected by [ 18F]FDG PET/CT during and after Chemotherapy and Their Prognostic Role in Elderly Hodgkin Lymphoma. Cancers (Basel) 2022; 14:cancers14205147. [PMID: 36291931 PMCID: PMC9601090 DOI: 10.3390/cancers14205147] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/10/2022] [Accepted: 10/19/2022] [Indexed: 11/17/2022] Open
Abstract
The aim of this retrospective study was to investigate the longitudinal body changes in terms of muscle and adipose areas and their prognostic role in elderly (>65 years) patients affected by Hodgkin lymphoma (HL). Skeletal muscle area (SMA), skeletal muscle index (SMI), visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), intramuscular adipose tissue (IMAT), and total dispose tissue (TAT) were measured using the computed tomography (CT) of fluorine-18-fluorodeoxyglucose positron emission tomography/CT ([18F]FDG PET/CT) in 88 patients who undertook baseline, interim (after two cycles of chemotherapy), and end-of-treatment (after 6 cycles of chemotherapy) PET/CT scans. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were measured at pre-treatment PET/CT. Metabolic response applying Deauville score was evaluated at interim and end-of-treatment PET/CT. Survival curves, such as progression free survival (PFS) and overall survival (OS), were calculated for the whole population. Fifty-eight (66%) patients had sarcopenia at baseline and sarcopenia rate increased at interim scan with 68 (77%) cases and at end-of-treatment scan with 73 (83%) cases. Muscular areas (SMA and SMI) declined significantly during the treatment (p < 0.001), decreasing from baseline by 5% and 7% at interim and end-of-treatment evaluation, respectively. Instead, VAT, SAT, IMAT, and TAT increased significantly over this time (p < 0.001). Sarcopenia was significantly related with comprehensive geriatric assessment. PET/CT response at interim and end-of-treatment, MTV, TLG, and baseline sarcopenia were independent prognostic factors for PFS. Instead, metabolic response at interim and end-of-treatment PET, baseline sarcopenia, ΔSMI at interim, and ΔSMI at end-of-treatment for OS were independent prognostic factors.
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14
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Clinical and prognostic role of 2-[ 18F]FDG PET/CT and sarcopenia in treatment-naïve patients with T-cell lymphoblastic lymphoma. Ann Hematol 2022; 101:2699-2709. [PMID: 36123452 DOI: 10.1007/s00277-022-04988-4] [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: 06/30/2022] [Accepted: 09/15/2022] [Indexed: 11/01/2022]
Abstract
T-cell lymphoblastic lymphoma (T-LBL) is a rare and highly aggressive non-Hodgkin lymphoma. This study aimed to explore the role of 2-[18F]FDG PET/CT, sarcopenia, clinical features, and treatment regimens in 49 treatment-naïve patients with T-LBL, and assess their predictive value in the prognosis. Sarcopenia was measured as skeletal muscle index (SMI) at L3 level from the CT component of PET/CT images. All 49 patients (35 males, 14 females; median age, 26 years [range, 3-66 years]) were enrolled in this study, including 36 adult patients and 13 pediatric patients. Lymph nodes, thymus, bone marrow, and pleura were the most common involved sites of T-LBL. The median SUVmax, MTV, and TLG of all lesions in these 49 patients were 12.4 (range, 4.2-40.5), 532.6 (17.4-3518.1), and 2112.2 (53.9-18,699.2), respectively. Eighteen out of 49 patients (36.7%) were diagnosed with sarcopenia. Sarcopenia patients had lower BMI and SUVmax of muscle at L3 level than non-sarcopenia patients (P < 0.05). Univariate Cox regression analysis indicated that higher MTV and TLG and intrathecal therapy (IT) were associated with longer progression-free survival (PFS) and overall survival (OS), while multivariate Cox regression analysis showed that TLG and IT were independent predictors for PFS, and only IT was an independent predictor for OS. In conclusion, low BMI and SUVmax of muscle at L3 level correlated with sarcopenia in T-LBL patients. Higher initial MTV and TLG and receiving IT were associated with better prognosis in T-LBL patients. TLG and IT, but not sarcopenia, were independent prognostic factors.
