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Lin WL, Nguyen THY, Huang WT, Guo HR, Wu LM. Sarcopenia and survival in colorectal cancer without distant metastasis: a systematic review and meta-analysis. J Gastroenterol Hepatol 2024. [PMID: 38986533 DOI: 10.1111/jgh.16681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 06/28/2024] [Accepted: 07/02/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND AND AIM Despite prior attempts to evaluate the effects of sarcopenia on survival among patients with colorectal cancer (CRC), the results of these studies have not been consistent. The present study aimed to evaluate the association between sarcopenia and survival among patients having CRC without distant metastasis by aggregating multiple studies. METHODS We performed a literature search using computerized databases and identified additional studies from among the bibliographies of retrieved articles. The quality of each study was evaluated using the Newcastle-Ottawa Scale, and meta-analyses were performed to evaluate overall survival (OS) and disease-free survival (DFS). RESULTS Thirteen studies with up to 6600 participants were included in the meta-analyses, with a mean age of 63.6 years (range: 18-93 years). We found that preoperative sarcopenia was associated with worse OS (hazard ratio [HR]: 1.61; 95% confidence interval [CI]: 1.38-1.88) and worse DFS (HR: 1.57; 95% CI: 1.10-2.24). Compared with patients without sarcopenia after tumor resection, those with postoperative sarcopenia had worse OS (HR: 1.76; 95% CI: 1.47-2.10) and DFS (HR: 1.79; 95% CI: 1.46-2.20). CONCLUSION These meta-analyses suggest that sarcopenia, no matter observed before or after tumor resection, is associated with worse OS and DFS in patients with CRC who have no distant metastasis.
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Affiliation(s)
- Wen-Li Lin
- Center for Quality Management, Chi Mei Medical Center, Tainan City, Taiwan
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Thi-Hoang-Yen Nguyen
- Department of Environmental and Occupational Health, National Cheng Kung University, Tainan City, Taiwan
| | - Wen-Tsung Huang
- Division of Hematology and Oncology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan City, Taiwan
| | - How-Ran Guo
- Department of Environmental and Occupational Health, National Cheng Kung University, Tainan City, Taiwan
- Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan City, Taiwan
| | - Li-Min Wu
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
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da Silva Nascimento ML, Alves Bennemann N, de Sousa IM, de Oliveira Bezerra MR, Villaça Chaves G, Moreira Lima Verde SM, Fernandes Maurício S, Barreto Campello Carvalheira J, Santos Mendes MC, Miranda AL, da Costa Pereira JP, Gonzalez MC, Prado CM, Fayh APT. Examining variations in body composition among patients with colorectal cancer according to site and disease stage. Sci Rep 2024; 14:10829. [PMID: 38734789 PMCID: PMC11088614 DOI: 10.1038/s41598-024-61790-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/09/2024] [Indexed: 05/13/2024] Open
Abstract
Patients with colorectal cancer (CRC) often exhibit changes in body composition (BC) which are associated with poorer clinical outcomes. Many studies group colon and rectal cancers together, irrespective of staging, potentially affecting assessment and treatment strategies. Our study aimed to compare BC in patients with CRC focusing on tumor location and metastasis presence. A total of 635 individuals were evaluated, with a mean age of 61.8 ± 12.4 years and 50.2% female. The majority had rectal cancer as the primary cancer site (51.0%), and 23.6% had metastatic disease. The first regression model showed tumor site and metastasis as independent factors influencing skeletal muscle (SM), skeletal muscle index (SMI), and visceral adipose tissue variability (all p values < 0.05). The second model, adjusted for BMI, indicated tumor site as the primary factor affecting SMI variations (adjusted R2 = 0.50 p < 0.001), with colon tumors inversely associated with SM (standardized β - 2.15(- 3.3; - 0.9) p < 0.001). A third model, considering all the confounders from the directed acyclic graphs, was constructed and the found association remained independent. Our findings highlight significant BC variations in patients with CRC, influenced by tumor location and metastases presence, underscoring the need for location-specific assessment in CRC management.
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Affiliation(s)
- Mayra Laryssa da Silva Nascimento
- PesqClin Lab, Onofre Lopes University Hospital, Brazilian Company of Hospital Services (EBSERH), Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Nithaela Alves Bennemann
- PesqClin Lab, Onofre Lopes University Hospital, Brazilian Company of Hospital Services (EBSERH), Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Iasmin Matias de Sousa
- Health Sciences Center, Federal University of Rio Grande do Norte, Avenida Senador Salgado Filho, No 3000, Natal, RN, 59078-970, Brazil
| | - Mara Rubia de Oliveira Bezerra
- Health Sciences Center, Federal University of Rio Grande do Norte, Avenida Senador Salgado Filho, No 3000, Natal, RN, 59078-970, Brazil
| | | | | | | | - José Barreto Campello Carvalheira
- Division of Oncology, Department of Anesthesiology, Oncology and Radiology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Maria Carolina Santos Mendes
- Division of Oncology, Department of Anesthesiology, Oncology and Radiology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Ana Lucia Miranda
- Health Sciences Center, Federal University of Rio Grande do Norte, Avenida Senador Salgado Filho, No 3000, Natal, RN, 59078-970, Brazil
- Liga Norteriograndense Contra o Câncer, Natal, Rio Grande do Norte, Brazil
| | | | | | - Carla M Prado
- Human Nutrition Research Unit, Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Ana Paula Trussardi Fayh
- PesqClin Lab, Onofre Lopes University Hospital, Brazilian Company of Hospital Services (EBSERH), Federal University of Rio Grande do Norte, Natal, RN, Brazil.
- Health Sciences Center, Federal University of Rio Grande do Norte, Avenida Senador Salgado Filho, No 3000, Natal, RN, 59078-970, Brazil.
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Di Fiore R, Drago-Ferrante R, Suleiman S, Veronese N, Pegreffi F, Calleja-Agius J. Sarcopenia in gynaecological cancers. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024:108403. [PMID: 38760237 DOI: 10.1016/j.ejso.2024.108403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/26/2024] [Accepted: 05/07/2024] [Indexed: 05/19/2024]
Abstract
Gynaecological cancers (GCs) comprise a group of cancers that originate in the female reproductive organs. Each GC is unique, with different signs and symptoms, risk factors and therapeutic strategies. Worldwide, the majority of GCs are still associated with high mortality rates, especially ovarian, due to difficulty in early detection. Despite numerous studies on the underlying pathophysiology, research in the field of GCs poses unique scientific and technological challenges. These challenges require a concerted multi- and inter-disciplinary effort by the clinical, scientific and research communities to accelerate the advancement of prognostic, diagnostic, and therapeutic approaches. Sarcopenia is a multifactorial disease which leads to the systemic loss of skeletal muscle mass and function. It can be caused by malignancies, as well as due to malnutrition, physical inactivity, ageing and neuromuscular, inflammatory, and/or endocrine diseases. Anorexia and systemic inflammation can shift the metabolic balance of patients with cancer cachexia towards catabolism of skeletal muscle, and hence sarcopenia. Therefore, sarcopenia is considered as an indicator of poor general health status, as well as the possible indicator of advanced cancer. There is a growing body of evidence showing the prognostic significance of sarcopenia in various cancers, including GCs. This review will outline the clinical importance of sarcopenia in patients with GCs.
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Affiliation(s)
- Riccardo Di Fiore
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, MSD 2080, Msida, Malta; Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, PA, 19122, USA.
| | - Rosa Drago-Ferrante
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, MSD 2080, Msida, Malta; BioDNA Laboratories, Malta Life Sciences Park, SGN 3000, San Gwann, Malta.
| | - Sherif Suleiman
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, MSD 2080, Msida, Malta.
| | - Nicola Veronese
- Department of Internal Medicine, Geriatrics Section, University of Palermo, 90128, Palermo, Italy.
| | - Francesco Pegreffi
- Department of Medicine and Surgery, Kore University of Enna, 94100, Enna, Italy.
| | - Jean Calleja-Agius
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, MSD 2080, Msida, Malta.
