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Wakefield CJ, Baucom M, Sisak S, Seder CW, Janowak CF. Pectoralis Muscle Index as Predictor of Outcomes in Patients With Severe Blunt Chest Wall Injury. J Surg Res 2024; 300:247-252. [PMID: 38824855 DOI: 10.1016/j.jss.2024.04.013] [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: 12/30/2023] [Revised: 03/01/2024] [Accepted: 04/17/2024] [Indexed: 06/04/2024]
Abstract
INTRODUCTION Sarcopenia has been shown to portend worse outcomes in injured patients; however, little is known about the impact of thoracic muscle wasting on outcomes of patients with chest wall injury. We hypothesized that reduced pectoralis muscle mass is associated with poor outcomes in patients with severe blunt chest wall injury. METHODS All patients admitted to the intensive care unit between 2014 and 2019 with blunt chest wall injury requiring mechanical ventilation were retrospectively identified. Blunt chest wall injury was defined as the presence of one or more rib fractures as a result of blunt injury mechanism. Exclusion criteria included lack of admission computed tomography imaging, penetrating trauma, <18 y of age, and primary neurologic injury. Thoracic musculature was assessed by measuring pectoralis muscle cross-sectional area (cm2) that was obtained at the fourth thoracic vertebral level using Slice-O-Matic software. The area was then divided by the patient height in meters2 to calculate pectoralis muscle index (PMI) (cm2/m2). Patients were divided into two groups, 1) the lowest gender-specific quartile of PMI and 2) second-fourth gender-specific PMI quartiles for comparative analysis. RESULTS One hundred fifty-three patients met the inclusion criteria with a median (interquartile range) age 48 y (34-60), body mass index of 30.1 kg/m2 (24.9-34.6), and rib score of 3.0 (2.0-4.0). Seventy-five percent of patients (116/153) were male. Fourteen patients (8%) had prior history of chronic lung disease. Median (IQR) intensive care unit length-of-stay and duration of mechanical ventilation (MV) was 18.0 d (13.0-25.0) and 15.0 d (10.0-21.0), respectively. Seventy-three patients (48%) underwent tracheostomy and nine patients (6%) expired during hospitalization. On multivariate linear regression, reduced pectoralis muscle mass was associated with increased MV duration when adjusting for rib score and injury severity score (β 5.98, 95% confidence interval 1.28-10.68, P = 0.013). CONCLUSIONS Reduced pectoralis muscle mass is associated with increased duration of MV in patients with severe blunt chest wall injury. Knowledge of this can help guide future research and risk stratification of critically ill chest wall injury patients.
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Affiliation(s)
- Connor J Wakefield
- Brooke Army Medical Center, Department of Internal Medicine, Fort Sam Houston, Texas.
| | - Matthew Baucom
- University of Cincinnati Medical Center, Department of Trauma Surgery, Cincinnati, Ohio
| | - Stephanie Sisak
- University of Cincinnati Medical Center, Department of Trauma Surgery, Cincinnati, Ohio
| | - Christopher W Seder
- Rush University Medical Center, Department of Cardiovascular and Thoracic Surgery, Chicago, Illinois
| | - Christopher F Janowak
- University of Cincinnati Medical Center, Department of Trauma Surgery, Cincinnati, Ohio
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Yang D, Su L, Zhang L, Zhang Y, Li Y, Huang T, Huang X. Sarcopenia predicts postoperative complications in head and neck cancer: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2024; 281:3959-3975. [PMID: 38647686 DOI: 10.1007/s00405-024-08577-1] [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: 12/23/2023] [Accepted: 02/19/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE We performed this systematic review and meta-analysis to explore the impact of preoperative sarcopenia on postoperative complication risks after head and neck cancer (HNC) surgery. METHODS We identified eligible studies by searching Ovid-MEDLINE, Ovid-Embase, EBM Reviews-Cochrane Central Register of Controlled Trials, Web of Science Core Collection, and Scopus. This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. RESULTS Twenty-one studies with a total of 3480 patients met our inclusion criteria. The presence of sarcopenia significantly increased the incidence of overall postoperative complications (OR = 1.72, 95% CI 1.23, 2.41; P = 0.002; I2 = 59%). Subgroup analyses showed a higher risk of postoperative complications in the populations in which sarcopenia was diagnosed with low L3-skeletal muscle index (L3-SMI) or low cross-sectional area of the rectus femoris, but not in the group that sarcopenia was diagnosed with low C3-SMI. Preoperative sarcopenia also substantially increased the risk of severe postoperative complications (OR = 2.26), pharyngocutaneous fistulas (OR = 2.15), free flap-related complications (OR = 1.63), and surgical site infections (OR = 1.84). We also found a tendency toward a higher incidence of wound complications and 30-day mortality in patients with sarcopenia. CONCLUSION Preoperative sarcopenia is a negative prognostic indicator for postoperative complications in patients with HNC after surgery. To reduce the incidence of postoperative complications and improve poor prognosis, further attention needs to be paid to the evaluation and management of preoperative sarcopenia.
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Affiliation(s)
- Dan Yang
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Lin Su
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Liying Zhang
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yu Zhang
- Department of Biomedical Engineering, Sichuan University Library, Chengdu, 610041, Sichuan, China
| | - Yina Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Tingxuan Huang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Xiaoli Huang
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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Zhang J, Tang X, Zhang W, Xu Y, Zhang H, Fan Y. Cancer cachexia as a predictor of adverse outcomes in patients with non-small cell lung cancer: A meta-analysis. Clin Nutr 2024; 43:1618-1625. [PMID: 38788267 DOI: 10.1016/j.clnu.2024.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/09/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024]
Abstract
INTRODUCTION Cancer cachexia is a complex problem characterized by weight loss due to skeletal muscle and adipose tissue reduction. The purpose of this meta-analysis is to examine the association between cancer cachexia and adverse outcomes in patients with non-small cell lung cancer (NSCLC). METHODS A comprehensive search was conducted in the PubMed, Web of Science, and Embase databases from their inception to January 15, 2024. Retrospective or prospective studies that investigated the cancer cachexia as a predictor of overall survival (OS), progression-free survival (PFS), overall response rate (ORR), or disease control rate (DCR) in NSCLC patients were included in this analysis. RESULTS Sixteen studies, comprising 5919 NSCLC patients, were identified. The pooled prevalence of cachexia in NSCLC patients was 39%, with individual studies reporting rates ranging from 19% to 63.8%. A meta-analysis using a random effects model showed that cachexia was associated with reduced OS (hazard ratio [HR] 1.84; 95% confidence interval [CI] 1.54-2.21) and PFS (HR 1.49; 95% CI 1.27-1.73). Subgroup analysis indicated that cancer cachexia significantly predicted OS, regardless of study design, NSCLC subtypes, cancer stage, definitions of cachexia, or follow-up duration. However, there was no clear association between cancer cachexia and ORR or DCR. CONCLUSIONS Cancer cachexia emerges is a negative prognostic factor for OS and PFS in NSCLC patients. Assessing cancer cachexia can improve risk classification for survival outcomes in this patient population.
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Affiliation(s)
- Junfang Zhang
- Department of Medical Nutrition, Nanjing Lishui District People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing 211200, China
| | - Xuan Tang
- Cancer Institute, The Affiliated People's Hospital, Jiangsu University, Zhenjiang 212002, China
| | - Wenbo Zhang
- Department of General Surgery, The Affiliated People's Hospital, Jiangsu University, Zhenjiang 212002, China
| | - Ying Xu
- Department of Laboratory Center, The Affiliated People's Hospital, Jiangsu University, Zhenjiang 212002, China
| | - Heng Zhang
- Department of General Surgery, Nanjing Lishui District People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing 211200, China.
| | - Yu Fan
- Cancer Institute, The Affiliated People's Hospital, Jiangsu University, Zhenjiang 212002, China.
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Timsina SR, Tanomkiat W, Geater SL, Ina N. Exploring previously used thresholds for computed tomography-defined low skeletal muscle mass in predicting functional limitations among lung cancer patients. Thorac Cancer 2024; 15:1287-1295. [PMID: 38666456 PMCID: PMC11147667 DOI: 10.1111/1759-7714.15313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Various cutoffs have been used to diagnose computed tomography (CT)-defined low skeletal muscle mass; however, the impact of this variability on predicting physical functional limitations (PFL) remains unclear. In the present study we aimed to evaluate the diagnostic test metrics for predicting PFLs using a fixed cutoff value from previous reports and sought to create a prediction score that incorporated the skeletal muscle index (SMI) and other clinical factors. METHODS In this cross-sectional study including 237 patients with lung cancer, the SMI was assessed using CT-determined skeletal muscle area at the third lumbar vertebra. Physical function was assessed using the short physical performance battery (SPPB) test, with PFL defined as an SPPB score ≤9. We analyzed the diagnostic metrics of the five previous cutoffs for CT-defined low skeletal muscle mass in predicting PFL. RESULTS The mean age of participants was 66.0 ± 10.4 years. Out of 237 patients, 158 (66.7%) had PFLs. A significant difference was observed in SMI between individuals with and without PFLs (35.7 cm2/m2 ± 7.8 vs. 39.5 cm2/m2 ± 8.4, p < 0.001). Diagnostic metrics of previous cutoffs in predicting PFL showed suboptimal sensitivity (63.29%-91.77%), specificity (11.39%-50.63%), and area under the receiver operating characteristic curve (AUC) values (0.516-0.592). Age and the SMI were significant predictors of PFL; therefore, a score for predicting PFL (age - SMI + 21) was constructed, which achieved an AUC value of 0.748. CONCLUSION Fixed cutoffs for CT-defined low skeletal muscle mass may inadequately predict PFLs, potentially overlooking declining physical functions in patients with lung cancer.
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Affiliation(s)
- Shiva Raj Timsina
- Department of Radiology, Faculty of MedicinePrince of Songkla UniversitySongklaThailand
| | - Wiwatana Tanomkiat
- Department of Radiology, Faculty of MedicinePrince of Songkla UniversitySongklaThailand
| | - Sarayut L. Geater
- Unit of Respiratory and Respiratory Critical Care Medicine, Department of Medicine, Faculty of MedicinePrince of Songkla UniversitySongklaThailand
| | - Natee Ina
- Department of Radiology, Faculty of MedicinePrince of Songkla UniversitySongklaThailand
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Fukui M, Matsunaga T, Hattori A, Takamochi K, Tomita H, Nojiri S, Suzuki K. Prognostic significance of preoperative exercise tolerance in patients with early-stage lung cancer. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00006-0. [PMID: 38218531 DOI: 10.1016/j.jtcvs.2023.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/14/2023] [Accepted: 12/26/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVE To investigate the influence of simple preoperative exercise tests as prognostic factors for early-stage lung cancer. METHODS This single-institution retrospective study included consecutive patients who underwent pulmonary resection for stage 0 to I lung cancer between April 2017 and December 2019. Before surgery, 7 metabolic equivalents of task in the double Master 2-step test were loaded into the exercise echocardiogram. The relationship between prognosis and exercise stress test results in terms of availability, symptoms, and saturation of percutaneous oxygen was investigated. RESULTS This study included 862 patients with pathological stage 0 to I lung cancer. Among the 862 patients, 673 patients (78.1%) who were able to complete 7 metabolic equivalents of task exercise for 3 minutes without assistance were classified into the complete group. The 5-year survival of the complete group was significantly better than that of the incomplete group. Multivariable analysis revealed that age (hazard ratio, 1.06; P = .008), male sex (hazard ratio, 2.23; P = .011), carcinoembryonic antigen level >5 ng/mL (hazard ratio, 2.33; P = .011), and inability to complete 7 metabolic equivalents of task exercise (hazard ratio, 3.90; P < .001) were the prognostic factors. Patients in the older group who had the ability to complete exercise had a better prognosis than those in the younger group without the ability (P = .003). CONCLUSIONS Preoperative exercise ability is a prognostic factor for early-stage lung cancer. Patients who can tolerate an exercise load of 7 metabolic equivalents of task, even if they are aged 70 years or older, have a better prognosis than patients younger than age 70 years without exercise tolerance.
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Affiliation(s)
- Mariko Fukui
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
| | - Takeshi Matsunaga
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Aritoshi Hattori
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuya Takamochi
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Hisashi Tomita
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Shuko Nojiri
- Medical Technology Innovation Center, Juntendo University School of Medicine, Tokyo, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
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Morikawa H, Oba T, Kiyosawa N, Iji R, Amitani M, Chino T, Shimizu T, Ono M, Ito T, Kanai T, Maeno K, Ito KI. Significance of skeletal muscle index-to-body mass index ratio as a predictor of post-surgical bleeding after mastectomy in patients with breast cancer. Breast Cancer 2023; 30:933-942. [PMID: 37440158 DOI: 10.1007/s12282-023-01483-0] [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: 04/25/2023] [Accepted: 07/06/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Post-surgical bleeding is a major complication of mastectomy in patients with breast cancer. However, the risk factors for post-surgical bleeding have not been well studied. Although obesity or reduced skeletal muscle mass is an indicator of cancer surgery complications, its impact on post-surgical bleeding after mastectomy remains unknown. METHODS In total, 563 patients with breast cancer who underwent mastectomy were included in this study. We evaluated the preoperative body mass index (BMI), skeletal muscle index (SMI), and SMI-to-BMI ratio and analyzed the association between these values and the incidence of post-surgical bleeding. RESULTS Post-surgical bleeding occurred in 33 (5.6%) patients. Mean BMI was significantly higher in the bleeding group (26.3 ± 4.7) than in the no-bleeding group (23.0 ± 4.1) (p < 0.001), whereas mean SMI was lower in the former group (45.0 ± 8.5) than in the latter group (48.0 ± 8.5) (p = 0.08). The bleeding group had significantly lower SMI-to-BMI ratio (1.71 ± 0.16) than the no-bleeding group (2.10 ± 0.23) (p < 0.001). Among these three parameters, SMI-to-BMI ratio had the highest area under the curve value in their receiver operating characteristic curves (0.73 for BMI, 0.59 for SMI, 0.92 for SMI-to-BMI ratio). Furthermore, on multivariate analysis, SMI-to-BMI ratio was an independent risk factor for post-surgical bleeding (hazard ratio, 38.4; 95% confidence interval, 13.9-136.2; p < 0.001). CONCLUSIONS SMI-to-BMI ratio is a superior predictive factor of post-surgical bleeding after mastectomy to either BMI or SMI alone.