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15
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Ferraro V, Thormann M, Hinnerichs M, Pech M, Wolleschak D, Mougiakakos D, Wienke A, Strobel A, Zeremski V, Surov A, Omari J. Sarcopenia does not predict outcome in patients with CNS lymphoma undergoing systemic therapy. Oncol Lett 2022; 24:355. [PMID: 36168307 PMCID: PMC9478615 DOI: 10.3892/ol.2022.13475] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/03/2022] [Indexed: 11/05/2022] Open
Abstract
Low skeletal muscle mass as a proxy parameter for sarcopenia acts as a non-invasive imaging marker that is associated with poor prognosis in numerous types of cancer. The present study aimed to assess the influence of body composition parameters on overall survival (OS) and progression free survival (PFS) in patients diagnosed with primary central nervous system lymphoma (PCNSL). A total of 98 patients with PCNSL treated at University Hospital Magdeburg (Magdeburg, Germany) from 2013–2019 were retrospectively studied. Patients with a pre-treatment staging computed tomography (CT) scan that included the third lumbar vertebra were reviewed for analysis. Skeletal muscle area (SMA), skeletal muscle index (SMI), mean muscle density and skeletal muscle gauge (SMG) were measured on the CT scan prior to treatment. Parameters were associated with OS and PFS. Overall, 72 patients were included in the present study. Results of the present study demonstrated that the median OS was 10 months (range, 1–181 months), and 37 patients (51.4%) presented with sarcopenia. Moreover, the median OS was 7 months in the sarcopenic group and 32 months in the non-sarcopenic group. Results of the present study further illustrated that SMI, SMA, density and SMG did not exert a significant effect on OS. Notably, the median PFS was 2.5 months in the low SMI group and 10 months in the normal SMI group. Body composition parameters did not exert a significant effect on PFS. Overall, the results of the present study demonstrated that sarcopenia was not a risk factor for decreased OS or PFS in patients with PCNSL undergoing systemic treatment.
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Affiliation(s)
- Vincenzo Ferraro
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, D‑39120 Magdeburg, Germany
| | - Maximilian Thormann
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, D‑39120 Magdeburg, Germany
| | - Mattes Hinnerichs
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, D‑39120 Magdeburg, Germany
| | - Maciej Pech
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, D‑39120 Magdeburg, Germany
| | - Denise Wolleschak
- Department of Hematology and Oncology, University Hospital Magdeburg, D‑39120 Magdeburg, Germany
| | - Dimitrios Mougiakakos
- Department of Hematology and Oncology, University Hospital Magdeburg, D‑39120 Magdeburg, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biometry and Informatics, Martin‑Luther‑University, D‑06112 Halle‑Wittenberg, Germany
| | - Alexandra Strobel
- Institute of Medical Epidemiology, Biometry and Informatics, Martin‑Luther‑University, D‑06112 Halle‑Wittenberg, Germany
| | - Vanja Zeremski
- Department of Hematology and Oncology, University Hospital Magdeburg, D‑39120 Magdeburg, Germany
| | - Alexey Surov
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, D‑39120 Magdeburg, Germany
| | - Jazan Omari
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, D‑39120 Magdeburg, Germany
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16
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Sun Q, Jiang X, Qin R, Yang Y, Gong Y, Wang K, Peng J. Sarcopenia among older patients with cancer: A scoping review of the literature. J Geriatr Oncol 2022; 13:924-934. [DOI: 10.1016/j.jgo.2022.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/21/2022] [Accepted: 03/28/2022] [Indexed: 12/25/2022]
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17
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Prognostic Role of "Radiological" Sarcopenia in Lymphoma: A Systematic Review. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:e340-e349. [PMID: 34893457 DOI: 10.1016/j.clml.2021.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/29/2021] [Accepted: 11/06/2021] [Indexed: 01/06/2023]
Abstract
Sarcopenia is considered to be a poor prognostic factor for several oncological diseases; however, some promising results for lymphoma are now available. The definition of sarcopenia is mainly based upon muscle strength, quantity or quality and physical performance, but some imaging tools (such as CT) have been introduced to estimate quantitatively the muscle areas as an indirect expression of sarcopenia. Our aim was to perform a systematic review on the prognostic role of "radiological" sarcopenia in lymphoma. A comprehensive online search of PubMed/MEDLINE, Embase and Cochrane library databases was conducted up to June 2021 to find relevant articles on the prognostic role of sarcopenia in lymphoma measured by CT. In total, 25 articles with a total of 4454 patients were included. Diffuse large B-cell lymphoma was the most common lymphoma variant studied, followed by Hodgkin lymphoma. Skeletal muscle area (SMA) was defined as the parameter to distinguish between sarcopenic and nonsarcopenic lymphoma on CT scans and was usually measured at the level of the third lumbar vertebra. In the literature, different thresholds are used to define sarcopenia, related to the features of patients included in the studies. Despite this heterogeneity, in most cases, sarcopenia was demonstrated to be significantly correlated with OS and PFS. Sarcopenia measurement with CT (high dose or low dose) is a safe, accurate and precise method.