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Lee C, Tseng T, Chang R, Yen H, Chen Y, Chen Y, Wu C, Hu M, Yen M, Bongers M, Groot OQ, Lai C, Lin W. Psoas muscle area is an independent survival prognosticator in patients undergoing surgery for long-bone metastases. Cancer Med 2024; 13:e7072. [PMID: 38457220 PMCID: PMC10922028 DOI: 10.1002/cam4.7072] [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: 09/13/2023] [Revised: 02/02/2024] [Accepted: 02/20/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Predictive analytics is gaining popularity as an aid to treatment planning for patients with bone metastases, whose expected survival should be considered. Decreased psoas muscle area (PMA), a morphometric indicator of suboptimal nutritional status, has been associated with mortality in various cancers, but never been integrated into current survival prediction algorithms (SPA) for patients with skeletal metastases. This study investigates whether decreased PMA predicts worse survival in patients with extremity metastases and whether incorporating PMA into three modern SPAs (PATHFx, SORG-NG, and SORG-MLA) improves their performance. METHODS One hundred eighty-five patients surgically treated for long-bone metastases between 2014 and 2019 were divided into three PMA tertiles (small, medium, and large) based on their psoas size on CT. Kaplan-Meier, multivariable regression, and Cox proportional hazards analyses were employed to compare survival between tertiles and examine factors associated with mortality. Logistic regression analysis was used to assess whether incorporating adjusted PMA values enhanced the three SPAs' discriminatory abilities. The clinical utility of incorporating PMA into these SPAs was evaluated by decision curve analysis (DCA). RESULTS Patients with small PMA had worse 90-day and 1-year survival after surgery (log-rank test p < 0.001). Patients in the large PMA group had a higher chance of surviving 90 days (odds ratio, OR, 3.72, p = 0.02) and 1 year than those in the small PMA group (OR 3.28, p = 0.004). All three SPAs had increased AUC after incorporation of adjusted PMA. DCA indicated increased net benefits at threshold probabilities >0.5 after the addition of adjusted PMA to these SPAs. CONCLUSIONS Decreased PMA on CT is associated with worse survival in surgically treated patients with extremity metastases, even after controlling for three contemporary SPAs. Physicians should consider the additional prognostic value of PMA on survival in patients undergoing consideration for operative management due to extremity metastases.
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Affiliation(s)
- Chia‐Che Lee
- Graduate Institute of Biomedical Electronics and BioinformaticsNational Taiwan UniversityTaipeiTaiwan
- Department of Orthopaedic SurgeryNational Taiwan University HospitalTaipeiTaiwan
| | - Ting‐En Tseng
- Department of Orthopaedic SurgeryNational Taiwan University HospitalTaipeiTaiwan
| | - Ruey‐Feng Chang
- Graduate Institute of Biomedical Electronics and BioinformaticsNational Taiwan UniversityTaipeiTaiwan
| | - Hung‐Kuan Yen
- Department of Orthopaedic SurgeryNational Taiwan University HospitalTaipeiTaiwan
- Department of Orthopaedic SurgeryNational Taiwan University HospitalHsinchuTaiwan
- Department of Medical EducationNational Taiwan University HospitalHsinchuTaiwan
| | - Yu‐An Chen
- Department of Medical EducationNational Taiwan University HospitalTaipeiTaiwan
| | - Yu‐Yung Chen
- Department of Medical EducationNational Taiwan University HospitalTaipeiTaiwan
| | - Chih‐Horng Wu
- Department of Medical ImagingNational Taiwan University HospitalTaipeiTaiwan
| | - Ming‐Hsiao Hu
- Department of Orthopaedic SurgeryNational Taiwan University HospitalTaipeiTaiwan
| | - Mao‐Hsu Yen
- Department of Computer Science and EngineeringNational Taiwan Ocean UniversityKeelungTaiwan
| | - Michiel Bongers
- Department of Orthopaedic SurgeryMassachusetts General HospitalBostonMassachusettsUSA
| | - Olivier Q. Groot
- Department of Orthopaedic SurgeryMassachusetts General HospitalBostonMassachusettsUSA
- Department of OrthopaedicsUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Cheng‐Yo Lai
- Department of Orthopaedic SurgeryNational Taiwan University HospitalHsinchuTaiwan
| | - Wei‐Hsin Lin
- Department of Orthopaedic SurgeryNational Taiwan University HospitalTaipeiTaiwan
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Lewis L, Thompson B, Stellmaker R, Koelmeyer L. Body composition and chemotherapy toxicities in breast cancer: a systematic review of the literature. J Cancer Surviv 2024:10.1007/s11764-023-01512-z. [PMID: 38206431 DOI: 10.1007/s11764-023-01512-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 12/13/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE Breast cancer is the most diagnosed cancer in women with chemotherapy being a common treatment. Toxicities due to chemotherapy can result in dose reduction, delay, and early cessation of treatment, which along with causing distress for individuals during their cancer treatment might also reduce the therapeutic effect. The purpose of this systematic review is to examine the role of body composition on chemotherapy toxicities in women with breast cancer. METHODS A systematic search of the literature was completed on electronic databases Pubmed, Embase, CINHAHL, and Cochrane. Studies were included if the direct effect of body composition on chemotherapy toxicities was reported and excluded if body composition could not be isolated. A critical appraisal of the studies included was performed using McMasters University Critical Review Form for Quantitative Studies. RESULTS Eleven studies were included with a total of 2881 female participants. All studies reported significant relationships between body composition and chemotherapy toxicities; however, individual parameters differed between the studies. Adding to the heterogeneity, different thresholds were reported to determine both sarcopenia and myosteatosis, making it difficult to identify a common finding. CONCLUSION This review suggests that body composition may be an important factor in predicting the severity of chemotherapy toxicities during treatment for breast cancer; however, the lack of international consensus as to thresholds in the literature for sarcopenia and myosteatosis may result in bias. The review supports the need for further prospective studies, allowing for more robust, pre-determined data collection, to better understand the implications of body composition on toxicities and benefits of using body composition to individualize chemotherapy dosing. IMPLICATIONS FOR CANCER SURVIVORS Toxicities due to chemotherapy can result in treatment being unable to be completed as planned, potentially resulting in poorer survival outcomes. Improved knowledge in this area may give rise to a more reliable way of individualizing chemotherapy dosage to help mitigate this risk.
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Affiliation(s)
- Lori Lewis
- Australian Lymphoedema Education, Research & Treatment (ALERT) Program, Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 1, 75 Talavera Road, Sydney, NSW, 2109, Australia.
| | - Belinda Thompson
- Australian Lymphoedema Education, Research & Treatment (ALERT) Program, Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 1, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Rhiannon Stellmaker
- Australian Lymphoedema Education, Research & Treatment (ALERT) Program, Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 1, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Louise Koelmeyer
- Australian Lymphoedema Education, Research & Treatment (ALERT) Program, Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 1, 75 Talavera Road, Sydney, NSW, 2109, Australia
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Lin WL, Wu LM, Huang WT, Guo HR, Chen JJ. Age as a modifier of the effects of sarcopenia on survival among colon cancer patients after surgery. J Surg Oncol 2023; 128:1121-1132. [PMID: 37592877 DOI: 10.1002/jso.27405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/06/2023] [Accepted: 07/16/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Studies have been conducted to evaluate whether sarcopenia is a predictor for survival in patients with colon cancer postsurgery, but findings have been inconsistent, and effects of age were seldom evaluated. METHODS We recruited 133 patients with resectable colon cancer who underwent surgery between January 2014 and December 2017 at a teaching hospital to evaluate the effects of sarcopenia on survival, after adjusting for age and other potential predictors, including visceral adiposity (VA). RESULTS Preoperative sarcopenia was associated with worse overall survival (OS: 62.3% vs. 83.8%, p = 0.04) and longer hospital stay (20.6 vs. 14.9 days, p < 0.01) while VA was not. Cox proportional hazards regressions showed that sarcopenia was associated with an adjusted hazard ratio (HR) of 2.91 (95% confidence interval [CI]: 1.08-7.86) after adjustment for other independent risk factors, but was not associated with disease free survival. In stratified analyses, we found that sarcopenia was an independent factor for worse OS (adjusted HR = 1.94; 95% CI: 1.11-3.38) among patients >70 years, but not among patients ≤70 years (HR = 0.48; 95% CI: 0.55-4.55). CONCLUSIONS Age appeared to be a modifier of the effects of sarcopenia on OS among colon cancer patients postsurgery.