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Affiliation(s)
- Hiroki Morikawa
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan
| | - Takaaki Oba
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan.
| | - Nami Kiyosawa
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan
| | - Ryoko Iji
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan
| | - Masatsugu Amitani
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan
| | - Tatsunori Chino
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan
| | - Tadafumi Shimizu
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan
| | - Mayu Ono
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan
| | - Tokiko Ito
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan
| | - Toshiharu Kanai
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan
| | - Kazuma Maeno
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan
| | - Ken-Ichi Ito
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan
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Mahajan A, Goyal D, Agarwal U, Patil V, Shukla S, Noronha V, Joshi A, Menon N, Prabhash K. Exploring the implications of modified advanced lung cancer inflammation index on outcomes in patients with advanced non-small cell lung cancer. EXPLORATION OF TARGETED ANTI-TUMOR THERAPY 2023; 4:896-911. [PMID: 37970209 PMCID: PMC10645468 DOI: 10.37349/etat.2023.00172] [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: 02/03/2023] [Accepted: 07/20/2023] [Indexed: 11/17/2023] Open
Abstract
Aim Sarcopenia and skeletal muscle density (SMD) have been shown to be both predictive and prognostic marker in oncology. Advanced lung cancer inflammation index (ALI) has been shown to predict overall survival (OS) in small cell lung cancer (SCLC). Computed tomography (CT) enables skeletal muscle to be quantified, whereas body mass index (BMI) cannot accurately reflect body composition. The purpose was to evaluate the prognostic value of modified ALI (mALI) using CT-determined third lumbar vertebra (L3) muscle index beyond original ALI and see the interaction between sarcopenia, SMD, neutrophil-lymphocyte ratio (NLR), ALI and mALI at baseline and post 4 cycles of chemotherapy and their effects on OS and progress free survival (PFS) in patients with advanced non-SCLC (NSCLC). Methods This retrospective study consisted of a total of 285 advanced NSCLC patients. The morphometric parameters such as SMD, skeletal muscle index (SMI) and fat-free mass (FFM) were measured by CT at the L3 vertebra. ALI was defined as BMI × serum albumin/NLR and mALI was defined as SMI × serum albumin/NLR. Results Sarcopenia was observed in over 70% of patients across all BMI categories. Patients having sarcopenia suffered from a higher incidence of chemotherapeutic drug toxicities but this was not found to be statistically significant. Concordance was seen between ALI and mALI in the pre-treatment setting and this was statistically significant. A significant proportion of patients with poor ALI (90.9%), poor pre-chemotherapy mALI (91.3%) and poor post-chemotherapy mALI (89%) had poor NLR and each of them was statistically significant. Conclusions In both univariate and multivariate analyses, this study demonstrated the statistical significance of sarcopenia, SMD, and mALI as predictive factors for OS. Additionally, sarcopenia and SMD were also found to be statistically significant factors in predicting PFS. These biomarkers could potentially help triage patients for active nutritional intervention for better outcomes.
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Affiliation(s)
- Abhishek Mahajan
- Clatterbridge Centre for Oncology NHS Foundation Trust, L7 8YA Liverpool, UK
| | - Devendra Goyal
- Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Ujjwal Agarwal
- Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Shreya Shukla
- Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
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Meggyesy AM, Wilshire CL, Chang SC, Gorden JA, Gilbert CR. Muscle mass cross-sectional area is associated with survival outcomes in malignant pleural disease related to lung cancer. Respir Med 2023; 217:107371. [PMID: 37516273 DOI: 10.1016/j.rmed.2023.107371] [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: 01/24/2023] [Revised: 06/04/2023] [Accepted: 07/25/2023] [Indexed: 07/31/2023]
Abstract
INTRODUCTION Malignant pleural effusions are common in advanced malignancy and associated with overall poor survival. The presence of sarcopenia (decreased muscle mass) is associated with poor outcomes in numerous disease states, however, its relationship to malignant pleural disease has not been defined. We sought to understand if there was an association between decreased survival and decreased muscle mass in patients with malignant pleural effusion. METHODS Patients with malignant pleural disease undergoing indwelling tunneled pleural catheter placement were retrospectively reviewed. Computed tomography was reviewed and cross-sectional area of pectoralis and paraspinous muscle areas were calculated. Overall survival and associations with muscle mass were calculated. RESULTS A total of 309 patients were available for analysis, with a median age of 67 years and the majority female (58%). The median survival was 129 days from initial pleural drainage to death. Regression analysis and Kaplan-Meier survival analysis did not reveal an association with survival and muscle mass for the entire population. However, Kaplan-Meier survival analysis of the lung cancer subgroup revealed the presence of decreased muscle mass and decreased survival time. CONCLUSION The presence of decreased muscle mass within a lung cancer population that has malignant pleural effusions are associated with decreased survival. However, the presence of decreased muscle mass within a heterogenous population of malignant pleural disease was not associated with decreased overall survival time. Further study of the role that sarcopenia may play in malignant pleural disease is warranted.
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Affiliation(s)
- Austin M Meggyesy
- Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WA, USA; The Center for Lung Research in Honor of Wayne Gittinger, Seattle, WA, USA
| | - Candice L Wilshire
- Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WA, USA; The Center for Lung Research in Honor of Wayne Gittinger, Seattle, WA, USA
| | - Shu-Ching Chang
- Section of Biostatistics, Providence-St. Vincent Medical Center, Portland, OR, USA
| | - Jed A Gorden
- Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WA, USA; The Center for Lung Research in Honor of Wayne Gittinger, Seattle, WA, USA
| | - Christopher R Gilbert
- The Center for Lung Research in Honor of Wayne Gittinger, Seattle, WA, USA; Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Medical University of South Carolina, Charleston, SC, USA.
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9
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Emekli E, Bostancı Can EZ. Prognostic Value of Diaphragm Diameter, Muscle Volume, and Bone Mineral Density in Critically Ill COVID-19 Patients. J Intensive Care Med 2023; 38:847-855. [PMID: 37050868 PMCID: PMC10099913 DOI: 10.1177/08850666231169494] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/22/2023] [Accepted: 03/28/2023] [Indexed: 04/14/2023]
Abstract
Objective: We aimed to analyze the prognostic value of muscle volume (MV), bone mineral density (BMD), and diaphragm diameter (DD) in COVID-19. Method: The study included 498 patients admitted to the intensive care unit (ICU) with a positive polymerase chain reaction test for COVID-19 from March 11, 2020, through August 31, 2022. The patients' laboratory and demographic data of the patients at the time of ICU admission were recorded. MV, DD, and BMD measurements were performed using computed tomography examinations. Muscle index (MI) was calculated as MV/height2. Quartiles were determined for all 4 measurements. Patients in the lowest quartile were recorded as having low MV, MI, DD, and BMD values. The parameters were evaluated for the whole group and compared according to gender and mortality. The multiple regression analysis was performed for the prediction of mortality. Results: In the mortality group, the male and female patients had significantly statistically lower values in MV (P < .001 and P = .002, respectively), MI (P < .001 and P = .005, respectively), DD (P < .001 and P < .001, respectively), and BMD (P = .002 and P < .001, respectively). In the multiple regression analysis, low MI (OR: 2.03, 95% CI: 1.14-3.61, P = .016) and DD (OR: 10.47, 95% CI: 5.59-19.59, P < .001) values remained significant for the prediction of mortality. Conclusion: BMD is a risk factor for mortality in patients with severe COVID-19, but cannot be used as an independent predictor. However, MI and DD can be used as independent predictors of mortality even in severe cases.
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Affiliation(s)
- Emre Emekli
- Department of Radiology, Etimesgut
Şehit Sait Ertürk State Hospital, Ankara, Turkey
| | - Emine Zülal Bostancı Can
- Department of Anesthesiology and
Reanimation, Etimesgut Şehit Sait Ertürk State Hospital, Ankara, Turkey
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10
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Jogiat U, Jimoh Z, Turner SR, Baracos V, Eurich D, Bédard ELR. Sarcopenia in Lung Cancer: A Narrative Review. Nutr Cancer 2023:1-14. [PMID: 37177914 DOI: 10.1080/01635581.2023.2212425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
It has been over 10 years since the relationship between sarcopenia and lung cancer was first explored. Since then, sarcopenia research has progressed substantially, and the prognostic value of this condition is becoming increasingly apparent. Prior systematic reviews and meta-analyses have established sarcopenia to be negatively associated with disease-free and overall-survival, as well as a major risk factor for post-operative complications. The bulk of the literature has explored sarcopenia in the resectable setting, with less emphasis placed on studies evaluating this condition in advanced disease. In this up-to-date review, an examination of the literature exploring the association between sarcopenia and long-term outcomes in advanced lung cancer is provided. We further explore the association between adverse events of medical therapy and the role of sarcopenia as a predictor of tumor response. Finally, the interventions on sarcopenia and cancer cachexia are reviewed, with an emphasis placed on prospective studies.
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Affiliation(s)
- Uzair Jogiat
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | | | - Simon R Turner
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | - Vickie Baracos
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Canada
| | - Dean Eurich
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Eric L R Bédard
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
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11
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da Rocha DS, Tessari JA, Mainardi NB, Hax V, Gasparin AA, de Oliveira CAV, Garcia TS, Xavier RM, Chakr RMDS. Assessment of muscle mass using chest computed tomography-based quantitative and qualitative measurements in patients with systemic sclerosis: A retrospective study with cross-sectional and longitudinal analyses. Semin Arthritis Rheum 2023; 59:152168. [PMID: 36736023 DOI: 10.1016/j.semarthrit.2023.152168] [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: 09/02/2022] [Revised: 01/03/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND/ PURPOSE Sarcopenia has been increasingly studied in systemic sclerosis (SSc), which is one of the most lethal autoimmune diseases, mainly due to lung involvement. Our objective was to study the associations of myopenia and/or myosteatosis with clinical features of SSc and subsequent adverse outcomes. METHODS This is a retrospective study with cross-sectional and longitudinal analyses, in which patients with SSc were consecutively included in the outpatient clinic of a tertiary university hospital between 2012 and 2021. Clinical and laboratory parameters of patients with SSc were collected from their medical records. Skeletal muscle mass was assessed on chest computed tomography (CT) at the level of the first lumbar vertebra (L1) by skeletal muscle area (SMA), skeletal muscle index ([SMI] SMA/height2), and skeletal muscle radiation attenuation (SMRA). Cut-off values for myopenia in women and men were SMA <70.1 cm² and <110.4 cm², and SMI <25.9 cm²/m² and <34.6 cm²/m², respectively; values for myosteatosis in women and men were SMRA <29.8 HU and <36.3 HU, respectively. In a subgroup of 31 patients followed-up between 2017 and 2019, the diagnostic properties of SMA, SMI, and SMRA by CT were compared with the appendicular skeletal muscle mass index (ASMI) by dual-energy X-ray absorptiometry (DXA). Low muscle quantity was defined according to the European Working Group on Sarcopenia in Older People 2: ASMI <5.5 kg/m2 in women and <7.0 kg/m2 in men. Afterwards, a better tomographic index was used for correlating with clinical and laboratory parameters. RESULTS Myopenia and/or myosteatosis were present in 75.7 % of patients with SSc. The prevalence rates according to each index were SMA 25.2%, SMI 12.1%, and SMRA 69.2%. In 73% of the patients with overweight/obesity (body mass index [BMI] ≥25 kg/m²), only SMRA was reduced. Considering ASMI as the gold standard, the sensitivity, specificity, positive and negative predictive values for SMA were 60%, 96.2%, 75% and 92.6%, respectively; for SMI, they were 40%, 96.2%, 66.7%, and 89.3%, respectively; for SMRA, these values were 60%, 34.6%, 15%, and 81.8%. Pearson's correlation coefficients were 0.73, 0.74, and 0.10 for SMA, SMI, and SMRA, respectively, and ASMI significantly agreed with SMA (kappa 0.611, p < 0.001) and SMI (kappa 0.431, p = 0.012). After adjustments in a multivariate model, BMI (p < 0.001) and female sex (p < 0.001) remained significantly associated with myopenia by SMA; BMI (p =0.010) remained significantly associated with low muscle mass by ASMI. CONCLUSION The SMA index at L1 level on chest CT was demonstrated to be an accurate measure that is useful for detecting myopenia in patients with SSc. BMI and male sex predicted low SMA and BMI was associated with low ASMI on DXA. STATEMENT OF CLINICAL SIGNIFICANCE In recent years, great advances have been made in sarcopenia-related research, resulting in broader knowledge on its definition, causes, diagnosis, and treatment options. Regarding the techniques used for assessing muscle composition, computed tomography (CT) was demonstrated by many studies to be an efficient and easy-to-use method that can be employed by professionals of different specialties, including rheumatologists. This study was able to demonstrate that although the L3 image was not present on CT, the analysis of SMA at the L1 level on chest CT proved to be an accurate and useful measure to detect myopenia in patients with SSc. This study identified some associated factors of myopenia and/or myosteatosis according to each method employed for assessing muscle composition. Reduced BMI and male sex were associated factors of myopenia when using SMA, and reduced BMI was associated with myopenia when employing ASMI by DXA. Finally, we highlight the need not to generalize the term "sarcopenia" in clinical studies assessing imaging parameters of body composition. The use of the terms myopenia and/or myosteatosis would be more adequate, because CT allows the assessment of muscle composition and not strength or physical performance.
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Affiliation(s)
- Daniela Silva da Rocha
- Rheumatology Service, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, Porto Alegre, RS 90035-903, Brazil; School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), R. Ramiro Barcelos, 2400, Porto Alegre, RS 90035-003, Brazil.
| | - Julia Andressa Tessari
- School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), R. Ramiro Barcelos, 2400, Porto Alegre, RS 90035-003, Brazil
| | - Natalia Bocaccio Mainardi
- School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), R. Ramiro Barcelos, 2400, Porto Alegre, RS 90035-003, Brazil
| | - Vanessa Hax
- Rheumatology Service, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, Porto Alegre, RS 90035-903, Brazil; School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), R. Ramiro Barcelos, 2400, Porto Alegre, RS 90035-003, Brazil
| | - Andrese Aline Gasparin
- Rheumatology Service, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, Porto Alegre, RS 90035-903, Brazil; School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), R. Ramiro Barcelos, 2400, Porto Alegre, RS 90035-003, Brazil
| | | | - Tiago Severo Garcia
- School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), R. Ramiro Barcelos, 2400, Porto Alegre, RS 90035-003, Brazil
| | - Ricardo Machado Xavier
- Rheumatology Service, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, Porto Alegre, RS 90035-903, Brazil; School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), R. Ramiro Barcelos, 2400, Porto Alegre, RS 90035-003, Brazil
| | - Rafael Mendonça da Silva Chakr
- Rheumatology Service, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, Porto Alegre, RS 90035-903, Brazil; School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), R. Ramiro Barcelos, 2400, Porto Alegre, RS 90035-003, Brazil
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Del Toro R, Palmese F, Feletti F, Zani G, Minguzzi MT, Maddaloni E, Napoli N, Bedogni G, Domenicali M. Relationship between Muscle Mass, Bone Density and Vascular Calcifications in Elderly People with SARS-CoV-2 Pneumonia. J Clin Med 2023; 12:jcm12062372. [PMID: 36983372 PMCID: PMC10059976 DOI: 10.3390/jcm12062372] [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: 02/01/2023] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Little is known about the changes in organs and tissues that may make elder patients more vulnerable to acute stressors such as SARS-CoV-2 infection. METHODS In 80 consecutive elderly patients with SARS-CoV-2 infection, we evaluated the association between the descending thoracic aorta calcium score, L1 bone density and T12 skeletal muscle density measured on the same scan by high-resolution computed tomography. RESULTS At median regression, the ln-transformed DTA calcium score was inversely associated with L1 bone density (-0.02, 95%CI -0.04 to -0.01 ln-Agatston units for an increase of 1 HU) and with T12 muscle density (-0.03, -0.06 to -0.001 ln-Agatston units for an increase of 1 HU). At penalized logistic regression, an increase of 1 ln-Agatston unit of DTA calcium score was associated with an OR of death of 1.480 (1.022 to 2.145), one of 1 HU of bone density with an OR of 0.981 (0.966 to 0.996) and one of 1 HU of muscle density with an OR of 0.973 (0.948 to 0.999). These relationships disappeared after correction for age and age was the stronger predictor of body composition and death. CONCLUSIONS Age has a big effect on the relationship between vascular calcifications, L1 bone density and T12 muscle density and on their relationship with the odds of dying.
