Prevalence and clinical outcomes of sarcopenia in patients with esophageal, gastric or colorectal cancers receiving preoperative neoadjuvant therapy: A meta-analysis

Artificial Intelligence-Driven Volumetric Analysis of Muscle Mass as a Predictor of Tumor Response to Neoadjuvant Chemoradiotherapy in Patients with Rectal Cancer

Background/Objectives: Artificial intelligence (AI)-based volumetric measurements for assessing sarcopenia are expected to offer comprehensive insight into three-dimensional muscle volume and distribution. Therefore, we investigated the role of sarcopenia using computed tomography (CT)-based automated AI volumetric muscle measurements in predicting neoadjuvant chemoradiotherapy (nCRT) response and prognosis in patients with rectal cancer who underwent nCRT. Methods: We retrospectively analyzed the data of patients who underwent nCRT followed by curative resection between March 2010 and August 2021. Sarcopenia was defined using the Q1 cutoff value of the volumetric skeletal muscle index (SMI). The association between pre-nCRT volumetric sarcopenia and nCRT response was analyzed using logistic regression. A Cox proportional hazards model was used to identify the prognostic value of the pre- and post-nCRT volumetric SMIs. Results: Notably, 22 (25.6%) of the 86 patients had volumetric sarcopenia. The sarcopenia group showed a poorer nCRT response than the non-sarcopenia group. Pre-nCRT sarcopenia was a significant predictor of poor nCRT response (OR, 0.34 [95% CI, 0.12-0.96]; p = 0.041). Furthermore, an increased volumetric SMI during nCRT was a more significant prognostic factor on recurrence-free survival (aHR, 0.26 [95% CI, 0.08-0.83]; p = 0.023) and overall survival (aHR, 0.41 [95% CI, 0.17-0.99]; p = 0.049) than a decreased SMI. Conclusions: Volumetric sarcopenia can be used to predict poor nCRT response. A reduction in volumetric sarcopenia can be a poor prognostic factor in patients with rectal cancer who undergo nCRT.

Textbook oncological outcome of locally advanced gastric cancer patients with preoperative sarcopenia: a multicenter clinical study

BACKGROUND

The impact of postoperative sarcopenia on the Textbook Oncological Outcome (TOO) in locally advanced gastric cancer (LAGC) remains uncertain. This study investigates the relationship between sarcopenia and TOO, explores its long-term prognostic value, and develops a prognostic model incorporating sarcopenia and TOO for survival prediction.

METHODS

We performed a retrospective analysis of clinical and pathological data from patients with LAGC who underwent radical surgery at two Chinese tertiary referral hospitals. Sarcopenia was defined as an SMI < 36.4 cm2/m2 in males and < 28.4 cm2/m2 in females. TOO was defined as the addition of perioperative chemotherapy to the textbook outcomes (TO). A nomogram was developed to predict postoperative overall survival (OS) and recurrence-free survival (RFS) in LAGC patients.

RESULTS

The study included 972 patients with LAGC. The overall TOO achievement rate was 67.1%. The TOO achievement rate was significantly higher in patients non-sarcopenia compared to those with sarcopenia (68.9% vs. 61.1%, P = 0.031). Logistic regression revealed that age ≥ 65, high ASA score, and sarcopenia were independent risk factors for TOO failure. Cox regression analysis identified TOO, sarcopenia, tumor size, differentiation, vascular invasion, pT stage, and pN stage as independent predictors of OS and RFS. Nomogram models based on sarcopenia and TOO accurately predicted the 3-year and 5-year OS and RFS.

CONCLUSION

Preoperative sarcopenia was an independent predictor of TOO implementation. A prognostic prediction model that integrates preoperative sarcopenia and TOO, which outperforms the current staging system, can aid clinicians in effectively assessing the prognosis of patients with LAGC.

Prevalence of Sarcopenia Determined by Computed Tomography in Pancreatic Cancer: A Systematic Review and Meta-Analysis of Observational Studies

Introduction: Sarcopenia, a condition characterized by a loss of skeletal muscle mass, is increasingly recognized as a significant factor influencing patient outcomes in pancreatic cancer (PC). This systematic review and meta-analysis aimed to estimate the prevalence of sarcopenia in patients with PC using computed tomography and to explore how different measurement methods and cut-off values impact such prevalence. Materials and Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a comprehensive search of PubMed, Web of Science, and EMBASE databases was performed, identifying 48 observational studies involving 9063 patients. Results: The overall pooled prevalence of sarcopenia was 45% (95% CI, 40-50%), but varied significantly by the method used: 47% when measured with the skeletal muscle index and 33% when assessed with the total psoas area. In addition, in studies using SMI, sarcopenia prevalence was 19%, 45%, and 57% for cutoff values <40 cm2/m2, 40-50 cm2/m2, and >50 cm2/m2, respectively. Moreover, the prevalence was higher in patients receiving palliative care (50%) compared to those treated with curative intent (41%). High heterogeneity was observed across all analyses, underscoring the need for standardized criteria in sarcopenia assessment. Conclusions: Our findings highlight the substantial variability in sarcopenia prevalence, which could influence patient outcomes, and stress the importance of consensus in measurement techniques to improve clinical decision making and research comparability.

Sarcopenia: A dive into metabolism to promote a multimodal, preventive, and regenerative approach

Sarcopenia, the age-related loss of skeletal muscle mass and function, poses a significant challenge in the field of geriatrics and gerontology, impacting the health and independence of older adults. Understanding and addressing sarcopenia is crucial for optimizing clinical outcomes and enhancing the quality of life along with aging. By synthesizing current research findings and theoretical frameworks, this review elucidates the multifaceted mechanisms underlying sarcopenia, mainly focusing on energy balance and metabolic processes. Furthermore, the manuscript explores the implications of sarcopenia on overall health outcomes, functional decline, and quality of life in older individuals. The study concludes with a perspective on the role of preventive and regenerative medicine in sarcopenia, where the two main lifestyle pillars (exercise and diet) represent key factors.