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Affiliation(s)
- Wen-Li Lin
- Center for Quality Management, Chi Mei Hospital, Liouying, Tainan, Taiwan
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Li-Min Wu
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wen-Tsung Huang
- Division of Hematology and Oncology, Chi Mei Hospital, Liouying, Tainan, Taiwan
| | - How-Ran Guo
- Department of Environmental and Occupational Health, National Cheng Kung University, Tainan, Taiwan
- Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Jyh-Jou Chen
- Division of Gastroenterology and Hepatology, Chi Mei Hospital, Liouying, Tainan, Taiwan
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Xi F, You Y, Ding W, Gao T, Cao Y, Tan S, Yu W. Association of longitudinal changes in skeletal muscle mass with prognosis and nutritional intake in acutely hospitalized patients with abdominal trauma: a retrospective observational study. Front Nutr 2023; 10:1085124. [PMID: 37324740 PMCID: PMC10264603 DOI: 10.3389/fnut.2023.1085124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 05/04/2023] [Indexed: 06/17/2023] Open
Abstract
Background The objective of this study was to explore whether longitudinal changes in skeletal muscle mass, from hospital admission to 3 weeks post-trauma, are associated with poor prognosis and nutritional intake in acutely hospitalized patients with abdominal trauma. Methods A single-center retrospective observational review was conducted on 103 patients with abdominal trauma admitted to the Affiliated Jinling Hospital, Medical School of Nanjing University between January 2010 and April 2020. Skeletal muscle mass was assessed by abdominal computed tomography (CT) performed within 14 days before surgery and on post-trauma days 1-3 (week 0), 7-10 (week 1), 14-17 (week 2), and 21-24 (week 3). The skeletal muscle index (SMI) at L3, change in SMI per day (ΔSMI/day), and percent change in SMI per day (ΔSMI/day [%]) were calculated. The receiver-operating characteristic (ROC) curve was used to evaluate the discriminatory performance of ΔSMI/day (%) for mortality. Linear correlation analysis was used to evaluate the associations between ΔSMI/day (%) and daily caloric or protein intake. Results Among the included patients, there were 91 males and 12 females (mean age ± standard deviation 43.74 ± 15.53 years). ΔSMI4-1/d (%) had a ROC-area under the curve of 0.747 (p = 0.048) and a cut-off value of -0.032 for overall mortality. There were significant positive correlations between ΔSMI4-1/d (%) and daily caloric intake and protein intake (Y = 0.0007501*X - 1.397, R2 = 0.282, R = 0.531, p < 0.001; Y = 0.008183*X - 0.9228, R2 = 0.194, R = 0.440, p < 0.001). Δ SMI/day (%) was positively correlated with daily caloric intake ≥80% of resting energy expenditure in weeks 2, 3, and 1-3 post-trauma and with protein intake >1.2 g/kg/d in weeks 3 and 1-3 post-trauma. Conclusion Loss of skeletal muscle mass is associated with poor prognosis and nutritional intake in patients admitted to hospital with abdominal trauma.
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Affiliation(s)
- Fengchan Xi
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
- Department of Intensive Care Unit, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, China
| | - Yong You
- Department of Intensive Care Unit, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Weiwei Ding
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Tao Gao
- Department of Intensive Care Unit, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Yang Cao
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Shanjun Tan
- Department of General Surgery, Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wenkui Yu
- Department of Intensive Care Unit, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
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Yang YR, Shi CS, Chang SW, Wu YY, Su YL, Lin GP, Kuan FC. The impact of sarcopenia on overall survival in patients with pan-RAS wild-type colorectal liver metastasis receiving hepatectomy. Sci Rep 2023; 13:6911. [PMID: 37106073 PMCID: PMC10140270 DOI: 10.1038/s41598-023-33439-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
Sarcopenia has been associated with conventional chemotherapy-related toxicity, postoperative complications and poor overall survival in patients with genotype-unselected metastatic colorectal cancer (mCRC). This study aimed to evaluate the prognostic implications of sarcopenia and its change after perioperative cetuximab plus doublet chemotherapy and hepatectomy in patients with RAS wild-type colorectal liver metastasis (CRLM). Patients with CRLM from 2007 to 2018 in Chang Gung Research Database were retrospectively analyzed. Baseline characteristics as well as skeletal muscle index (SMI) at baseline and dynamic changes after interventions were collected. A multivariate Cox proportional hazard model was used to evaluate the effect of each parameter on overall survival (OS), and the Kaplan-Meier method was used to establish survival curves. A two-sided p value < 0.05 was considered statistically significance. Of 214 RAS wild-type mCRC patients who received both cetuximab and doublet chemotherapy, 77 who received upfront or subsequent hepatectomy were included in this study. The median follow-up time was 2.3 years. The rate of sarcopenia was higher in the patients who received neoadjuvant cetuximab-containing regimens than in those who received upfront hepatectomy (95% versus 63%, p = 0.001). Increased SMI after perioperative systemic therapy remained independently associated with better OS in multivariate analysis [hazard ratio (HR) = 0.27/10% increase, p = 0.013). The patients with sarcopenia had a trend of worse OS than those without sarcopenia (median OS: 4.5 versus 3.6 years, log-rank p = 0.282). Improvement in sarcopenia ([SMI after intervention - initial SMI]/initial SMI × 100%) is an important prognostic factor for OS. Future research is warranted to investigate direct interventions for sarcopenia and the impact on OS.
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Affiliation(s)
- Yao-Ren Yang
- Division of Hematology and Oncology, Department of Medicine, Chang-Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan
| | - Chung-Sheng Shi
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan
| | - Sheng-Wei Chang
- Department of Radiology, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan
| | - Yu-Ying Wu
- Division of Hematology and Oncology, Department of Medicine, Chang-Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan
| | - Yu-Li Su
- Division of Hematology Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, Taiwan
| | - Geng-Ping Lin
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, 33305, Taiwan
| | - Feng-Che Kuan
- Division of Hematology and Oncology, Department of Medicine, Chang-Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan.
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Abe S, Nozawa H, Sasaki K, Murono K, Emoto S, Yokoyama Y, Matsuzaki H, Nagai Y, Yoshioka Y, Shinagawa T, Sonoda H, Ishihara S. Sarcopenia is Associated With Oncological Prognosis and the Incidence of Secondary Cancer in Patients With Middle/Lower Rectal Cancer. Clin Colorectal Cancer 2023; 22:143-152. [PMID: 36418196 DOI: 10.1016/j.clcc.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/26/2022] [Accepted: 10/04/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study evaluated the clinical implications of sarcopenia for patients with rectal cancer according to cancer progression. SUMMARY BACKGROUND DATA The negative impact of body composition on long-term outcome has been demonstrated for various malignancies. METHODS We retrospectively reviewed 708 patients with rectal cancer who underwent curative resection at our institution between 2003 and 2020. Factors contributing to long-term outcomes and the incidence of secondary cancer (ISC) were analyzed. Psoas muscle mass index (PMI) was assessed using preoperative computed tomography. Sarcopenia was defined using the PMI cut-off values for Asian adults (6.36 cm2/m2 for males and 3.92 cm2/m2 for females). RESULTS Sarcopenia was identified in 306 patients (43.2%). Sarcopenia was associated with advanced age, low body mass index, smoking history, and advanced T-stage. Multivariate analysis showed sarcopenia was an independent poor prognostic factor for OS (HR 1.71; P = .0102) and cancer-specific survival (HR 1.64; P = .0490). Patients with sarcopenia had significantly higher mortality due to cancer-related death in stages III and IV, whereas non-rectal cancer-related death, including secondary cancer, was markedly increased in stage 0-II sarcopenic rectal patients. Five-year cumulative ISC in patients with and without sarcopenia was 11.8% and 5.9%, respectively. Multivariate analysis revealed that sarcopenia was an independent predictive factor for ISC (HR 2.05; P = .0063). CONCLUSIONS Sarcopenia helps predict survival outcomes and cause of death according to cancer stage for patients with middle/lower rectal cancer who underwent radical surgery. Furthermore, sarcopenia increased the development of secondary cancer in those patients.