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Affiliation(s)
- Rossella Del Toro
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, Santa Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
| | - Francesco Palmese
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, Santa Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
| | - Francesco Feletti
- Department of Translational Medicine and for Romagna, University of Ferrara, 44121 Ferrara, Italy
- Department of Diagnostic Imaging, Radiology Unit, Santa Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
| | - Gianluca Zani
- Department of Anesthesia and Intensive Care, Santa Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
| | - Maria Teresa Minguzzi
- Department of Diagnostic Imaging, Radiology Unit, Santa Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
| | - Ernesto Maddaloni
- Department of Experimental Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Nicola Napoli
- Department of Medicine and Surgery, Research Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Giorgio Bedogni
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, Santa Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
| | - Marco Domenicali
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, Santa Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
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Role of Machine Learning-Based CT Body Composition in Risk Prediction and Prognostication: Current State and Future Directions. Diagnostics (Basel) 2023; 13:diagnostics13050968. [PMID: 36900112 PMCID: PMC10000509 DOI: 10.3390/diagnostics13050968] [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: 12/23/2022] [Revised: 02/11/2023] [Accepted: 02/18/2023] [Indexed: 03/08/2023] Open
Abstract
CT body composition analysis has been shown to play an important role in predicting health and has the potential to improve patient outcomes if implemented clinically. Recent advances in artificial intelligence and machine learning have led to high speed and accuracy for extracting body composition metrics from CT scans. These may inform preoperative interventions and guide treatment planning. This review aims to discuss the clinical applications of CT body composition in clinical practice, as it moves towards widespread clinical implementation.
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14
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Arayne AA, Gartrell R, Qiao J, Baird PN, Yeung JMC. Comparison of CT derived body composition at the thoracic T4 and T12 with lumbar L3 vertebral levels and their utility in patients with rectal cancer. BMC Cancer 2023; 23:56. [PMID: 36647027 PMCID: PMC9843961 DOI: 10.1186/s12885-023-10522-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 01/09/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Computed tomography (CT) derived body composition measurements of sarcopenia are an emerging form of prognostication in many disease processes. Although the L3 vertebral level is commonly used to measure skeletal muscle mass, other studies have suggested the utilisation of other segments. This study was performed to assess the variation and reproducibility of skeletal muscle mass at vertebral levels T4, T12 and L3 in pre-operative rectal cancer patients. If thoracic measurements were equivalent to those at L3, it will allow for body composition comparisons in a larger range of cancers where lumbar CT images are not routinely measured. RESEARCH METHODS Patients with stage I - III rectal cancer, undergoing curative resection from 2010 - 2014, were assessed. CT based quantification of skeletal muscle was used to determine skeletal muscle cross sectional area (CSA) and skeletal muscle index (SMI). Systematic differences between the measurements at L3 with T4 and T12 vertebral levels were evaluated by percentile rank differences to assess distribution of differences and ordinary least product regression (OLP) to detect and distinguish fixed and proportional bias. RESULTS Eighty eligible adult patients were included. Distribution of differences between T12 SMI and L3 SMI were more marked than differences between T4 SMI and L3 SMI. There was no fix or proportional bias with T4 SMI, but proportional bias was detected with T12 SMI measurements. T4 CSA duplicate measurements had higher test-retest reliability: coefficient of repeatability was 34.10 cm2 for T4 CSA vs 76.00 cm2 for T12 CSA. Annotation time (minutes) with L3 as reference, the median difference was 0.85 for T4 measurements and -0.03 for T12 measurements. Thirty-seven patients (46%) had evidence of sarcopenia at the L3 vertebral level, with males exhibiting higher rates of sarcopenia. However, there was no association between sarcopenia and post-operative complications, recurrence or hospital LOS (length of stay) in patients undergoing curative resection. CONCLUSIONS Quantifying skeletal muscle mass at the T4 vertebral level is comparable to measures achieved at L3 in patients with rectal cancer, notwithstanding annotation time for T4 measurements are longer.
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Affiliation(s)
- Aisha A Arayne
- grid.417072.70000 0004 0645 2884Department of Surgery, Western Health, Footscray, VIC Australia
| | - Richard Gartrell
- grid.417072.70000 0004 0645 2884Department of Surgery, Western Health, Footscray, VIC Australia ,grid.1008.90000 0001 2179 088XDepartment of Surgery, Western Precinct, University of Melbourne, VIC, Australia ,grid.417072.70000 0004 0645 2884Department of Colorectal Surgery, Western Health, Footscray, VIC Australia
| | - Jing Qiao
- grid.417072.70000 0004 0645 2884Department of Surgery, Western Health, Footscray, VIC Australia
| | - Paul N Baird
- grid.1008.90000 0001 2179 088XDepartment of Surgery, Western Precinct, University of Melbourne, VIC, Australia ,grid.1008.90000 0001 2179 088XDepartment of Surgery, Ophthalmology, University of Melbourne, Victoria, Australia
| | - Justin MC Yeung
- grid.1008.90000 0001 2179 088XDepartment of Surgery, Western Precinct, University of Melbourne, VIC, Australia ,grid.417072.70000 0004 0645 2884Department of Colorectal Surgery, Western Health, Footscray, VIC Australia ,grid.417072.70000 0004 0645 2884Western Chronic Disease Alliance, Western Health, Sunshine, VIC Australia ,grid.1008.90000 0001 2179 088XDepartment of Surgery, Melbourne Medical School – Western Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Level 3, WCHRE Building, Sunshine Hospital, 176 Furlong Road, St Albans, VIC 3021 Australia
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15
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Sato S, Sato M, Shinohara H. Significance of preoperative evaluation of skeletal muscle index and immune-nutritional status for patients with early-stage non-small cell lung cancer. Gan To Kagaku Ryoho 2022; 71:354-362. [PMID: 36562876 DOI: 10.1007/s11748-022-01899-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Sarcopenia involves several mechanisms, including age-related changes, nutritional deficiencies, and inflammation, and is associated with unfavorable clinical outcomes. However, the significance of skeletal muscle index (SMI) and immune-nutritional status for patients with early-stage non-small cell lung cancer (NSCLC) remains unclear. This retrospective study was performed to investigate associations between preoperative SMI based on computed tomography (CT) at the L1 level and immune-nutritional status, and whether these factors correlated with surgical outcomes. METHODS We retrospectively investigated 386 patients with stage I-II NSCLC who underwent curative anatomical pulmonary resection. SMI was assessed on CT at the L1 level and patients were divided into low-SMI (n = 97) and high-SMI (n = 289) groups. We examined the significance of SMI for postoperative outcomes and evaluated correlations between SMI and clinical characteristics, including immune-nutritional status. RESULTS Low SMI was significantly associated with body mass index and geriatric nutritional risk index. Five-year overall survival rate was significantly lower in the low-SMI group (66.0%) than in the high-SMI group (82.2%, P = 0.004). Multivariate analysis revealed SMI (hazard ratio [HR] 1.850; 95% confidence interval [CI] 1.091-3.135; P = 0.022) and prognostic nutritional index (PNI) (HR 2.031; 95% CI 1.231-3.352; P = 0.006) as independent predictors of overall survival. Low SMI correlated significantly with postoperative complications (P = 0.024). CONCLUSIONS Low preoperative SMI based on CT at the L1 level appears associated with poor prognosis and postoperative complications among patients with early-stage NSCLC. PNI is also an independent prognostic factor for surgical outcomes.
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Affiliation(s)
- Seijiro Sato
- Division of General Thoracic Surgery, Nagaoka Red Cross Hospital, 2-297-1 Senshu, Nagaoka City, Niigata, 940-2085, Japan.
| | - Mao Sato
- Division of General Thoracic Surgery, Nagaoka Red Cross Hospital, 2-297-1 Senshu, Nagaoka City, Niigata, 940-2085, Japan
| | - Hirohiko Shinohara
- Division of General Thoracic Surgery, Nagaoka Red Cross Hospital, 2-297-1 Senshu, Nagaoka City, Niigata, 940-2085, Japan
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16
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Lin TY, Chen YF, Wu WT, Han DS, Tsai IC, Chang KV, Özçakar L. Impact of sarcopenia on the prognosis and treatment of lung cancer: an umbrella review. Discov Oncol 2022; 13:115. [PMID: 36307591 PMCID: PMC9616989 DOI: 10.1007/s12672-022-00576-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/17/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Lung cancer is the leading cause of cancer-related mortality worldwide. Sarcopenia, defined as the loss of muscle mass and function, is known to cause adverse health outcomes. The purpose of this umbrella review was to integrate published systematic reviews and meta-analyses exploring sarcopenia and lung cancer to provide comprehensive knowledge on their relationship. METHODS Eligible studies were searched from scientific databases until June 28, 2022. Critical appraisal was performed using A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2. The impact of sarcopenia on the pathophysiology, prevalence, and prognosis of lung cancer is summarized at the level of systematic reviews or meta-analyses. RESULTS Fourteen reviews and meta-analyses were conducted. The methodological quality was high for one review, low for nine, and critically low for four. The most common standard for diagnosing sarcopenia in the lung cancer population is computed tomography (CT) to measure the skeletal muscle index at the third lumbar vertebra (L3). Sarcopenia was highly prevalent among patients with lung cancer, with a pooled prevalence ranging from 42.8% to 45.0%. The association between sarcopenia and increased postoperative complications and decreased disease control rates with immune checkpoint inhibitors has been demonstrated. Mortality was significantly higher in sarcopenic patients than in non-sarcopenic patients with lung cancer, regardless of the stage of disease or type of treatment. CONCLUSIONS Sarcopenia is a poor prognostic factor for lung cancer. Future studies are necessary to clarify the pathophysiology of sarcopenia and develop effective interventions for sarcopenia in patients with lung cancer.
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Affiliation(s)
- Ting-Yu Lin
- Department of Physical Medicine and Rehabilitation, Lo-Hsu Medical Foundation, Inc., Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Yen-Fu Chen
- Department of Internal Medicine, National Taiwan University Hospital, Yunlin Branch, Douliu, Yunlin, Taiwan
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
| | - Der-Sheng Han
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
| | - I-Chen Tsai
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Congenital Heart Disease Study Group, Asian Society of Cardiovascular Imaging, Seoul, Korea
- InnovaRad Inc., Taichung, Taiwan
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan.
- Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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Mirzai S, Eck BL, Chen PH, Estep JD, Tang WHW. Current Approach to the Diagnosis of Sarcopenia in Heart Failure: A Narrative Review on the Role of Clinical and Imaging Assessments. Circ Heart Fail 2022; 15:e009322. [PMID: 35924562 PMCID: PMC9588634 DOI: 10.1161/circheartfailure.121.009322] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Sarcopenia has been established as a predictor of poor outcomes in various clinical settings. It is particularly prevalent in heart failure, a clinical syndrome that poses significant challenges to health care worldwide. Despite this, sarcopenia remains overlooked and undertreated in cardiology practice. Understanding the currently proposed diagnostic process is paramount for the early detection and treatment of sarcopenia to mitigate downstream adverse health outcomes.
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Affiliation(s)
- Saeid Mirzai
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH
| | - Brendan L. Eck
- Section of Musculoskeletal Imaging, Imaging Institute, Cleveland Clinic, Cleveland, OH
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Po-Hao Chen
- Section of Musculoskeletal Imaging, Imaging Institute, Cleveland Clinic, Cleveland, OH
| | - Jerry D. Estep
- Department of Cardiology, Cleveland Clinic Florida, Weston, FL
| | - W. H. Wilson Tang
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
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Detopoulou P, Voulgaridou G, Papadopoulou S. Cancer, Phase Angle and Sarcopenia: The Role of Diet in Connection with Lung Cancer Prognosis. Lung 2022; 200:347-379. [PMID: 35616720 DOI: 10.1007/s00408-022-00536-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/07/2022] [Indexed: 12/12/2022]
Abstract
Lung cancer is the most common cause of cancer death and is associated with malnutrition and sarcopenia. The detection of sarcopenia and conduction of simple body composition measurements, such as the phase angle (PhA) deriving from bioelectrical impedance analysis (BIA), can help to early identify, monitor, prevent and treat malnutrition. The present review aims to clarify the relationship between PhA and sarcopenia with the pathophysiology, clinical outcomes, and therapeutic aspects of lung cancer. PhA and sarcopenia are connected to lung cancer prognosis through various mechanisms including inflammation and oxidative stress, although more research is needed to identify the critical thresholds for increased mortality risk. Moreover, emphasis is given on the role of dietary interventions (oral nutritional supplementation, and dietary counseling) to manage sarcopenia and related variables in patients with lung cancer. Oral nutritional supplements and/or those containing n - 3 polyunsaturated fatty acids may have a positive effect on physical strength measures and muscle mass if administered at the beginning of chemotherapy. Data on sole dietary counseling or multimodal interventions are less promising so far. In the future, sophisticated body composition phenotypes deriving from the described methods along with artificial intelligence techniques could be used to design personalized nutrition interventions and timely treat these patients.
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Affiliation(s)
- Paraskevi Detopoulou
- Department of Clinical Nutrition, General Hospital Korgialenio Benakio, Athens, Greece.,Department of Nutritional Science and Dietetics, University of the Peloponnese, Kalamata, Greece
| | - Gavriela Voulgaridou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Sindos, Thessaloniki, Greece
| | - Sousana Papadopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Sindos, Thessaloniki, Greece.
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Avancini A, Belluomini L, Borsati A, Riva ST, Trestini I, Tregnago D, Dodi A, Lanza M, Pompili C, Mazzarotto R, Micheletto C, Motton M, Scarpa A, Schena F, Milella M, Pilotto S. Integrating supportive care into the multidisciplinary management of lung cancer: we can't wait any longer. Expert Rev Anticancer Ther 2022; 22:725-735. [PMID: 35608060 DOI: 10.1080/14737140.2022.2082410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Due to important achievements in terms of diagnostic and therapeutic tools and the complexity of the disease itself, lung cancer management needs a multidisciplinary approach. To date, the classical multidisciplinary team involves different healthcare providers mainly dedicated to lung cancer diagnosis and treatments. Nevertheless, the underlying disease and related treatments significantly impact on patient function and psychological well-being. In this sense, supportive care may offer the best approach to relieve and manage patient symptoms and treatment-related adverse events. AREAS COVERED Evidence report that exercise, nutrition, smoking cessation and psychological well-being bring many benefits in patients with lung cancer, from both a physical and socio-psychological points of view, and potentially improving their survival. Nevertheless, supportive care is rarely offered to patients, and even less frequently these needs are discussed within the multidisciplinary meeting. EXPERT OPINION Integrating supportive care as part of the standard multidisciplinary approach for lung cancer involves a series of challenges, the first one represented by the daily necessity of specialists, such as kinesiologists, dietitians, psycho-oncologists, able to deliver a personalized approach. In the era of precision medicine this is an essential step forward to guarantee comprehensive and patient-centered care for all patients with lung cancer.