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18
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Albano D, Pasinetti N, Dondi F, Giubbini R, Tucci A, Bertagna F. Prognostic Role of Pre-Treatment Metabolic Parameters and Sarcopenia Derived by 2-[ 18F]-FDG PET/CT in Elderly Mantle Cell Lymphoma. J Clin Med 2022; 11:jcm11051210. [PMID: 35268301 PMCID: PMC8911178 DOI: 10.3390/jcm11051210] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 01/06/2023] Open
Abstract
The goal of this retrospective study was to analyze and compare the prognostic role of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (2-[18F]-FDG PET/CT) features and sarcopenia, estimated by CT of PET in elderly (≥65 years) Mantle Cell Lymphoma (MCL). We recruited 53 patients, who underwent pre-treatment 2-[18F]-FDG PET/CT and end-of-treatment PET/CT, and the main semiquantitative parameters were calculated. Sarcopenia was measured as skeletal muscle index (SMI, cm2/m2) and derived by low-dose PET/CT images at the L3 level. Specific cut-offs for SMI were calculated by receiver operator curve and divided by gender. Metabolic response was evaluated at end-of-treatment PET/CT, applying the Deauville score. Progression Free Survival (PFS) and Overall Survival (OS) were calculated for the whole population and for different subgroups, defined as per different sarcopenia cut-off levels. The specific cut-offs to define sarcopenia were 53 cm2/m2 for male and 45.6 cm2/m2 for female. Thirty-two (60%) patients were defined as sarcopenic. The 3-year and 5-year PFS rates were 29% and 23%, while the 3-year and 5-year OS rates were 43% and 33%. Metabolic response, total metabolic tumor volume (tMTV), total lesion glycolysis (tTLG) and sarcopenia were independent prognostic factors for PFS. Considering OS, no variable was significantly associated. Combination between PET features and sarcopenia may help to predict PFS.
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Affiliation(s)
- Domenico Albano
- Nuclear Medicine, ASST Spedali Civili Brescia, 25128 Brescia, Italy; (F.D.); (F.B.)
- Nuclear Medicine Department, University of Brescia, 25121 Brescia, Italy;
- Correspondence:
| | - Nadia Pasinetti
- Radiation Oncology Department, ASST Valcamonica Esine and University of Brescia, 25128 Brescia, Italy;
| | - Francesco Dondi
- Nuclear Medicine, ASST Spedali Civili Brescia, 25128 Brescia, Italy; (F.D.); (F.B.)
- Nuclear Medicine Department, University of Brescia, 25121 Brescia, Italy;
| | - Raffaele Giubbini
- Nuclear Medicine Department, University of Brescia, 25121 Brescia, Italy;
| | - Alessandra Tucci
- Hematology, ASST Spedali Civili of Brescia, 25128 Brescia, Italy;
| | - Francesco Bertagna
- Nuclear Medicine, ASST Spedali Civili Brescia, 25128 Brescia, Italy; (F.D.); (F.B.)
- Nuclear Medicine Department, University of Brescia, 25121 Brescia, Italy;
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19
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Koyuncu MB, Guler E, Koseci T, Ucar MA, Tombak A, Akdeniz A, Tiftik EN, Cavusoglu C. Integration of low muscle mass into the IPS system and its prognostic significance in patients with Hodgkin's lymphoma. Biomark Med 2021; 16:57-67. [PMID: 34753299 DOI: 10.2217/bmm-2021-0696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: The aim of this study is to determine whether a novel prognostic score can be obtained by including low muscle mass in the international prognostic score (IPS) system. Materials & Methods: Psoas muscle areas were determined in the PET/CT scans of the patients taken for staging at the time of diagnosis and after two cycles of ABVD. After evaluating the effect of low muscle mass on overall survival, receiver operating characteristic (ROC) analyzes were performed by including it in IPS systems. Results: Overall survival was significantly lower in patients with low muscle mass. Adding low muscle mass to IPS scores increased AUC, sensitivity and specificity. Conclusion: The integration of low muscle mass into the IPS scoring systems increased the success of these systems in predicting a prognosis.