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Affiliation(s)
- Shinya Abe
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
| | - Hiroaki Nozawa
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kazuhito Sasaki
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Koji Murono
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Shigenobu Emoto
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yuichiro Yokoyama
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Hiroyuki Matsuzaki
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yuzo Nagai
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yuichiro Yoshioka
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Takahide Shinagawa
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Hirofumi Sonoda
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Luo L, Shen X, Fang S, Wan T, Liu P, Li P, Tan H, Fu Y, Guo W, Tang X. Sarcopenia as a risk factor of progression-free survival in patients with metastases: a systematic review and meta-analysis. BMC Cancer 2023; 23:127. [PMID: 36750774 PMCID: PMC9906917 DOI: 10.1186/s12885-023-10582-2] [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: 11/28/2022] [Accepted: 01/25/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Metastasis of cancer causes more than 90% of cancer deaths and is severely damaging to human health. In recent years, several studies have linked sarcopenia to shorter survival in patients with metastatic cancer. Several predictive models exist to predict mortality in patients with metastatic cancer, but have reported limited accuracy. METHODS We systematically searched Medline, EMBASE, and the Cochrane Library for articles published on or before October 14, 2022. Pooled Hazard Ratio (HR) estimates with 95% confidence intervals (CIs) were calculated using a random effects model. The primary outcome was an increased risk of death or tumor progression in patients with metastatic cancer, which is expressed as progression-free survival (PFS). In addition, we performed subgroup analyses and leave-one-out sensitivity analyses to explore the main sources of heterogeneity and the stability of the results. RESULTS Sixteen retrospective cohort studies with 1,675 patients were included in the 888 papers screened. The results showed that sarcopenia was associated with lower progression-free survival (HR = 1.56, 95% CI = 1.19-2.03, I2 = 76.3%, P < 0.001). This result was further confirmed by trim-and-fill procedures and leave-one-out sensitivity analysis. CONCLUSIONS This study suggests that sarcopenia may be a risk factor for reduced progression-free survival in patients with metastatic cancer. Further studies are still needed to explain the reason for this high heterogeneity in outcome. TRIAL REGISTRATION CRD42022325910.
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Affiliation(s)
- Lingli Luo
- Medical College, Hunan Polytechnic of Environment and Biology, Hunan Province 421005 Hengyang, China
| | - Xiangru Shen
- grid.412017.10000 0001 0266 8918Hengyang Medical College, University of South China, Hunan 421001 Hengyang, China
| | - Shuai Fang
- grid.412017.10000 0001 0266 8918Hengyang Medical College, University of South China, Hunan 421001 Hengyang, China
| | - Teng Wan
- grid.33199.310000 0004 0368 7223Department of Neurology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, 518060 China
| | - Pan Liu
- grid.412017.10000 0001 0266 8918Hengyang Medical College, University of South China, Hunan 421001 Hengyang, China
| | - Peiling Li
- grid.412017.10000 0001 0266 8918Hengyang Medical College, University of South China, Hunan 421001 Hengyang, China
| | - Haifeng Tan
- grid.412017.10000 0001 0266 8918Hengyang Medical College, University of South China, Hunan 421001 Hengyang, China
| | - Yong Fu
- grid.412017.10000 0001 0266 8918Department of Trauma Orthopaedic, The Second Affiliated Hospital, Hengyang Medical College, University of South China, Hengyang, 421001 Hunan China
| | - Weiming Guo
- grid.33199.310000 0004 0368 7223Department of Sports Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, 518060 China
| | - Xiaojun Tang
- The Second Affiliated Hospital, Department of Spinal Surgery, Hengyang Medical School, University of South China, Hunan, 421001, Hengyang, China.
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Keyl J, Hosch R, Berger A, Ester O, Greiner T, Bogner S, Treckmann J, Ting S, Schumacher B, Albers D, Markus P, Wiesweg M, Forsting M, Nensa F, Schuler M, Kasper S, Kleesiek J. Deep learning-based assessment of body composition and liver tumour burden for survival modelling in advanced colorectal cancer. J Cachexia Sarcopenia Muscle 2023; 14:545-552. [PMID: 36544260 PMCID: PMC9891942 DOI: 10.1002/jcsm.13158] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/16/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Personalized therapy planning remains a significant challenge in advanced colorectal cancer care, despite extensive research on prognostic and predictive markers. A strong correlation of sarcopenia or overall body composition and survival has been described. Here, we explore whether automated assessment of body composition and liver metastases from standard of care CT images can add to clinical parameters in personalized survival risk prognostication. METHODS We retrospectively analysed clinical imaging data from 85 patients (50.6% female, mean age 58.9 SD 12.2 years) with colorectal cancer and synchronous liver metastases. Pretrained deep learning models were used to assess body composition and liver metastasis geometry from abdominal CT images before the initiation of systemic treatment. Abdominal muscle-to-bone ratio (MBR) was calculated by dividing abdominal muscle volume by abdominal bone volume. MBR was compared with body mass index (BMI), abdominal muscle volume, and abdominal muscle volume divided by height squared. Differences in overall survival based on body composition and liver metastasis parameters were compared using Kaplan-Meier survival curves. Results were correlated with clinical and biomarker data to develop a machine learning model for survival risk prognostication. RESULTS The MBR, unlike abdominal muscle volume or BMI, was significantly associated with overall survival (HR 0.39, 95% CI: 0.19-0.80, P = 0.009). The MBR (P = 0.022), liver metastasis surface area (P = 0.01) and primary tumour sidedness (P = 0.007) were independently associated with overall survival in multivariate analysis. Body composition parameters did not correlate with KRAS mutational status or primary tumour sidedness. A prediction model based on MBR, liver metastasis surface area and primary tumour sidedness achieved a concordance index of 0.69. CONCLUSIONS Automated segmentation enables to extract prognostic parameters from routine imaging data for personalized survival modelling in advanced colorectal cancer patients.