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Affiliation(s)
- Alice Avancini
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy.,Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Lorenzo Belluomini
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Anita Borsati
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Silvia Teresa Riva
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Ilaria Trestini
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Daniela Tregnago
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Alessandra Dodi
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Massimo Lanza
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Cecilia Pompili
- Thoracic Surgery Department, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Renzo Mazzarotto
- Section of Radiotherapy, Department of Surgery and Oncology, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Claudio Micheletto
- Pulmonary Unit, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Massimiliano Motton
- Radiology Department, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Aldo Scarpa
- Section of Pathology, Department of Diagnostic and Public Health, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Federico Schena
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Milella
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Sara Pilotto
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
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20
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Al Saedi A, Kirk B, Iuliano S, Zanker J, Vogrin S, Jayaram L, Thomas S, Golding C, Navarro-Perez D, Marusic P, Leng S, Nanan R, Duque G. Effects of 3 months of multi-nutrient supplementation on the immune system and muscle and respiratory function of older adults in aged care (The Pomerium Study): protocol for a randomised controlled trial. BMJ Open 2022; 12:e059075. [PMID: 35523505 PMCID: PMC9082724 DOI: 10.1136/bmjopen-2021-059075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Immunosenescence leads to increased morbidity and mortality associated with viral infections and weaker vaccine responses. This has been well documented for seasonal influenza and the current pandemic with SARS-CoV-2 (COVID-19), which disproportionately impact older adults, particularly those in residential aged care facilities. Inadequate nutrient intakes associated with impaired immunity, respiratory and muscle function are likely to augment the effects of immunosenescence. In this study, we test whether the impact of inadequate nutrition can be reversed using multi-nutrient supplementation, consequently enhancing vaccine responses, reducing the risk of viral infections and improving respiratory and muscle function. METHODS AND ANALYSIS The Pomerium Study is a 3-month, single-blind, randomised, controlled trial testing the effects of two daily servings of an oral multi-nutrient supplement (330 kcal, 20 g protein, 1.5 g calcium 3-hydroxy-3-methylbutyrate monohydrate (CaHMB), 449 mg calcium, 500 IU vitamin D3 and 25 vitamins and minerals) on the immune system and muscle and respiratory function of older adults in aged care in Melbourne, Australia. 160 older adults (≥75 years old) will be recruited from aged care facilities and randomised to treatment (multi-nutrient supplement) or control (usual care). The primary outcome is a change in T-cell subsets CD8 + and CD28null counts at months 1 and 3. Secondary outcomes measured at baseline and month 3 are multiple markers of immunosenescence (also at 1 month), body composition (bioimpedance), handgrip strength (dynamometer), physical function (short physical performance battery), respiratory function (spirometry) and quality of life (EQ-5D-5L). Incidence and complications of COVID-19 and/or viral infections (ie, hospitalisation, complications or death) will be recorded throughout the trial, including 3 months after supplementation is ceased. ETHICS AND DISSEMINATION This study was approved by Melbourne Health Human Research Ethics Committee (Ref No. HREC/73985/MH-2021, ERM Ref No. RMH73985, Melbourne Health Site Ref No. 2021.115). Written informed consent will be obtained from participants. Results will be published in peer-reviewed journals and made available to key aged care stakeholders, including providers, residents, and government bodies. TRIAL REGISTRATION NUMBER ACTRN12621000420842.
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Affiliation(s)
- Ahmed Al Saedi
- Medicine-Western Health, The University of Melbourne, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia
| | - Ben Kirk
- Medicine-Western Health, The University of Melbourne, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia
| | - Sandra Iuliano
- Medicine-Western Health, The University of Melbourne, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia
| | - Jesse Zanker
- Medicine-Western Health, The University of Melbourne, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia
| | - Sara Vogrin
- Medicine-Western Health, The University of Melbourne, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia
| | - Lata Jayaram
- Medicine-Western Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Shane Thomas
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia
| | - Christine Golding
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Diana Navarro-Perez
- Medicine-Western Health, The University of Melbourne, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia
| | - Petra Marusic
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia
| | - Sean Leng
- Johns Hopkins Center on Aging and Immune Remodeling, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ralph Nanan
- Nepean Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Gustavo Duque
- Medicine-Western Health, The University of Melbourne, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia
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21
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Prediction of abdominal CT body composition parameters by thoracic measurements as a new approach to detect sarcopenia in a COVID-19 cohort. Sci Rep 2022; 12:6443. [PMID: 35440794 PMCID: PMC9017415 DOI: 10.1038/s41598-022-10266-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 03/30/2022] [Indexed: 12/11/2022] Open
Abstract
As most COVID-19 patients only receive thoracic CT scans, but body composition, which is relevant to detect sarcopenia, is determined in abdominal scans, this study aimed to investigate the relationship between thoracic and abdominal CT body composition parameters in a cohort of COVID-19 patients. This retrospective study included n = 46 SARS-CoV-2-positive patients who received CT scans of the thorax and abdomen due to severe disease progression. The subcutaneous fat area (SF), the skeletal muscle area (SMA), and the muscle radiodensity attenuation (MRA) were measured at the level of the twelfth thoracic (T12) and the third lumbar (L3) vertebra. Necessity of invasive mechanical ventilation (IMV), length of stay, or time to death (TTD) were noted. For statistics correlation, multivariable linear, logistic, and Cox regression analyses were employed. Correlation was excellent for the SF (r = 0.96) between T12 and L3, and good for the respective SMA (r = 0.80) and MRA (r = 0.82) values. With adjustment (adj.) for sex, age, and body-mass-index the variability of SF (adj. r2 = 0.93; adj. mean difference = 1.24 [95% confidence interval (95% CI) 1.02–1.45]), of the SMA (adj. r2 = 0.76; 2.59 [95% CI 1.92–3.26]), and of the MRA (adj. r2 = 0.67; 0.67 [95% CI 0.45–0.88]) at L3 was well explained by the respective values at T12. There was no relevant influence of the SF, MRA, or SMA on the clinical outcome. If only thoracic CT scans are available, CT body composition values at T12 can be used to predict abdominal fat and muscle parameters, by which sarcopenia and obesity can be assessed.
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22
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Kamigaichi A, Harada H, Shibata S. Muscle Quality Predicts Outcomes after Surgery for Early-Stage Non-Small-Cell Lung Cancer. Ann Thorac Cardiovasc Surg 2022; 28:262-270. [PMID: 35296583 PMCID: PMC9433886 DOI: 10.5761/atcs.oa.21-00274] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose: This study investigated the impact of skeletal muscle quality on the outcomes of patients undergoing surgery for early-stage non–small-cell lung cancer (NSCLC). Methods: A total of 98 patients with pathological stage I–II NSCLC who underwent lobectomy or segmentectomy were retrospectively analyzed. Along with skeletal muscle quantity, muscle quality was evaluated by intramuscular adipose tissue content (IMAC) at the first lumbar vertebral level; a higher IMAC indicates lower skeletal muscle quality. Patients were divided into two groups according to the gender-specific quartiles of IMAC, and the prognostic impact of IMAC was investigated. Results: No significant differences in the body and skeletal mass indices, which indicate skeletal muscle quantity, were observed between patients with high and those with normal IMAC. Patients with high IMAC (n = 23) showed a significantly poorer prognosis in overall and disease-specific survivals than those with normal IMAC (n = 75; P <0.001 and P = 0.048, respectively). In a bivariate analysis that included other clinicopathological factors, a high IMAC was independently associated with worse overall survival. Conclusion: The skeletal muscle quality evaluated by IMAC could be used to predict survival risk after surgery for early-stage NSCLC.
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Affiliation(s)
- Atsushi Kamigaichi
- Department of Thoracic Surgery, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Hiroshima, Japan
| | - Hiroaki Harada
- Department of Thoracic Surgery, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Hiroshima, Japan
| | - Satoshi Shibata
- Department of Thoracic Surgery, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Hiroshima, Japan
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23
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Núñez-Cortés R, Cruz-Montecinos C, Martinez-Arnau F, Torres-Castro R, Zamora-Risco E, Pérez-Alenda S, Andersen LL, Calatayud J, Arana E. 30 s sit-to-stand power is positively associated with chest muscle thickness in COVID-19 survivors. Chron Respir Dis 2022; 19:14799731221114263. [PMID: 35957593 PMCID: PMC9379968 DOI: 10.1177/14799731221114263] [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] [Indexed: 12/03/2022] Open
Abstract
Introduction After hospitalization, early detection of musculoskeletal sequelae might help
healthcare professionals to improve and individualize treatment,
accelerating recovery after COVID-19. The objective was to determine the
association between the 30s sit-to-stand muscle power (30s-STS) and
cross-sectional area of the chest muscles (pectoralis) in COVID-19
survivors. Method This cross-sectional study collected routine data from COVID-19 survivors
one month after hospitalization: 1) a chest computed tomography (CT) scan
and 2) a functional capacity test (30s-STS). The pectoralis muscle area
(PMA) was measured from axial CT images. For each gender, patients were
categorized into tertiles based on PMA. The 30s-STS was performed to
determine the leg extension power. The allometric and relative STS power
were calculated as absolute 30s-STS power normalized to height squared and
body mass. The two-way ANOVA was used to compare the gender-stratified
tertiles of 30s-STS power variants. Results Fifty-eight COVID-19 survivors were included (mean age 61.2 ± 12.9 years,
30/28 (51.7%/48.3%) men/women). The two-way ANOVA showed significant
differences between the PMA tertiles in absolute STS power
(p = .002) and allometric STS power (p
= .001). There were no significant gender x PMA tertile interactions (all
variables p > .05). The high tertile of PMA showed a
higher allometric STS power compared to the low and middle tertile,
p = .002 and p = .004, respectively.
Absolute STS power and allometric STS power had a moderate correlation with
the PMA, r = 0.519 (p < .001) and r = 0.458
(p < .001) respectively. Conclusion The 30s-STS power is associated with pectoralis muscle thickness in both male
and female COVID-19 survivors. Thus, this test may indicate global
muscle-wasting and may be used as a screening tool for lower extremity
functional capacity in the early stages of rehabilitation planning in
COVID-19 survivors.
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Affiliation(s)
- Rodrigo Núñez-Cortés
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), 16781University of Valencia, Valencia, Spain.,Department of Physical Therapy, Faculty of Medicine, 14655University of Chile, Santiago, Chile.,Day Hospital Unit, Hospital Clínico Florida, Santiago, Chile
| | - Carlos Cruz-Montecinos
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), 16781University of Valencia, Valencia, Spain.,Department of Physical Therapy, Faculty of Medicine, 14655University of Chile, Santiago, Chile.,Section of Research, Innovation and Development in Kinesiology, Kinesiology Unit, San José Hospital, Santiago, Chile
| | - Francisco Martinez-Arnau
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), 16781University of Valencia, Valencia, Spain
| | - Rodrigo Torres-Castro
- Department of Physical Therapy, Faculty of Medicine, 14655University of Chile, Santiago, Chile.,International Physiotherapy Research Network (PhysioEvidence), Barcelona, Spain
| | | | - Sofía Pérez-Alenda
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), 16781University of Valencia, Valencia, Spain
| | - Lars L Andersen
- 2686National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Joaquín Calatayud
- 2686National Research Centre for the Working Environment, Copenhagen, Denmark.,Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, 16781University of Valencia, Valencia, Spain
| | - Estanislao Arana
- Department of Radiology, 16829Fundación Instituto Valenciano de Oncología, Valencia, Spain
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24
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Wang J, Xu L, Huang S, Hui Q, Shi X, Zhang Q. Low muscle mass and Charlson comorbidity index are risk factors for short-term postoperative prognosis of elderly patients with gastrointestinal tumor: a cross-sectional study. BMC Geriatr 2021; 21:730. [PMID: 34949161 PMCID: PMC8705191 DOI: 10.1186/s12877-021-02683-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/26/2021] [Indexed: 01/06/2023] Open
Abstract
Background Sarcopenia is one of the most frequent syndromes in older adults and one of its main characteristics is low muscle mass. Gastrointestinal tumor is a malignant disease with high incidence. This study aimed to investigate the risk factors of low muscle mass in older adults with gastrointestinal tumor, the prognostic indicators of and short-term outcomes after resection for gastrointestinal tumor, and to explore the relationship between low muscle mass and short-term postoperative prognosis. Method A total of 247 older patients with gastrointestinal tumors who underwent radical resection in 2019 were included in this study. Relevant indexes were calculated using L3 slice image of computed tomography (CT) to evaluate low muscle mass. Short-term postoperative complications and length of stay were considered as short-term outcomes of this study. Results Advanced age, lower higher body mass index (BMI), lower hemoglobin, having history of abdominal surgery and higher visceral fat index (VFI) were risk factors of low muscle mass, while higher BMI and lower subcutaneous fat index (SFI) were protective factors of low muscle mass. Further multivariate logistic regression analysis showed that having history of abdominal surgery, advanced age and lower BMI were independent risk factors. Low muscle mass and higher Charlson comorbidity index were independent risk factors of short-term postoperative complications in older adults with gastrointestinal tumor. Higher Charlson comorbidity index gave rise to longer length of stay. Conclusions Low muscle mass and higher Charlson comorbidity index predict poor short-term prognosis of older patients undergoing gastrointestinal tumor resection.
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Affiliation(s)
- Jiaqiu Wang
- Department of Geriatrics, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Raod, Hangzhou, Zhejiang, 310003, People's Republic of China.,Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Raod, Hangzhou, Zhejiang, 310003, People's Republic of China
| | - Liqian Xu
- Department of Geriatrics, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Raod, Hangzhou, Zhejiang, 310003, People's Republic of China.,Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Raod, Hangzhou, Zhejiang, 310003, People's Republic of China
| | - Shunmei Huang
- Department of Geriatrics, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Raod, Hangzhou, Zhejiang, 310003, People's Republic of China.,Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Raod, Hangzhou, Zhejiang, 310003, People's Republic of China
| | - Quan Hui
- Department of Geriatrics, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Raod, Hangzhou, Zhejiang, 310003, People's Republic of China.,Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Raod, Hangzhou, Zhejiang, 310003, People's Republic of China
| | - Xuexue Shi
- Department of Geriatrics, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Raod, Hangzhou, Zhejiang, 310003, People's Republic of China.,Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Raod, Hangzhou, Zhejiang, 310003, People's Republic of China
| | - Qin Zhang
- Department of Geriatrics, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Raod, Hangzhou, Zhejiang, 310003, People's Republic of China. .,Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Raod, Hangzhou, Zhejiang, 310003, People's Republic of China.