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Affiliation(s)
- Mahmut Bakir Koyuncu
- Department of Hematology, Adana City Research & Training Hospital, Adana, 01170, Turkey
| | - Erkan Guler
- Department of General Surgery, Faculty of Medicine, Mersin University, Mersin, 33343, Turkey
| | - Tolga Koseci
- Department of Medical Oncology, Adana City Research & Training Hospital, Adana, 01170, Turkey
| | - Mehmet Ali Ucar
- Department of Hematology, Faculty of Medicine, Cukurova University, Adana, 01260, Turkey
| | - Anil Tombak
- Department of Hematology, Faculty of Medicine, Mersin University, Mersin, 33343, Turkey
| | - Aydan Akdeniz
- Department of Hematology, Faculty of Medicine, Mersin University, Mersin, 33343, Turkey
| | - Eyup Naci Tiftik
- Department of Hematology, Faculty of Medicine, Mersin University, Mersin, 33343, Turkey
| | - Cagatay Cavusoglu
- Department of Geriatrics, Sanliurfa Research & Training Hospital, Sanliurfa, 63190, Turkey
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20
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Zilioli VR, Albano D, Arcari A, Merli F, Coppola A, Besutti G, Marcheselli L, Gramegna D, Muzi C, Manicone M, Camalori M, Ciammella P, Colloca G, Tucci A. Clinical and prognostic role of sarcopenia in elderly patients with classical Hodgkin lymphoma: a multicentre experience. J Cachexia Sarcopenia Muscle 2021; 12:1042-1055. [PMID: 34114749 PMCID: PMC8350211 DOI: 10.1002/jcsm.12736] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/31/2021] [Accepted: 05/21/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Elderly classical Hodgkin lymphoma (cHL) (ecHL) is a rare disease with dismal prognosis and no standard treatment. Fitness-based approaches may help design appropriate treatments. Sarcopenia has been associated with an increased risk of treatment-related toxicities and worse survival in various solid tumours, but its impact in ecHL is unknown. The aim of this retrospective multicentre study was to investigate the prognostic role of sarcopenia in ecHL. METHODS We included newly diagnosed >64 years old cHL patients who performed a baseline comprehensive geriatric assessment and high-dose computed tomography (CT) or 18fluorine-fluorodeoxyglucose positron emission tomography/CT before any treatment. Sarcopenia was measured as skeletal muscle index (SMI, cm2 /m2 ) by the analysis of high-dose CT or low-dose positron emission tomography/CT images at the L3 level. The specific cut-offs for the SMI were determined by receiver operator curve analysis and compared with those proposed in literature and studied in diffuse large B-cell lymphoma. Survival functions [progression-free survival [PFS] and overall survival (OS)] were calculated for the whole population and for different subgroups defined as per different sarcopenia cut-off levels. RESULTS We included 154 patients (median age 71 years old, 76 female). The median L3-SMI was 42 cm2 /m2 . The specific cut-off derived in our male population was 45 cm2 /m2 ; using this cut-off, 27 male patients (35%) were defined as sarcopenic. After a median follow-up of 5.9 years, the overall 5-year PFS and OS rates were 53% and 65%, respectively, and were significantly shorter in sarcopenic male patients compared with non-sarcopenic (PFS 31% vs. 61%, P = 0.008; OS 51% vs. 74%, P = 0.042). Applying diffuse large B-cell lymphoma-derived sarcopenic thresholds, there were no significant differences between sarcopenic and non-sarcopenic patients for both PFS and OS, with a sole exception of a significant reduced PFS in sarcopenic male patients using Namakura cut-off. The comprehensive geriatric assessment-determined frail functional status was an independent adverse prognostic factor for both female and male patients. CONCLUSIONS Baseline evaluation of sarcopenia through radiological examinations performed for ecHL staging may help define a proportion of male patients with unfavourable outcome with current treatment strategies. Also the functional status evaluation could allow to identify a frail subgroup of patients with worse outcome.
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Affiliation(s)
| | - Domenico Albano
- Division of Nuclear Medicine, ASST Spedali Civili, Brescia, Italy
| | - Annalisa Arcari
- Division of Hematology, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Francesco Merli
- Division of Hematology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alessandra Coppola
- Division of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giulia Besutti
- Division of Radiology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Clinical and Experimental PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Luigi Marcheselli
- Fondazione Italiana Linfomi Onlus, Trial Office Modena, Modena, Italy
| | | | - Cristina Muzi
- Division of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Moana Manicone
- Clinical and Experimental PhD Program, University of Modena and Reggio Emilia, Modena, Italy.,Division of Radiotherapy, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Manuela Camalori
- Division of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Patrizia Ciammella
- Division of Radiotherapy, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppe Colloca
- Division of Geriatrics, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
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