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Affiliation(s)
- Julius Keyl
- Department of Medical Oncology, West German Cancer CenterUniversity Hospital Essen (AöR)EssenGermany
- Institute for Artificial Intelligence in MedicineUniversity Hospital Essen (AöR)EssenGermany
- German Cancer Consortium (DKTK)Partner site University Hospital Essen (AöR)EssenGermany
| | - René Hosch
- Institute for Artificial Intelligence in MedicineUniversity Hospital Essen (AöR)EssenGermany
- Department of Diagnostic and Interventional Radiology and NeuroradiologyUniversity Hospital Essen (AöR)EssenGermany
| | - Aaron Berger
- Institute for Artificial Intelligence in MedicineUniversity Hospital Essen (AöR)EssenGermany
| | - Oliver Ester
- Institute for Artificial Intelligence in MedicineUniversity Hospital Essen (AöR)EssenGermany
| | | | - Simon Bogner
- Department of Medical Oncology, West German Cancer CenterUniversity Hospital Essen (AöR)EssenGermany
| | - Jürgen Treckmann
- Department of General, Visceral and Transplant Surgery, West German Cancer CenterUniversity Hospital Essen (AöR)EssenGermany
| | - Saskia Ting
- Institute of Pathology EssenWest German Cancer Center, University Hospital Essen (AöR)EssenGermany
| | | | - David Albers
- Department of GastroenterologyElisabeth Hospital EssenEssenGermany
| | - Peter Markus
- Department of General Surgery and TraumatologyElisabeth Hospital EssenEssenGermany
| | - Marcel Wiesweg
- Department of Medical Oncology, West German Cancer CenterUniversity Hospital Essen (AöR)EssenGermany
- Medical FacultyUniversity of Duisburg‐EssenEssenGermany
| | - Michael Forsting
- Department of Diagnostic and Interventional Radiology and NeuroradiologyUniversity Hospital Essen (AöR)EssenGermany
| | - Felix Nensa
- Institute for Artificial Intelligence in MedicineUniversity Hospital Essen (AöR)EssenGermany
- Department of Diagnostic and Interventional Radiology and NeuroradiologyUniversity Hospital Essen (AöR)EssenGermany
| | - Martin Schuler
- Department of Medical Oncology, West German Cancer CenterUniversity Hospital Essen (AöR)EssenGermany
- German Cancer Consortium (DKTK)Partner site University Hospital Essen (AöR)EssenGermany
- Medical FacultyUniversity of Duisburg‐EssenEssenGermany
| | - Stefan Kasper
- Department of Medical Oncology, West German Cancer CenterUniversity Hospital Essen (AöR)EssenGermany
- German Cancer Consortium (DKTK)Partner site University Hospital Essen (AöR)EssenGermany
- Medical FacultyUniversity of Duisburg‐EssenEssenGermany
| | - Jens Kleesiek
- Institute for Artificial Intelligence in MedicineUniversity Hospital Essen (AöR)EssenGermany
- Medical FacultyUniversity of Duisburg‐EssenEssenGermany
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Aichi M, Hasegawa S, Kurita Y, Shinoda S, Kato S, Mizushima T, Yokota NR, Miyagi E. Low skeletal muscle mass predicts poor prognosis for patients with stage III cervical cancer on concurrent chemoradiotherapy. Nutrition 2023; 109:111966. [PMID: 36731243 DOI: 10.1016/j.nut.2022.111966] [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: 06/20/2022] [Revised: 12/26/2022] [Accepted: 12/28/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate whether low skeletal muscle mass before initial treatment is an independent prognostic factor defining overall survival (OS) and progression-free survival (PFS) in patients diagnosed with stage III cervical cancer. METHODS Body composition and clinicopathologic data were collected retrospectively. Information was extracted and analyzed from the medical records of 92 patients with stage III cervical cancer and undergoing concurrent chemoradiotherapy. Skeletal muscle mass in the L3 region was measured using cross-sectional computed tomography images and corrected for body surface area to calculate the skeletal muscle index (SMI). The primary outcome was OS, and the secondary outcome was PFS. Statistical analyses were performed using the Mann-Whitney U test. The Kaplan-Meier method was used to determine OS and PFS. Univariate and multivariate analyses were performed with Cox proportional hazard ratios. RESULTS The optimal cutoff value for predicting 5-y survival was 35.6 cm2/m2, defined based on data derived from 24 patients with a low SMI and 68 patients without a low SMI. A low SMI was significantly associated with shorter OS (hazard ratio [HR], 2.470; 95% confidence interval [CI], 1.208-5.053; P = 0.013), with no significant difference in PFS (HR, 1.651; 95% CI, 0.876-3.110; P = 0.121). Multivariate analysis also identified a low SMI as an independent OS-defining prognostic factor (HR, 2.473; 95% CI, 1.151-5.314; P = 0.020). CONCLUSION A low pretreatment SMI is an independent prognostic factor for OS in patients diagnosed with stage III cervical cancer and treated with concurrent chemoradiotherapy.
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Affiliation(s)
- Masahiro Aichi
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine Graduate School of Medicine, Yokohama, Japan
| | - Sho Hasegawa
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine Graduate School of Medicine, Yokohama, Japan.
| | - Yusuke Kurita
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine Graduate School of Medicine, Yokohama, Japan
| | - Satoru Shinoda
- Department of Biostatstics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Shingo Kato
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine Graduate School of Medicine, Yokohama, Japan
| | - Taichi Mizushima
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine Graduate School of Medicine, Yokohama, Japan
| | - Naho Ruiz Yokota
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine Graduate School of Medicine, Yokohama, Japan
| | - Etsuko Miyagi
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine Graduate School of Medicine, Yokohama, Japan
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Lascala F, da Silva Moraes BK, Mendes MCS, de Carvalho MB, Branbilla SR, da Cunha Júnior AD, Lopes LR, Andreollo NA, Macedo LT, Prado CM, Carvalheira JBC. Prognostic value of myosteatosis and systemic inflammation in patients with resectable gastric cancer: A retrospective study. Eur J Clin Nutr 2023; 77:116-126. [PMID: 36076067 DOI: 10.1038/s41430-022-01201-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/13/2022] [Accepted: 08/16/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND/OBJECTIVES The association between systemic inflammation and myosteatosis upon diagnosis of gastric cancer (GC) and whether these factors could predict survival outcomes is not clear. Our aim was to explore the association between systemic inflammation and myosteatosis upon diagnosis of GC, specially whether the co-occurrence of these factors could predict survival outcomes. SUBJECTS/METHODS Computed tomography (CT) was performed at the level of the third lumbar vertebra for body composition analysis in 280 patients with GC. Myoesteatosis was defined as the lowest tertile of the muscle radiodensity distribution or based on clinical significance using optimal stratification analysis. Inflammatory indexes were measured, including the neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte and lymphocyte-to-monocyte ratios. RESULTS Patients with low skeletal muscle (SM) radiodensity were more likely to be older than 65 years, have a higher body mass index and have diabetes. They also had higher intermuscular visceral and subcutaneous adipose tissue areas and indexes. The highest tertile of SM radiodensity was associated with better disease-free survival (DFS) (HR = 0.51, 95% CI [0.31, 0.84], ptrend = 0.020) and overall survival (OS) (HR = 0.49, 95% CI [0.29, 0.82], ptrend = 0.022). Patients with NLR > 2.3 and myosteatosis had the worst DFS and OS (HR = 2.77, 95% CI [1.54, 5.00], p = 0.001; HR = 3.31, 95% CI [1.79, 6.15], p < 0.001, respectively). CONCLUSION Co-occurrence of myosteatosis and inflammation increased disease progression and death risk by almost three times. These regularly obtained biomarkers might improve prognostic risk prediction in resectable GC.
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Affiliation(s)
- Fabiana Lascala
- Division of Oncology, Department of anesthesiology, oncology and radiology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Bruna Karoline da Silva Moraes
- Division of Oncology, Department of anesthesiology, oncology and radiology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Maria Carolina Santos Mendes
- Division of Oncology, Department of anesthesiology, oncology and radiology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Mariluce Barbosa de Carvalho
- Division of Oncology, Department of anesthesiology, oncology and radiology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Sandra Regina Branbilla
- Division of Oncology, Department of anesthesiology, oncology and radiology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Ademar Dantas da Cunha Júnior
- Division of Oncology, Department of anesthesiology, oncology and radiology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
- Hematology and Oncology Clinics, Cancer Hospital of Cascavel, União Oeste de Estudos e Combate ao Câncer (UOPECCAN), Cascavel, PR, Brazil
- Department of Internal Medicine, State University of Western Paraná (UNIOESTE), Cascavel, PR, Brazil
| | - Luiz Roberto Lopes
- Division of Gastrointestinal Surgery, Department of Surgery, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Nelson Adami Andreollo
- Division of Gastrointestinal Surgery, Department of Surgery, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Lígia Traldi Macedo
- Division of Oncology, Department of anesthesiology, oncology and radiology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Carla M Prado
- Human Nutrition Research Unit, Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - José Barreto Campello Carvalheira
- Division of Oncology, Department of anesthesiology, oncology and radiology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil.
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Psoas Muscle Index – Could It Be an Indicator of Postoperative Complications in Colorectal Cancer? Case Presentation and Review of the Literature. JOURNAL OF INTERDISCIPLINARY MEDICINE 2022. [DOI: 10.2478/jim-2022-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Abstract
Introduction: Colorectal cancer is the third most commonly diagnosed cancer worldwide, and its incidence is rising in developing countries. Studies have shown an association between sarcopenia and various poor short-term outcomes in cancer patients who underwent surgery. In this case study, we sought to highlight the importance of a modern prognostic factor, the psoas muscle index (PMI), in colorectal cancer.
Case Presentation: We present the case of a 59-year-old male patient with sigmoid cancer. We calculated the PMI as the sum of the areas of the left and right psoas muscle at the level of the L3 vertebra, divided by the square of the patient’s height, using computed tomography measurements. We also measured the density of the proas muscles. Prior to surgery, the left psoas muscle had an area of 14.52 cm2, and the right 14.54 cm2, with a PMI of 9.4967 cm2/m2. The mean density of the psoas muscles was 43.60 UH. The surgery consisted in a rectosigmoid resection with termino-terminal colorectal anastomosis. The histopathological examination confirmed moderately differentiated adenocarcinoma, stage IIIB (pT3N1M0). The patient left the hospital eight days after surgery in good general condition. Long-term follow-up was performed by phone and CT scans at 1, 6, and 12 months.