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25
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Pennathur A, Brunelli A, Criner GJ, Keshavarz H, Mazzone P, Walsh G, Luketich J, Liptay M, Wafford QE, Murthy S, Marshall MB, Tong B, Lanuti M, Wolf A, Pettiford B, Loo BW, Merritt RE, Rocco G, Schuchert M, Varghese TK, Swanson SJ. Definition and assessment of high risk in patients considered for lobectomy for stage I non-small cell lung cancer: The American Association for Thoracic Surgery expert panel consensus document. J Thorac Cardiovasc Surg 2021; 162:1605-1618.e6. [PMID: 34716030 DOI: 10.1016/j.jtcvs.2021.07.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/08/2021] [Accepted: 07/09/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Lobectomy is a standard treatment for stage I non-small cell lung cancer, but a significant proportion of patients are considered at high risk for complications, including mortality, after lobectomy and might not be candidates. Identifying who is at risk is important and in evolution. The objective of The American Association for Thoracic Surgery Clinical Practice Standards Committee expert panel was to review important considerations and factors in assessing who is at high risk among patients considered for lobectomy. METHODS The American Association for Thoracic Surgery Clinical Practice Standards Committee assembled an expert panel that developed an expert consensus document after systematic review of the literature. The expert panel generated a priori a list of important risk factors in the determination of high risk for lobectomy. A survey was administered, and the expert panel was asked to grade the relative importance of each risk factor. Recommendations were developed using discussion and a modified Delphi method. RESULTS The expert panel survey identified the most important factors in the determination of high risk, which included the need for supplemental oxygen because of severe underlying lung disease, low diffusion capacity, the presence of frailty, and the overall assessment of daily activity and functional status. The panel determined that factors, such as age (as a sole factor), were less important in risk assessment. CONCLUSIONS Defining who is at high risk for lobectomy for stage I non-small cell lung cancer is challenging, but remains critical. There was impressive strong consensus on identification of important factors and their hierarchical ranking of perceived risk. The panel identified several key factors that can be incorporated in risk assessment. The factors are evolving and as the population ages, factors such as neurocognitive function and frailty become more important. A minimally invasive approach becomes even more critical in this older population to mitigate risk. The determination of risk is a clinical decision and judgement, which should also take into consideration patient perspectives, values, preferences, and quality of life.
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Affiliation(s)
- Arjun Pennathur
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, and UPMC Hillman Cancer Center, Pittsburgh, Pa.
| | - Alessandro Brunelli
- Department of Thoracic Surgery, St. James University Hospital, Leeds, United Kingdom
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pa
| | - Homa Keshavarz
- The American Association for Thoracic Surgery, Beverly, Mass
| | - Peter Mazzone
- Department of Pulmonology, Cleveland Clinic, Cleveland, Ohio
| | - Garrett Walsh
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass
| | - James Luketich
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, and UPMC Hillman Cancer Center, Pittsburgh, Pa
| | - Michael Liptay
- Department of Thoracic Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Tex
| | | | - Sudish Murthy
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, Ill
| | - M Blair Marshall
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Betty Tong
- Department of Thoracic Surgery, Duke University Hospital, Durham, NC
| | - Michael Lanuti
- Department of Thoracic Surgery, Massachusetts General Hospital, Boston, Mass
| | - Andrea Wolf
- The Icahn School of Medicine at Mount Sinai and Mount Sinai Hospital, New York, NY
| | - Brian Pettiford
- Section of Cardiothoracic Surgery, Ochsner Health System, New Orleans, La
| | - Billy W Loo
- Department of Radiation Oncology & Stanford Cancer Institute, Stanford University School of Medicine, Stanford, Calif
| | - Robert E Merritt
- Division of Thoracic Surgery, The Ohio State University-Wexner Medical Center, Columbus, Ohio
| | - Gaetano Rocco
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Matthew Schuchert
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, and UPMC Hillman Cancer Center, Pittsburgh, Pa
| | - Thomas K Varghese
- Division of Thoracic Surgery, University of Utah, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Scott J Swanson
- Division of Thoracic Surgery, Harvard Medical School and Brigham and Women's Hospital, Boston, Mass.
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26
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Han J, Harrison L, Patzelt L, Wu M, Junker D, Herzig S, Berriel Diaz M, Karampinos DC. Imaging modalities for diagnosis and monitoring of cancer cachexia. EJNMMI Res 2021; 11:94. [PMID: 34557972 PMCID: PMC8460705 DOI: 10.1186/s13550-021-00834-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 09/06/2021] [Indexed: 12/23/2022] Open
Abstract
Cachexia, a multifactorial wasting syndrome, is highly prevalent among advanced-stage cancer patients. Unlike weight loss in healthy humans, the progressive loss of body weight in cancer cachexia primarily implicates lean body mass, caused by an aberrant metabolism and systemic inflammation. This may lead to disease aggravation, poorer quality of life, and increased mortality. Timely detection is, therefore, crucial, as is the careful monitoring of cancer progression, in an effort to improve management, facilitate individual treatment and minimize disease complications. A detailed analysis of body composition and tissue changes using imaging modalities—that is, computed tomography, magnetic resonance imaging, (18F) fluoro-2-deoxy-d-glucose (18FDG) PET and dual-energy X-ray absorptiometry—shows great premise for charting the course of cachexia. Quantitative and qualitative changes to adipose tissue, organs, and muscle compartments, particularly of the trunk and extremities, could present important biomarkers for phenotyping cachexia and determining its onset in patients. In this review, we present and compare the imaging techniques that have been used in the setting of cancer cachexia. Their individual limitations, drawbacks in the face of clinical routine care, and relevance in oncology are also discussed.
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Affiliation(s)
- Jessie Han
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts Der Isar, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Luke Harrison
- Institute for Diabetes and Cancer, Helmholtz Center Munich, 85764, Neuherberg, Germany.,German Center for Diabetes Research (DZD), 85764, Neuherberg, Germany
| | - Lisa Patzelt
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts Der Isar, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Mingming Wu
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts Der Isar, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Daniela Junker
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts Der Isar, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Stephan Herzig
- Institute for Diabetes and Cancer, Helmholtz Center Munich, 85764, Neuherberg, Germany.,German Center for Diabetes Research (DZD), 85764, Neuherberg, Germany.,Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital, Heidelberg, Germany.,Chair of Molecular Metabolic Control, Technical University of Munich, Munich, Germany
| | - Mauricio Berriel Diaz
- Institute for Diabetes and Cancer, Helmholtz Center Munich, 85764, Neuherberg, Germany.,German Center for Diabetes Research (DZD), 85764, Neuherberg, Germany
| | - Dimitrios C Karampinos
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts Der Isar, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
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27
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Ge X, Jiang L, Yu W, Wu Y, Liu W, Qi W, Cao Q, Bai R, Zhou W. The importance of sarcopenia as a prognostic predictor of the clinical course in acute severe ulcerative colitis patients. Dig Liver Dis 2021; 53:965-971. [PMID: 33934998 DOI: 10.1016/j.dld.2021.03.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/05/2021] [Accepted: 03/24/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Acute severe ulcerative colitis (ASUC) is a life-threatening condition that requires timely referral for therapy. Sarcopenia has been associated with clinical outcomes of inflammatory bowel disease (IBD). This study investigated the role of sarcopenia in predicting the clinical course of ASUC. METHODS This retrospective cohort study included ASUC patients with abdominal CT scans. Univariate and multivariable regression analyses were performed to identify a practical predictive index for the clinical course of ASUC. RESULTS Of 233 included patients, 151 had intravenous corticosteroid (IVS) failure, among whom 32 received surgery without medical rescue therapy. Fifty patients underwent colectomy after medical rescue therapy failure. Of these 82 surgical patients, 42 suffered postoperative complications. Multivariable regression analysis showed that sarcopenia remained an independent risk factor for IVS failure (OR=2.969; 95% CI, 1.547-5.701; p = 0.001), colectomy after medical rescue therapy failure (OR=3.411; 95% CI, 1.147-10.141; p = 0.027), and postoperative complications after colectomy (OR=4.157; 95% CI, 1.364-12.667; p = 0.012). During follow-up, patients with colectomy after first-line treatment had a lower comprehensive complication index and better health-related quality of life. CONCLUSION Sarcopenia is useful in predicting the clinical course and postoperative outcomes of ASUC.
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Affiliation(s)
- Xiaolong Ge
- Department of General Surgery, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang 310016, China
| | - Liping Jiang
- Department of Medicine, Guangxi Medical College, Nanning, GuangXi 530023, China
| | - Weihua Yu
- Department of General Surgery, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang 310016, China
| | - Yan Wu
- Department of Gastroenterology, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016, China
| | - Wei Liu
- Department of General Surgery, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang 310016, China
| | - Weilin Qi
- Department of General Surgery, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang 310016, China
| | - Qian Cao
- Department of Gastroenterology, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016, China
| | - Rongpan Bai
- Department of General Surgery, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang 310016, China.
| | - Wei Zhou
- Department of General Surgery, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang 310016, China.
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28
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Attenuation of Muscle Mass and Density Is Associated With Poor Outcomes Among Patients Undergoing Major Gynecologic Surgery: A Retrospective Cohort Study. Anesth Analg 2021; 132:1692-1699. [PMID: 33651572 DOI: 10.1213/ane.0000000000005380] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The aim of this study was to explore the associations of preoperative sarcopenia (muscle mass depletion) and myosteatosis (muscle quality attenuation) with the incidence of postinduction hypotension (PIH) and postoperative complications among patients undergoing major gynecologic surgery. METHODS Based on a previous prospective surgical registry of gynecologic patients, we included patients with an available preoperative abdominal computed tomography (CT) scan performed within 3 months before surgery. The cross-sectional muscle mass and density at the third lumbar vertebra (L3) level were measured from the CT scan. The primary outcome was PIH, which was defined as a blood pressure reduction >30% from baseline. The secondary outcome was postoperative complications based on the Clavien-Dindo classification. Multivariable logistic regression analyses were performed to identify the associations between the muscle parameters and outcomes. RESULTS Of the 167 gynecologic surgical patients included in this study, the mean (standard deviation [SD]) age was 53.0 (12.2) years. Sarcopenia was present in 86 (51.5%) patients. Fifty-six (33.5%) patients experienced PIH, and 89 (53.3%) patients experienced different degrees of postoperative complications. Multivariable analysis showed that myosteatosis was significantly associated with an increased risk of PIH (odds ratio [OR] = 2.95, 95% confidence interval [CI], 1.24-7.04; P = .015), and sarcopenia was associated with an increased risk of postoperative complications (OR = 2.30; 95% CI, 1.16-4.57; P = .018). CONCLUSIONS Muscle assessments using preoperative CT scans may help identify high-risk patients and determine perioperative management strategies among gynecologic patients.
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Lawson C, Ferreira V, Carli F, Chevalier S. Effects of multimodal prehabilitation on muscle size, myosteatosis, and dietary intake of surgical patients with lung cancer - a randomized feasibility study. Appl Physiol Nutr Metab 2021; 46:1407-1416. [PMID: 34265218 DOI: 10.1139/apnm-2021-0249] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Many patients with lung cancer undergo surgery, which can increase the risk for muscle loss, leading to worsened outcomes. A multimodal prehabilitation intervention integrating dietary and muscle assessment may help clinicians better understand changes in these outcomes. This pilot assessed feasibility of multimodal prehabilitation in early-stage surgical lung cancer patients and explored relationships between body composition, muscle characteristics and dietary intake, as well as muscle changes due to prehabilitation. Patients were randomized to one of two groups: multimodal prehabilitation including nutritional supplements (fish oil with vitamin D3 + whey protein with leucine), exercise and relaxation, or standard of care. Physical function, dietary intake and muscle were evaluated at 0 and 4 weeks pre-operatively. Of 87 patients assessed for eligibility, 34 (39%) were randomized and 3 (9%) were lost to follow-up. Median age was 69 years and baseline protein intake was 1.0 g/kg/d. Adherence to exercise (86%) and supplements was high (93%); 3 patients (16%) reported side effects. Supplements significantly increased protein, omega-3 fatty acid, leucine and vitamin D intake. There were no significant changes in muscle characteristics. Multimodal prehabilitation with dietary and muscle analyses proved to be feasible. An adequately powered randomized controlled trial is warranted. ClinicalTrials.gov registration no: NCT04610606. Novelty: • Multimodal prehabilitation incorporating dietary assessment and muscle analysis is feasible for early-stage surgical lung cancer patients. • An adequately powered randomized controlled trial is warranted to further explore functional and post-operative outcomes.
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Affiliation(s)
- Claire Lawson
- McGill University, 5620, School of Human Nutrition, Montreal, Quebec, Canada.,Research Institute of the McGill University Health Centre, 507266, Montreal, Quebec, Canada;
| | - Vanessa Ferreira
- McGill University, 5620, Department of Kinesiology and Physical Education, Montreal, Quebec, Canada;
| | - Francesco Carli
- McGill University, 5620, Department of Anesthesia, Montreal, Quebec, Canada;
| | - Stéphanie Chevalier
- McGill University, School of Human Nutrition, Ste-Anne-de-Bellevue, Quebec, Canada.,Research Institute of the McGill University Health Centre, 507266, Montreal, Quebec, Canada;
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Çınar HU, Çelik B, Taşkın G, İnce Ö. Low thoracic muscle mass index on computed tomography predicts adverse outcomes following lobectomy via thoracotomy for lung cancer. Interact Cardiovasc Thorac Surg 2021; 33:712-720. [PMID: 34244772 DOI: 10.1093/icvts/ivab150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 04/14/2021] [Accepted: 04/14/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES The aim of this study was to determine whether the preoperative thoracic muscle mass is associated with postoperative outcomes in patients undergoing lobectomy via thoracotomy for lung cancer. METHODS Consecutive patients undergoing lobectomy were retrospectively reviewed. The thoracic muscle mass index (TMMI) was obtained at the level of the fifth thoracic vertebra on preoperative thoracic computed tomography (CT). Patients were analysed comparatively by being dividing into low and high muscle index groups by the median of sex-specific TMMI. The primary outcomes were the incidence of any or postoperative pulmonary complications. The secondary outcomes were postoperative intensive care unit (ICU) admission, length of stay (LOS) in the ICU, total hospital LOS, readmission and mortality. RESULTS The study population consisted of 120 patients (63.6 ± 9.8 years; 74% male). Each groups included 60 patients. Major complications occurred in 28.3% (34/120) and readmission in 18.3% (22/120) of patients. The adjusted multivariable analysis showed that each unit increase in TMMI (cm2/m2) was independently associated with the rates of less any complications [odds ratio (OR) 0.92, P = 0.014], pulmonary complications (OR 0.27, P = 0.019), ICU admission (OR 0.76, P = 0.031), hospitalization for >6 days (OR 0.90, P = 0.008) and readmission (OR 0.93, P = 0.029). CONCLUSIONS Low TMMI obtained from the preoperative thoracic CT is an independent predictor of postoperative adverse outcomes in patients following lobectomy via thoracotomy for lung cancer. TMMI measurements may contribute to the development of preoperative risk stratification studies in the future.
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Affiliation(s)
- Hüseyin Ulaş Çınar
- Department of Thoracic Surgery, Medicana International Hospital, Samsun, Turkey
| | - Burçin Çelik
- Department of Thoracic Surgery, Medicana International Hospital, Samsun, Turkey.,Department of Thoracic Surgery, Ondokuz Mayıs University Medical Faculty, Samsun, Turkey
| | - Gülten Taşkın
- Department of Radiology, Medicana International Hospital, Samsun, Turkey
| | - Özgür İnce
- Department of Chest Diseases, Medicana International Hospital, Samsun, Turkey
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Wang JW, Williams M. Exploring definitions of radiological sarcopenia in cancer: a protocol for a scoping review. BMJ Open 2021; 11:e053076. [PMID: 34215616 PMCID: PMC8256756 DOI: 10.1136/bmjopen-2021-053076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Sarcopenia is the loss of skeletal muscle volume or quality, a concept previously established in age-related frailty. Sarcopenia is part of the cancer cachexia syndrome and has therefore been explored as biomarker through the opportunistic measurement of skeletal muscle from routine cancer imaging. However, there is inconsistency in diagnostic landmarks and cut-offs. The most common assessment method is skeletal muscle area at the slice level of the third lumbar vertebrae divided by height squared. Alternative sarcopenia measures have been derived from morphological descriptions of the psoas, thoracic and cervical muscles, driven by tumour-specific anatomical imaging.Current tumour-site specific reviews suggest a link between heterogeneously defined sarcopenia on tumour site-specific outcomes. Because lack of uniformity, a scoping review is best suited to streamline anatomically based definitions and map the evidence to outcomes. The aim of this article is to describe a protocol for a scoping review that will homogenise the evidence of radiological sarcopenia in cancer. The extent, range and nature of reports will be examined, after which possible titles for potential systematic reviews identified. METHODS AND ANALYSIS We will apply methods based on the Joanna Briggs Institute scoping review manual. Predefined search terms compiled with a librarian experienced in systematic reviews will be used to search PubMed/Medline, Embase, Scopus and Cochrane databases studies correlating cross-sectional cancer sarcopenia biomarkers with clinical outcomes. Studies will be mapped according to whether they have defined new sarcopenia measures or applied previous definitions to new populations, both with reported outcomes. This review will generate a numerical analysis on the extent of cancer sarcopenia measures as well as a narrative synthesis to describe the applications of radiologically derived sarcopenia in cancer. ETHICS AND DISSEMINATION Formal ethical approval was not required to undertake this scoping review. Findings will be published in peer-reviewed journals and conference presentations.
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Affiliation(s)
- James Wei Wang
- Computational Oncology Laboratory, Imperial College London, London, UK
- Department of Radiotherapy, Charing Cross Hospital, London, UK
| | - Matthew Williams
- Computational Oncology Laboratory, Imperial College London, London, UK
- Department of Radiotherapy, Charing Cross Hospital, London, UK
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Sarcopenia is associated with poor prognosis after chemoradiotherapy in patients with stage III non-small-cell lung cancer: a retrospective analysis. Sci Rep 2021; 11:11882. [PMID: 34088965 PMCID: PMC8178326 DOI: 10.1038/s41598-021-91449-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/26/2021] [Indexed: 12/25/2022] Open
Abstract
We intended to investigate whether muscle and adipose masses were associated with prognosis among patients with stage III non-small-cell lung cancer (NSCLC) who were undergoing chemoradiotherapy (CCRT). We retrospectively explored data of patients with stage III NSCLC who underwent definitive CCRT (≥ 60 Gy) between January 2004 and March 2018 at our hospital. We examined the relationship of overall survival (OS) with body mass index (BMI), skeletal muscle index (SMI), psoas muscle index (PMI), visceral adipose tissue index (VAI), subcutaneous adipose tissue index (SAI), and visceral-to-subcutaneous adipose tissue area ratio (VSR) using log-rank tests for the univariate analysis and Cox proportional hazard models for the multivariate analysis. Overall, 16, 32, and 12 patients had stage IIIA, IIIB, and IIIC NSCLC, respectively. The total radiotherapy dose ranged from 60 Gy/30 fractions to 66 Gy/33 fractions. In the univariate analysis, the performance status (PS), BMI, and SMI were associated with OS, whereas the PMI, VAI, SAI, and VSR were not. In the multivariate analysis, the PS and SMI were associated with OS. The hazard ratios and 95% confidence intervals were 2.91 and 1.28–6.64 for PS, and 2.36 and 1.15–4.85 for SMI, respectively. The 1, 3, and 5-year OS rates were 92.1%, 59.6%, and 51.0% in patients with high SMI, and 63.6%, 53.8%, and 17.9% in patients with low SMI, respectively. The SMI correlated with prognosis in our study population, whereas adipose mass did not. Therefore, sarcopenia should be considered while predicting the OS in such patients.
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Tanaka S, Ozeki N, Mizuno Y, Nakajima H, Hattori K, Inoue T, Nagaya M, Fukui T, Nakamura S, Goto M, Sugiyama T, Nishida Y, Chen-Yoshikawa TF. Preoperative paraspinous muscle sarcopenia and physical performance as prognostic indicators in non-small-cell lung cancer. J Cachexia Sarcopenia Muscle 2021; 12:646-656. [PMID: 33665984 PMCID: PMC8200441 DOI: 10.1002/jcsm.12691] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/12/2021] [Accepted: 02/01/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Despite the associations of both preoperative sarcopenia and physical performance with post-operative mortality in non-small-cell lung cancer (NSCLC), there have been no comprehensive studies of the impact of physical status on prognosis. This study was performed to investigate the prognostic significance of preoperative sarcopenia and physical performance in NSCLC. METHODS This retrospective cohort study was performed in NSCLS patients undergoing curative lung resection at a university hospital between January 2014 and December 2017. The patients were divided into four groups according to the skeletal muscle index [sarcopenia (lowest sex-specific tertile) and non-sarcopenia] and 6 min walking distance (6MWD) [short distance (<400 m) and long distance (≥400 m)]. Sarcopenia was assessed by preoperative cross-sectional areas of right and left paraspinous muscles at the level of the 12th thoracic vertebra from computed tomography images, and physical performance was determined by preoperative 6MWD. The primary and secondary endpoints were post-operative overall survival (OS) and disease-free survival (DFS). RESULTS The 587 patients [mean age: 68.5 ± 8.8 years, 399 men (68%)] included in the study were divided into the non-sarcopenia/long-distance group (58%), sarcopenia/long-distance group (26%), non-sarcopenia/short-distance group (9%), and sarcopenia/short-distance group (7%). A total of 109 (18.6%) deaths and 209 (35.6%) combined endpoints were observed over a mean follow-up of 3.1 ± 1.3 years. After adjusting for other covariates, the sarcopenia/short-distance group showed significant associations with shorter OS (hazard ratio, 3.38; 95% confidence interval, 1.79-6.37; P < 0.001) and DFS (hazard ratio, 2.11; 95% confidence, 1.27-3.51; P = 0.004) compared with the non-sarcopenia/long-distance group on multivariate analyses. Although not significant, adding skeletal muscle index and 6MWD to the pre-existing risk model increased the area under the curve on time-dependent receiver operating characteristic curve analysis for OS and DFS, except within 2 years of surgery. CONCLUSIONS The presence of both preoperative paraspinous muscle sarcopenia and short distance in 6MWD had an adverse effect on post-operative prognosis in patients with NSCLC, suggesting that preoperative assessment of thoracic sarcopenia and physical performance may be useful for risk stratification of surgical candidates with potential for targeted interventions.
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Affiliation(s)
- Shinya Tanaka
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Naoki Ozeki
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yota Mizuno
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Hiroki Nakajima
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Keiko Hattori
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Takayuki Inoue
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Motoki Nagaya
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Takayuki Fukui
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shota Nakamura
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaki Goto
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoshi Sugiyama
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshihiro Nishida
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan.,Department of Orthopaedic Surgery, Nagoya University Graduate School and School of Medicine, Nagoya, Japan
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Wakefield CJ, Jochum SB, Hejna E, Hamati F, Peterson S, Vines D, Shah P, Balk RA, Hayden DM. Novel application of respiratory muscle index obtained from chest computed tomography to predict postoperative respiratory failure after major non-cardiothoracic surgery. Am J Surg 2021; 222:1029-1033. [PMID: 33941359 DOI: 10.1016/j.amjsurg.2021.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Postoperative respiratory failure (PRF) is a serious complication associated with significant morbidity and mortality. We propose a new method to predict PRF by utilizing computed tomography (CT) of the chest to assess degree of respiratory muscle wasting prior to surgery. METHODS Patients who received a chest CT and required invasive mechanical ventilation (MV) after major non-cardiothoracic surgery were included. Exclusion criteria included cardiothoracic surgery. Respiratory muscle index (RMI) was calculated at the T6 vertebra measured on Slice-O-Matic® software. RESULTS Thirty three patients met inclusion with a mean (±SD) age, BMI, and APACHE II score of 62.2 years (±12.1), 28.1 kg/m2 (±7.8), and 14.1 (±4.7). Most patients were female (n = 22 [67%]). Eleven patients (33%) developed PRF with a mean of 6.0 (±10.7) initial ventilation days. There was no difference in baseline demographics between groups. RMI values for the PRF group were significantly lower when compared to the non-PRF group: 22.7 cm2/m2 (±5.3) vs. 28.5 cm2/m2 (±5.9) (p = 0.008). CONCLUSION Presence of respiratory muscle wasting prior to surgery was found to be associated with postoperative respiratory failure.
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Affiliation(s)
- Connor J Wakefield
- Department of Surgery, Division of Colon and Rectal Surgery, Rush University Medical Center, United States.
| | - Sarah B Jochum
- Department of Surgery, Division of Colon and Rectal Surgery, Rush University Medical Center, United States
| | - Emily Hejna
- Department of Surgery, Division of Colon and Rectal Surgery, Rush University Medical Center, United States
| | - Fadi Hamati
- Department of Surgery, Division of Colon and Rectal Surgery, Rush University Medical Center, United States
| | - Sarah Peterson
- Department of Clinical Nutrition, College of Health Sciences, Rush University Medical Center, United States
| | - David Vines
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University Medical Center, United States
| | - Palmi Shah
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, United States
| | - Robert A Balk
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Rush University Medical Center, United States
| | - Dana M Hayden
- Department of Surgery, Division of Colon and Rectal Surgery, Rush University Medical Center, United States
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Katsui K, Ogata T, Watanabe K, Yoshio K, Kuroda M, Yamane M, Hiraki T, Kiura K, Toyooka S, Kanazawa S. Sarcopenia is related to poor prognosis in patients after trimodality therapy for locally advanced non-small cell lung cancer. Int J Clin Oncol 2021; 26:1450-1460. [PMID: 33880655 DOI: 10.1007/s10147-021-01927-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/13/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND The association between sarcopenia and prognosis in patients with locally advanced non-small cell lung cancer (NSCLC) undergoing trimodality therapy, consisting of preoperative concurrent chemoradiotherapy and surgery, has not been reported. Therefore, we aimed to investigate the association of sarcopenia and fat mass with prognosis after trimodality therapy. METHODS To assess sarcopenia, the psoas muscle mass was measured. Using computed tomography data, including third lumbar vertebra level images, psoas muscle mass and visceral and subcutaneous fat mass were measured. Additionally, body mass indices, and visceral/subcutaneous fat ratio, obtained by dividing the visceral fat index by the subcutaneous fat index, were calculated. We investigated the relationship between these parameters and overall survival. RESULTS Ninety-nine eligible patients were included. In the univariate analysis, age, clinical stage, tumor location, psoas muscle index, and visceral/subcutaneous fat ratio were significant prognostic factors for overall survival (P = 0.008, P = 0.04, P = 0.04, P = 0.02, and P = 0.02, respectively). In the multivariate analysis, age and psoas muscle index were significant prognostic factors for overall survival (P = 0.01 and P = 0.03, respectively). The 5-year overall survival rates for the high and low psoas muscle index groups were 79.6% [95% confidence interval (CI), 67.1-94.5%] and 66.2% (95% CI, 54.1-81.1%), respectively; whereas, the 10-year overall survival rates were 61.9% (95% CI, 42.0-91.4%) and 25.3% (95% CI, 8.6-74.2%), respectively. CONCLUSION Sarcopenia was related to poor overall survival in patients with locally advanced NSCLC undergoing trimodality therapy. Assessment of body composition prior to treatment may provide important information for formulating rational therapeutic strategies.
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Affiliation(s)
- Kuniaki Katsui
- Department of Proton Beam Therapy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Takeshi Ogata
- Department of Radiology, Iwakuni Clinical Center, 1-1-1 Atagomachi, Iwakuni,, Yamaguchi, 740-8510, Japan
| | - Kenta Watanabe
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Kotaro Yoshio
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Masahiro Kuroda
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama, University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Masaomi Yamane
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Takao Hiraki
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Katsuyuki Kiura
- Department of Allergy and Respiratory Medicine, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Shinichi Toyooka
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Susumu Kanazawa
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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das Neves W, Alves CRR, de Souza Borges AP, de Castro G. Serum Creatinine as a Potential Biomarker of Skeletal Muscle Atrophy in Non-small Cell Lung Cancer Patients. Front Physiol 2021; 12:625417. [PMID: 33912068 PMCID: PMC8072336 DOI: 10.3389/fphys.2021.625417] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/24/2021] [Indexed: 12/25/2022] Open
Abstract
Objectives: Identifying simple biomarkers to determine muscle atrophy in non-small-cell lung cancer (NSCLC) patients remains a critical research gap. Since creatinine is mainly a product from intramuscular creatine metabolism, we tested the hypothesis that low serum creatinine levels would be associated to skeletal muscle atrophy in NSCLC patients. Materials and Methods: This is a prospective cohort study including 106 treatment-naive patients with histologically confirmed stage IV NSCLC. All patients performed routine serum creatinine laboratory tests. We divided patients into two groups based on low (<0.7 mg/dL for male and <0.5 mg/dL for female) or normal creatinine levels. We compared body mass index (BMI), psoas muscle cross-sectional area, adipose tissue area and complete blood counts between groups. Results: Male and female NSCLC patients with low serum creatinine levels had low muscle cross-sectional area as compared to patients with normal serum creatinine levels. Male NSCLC patients with low serum creatinine also displayed reduced BMI, reduced adipose tissue area, and elevated systemic inflammation compared to NSCLC patients with normal serum creatinine levels. There were no significant differences between female groups for BMI, adipose tissue area and inflammatory markers. Conclusions: Serum creatinine is a potential prognostic biomarker of skeletal muscle atrophy in NSCLC patients. Since serum creatinine is a simple and accessible measurement, we suggest that it should be monitored in longitudinal follow-up of NSCLC patients as a biomarker of muscle atrophy.
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Affiliation(s)
- Willian das Neves
- Instituto do Cancer do Estado de São Paulo ICESP, Hospital das Clinicas HC FMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Christiano R R Alves
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Ana Paula de Souza Borges
- Instituto do Cancer do Estado de São Paulo ICESP, Hospital das Clinicas HC FMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Gilberto de Castro
- Instituto do Cancer do Estado de São Paulo ICESP, Hospital das Clinicas HC FMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Schiaffino S, Albano D, Cozzi A, Messina C, Arioli R, Bnà C, Bruno A, Carbonaro LA, Carriero A, Carriero S, Danna PSC, D'Ascoli E, De Berardinis C, Della Pepa G, Falaschi Z, Gitto S, Malavazos AE, Mauri G, Monfardini L, Paschè A, Rizzati R, Secchi F, Vanzulli A, Tombini V, Vicentin I, Zagaria D, Sardanelli F, Sconfienza LM. CT-derived Chest Muscle Metrics for Outcome Prediction in Patients with COVID-19. Radiology 2021; 300:E328-E336. [PMID: 33724065 PMCID: PMC7971428 DOI: 10.1148/radiol.2021204141] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Lower muscle mass is a known predictor of unfavorable outcomes, but its prognostic impact on patients with COVID-19 is unknown. Purpose To investigate the contribution of CT-derived muscle status in predicting clinical outcomes in patients with COVID-19. Materials and Methods Clinical or laboratory data and outcomes (intensive care unit [ICU] admission and death) were retrospectively retrieved for patients with reverse transcriptase polymerase chain reaction-confirmed SARS-CoV-2 infection, who underwent chest CT on admission in four hospitals in Northern Italy from February 21 to April 30, 2020. The extent and type of pulmonary involvement, mediastinal lymphadenopathy, and pleural effusion were assessed. Cross-sectional areas and attenuation by paravertebral muscles were measured on axial CT images at the T5 and T12 vertebral level. Multivariable linear and binary logistic regression, including calculation of odds ratios (ORs) with 95% CIs, were used to build four models to predict ICU admission and death, which were tested and compared by using receiver operating characteristic curve analysis. Results A total of 552 patients (364 men and 188 women; median age, 65 years [interquartile range, 54-75 years]) were included. In a CT-based model, lower-than-median T5 paravertebral muscle areas showed the highest ORs for ICU admission (OR, 4.8; 95% CI: 2.7, 8.5; P < .001) and death (OR, 2.3; 95% CI: 1.0, 2.9; P = .03). When clinical variables were included in the model, lower-than-median T5 paravertebral muscle areas still showed the highest ORs for both ICU admission (OR, 4.3; 95%: CI: 2.5, 7.7; P < .001) and death (OR, 2.3; 95% CI: 1.3, 3.7; P = .001). At receiver operating characteristic analysis, the CT-based model and the model including clinical variables showed the same area under the receiver operating characteristic curve (AUC) for ICU admission prediction (AUC, 0.83; P = .38) and were not different in terms of predicting death (AUC, 0.86 vs AUC, 0.87, respectively; P = .28). Conclusion In hospitalized patients with COVID-19, lower muscle mass on CT images was independently associated with intensive care unit admission and in-hospital mortality. © RSNA, 2021 Online supplemental material is available for this article.