Conclusions: CT-measured PMI may be a potential prognostic imaging marker in patients with colorectal cancer that can be easily and routinely assessed preoperatively.
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15
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Kotti A, Holmqvist A, Woisetschläger M, Sun XF. Computed tomography-measured body composition and survival in rectal cancer patients: a Swedish cohort study. Cancer Metab 2022; 10:19. [PMID: 36419131 PMCID: PMC9686115 DOI: 10.1186/s40170-022-00297-6] [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: 05/08/2022] [Accepted: 11/07/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The association between body composition and survival in rectal cancer patients is still unclear. Therefore, we aimed to evaluate the impact of computed tomography (CT)-measured body composition on survival in rectal cancer patients, stratifying our analyses by sex, tumour location, tumour stage and radiotherapy. METHODS This retrospective cohort study included 173 patients with rectal adenocarcinoma. CT colonography scans at the time of diagnosis were used to assess the skeletal muscle index (SMI) and the visceral adipose tissue area (VAT). The patients were divided into a low or high SMI group and a low or high VAT group according to previously defined cutoff values. Endpoints included cancer-specific survival (CSS) and overall survival (OS). RESULTS In all patients, low SMI was associated with worse CSS (HR, 2.63; 95% CI, 1.35-5.12; P = 0.004) and OS (HR, 3.57; 95% CI, 2.01-6.34; P < 0.001) compared to high SMI. The differences remained significant after adjusting for potential confounders (CSS: adjusted HR, 2.28; 95% CI, 1.13-4.58; P = 0.021; OS: adjusted HR, 3.17; 95% CI, 1.73-5.82; P < 0.001). Low SMI was still related to a poor prognosis after stratifying by sex, tumour location, stage and radiotherapy (P < 0.05). High VAT was associated with better CSS (HR, 0.31; 95% CI, 0.11-0.84; P = 0.022) and OS (HR, 0.40; 95% CI, 0.17-0.97; P = 0.044) compared to low VAT among men with rectal cancer ≤ 10 cm from the anal verge. High VAT was associated with worse CSS (HR, 4.15; 95% CI, 1.10-15.66; P = 0.036) in women with rectal cancer ≤ 10 cm from the anal verge. CONCLUSIONS Low SMI was associated with worse survival. High VAT predicted better survival in men but worse survival in women. The results suggest that CT-measured body composition is a useful tool for evaluating the prognosis of rectal cancer patients and demonstrate the need to include the sex and the tumour location in the analyses.
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Affiliation(s)
- Angeliki Kotti
- grid.5640.70000 0001 2162 9922Department of Radiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 85 Linköping, Sweden ,grid.5640.70000 0001 2162 9922Department of Biomedical and Clinical Sciences, Linköping University, SE-581 83 Linköping, Sweden
| | - Annica Holmqvist
- grid.5640.70000 0001 2162 9922Department of Oncology, and Department of Biomedical and Clinical Sciences, Linköping University, SE-581 85 Linköping, Sweden
| | - Mischa Woisetschläger
- grid.5640.70000 0001 2162 9922Department of Radiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 85 Linköping, Sweden ,grid.5640.70000 0001 2162 9922Centre for Medical Image Science and Visualization (CMIV), Linköping University, SE-581 85 Linköping, Sweden
| | - Xiao-Feng Sun
- grid.5640.70000 0001 2162 9922Department of Biomedical and Clinical Sciences, Linköping University, SE-581 83 Linköping, Sweden
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Prognostic role of low-skeletal muscle mass on staging computed tomography in metastasized colorectal cancer: a systematic review and meta-analysis. Clin Colorectal Cancer 2022; 21:e213-e225. [DOI: 10.1016/j.clcc.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/08/2022] [Accepted: 03/16/2022] [Indexed: 11/22/2022]
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Barnes O, Wilson RL, Gonzalo-Encabo P, Kang DW, Christopher CN, Bentley T, Dieli-Conwright CM. The Effect of Exercise and Nutritional Interventions on Body Composition in Patients with Advanced or Metastatic Cancer: A Systematic Review. Nutrients 2022; 14:nu14102110. [PMID: 35631251 PMCID: PMC9145470 DOI: 10.3390/nu14102110] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/11/2022] [Accepted: 05/16/2022] [Indexed: 02/07/2023] Open
Abstract
Advanced and metastatic cancers significantly alter body composition, leading to decreased lean mass and variable effects on fat mass. These effects on body composition are associated with significant physical dysfunction and poor prognosis in patients with cancer. Whilst exercise and nutritional interventions are likely to be of benefit in counteracting these effects, relatively little is known about using such interventions in patients with advanced or metastatic cancer. Therefore, in this systematic review we examine the effect of exercise and combined exercise and nutritional interventions on lean mass and fat mass among patients diagnosed with advanced or metastatic cancer. Following PRISMA guidelines, we identified 20 articles from PubMed, EMBASE, CINAHL, Cochrane CENTRAL, PEDro, SPORTDiscus, and REHABDATA. Overall, advanced or metastatic cancer populations comprising of mixed cancer types were most commonly examined (n = 8) with exercise or combined exercise and nutritional interventions being well-tolerated with few adverse effects. Both intervention approaches may preserve lean mass, while only combined interventions may lead to alterations in fat mass. However, further exercise and nutritional studies are needed to definitively understand their effects on body composition. As exercise and nutrition-related research continues in this understudied population, the knowledge gained will help guide supportive clinical treatments.
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Affiliation(s)
- Oscar Barnes
- Green Templeton College, University of Oxford, Oxford OX2 6HG, UK; (O.B.); (T.B.)
| | - Rebekah L. Wilson
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 375 Longwood Avenue, Boston, MA 02215, USA; (R.L.W.); (P.G.-E.); (D.-W.K.); (C.N.C.)
- Department of Medicine, Harvard Medical School, Boston, MA 02215, USA
| | - Paola Gonzalo-Encabo
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 375 Longwood Avenue, Boston, MA 02215, USA; (R.L.W.); (P.G.-E.); (D.-W.K.); (C.N.C.)
- Department of Medicine, Harvard Medical School, Boston, MA 02215, USA
| | - Dong-Woo Kang
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 375 Longwood Avenue, Boston, MA 02215, USA; (R.L.W.); (P.G.-E.); (D.-W.K.); (C.N.C.)
- Department of Medicine, Harvard Medical School, Boston, MA 02215, USA
| | - Cami N. Christopher
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 375 Longwood Avenue, Boston, MA 02215, USA; (R.L.W.); (P.G.-E.); (D.-W.K.); (C.N.C.)
- Department of Epidemiology, Boston University, Boston, MA 02118, USA
| | - Thomas Bentley
- Green Templeton College, University of Oxford, Oxford OX2 6HG, UK; (O.B.); (T.B.)
| | - Christina M. Dieli-Conwright
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 375 Longwood Avenue, Boston, MA 02215, USA; (R.L.W.); (P.G.-E.); (D.-W.K.); (C.N.C.)
- Department of Medicine, Harvard Medical School, Boston, MA 02215, USA
- Correspondence:
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Clinical Relevance of Myopenia and Myosteatosis in Colorectal Cancer. J Clin Med 2022; 11:jcm11092617. [PMID: 35566740 PMCID: PMC9100218 DOI: 10.3390/jcm11092617] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/28/2022] [Accepted: 05/04/2022] [Indexed: 02/01/2023] Open
Abstract
Sarcopenia was initially described as a decrease in muscle mass associated with aging and subsequently also as a consequence of underlying disease, including advanced malignancy. Accumulating evidence shows that sarcopenia has clinically significant effects in patients with malignancy, including an increased risk of adverse events associated with medical treatment, postoperative complications, and a poor survival outcome. Colorectal cancer (CRC) is one of the most common cancers worldwide, and several lines of evidence suggest that preoperative sarcopenia negatively impacts various outcomes in patients with CRC. In this review, we summarize the current evidence in this field and the clinical relevance of sarcopenia in patients with CRC from three standpoints, namely, the adverse effects of medical treatment, postoperative infectious complications, and oncological outcomes.