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Affiliation(s)
- Simone Schiaffino
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Domenico Albano
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Andrea Cozzi
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Carmelo Messina
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Roberto Arioli
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Claudio Bnà
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Antonio Bruno
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Luca A Carbonaro
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Alessandro Carriero
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Serena Carriero
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Pietro S C Danna
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Elisa D'Ascoli
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Claudia De Berardinis
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Gianmarco Della Pepa
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Zeno Falaschi
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Salvatore Gitto
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Alexis E Malavazos
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Giovanni Mauri
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Lorenzo Monfardini
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Alessio Paschè
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Roberto Rizzati
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Francesco Secchi
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Angelo Vanzulli
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Valeria Tombini
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Ilaria Vicentin
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Domenico Zagaria
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Francesco Sardanelli
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
| | - Luca M Sconfienza
- From the Unit of Radiology (S.S., L.A.C., F. Secchi, F. Sardanelli) and High Specialty Center for Dietetics, Nutritional Education and Cardiometabolic Prevention (A.E.M.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Via Rodolfo Morandi 30, 20097 San Donato Milanese, Milan, Italy; Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Palermo, Italy (D.A.); Unit of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Ortopedico Galeazzi, Milan, Italy (D.A., C.M., L.M.S.); Department of Biomedical Sciences for Health (A. Cozzi, S.G., F. Secchi, F. Sardanelli, L.M.S.), Postgraduate School in Radiodiagnostics (S.C., E.D., C.D.B., G.D.P.), and Department of Oncology and Hematology-Oncology (G.M., A.V.), Università degli Studi di Milano, Milan, Italy; Division of Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy (R.A., A. Carriero, P.S.C.D., Z.F., A.P., D.Z.); Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (C.B., L.M.); Department of Radiology, Ospedale Santissima Annunziata, Cento, Italy (A.B., R.R.); Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy (A. Carriero); Division of Interventional Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Europeo di Oncologia, Milan, Italy (G.M.); and Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy (A.V., V.T., I.V.)
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Diagnosing sarcopenia at the point of imaging care: analysis of clinical, functional, and opportunistic CT metrics. Skeletal Radiol 2021; 50:543-550. [PMID: 32892227 DOI: 10.1007/s00256-020-03576-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/30/2020] [Accepted: 08/06/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the relationship between CT-derived muscle metrics and standardized metrics of sarcopenia in patients undergoing routine CT imaging. MATERIALS AND METHODS Data collected in 443 consecutive patients included body CT, grip strength, usual gait speed, and responses to SARC-F and FRAIL scale questionnaires. Functional and clinical metrics of sarcopenia were acquired at the time of CT. Metrics were analyzed using the diagnostic framework of the European Working Group on Sarcopenia in Older People (EWGSOP2). The skeletal muscle index (SMI) and skeletal muscle density (SMD) were measured at the T12 and L3 levels. Statistical methods include linear prediction models and ROC analysis. RESULTS T12-SMD and L3-SMD in women and T12-SMD and L3-SMI in men show weak but significant (p < 0.05) predictive value for gait speed, after adjusting for subject age and body mass index. The prevalence of abnormal CT SMI at T12 and L3 was 29% and 71%, respectively, corresponding to prevalences of confirmed sarcopenia by EWGSOP2 of 10% and 15%, respectively. The agreement of abnormal SARC-F and FRAIL scale screening and EWGSOP2 confirmed sarcopenia was slight to fair (kappa: 0.20-0.28). CT cutpoints, based on EWGSOP2 criteria for abnormal grip strength or gait speed, are generally lower than cutpoints based on normative population data. CONCLUSION Collection of clinical and functional sarcopenia information at the point of imaging care can be accomplished quickly and safely. CT-derived muscle metrics show convergent validity with gait speed. Only a minority of subjects with low CT metrics have confirmed sarcopenia by EWGSOP2 definition.
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Kneuertz PJ, Yudovich MS, Amadi CC, Bashian E, D'Souza DM, Abdel-Rasoul M, Merritt RE. Pulmonary artery size on computed tomography is associated with major morbidity after pulmonary lobectomy. J Thorac Cardiovasc Surg 2021; 163:1521-1529.e2. [PMID: 33685731 DOI: 10.1016/j.jtcvs.2021.01.124] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To investigate the relationship of pulmonary artery diameter (PAD) measured by computed tomography (CT) with outcomes following lobectomy. METHODS Records of patients undergoing pulmonary lobectomy for lung cancer between 2011 and 2018 were reviewed. Baseline characteristics and postoperative outcome data were derived from the institutional Society of Thoracic Surgeons database. Luminal diameter of the central pulmonary arteries and ascending aorta were measured on preoperative CTs. Logistic regression analyses were performed to test the association of PAD with complications. RESULTS A total of 736 lobectomy patients were included, who had a preoperative CT scan (25% with contrast, 75% noncontrast) available for review. A total of 141 (19.2%) patients had an enlarged main PAD ≥30 mm, and 58 (7.9%) patients had a main PAD that was larger than the ascending aorta (PA/ascending aorta ratio > 1). The right or left PAD on the surgical side was associated with major complication (odds ratio per mm, 1.12; 95% confidence interval, 1.05-1.18; P < .001), unexpected intensive care unit admission (odds ratio per millimeter, 1.11; 95% confidence interval, 1.04-1.19; P = .002), and 30-day mortality (odds ratio per millimeter, 1.25; 95% confidence interval, 1.06-1.46; P = .007). On multivariable analysis, adjusted for cardiovascular comorbidities, pulmonary function, and the operative approach, surgical side PAD remained an independent factor associated with major complication. CONCLUSIONS CT-based measurements of the PAD on the operative side may inform of the about the risk of major complications after lobectomy. Review of PA size on preoperative CT scans may help identify patients who would benefit from formal evaluation of PA pressures to improve the operative risk assessment.
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Affiliation(s)
- Peter J Kneuertz
- Division of Thoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Max S Yudovich
- Division of Thoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Chiemezie C Amadi
- Division of Thoracic Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Elizabeth Bashian
- Division of Thoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Desmond M D'Souza
- Division of Thoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Mahmoud Abdel-Rasoul
- Center for Biostatistics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Robert E Merritt
- Division of Thoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Cotogni P, Stragliotto S, Ossola M, Collo A, Riso S. The Role of Nutritional Support for Cancer Patients in Palliative Care. Nutrients 2021; 13:306. [PMID: 33498997 PMCID: PMC7911232 DOI: 10.3390/nu13020306] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/11/2021] [Accepted: 01/19/2021] [Indexed: 02/07/2023] Open
Abstract
The role of nutritional support for cancer patients in palliative care is still a controversial topic, in part because there is no consensus on the definition of a palliative care patient because of ambiguity in the common medical use of the adjective palliative. Nonetheless, guidelines recommend assessing nutritional deficiencies in all such patients because, regardless of whether they are still on anticancer treatments or not, malnutrition leads to low performance status, impaired quality of life (QoL), unplanned hospitalizations, and reduced survival. Because nutritional interventions tailored to individual needs may be beneficial, guidelines recommend that if oral food intake remains inadequate despite counseling and oral nutritional supplements, home enteral nutrition or, if this is not sufficient or feasible, home parenteral nutrition (supplemental or total) should be considered in suitable patients. The purpose of this narrative review is to identify in these cancer patients the area of overlapping between the two therapeutic approaches consisting of nutritional support and palliative care in light of the variables that determine its identification (guidelines, evidence, ethics, and law). However, nutritional support for cancer patients in palliative care may be more likely to contribute to improving their QoL when part of a comprehensive early palliative care approach.
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Affiliation(s)
- Paolo Cotogni
- Department of Anesthesia, Pain Management and Palliative Care, Intensive Care and Emergency, Molinette Hospital, University of Turin, 10126 Turin, Italy
| | - Silvia Stragliotto
- Medical Oncology 1, Veneto Institute of Oncology-IRCCS, 35128 Padova, Italy;
| | - Marta Ossola
- Clinical Nutrition and Dietetics Unit, Department of Internal Medicine, Molinette Hospital, 10126 Turin, Italy;
| | - Alessandro Collo
- Clinical Nutrition and Dietetics Unit, Maggiore della Carità Hospital, University of Eastern Piedmont, 28100 Novara, Italy; (S.R.); (A.C.)
| | - Sergio Riso
- Clinical Nutrition and Dietetics Unit, Maggiore della Carità Hospital, University of Eastern Piedmont, 28100 Novara, Italy; (S.R.); (A.C.)
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Hansen TTD, Omland LH, von Heymann A, Johansen C, Clausen MB, Suetta C, Pappot H, Rafn BS. Development of Sarcopenia in Patients With Bladder Cancer: A Systematic Review. Semin Oncol Nurs 2021; 37:151108. [PMID: 33431235 DOI: 10.1016/j.soncn.2020.151108] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Sarcopenia is known to influence cancer-related complications and overall survival. However, the effect of cancer treatment on the development or progression of sarcopenia is relatively unknown. The primary aim of this systematic review was to determine the prevalence and development of sarcopenia among people with bladder cancer. DATA SOURCES A systematic search was performed in PubMed, Web of Science, and EMBASE. Studies with ≥2 assessments of sarcopenia were eligible for inclusion. Five retrospective cohorts were included with a total of 438 participants. The baseline prevalence of sarcopenia across studies varied from 25% to 69% and post-treatment prevalence from 50% to 81%. The average loss of muscle mass was 2.2% to 10% during a time course of 3 to 12 months. CONCLUSION The prevalence of sarcopenia markedly increased during cancer treatment in patients with bladder cancer. Further research into the effect of different treatment regimens on the development of sarcopenia, and how these changes might affect functional capacity and survival is needed. IMPLICATIONS FOR NURSING PRACTICE The development of sarcopenia is important to understand because of its negative affect on quality of life, complications, and mortality. Further, understanding how sarcopenia develops during treatment could potentially strengthen nurses' future care plans for patients with bladder cancer.
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Affiliation(s)
- Tobias Tuse Dunk Hansen
- Cancer Survivorship and Treatment Late Effects, Department of Oncology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Lise Høj Omland
- Department of Oncology, 5073, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Annika von Heymann
- Cancer Survivorship and Treatment Late Effects, Department of Oncology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Christoffer Johansen
- Cancer Survivorship and Treatment Late Effects, Department of Oncology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Mikkel Bek Clausen
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy. University College Copenhagen, Faculty of Health, Copenhagen, Denmark
| | - Charlotte Suetta
- Geriatric Research Unit, Department of Geriatric and Palliative Medicine, Bispebjerg and Frederiksberg Hospital-Bispebjerg, Copenhagen, Denmark; Geriatric Research Unit, Department of Medicine, Herlev and Gentofte Hospitals, Herlev Denmark; CopenAge-Copenhagen Center for Clinical Age Research, University of Copenhagen, Copenhagen, Denmark
| | - Helle Pappot
- Department of Oncology, 5073, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Bolette Skjødt Rafn
- Cancer Survivorship and Treatment Late Effects, Department of Oncology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.
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Sakai NS, Bhagwanani A, Bray TJP, Hall-Craggs MA, Taylor SA. Assessment of body composition and association with clinical outcomes in patients with lung and colorectal cancer. BJR Open 2021; 3:20210048. [PMID: 35707759 PMCID: PMC9185845 DOI: 10.1259/bjro.20210048] [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: 07/23/2021] [Revised: 10/17/2021] [Accepted: 11/09/2021] [Indexed: 11/09/2022] Open
Abstract
Objectives: To assess body composition in patients with non-small cell lung cancer (NSCLC) and colorectal cancer using whole-body MRI and relate this to clinical outcomes. Methods: 53 patients with NSCLC (28 males, 25 females; mean age 66.9) and 74 patients with colorectal cancer (42 males, 32 females; mean age 62.9) underwent staging whole-body MRI scans, which were post-processed to derive fat mass (FM), fat free mass (FFM) and skeletal muscle (SM) indices and SM fat fraction (FF). These were compared between the two cancer cohorts using two-sided t-tests and the chi-squared test. Measurements of body composition were correlated with outcomes including length of hospital stay, metastatic status and mortality. Results: Patients with NSCLC had significantly lower FFM (p = 0.0071) and SM (p = 0.0084) indices. Mean SM FF was greater in patients with NSCLC (p = 0.0124) and was associated with longer hospital stay (p = 0.035). There was no significant relationship between FM, FFM and SM indices and length of hospital stay, metastatic status or mortality. Conclusions: Patients with NSCLC had lower FFM and SM indices than patients with colorectal cancer and greater SMFF, indicating lower SM mass with fatty infiltration. These findings reflect differences in the phenotype of the two groups and suggest patients with lung cancer are more likely to require additional nutritional support. Advances in knowledge: Body composition differs between NSCLC and colorectal cancer. Patients with NSCLC have both a reduced SM mass and greater SM FF suggesting that they are more nutritionally deplete than patients with colorectal cancer.
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Affiliation(s)
- Naomi S Sakai
- UCL Centre for Medical Imaging, London, UK
- University College London Hospital, London, UK
| | | | - Timothy JP Bray
- UCL Centre for Medical Imaging, London, UK
- University College London Hospital, London, UK
| | - Margaret A Hall-Craggs
- UCL Centre for Medical Imaging, London, UK
- University College London Hospital, London, UK
| | - Stuart Andrew Taylor
- UCL Centre for Medical Imaging, London, UK
- University College London Hospital, London, UK
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The prognostic impact of skeletal muscle status and bone mineral density for resected distal cholangiocarcinoma. Clin Nutr 2020; 40:3552-3558. [PMID: 33358552 DOI: 10.1016/j.clnu.2020.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 11/27/2020] [Accepted: 12/09/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND & AIMS The preoperative body composition and bone mineral density (BMD) have been reported as prognostic factors for several cancers. However, the prognostic impact of the preoperative body composition and BMD for resected distal cholangiocarcinoma (DCC) remains unclear. METHODS A total of 111 patients who underwent pancreatoduodenectomy for DCC between 2002 and 2017 were analyzed. The skeletal muscle index (SMI) and BMD were measured by preoperative computed tomography. The optimal cut-off value of the body composition and BMD were selected based on the minimum P-value obtained by the log-rank test. The prognostic significance of the preoperative body composition and BMD was investigated using multivariate analysis. RESULTS The median values of the SMI (45.7 vs. 36.7 cm2/m2, P < 0.001) and BMD (128.5 vs. 101.0 Hounsfield units [HU], P = 0.005) in male and female were significantly different. The optimal cut-off values for the SMI were 55 cm2/m2 in male and 36 cm2/m2 in female, and those for the BMD were 75 HU in male and 74 HU in female. A multivariate analysis identified low SMI (hazard ratio [HR], 4.340; P = 0.044), low BMD (HR, 5.333; P < 0.001) and microscopic venous invasion (HR, 2.019; P = 0.026) as independent prognostic factors for the survival. CONCLUSIONS A preoperative low SMI and low BMD were independent prognostic factors for resected DCC.
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Xu L, Jing Y, Zhao C, Zhang Q, Zhao X, Yang J, Wu L, Yang Y. Preoperative computed tomography-assessed skeletal muscle index is a novel prognostic factor in patients with hepatocellular carcinoma following hepatectomy: a meta-analysis. J Gastrointest Oncol 2020; 11:1040-1053. [PMID: 33209496 DOI: 10.21037/jgo-20-122] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Recently, several studies have examined the association between preoperative sarcopenia and prognosis evaluation in patients with hepatocellular carcinoma (HCC) undergoing hepatectomy. However, their conclusions remain ambiguous and controversial. Thus, we conducted a meta-analysis to assess the prognostic role of preoperative sarcopenia in patients with HCC undergoing hepatectomy. Methods We searched the existing literature reporting on the prognostic value of preoperative computed tomography (CT)-assessed sarcopenia for the survival of patients with HCC undergoing hepatectomy. The pooled hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) of overall survival (OS) and disease-free survival (DFS) were used to assess the prognostic value of preoperative sarcopenia in HCC patients. The associations between preoperative sarcopenia and clinicopathological characteristics were also evaluated. Results A total of six studies with 1,420 patients (including 458 sarcopenia and 962 non-sarcopenia patients) were included in the meta-analysis. The results showed that preoperative sarcopenia was significantly associated with poor OS (HR =1.572, 95% CI: 1.342-1.840, P=0) and shorter DFS (HR =1.544, 95% CI: 1.178-2.024, P=0.002) in patients with HCC undergoing hepatectomy. Preoperative sarcopenia was also significantly related to larger diameter tumors (WMD =0.598, 95% CI: 0.216-0.980, P=0.002). The results of the sensitivity analysis were stable in this meta-analysis. Egger's tests revealed that there was no significant publication bias. Conclusions Sarcopenia appears to have significant adverse impacts on postoperative outcomes in patients with hepatocellular carcinoma following hepatectomy. However, further large-scale prospective studies are needed to confirm our findings.
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Affiliation(s)
- Liqian Xu
- Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Department of Geriatrics, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yuxia Jing
- Department of Geriatrics, Tianjin Fifth Central Hospital, Tianjin, China
| | - Chen Zhao
- Institute of Physical Education, Huzhou University, Huzhou, China
| | - Qin Zhang
- Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Department of Geriatrics, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaohong Zhao
- Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Department of Geriatrics, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ji Yang
- Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Department of Geriatrics, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lizhen Wu
- Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Department of Geriatrics, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yunmei Yang
- Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Department of Geriatrics, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Sun C, Anraku M, Kawahara T, Karasaki T, Kitano K, Nagayama K, Sato M, Nakajima J. Respiratory strength and pectoralis muscle mass as measures of sarcopenia: Relation to outcomes in resected non-small cell lung cancer. J Thorac Cardiovasc Surg 2020; 163:779-787.e2. [PMID: 33317785 DOI: 10.1016/j.jtcvs.2020.10.133] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 10/07/2020] [Accepted: 10/12/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Physical biomarkers to stratify patients with lung cancer into subtypes predictive of outcome beyond tumor-related characteristics are underexplored. This study was designed to investigate the clinical utility of preoperative sarcopenia based on respiratory strength and pectoralis muscle mass to predict the risk of death. METHODS This retrospective study included 346 consecutive patients undergoing curative-intent resection of non-small cell lung cancer from 2009 to 2013. Respiratory strength and muscle mass were assessed by peak expiratory flow rate and pectoralis muscle index (pectoralis muscle area/body mass index) using preoperative spirometry and chest axial images, respectively. Sarcopenia cutoff points were defined by gender-specific medians of peak expiratory flow rates and pectoralis muscle indices. Survival was compared between patients with sarcopenia and patients without. RESULTS Sarcopenia was present in 98 patients (28.3%) and was significantly associated with advancing age (P < .001). Patients with sarcopenia exhibited worse 5-year overall survival compared with patients without sarcopenia (69.9% vs 87.2%, P < .001). Multivariate analysis revealed that sarcopenia was an independent adverse prognostic factor (hazard ratio, 1.88; 95% confidence interval, 1.09-3.24; P = .023) after adjustment for gender, age, smoking status, coronary heart disease, diffusing capacity for carbon monoxide, neutrophil-to-lymphocyte ratio, albumin, histologic type, and pathologic stage. CONCLUSIONS Preoperative sarcopenia as identified by the criteria of low respiratory strength and reduced pectoralis muscle mass is significantly associated with poor overall survival. This may help to develop more individualized management strategies and optimize longitudinal care for patients.
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Affiliation(s)
- Changbo Sun
- Department of Thoracic Surgery, University of Tokyo Graduate School of Medicine, Tokyo, Japan; Department of Thoracic Surgery, First Hospital of China Medical University, Shenyang, China
| | - Masaki Anraku
- Department of Thoracic Surgery, University of Tokyo Graduate School of Medicine, Tokyo, Japan.
| | - Takuya Kawahara
- Biostatistics Division of Clinical Research Support Center, University of Tokyo Hospital, Tokyo, Japan
| | - Takahiro Karasaki
- Department of Thoracic Surgery, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Kentaro Kitano
- Department of Thoracic Surgery, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Kazuhiro Nagayama
- Department of Thoracic Surgery, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Masaaki Sato
- Department of Thoracic Surgery, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Jun Nakajima
- Department of Thoracic Surgery, University of Tokyo Graduate School of Medicine, Tokyo, Japan
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[Approaches to the pre-operative functional assessment of patients with lung cancer and preoperative rehabilitation]. Rev Mal Respir 2020; 37:800-810. [PMID: 33199069 DOI: 10.1016/j.rmr.2020.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/08/2020] [Indexed: 12/25/2022]
Abstract
Surgery is the best treatment for early lung cancer but requires a preoperative functional evaluation to identify patients who may be at a high risk of complications or death. Guideline algorithms include a cardiological evaluation, a cardiopulmonary assessment to calculate the predicted residual lung function, and identify patients needing exercise testing to complete the evaluation. According to most expert opinion, exercise tests have a very high predictive value of complications. However, since the publication of these guidelines, minimally-invasive surgery, sublobar resections, prehabilitation and enhanced recovery after surgery (ERAS) programmes have been developed. Implementation of these techniques and programs is associated with a decrease in postoperative mortality and complications. In addition, the current guidelines and the cut-off values they identified are based on early series of patients, and are designed to select patients before major lung resection (lobectomy-pneumonectomy) performed by thoracotomy. Therefore, after a review of the current guidelines and a brief update on prehabilitation (smoking cessation, exercise training and nutritional aspects), we will discuss the need to redefine functional criteria to select patients who will benefit from lung surgery.
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Sarcopenia affects clinical efficacy of immune checkpoint inhibitors in non-small cell lung cancer patients: A systematic review and meta-analysis. Int Immunopharmacol 2020; 88:106907. [DOI: 10.1016/j.intimp.2020.106907] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/30/2020] [Accepted: 08/15/2020] [Indexed: 02/06/2023]
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Kong S, Shin S, Lee JK, Lee G, Kang D, Cho J, Kim HK, Zo JI, Shim YM, Park HY, Shin DW. Association between Sarcopenia and Physical Function among Preoperative Lung Cancer Patients. J Pers Med 2020; 10:E166. [PMID: 33066134 PMCID: PMC7712435 DOI: 10.3390/jpm10040166] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/28/2020] [Accepted: 10/08/2020] [Indexed: 12/26/2022] Open
Abstract
We aimed to investigate the prevalence of sarcopenia using new diagnostic criteria and association of sarcopenia with cardiopulmonary function and physical activity (PA) in preoperative lung cancer patients. The data of 614 patients were obtained from the CATCH-LUNG cohort study. Patients were classified into three groups-normal (n = 520), pre-sarcopenia (n = 60, low skeletal muscle mass index only), and sarcopenia (n = 34, low SMI and strength). Cardiopulmonary function was measured using the 6-min walk test (6MWT), and PA was objectively measured using a wearable device. The adjusted odds ratio (aOR) for a <400-m distance in 6MWT was 3.52 (95% confidence interval (CI) 1.34-9.21) and 6.63 (95% CI 2.25-19.60) in the pre-sarcopenia and sarcopenia groups, respectively, compared to that in the normal group. The aOR (95% CI) for <5000 steps/day was 1.64 (0.65-4.16) and 4.20 (1.55-11.38) in the pre-sarcopenia and sarcopenia groups, respectively, compared to that in the normal group. In conclusion, the prevalence of pre-sarcopenia and sarcopenia was 9.8% and 5.5%, respectively, among preoperative lung cancer patients. Cardiopulmonary function and physical activity were significantly lower in the pre-sarcopenia and sarcopenia groups than in the normal group. Patients with sarcopenia had more robust findings, suggesting the importance of muscle strength and mass.
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Affiliation(s)
- Sunga Kong
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul 06351, Korea; (S.K.); (G.L.); (D.K.); (J.C.)
- Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul 06351, Korea;
| | - Sumin Shin
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea; (S.S.); (H.K.K.); (J.I.Z.); (Y.M.S.)
| | - Jae Kyung Lee
- Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul 06351, Korea;
| | - Genehee Lee
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul 06351, Korea; (S.K.); (G.L.); (D.K.); (J.C.)
- Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul 06351, Korea;
| | - Danbee Kang
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul 06351, Korea; (S.K.); (G.L.); (D.K.); (J.C.)
- Center for Clinical Epidemiology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea
| | - Juhee Cho
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul 06351, Korea; (S.K.); (G.L.); (D.K.); (J.C.)
- Center for Clinical Epidemiology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea
- Departments of Epidemiology and Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea; (S.S.); (H.K.K.); (J.I.Z.); (Y.M.S.)
| | - Jae Ill Zo
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea; (S.S.); (H.K.K.); (J.I.Z.); (Y.M.S.)
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea; (S.S.); (H.K.K.); (J.I.Z.); (Y.M.S.)
| | - Hye Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea
| | - Dong Wook Shin
- Department of Family Medicine & Supportive Care Center, Samsung Medical Center, Seoul 06351, Korea
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul 06351, Korea
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The prognostic value of pneumonia severity score and pectoralis muscle Area on chest CT in adult COVID-19 patients. Eur J Radiol 2020; 131:109271. [PMID: 32942198 PMCID: PMC7480333 DOI: 10.1016/j.ejrad.2020.109271] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/03/2020] [Accepted: 09/05/2020] [Indexed: 01/08/2023]
Abstract
Purpose To assess the prognostic value of pneumonia severity score (PSS), pectoralis muscle area (PMA), and index (PMI) on chest computed tomography (CT) in adult coronavirus disease 2019 (COVID-19) patients. Method The chest CT images of COVID-19 patients were evaluated for the PSS as the ratio of the volume of involved lung parenchyma to the total lung volume. The cross-sectional areas of the pectoralis muscles (PMA, cm2) were also measured automatically on axial CT images, and PMI was calculated as the following formula: PMI = PMA / patient’s height square (m2). The relationship between clinical variables, PSS, PMA, sex-specific PMI values, and patient outcomes (intubation, prolonged hospital stay, and death) were investigated using multivariable logistic regression analysis. All patients were followed for more than a month. Results One-hundred thirty patients (76 males, 58.46 %) were included in the study. Fifteen patients (11.54 %) were intubated, 24 patients (18.46 %) had prolonged hospital stay, and eight patients (6.15 %) died during follow-up. Patients with comorbidity had a higher mean of PSS (6.3 + 4.5 vs 3.9 + 3.8; p = 0.001). After adjusting the confounders, PSS was an independent predictor of intubation (adjusted Odds Ratio [OR]: 1.73, 95 % CI 1.31−2.28, p < 0.001), prolonged hospital stay (OR: 1.20, 95 % CI 1.09−1.33, p < 0.001), and death (OR: 2.13, 95 % CI 1.1−4.13, p = 0.026. PMI value was a predictor of prolonged hospital stay (OR: 0.83, 95 % CI 0.72−0.96, p = 0.038) and death (OR: 0.53, 95 % CI 0.29−0.96, p = 0.036). Incrementally increasing PMA value was a predictor of prolonged hospital stay (OR: 0.93, 95 % CI 0.89−0.98, p = 0.01) and intubation (OR: 0.98, 95 % CI 0.96−1, p = 0.036). Conclusion PSS, PMA, and PMI values have prognostic value in adult COVID-19 patients and can be easily assessed on chest CT images.
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Formula for the Cross-Sectional Area of the Muscles of the Third Lumbar Vertebra Level from the Twelfth Thoracic Vertebra Level Slice on Computed Tomography. Geriatrics (Basel) 2020; 5:geriatrics5030047. [PMID: 32899577 PMCID: PMC7555041 DOI: 10.3390/geriatrics5030047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/01/2020] [Accepted: 09/04/2020] [Indexed: 01/06/2023] Open
Abstract
The purpose of this study was to investigate a means by which to reflect muscle mass using chest computed tomography (CT). A cross-sectional study was conducted with patients aged ≥ 65 years having abdominal and chest CT scans. The formula to predict third lumbar vertebra (L3) cross-sectional area (CSA) of the muscles from the erector muscles of the spine at the twelfth thoracic vertebra (Th12) level slice on CT was created using the five-fold cross-validation method. Correlation between predicted L3 CSA and measured L3 CSA of the muscles was assessed by intraclass correlation coefficients (ICC) and correlation coefficients (r) in the data of the development, and predictability was examined with accuracy and F-values in the validation study. The development study included 161 patients. The developed formula was as follows: −1006.38 + 16.29 × age + 1161.80 × sex (if female, 0; if male, 1) + 55.91 × body weight + 2.22 × CSA of the erector muscles at Th12. The formula demonstrated strong concordance and correlation (ICC = 0.849 [0.800–0.887] and r = 0.858 [0.811–0.894]). The validation study included 34 patients. The accuracy and F-value between predicted CSA and measured CSA were high (accuracy = 0.889–0.944, F-value = 0.931–0.968). We developed a formula predicting CSA at L3 using Th12 CT slice. This formula could be used to assess decreased muscle mass even with chest CT alone.
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