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Computed Tomography Assessment of Sarcopenic Myosteatosis for Predicting Overall Survival in Colorectal Carcinoma: Systematic Review. J Comput Assist Tomogr 2022; 46:157-162. [PMID: 35297571 DOI: 10.1097/rct.0000000000001281] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND As the US population ages, cancer incidence and prevalence are projected to increase. In the last decade, there has been an increased interest in the opportunistic use of computed tomography (CT) scan data to predict cancer prognosis and inform treatment based on body composition measures, especially muscle measures for sarcopenia. OBJECTIVE This article aimed to perform a systematic review of current literature related to CT assessment of muscle attenuation values for myosteatosis in colorectal cancer (CRC) survival prediction. RESULTS Initial broad search of CT and CRC yielded 4234 results. A more focused search strategy narrowed this to 129 research papers, and 13 articles met the final inclusion criteria. Twelve of 13 studies found a statistically significant decrease in overall survival according to Hounsfield unit (HU)-based sarcopenia, with hazard ratios ranging from 1.36 to 2.94 (mean, 1.78). However, the specific criteria used to define myosteatosis by CT varied widely, with attenuation thresholds ranging from 22.5 to 47.3 HU, often further subdivided by sex and/or body mass index. CONCLUSIONS Current evidence suggests that a strong association between CT-based muscle attenuation values for myosteatosis assessment correlates with overall survival in CRC. However, more research is needed to verify these findings and determine appropriate threshold values for more diverse patient populations. Because CRC patients are staged and followed by CT, the opportunity exists for routine objective myosteatosis assessment in the clinical setting.
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Tamiya H, Imura Y, Wakamatsu T, Takenaka S. Comorbidity, body mass index, and performance status as prognostic factors in older patients with soft-tissue sarcoma. J Geriatr Oncol 2022; 13:673-681. [DOI: 10.1016/j.jgo.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 01/31/2022] [Accepted: 02/16/2022] [Indexed: 10/19/2022]
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21
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da Silva Dias D, Machado M, Trabulo C, Gosálbez B, Ravasco P. Impact of Body Composition on Prognosis and Dose-Limiting Toxicities on Metastatic Colorectal Cancer. Front Nutr 2022; 8:671547. [PMID: 35155507 PMCID: PMC8830532 DOI: 10.3389/fnut.2021.671547] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 12/09/2021] [Indexed: 12/19/2022] Open
Abstract
Sarcopenia is a progressive skeletal muscle disease, often present in oncological patients, that is associated with multiple adverse events such as worse prognosis, physical performance, and quality of life. Body composition evaluation by CT cross-section at the L3 vertebrae region appears to be a precise method to quantify skeletal muscle. The optimal cut-off for the definition of sarcopenia is not yet established, therefore the incidence of sarcopenia varies according to different studies. The main goal was to evaluate the presence of sarcopenia in patients with metastatic colorectal cancer (mCRC) and its impact on overall survival (OS) and dose-limiting toxicities (DLT). A retrospective cohort study of 178 patients with mCRC under first-line chemotherapy (ChT) in association with target therapy, in two hospital units, between January 2015 and December 2018. Skeletal mass area (SMA) was quantified with the NIH ImageJ software in CT cross-sectional images at the L3 vertebrae region. Statistical analysis was performed with IBM SPSS v25 software https://www.ibm.com/analytics/spss-statistics-software. The median age was 62 (SD ± 11) years old, 65% were men and 62.9% had an Eastern Cooperative Oncology Group (ECOG) performance status of 0. The cut-off value was established based on ROC analysis, with sarcopenia defined as SMI < 49.12 cm2/m2 for men and < 35.85 cm2/m2 for women. Despite the mean body mass index (BMI) of 25.71 (± 4.71) kg/m2, half of the patients presented sarcopenia. In a multivariate analysis using a Cox regression model, an association was observed between OS and higher ECOG PS (p = 0.014; HR 5.46, CI 95% [1.42-21.10]), neutrophil-to-lymphocyte ratio (NLR) >2.80 (p = 0.038; HR 2.20, CI 95% [1,05-4.62]), and sarcopenia (p = 0.01; HR 4.73, CI 95% [1.85-12.09]). Additionally, in a logistic regression model, age (p = 0.014; OR 1.09, IC 95% [1.02-1.16]) and sarcopenia (p= 0.030, OR 4.13, IC 95% [1.15-14.8]) were associated with higher incidence of DLT. The CT evaluation of the body composition at the L3 region allows for the quantification of sarcopenia, providing prognostic information and predictive value of DLT in patients with mCRC, although the establishment of optimal cut-off values are required for implementation in clinical practice. A multimodal strategy to delay muscle waste should be considered in these patients.
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Affiliation(s)
- David da Silva Dias
- Medical Oncology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal
- Centre for Interdisciplinary Research in Health, Universidade Católica Portuguesa, Lisbon, Portugal
| | - Mafalda Machado
- Radiology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Carolina Trabulo
- Centre for Interdisciplinary Research in Health, Universidade Católica Portuguesa, Lisbon, Portugal
- Medical Oncology Department, Centro Hospitalar Barreiro Montijo, Barreiro, Portugal
| | - Beatriz Gosálbez
- Medical Oncology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Paula Ravasco
- Centre for Interdisciplinary Research in Health, Universidade Católica Portuguesa, Lisbon, Portugal
- Católica Medical School, Universidade Católica Portuguesa, Lisbon, Portugal
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Caparica, Portugal
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22
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Groot OQ, Bongers MER, Buckless CG, Twining PK, Kapoor ND, Janssen SJ, Schwab JH, Torriani M, Bredella MA. Body composition predictors of mortality in patients undergoing surgery for long bone metastases. J Surg Oncol 2022; 125:916-923. [PMID: 35023149 PMCID: PMC8917991 DOI: 10.1002/jso.26793] [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] [Received: 09/22/2021] [Revised: 11/28/2021] [Accepted: 01/03/2022] [Indexed: 11/15/2022]
Abstract
Background and Objectives Body composition measurements using computed tomography (CT) may serve as imaging biomarkers of survival in patients with and without cancer. This study assesses whether body composition measurements obtained on abdominal CTs are independently associated with 90‐day and 1‐year mortality in patients with long‐bone metastases undergoing surgery. Methods This single institutional retrospective study included 212 patients who had undergone surgery for long‐bone metastases and had a CT of the abdomen within 90 days before surgery. Quantification of cross‐sectional areas (CSA) and CT attenuation of abdominal subcutaneous adipose tissue, visceral adipose tissue, and paraspinous and abdominal muscles were performed at L4. Multivariate Cox proportional‐hazards analyses were performed. Results Sarcopenia was independently associated with 90‐day mortality (hazard ratio [HR] = 1.87; 95% confidence interval [CI] = 1.11–3.16; p = 0.019) and 1‐year mortality (HR = 1.50; 95% CI = 1.02–2.19; p = 0.038) in multivariate analysis while controlling for clinical variables such as primary tumors, comorbidities, and chemotherapy. Abdominal fat CSAs and muscle attenuation were not associated with mortality. Conclusions The presence of sarcopenia assessed by CT is predictive of 90‐day and 1‐year mortality in patients undergoing surgery for long‐bone metastases. This body composition measurement can be used as novel imaging biomarker supplementing existing prognostic tools to optimize patient selection for surgery and improve shared decision making.
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Affiliation(s)
- Olivier Q Groot
- Department of Orthopaedic Surgery-Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts, USA
| | - Michiel E R Bongers
- Department of Orthopaedic Surgery-Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts, USA
| | - Colleen G Buckless
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Peter K Twining
- Department of Orthopaedic Surgery-Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts, USA
| | - Neal D Kapoor
- Department of Orthopaedic Surgery-Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts, USA
| | - Stein J Janssen
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam University Medical Center-University of Amsterdam Meibergdreef, Amsterdam, The Netherlands
| | - Joseph H Schwab
- Department of Orthopaedic Surgery-Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts, USA
| | - Martin Torriani
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Miriam A Bredella
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Lees JG, Abdulla M, Barkl-Luke ME, Livni L, Keating BA, Hayes J, Fiore NT, Park SB, Moalem-Taylor G, Goldstein D. Effect of exercise on neuromuscular toxicity in oxaliplatin-treated mice. Muscle Nerve 2021; 64:225-234. [PMID: 34036599 DOI: 10.1002/mus.27329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 01/06/2023]
Abstract
INTRODUCTION/AIMS Clinically, the chemotherapeutic agent oxaliplatin can cause peripheral neuropathy, impaired balance, and muscle wastage. Using a preclinical model, we investigated whether exercise intervention could improve these adverse conditions. METHODS Mice were chronically treated with oxaliplatin alone or in conjunction with exercise. Behavioral studies, including mechanical allodynia, rotarod, open-field, and grip-strength tests, were performed. After euthanasia, multiple organs and four different muscle types were dissected and weighed. The cross-sectional area (CSA) of muscle fibers in the gastrocnemius muscle was assessed and gene expression analysis performed on the forelimb triceps muscle. RESULTS Oxaliplatin-treated mice displayed reduced weight gain, mechanical allodynia, and exploratory behavior deficits that were not significantly improved by exercise. Oxaliplatin-treated exercised mice showed modest evidence of reduced muscle wastage compared with mice treated with oxaliplatin alone, and exercised mice demonstrated evidence of a mild increase in CSA of muscle fibers. DISCUSSION Exercise intervention did not improve signs of peripheral neuropathy but moderately reduced the negative impact of oxaliplatin chemotherapy related to muscle morphology, suggesting the potential for exploring the impact of exercise on reducing oxaliplatin-induced neuromuscular toxicity in cancer patients.
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Affiliation(s)
- Justin G Lees
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Munawwar Abdulla
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Mallory E Barkl-Luke
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Lital Livni
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Brooke A Keating
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Jessica Hayes
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Nathan T Fiore
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Susanna B Park
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Gila Moalem-Taylor
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - David Goldstein
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
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Shin DW, Kim MA, Lee JC, Kim J, Hwang JH. Maintenance of skeletal muscle mass during FOLFIRINOX is a favorable prognostic factor in pancreatic cancer patients. BMC Res Notes 2021; 14:272. [PMID: 34266478 PMCID: PMC8281692 DOI: 10.1186/s13104-021-05681-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 07/05/2021] [Indexed: 12/15/2022] Open
Abstract
Objective The study aimed to investigate the effect of body composition changes during chemotherapy on clinical outcomes in patients with pancreatic cancer. Results In patients with locally advanced pancreatic cancer (LAPC), the cross-sectional area of skeletal muscle (SM) and adipose tissue (AT) at the level of third lumbar vertebra was measured. The SM and AT ratios indicated the changes during chemotherapy. The patients were classified into three groups based on these ratios: group 1, ≥ 1.00; group 2, 0.85–0.99; group 3, < 0.85. The overall survival (OS) and surgical resection rates were estimated. Fifty-eight patients with LAPC who received first-line FOLFIRINOX were analyzed. Fifteen (25.9%) patients who underwent resection showed maintained BMI, SM, and AT as compared to the patients who did not undergo resection. As the SM ratio decreased, the risk for death increased significantly. Further, the resection rate was significantly higher in patients with maintained SM compared to those with low SM ratio. On the contrary, the change in AT ratio was not associated with OS and resection rate; however, significant decrease in AT more than 15% showed poor clinical outcomes. Maintenance of SM during chemotherapy is a reliable prognostic factor indicating longer OS and higher resection rate. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-021-05681-x.
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Affiliation(s)
- Dong Woo Shin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 463-707, South Korea.,Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Minseok Albert Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Jong-Chan Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 463-707, South Korea
| | - Jaihwan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 463-707, South Korea
| | - Jin-Hyeok Hwang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 463-707, South Korea.
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25
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Cross-Cultural Adaptation of the Brazilian Portuguese-Translated Version of the Mini Sarcopenia Risk Assessment (MSRA) Questionnaire in Cancer Patients. Clin Pract 2021; 11:395-403. [PMID: 34208530 PMCID: PMC8293221 DOI: 10.3390/clinpract11020054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Aims: This study sought (i) to adapt cross-culturally the Brazilian Portuguese-translated version of the MSRA questionnaire, (ii) to estimate the prevalence of risk of sarcopenia, and (iii) to correlate the MSRA Portuguese version with CC in hospitalized cancer patients. Methods: This was a cross-sectional study developed at the hospital in the year 2018. After being translated and adapted to the Portuguese language, the questionnaire was applied and associated with the measurement of calf circumference (CC) to verify its validity. Results: Of the 45 patients, 71.1% presented significant or severe body weight loss, and 55.5% indicated muscle mass loss (CC < 31 cm). From the MSRA of seven and five items, 91.1 and 84.5% of the patients, respectively, presented risk for sarcopenia. Among those at risk for sarcopenia, more than 60% were aged <70 years, >80% were hospitalized in the last year, more than 40% could not walk > 1000 m, >40% did not eat regularly, and >80% lost >2 kg in the last year. CC was correlated with MSRA of five items (r = 0.46, p = 0.001) and seven items (r = 0.53, p = 0.0002). Furthermore, both versions of the MSRA (seven and five items) presented strong agreement and high reliability. Conclusions: The MSRA full and short version was adapted for a Brazilian Portuguese-translated version and showed strong agreement and high reliability to identify the risk for sarcopenia in hospitalized cancer patients. Therefore, this questionnaire can be used as part of nutritional assessment protocols in order to enable early screening of the risk for sarcopenia
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26
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da Cunha AD, Silveira MN, Takahashi MES, de Souza EM, Mosci C, Ramos CD, Brambilla SR, Pericole FV, Prado CM, Mendes MCS, Carvalheira JBC. Adipose tissue radiodensity: A new prognostic biomarker in people with multiple myeloma. Nutrition 2021; 86:111141. [PMID: 33596528 DOI: 10.1016/j.nut.2021.111141] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/19/2020] [Accepted: 12/29/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Standard prognostic markers based on individual characteristics of individuals with multiple myeloma (MM) remain scarce. Body-composition features have often been associated with survival outcomes in different cancers. However, the association of adipose tissue radiodensity with MM prognosis has not yet, to our knowledge, been explored. METHODS Computed tomography at the third lumbar vertebra was used for body-composition analysis, including adipose tissue radiodensity, in 91 people with MM. Additionally, fludeoxyglucose F 18 (18F-FDG) positron emission tomography was used to assess adipose tissue 18F-FDG uptake. Proinflammatory cytokine and adipokine levels were measured. RESULTS Event-free survival and overall survival were both shorter in participants with high subcutaneous adipose tissue (SAT) radiodensity. Those in the highest SAT radiodensity tertile had an independently higher risk for both overall survival (hazard ratio, 4.55; 95% confidence interval, 1.26-16.44; Ptrend = 0.036) and event-free survival (hazard ratio, 3.08; 95% confidence interval, 1.02-9.27; Ptrend = 0.035). Importantly, higher SAT radiodensity was significantly correlated with increased 18F-FDG adipose tissue uptake and proinflammatory cytokine (tumor necrosis factor and interleukin-6) levels, and with decreased leptin levels. CONCLUSIONS SAT radiodensity may serve as a biomarker to predict host-related metabolic and proinflammatory milieu, which ultimately correlates with MM prognosis.
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Affiliation(s)
- Ademar Dantas da Cunha
- Division of Oncology, Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil; Hematology and Oncology Clinics, Cancer Hospital of Cascavel, União Oeste de Estudos e Combate ao Câncer (UOPECCAN), Cascavel, Brazil; Department of Internal Medicine, State University of Western Paraná (UNIOESTE), Cascavel, Brazil
| | - Marina Nogueira Silveira
- Division of Oncology, Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | | | - Edna Marina de Souza
- Center of Biomedical Engineering, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Camila Mosci
- Division of Nuclear Medicine, Department of Radiology, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Celso Dario Ramos
- Division of Nuclear Medicine, Department of Radiology, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Sandra Regina Brambilla
- Division of Oncology, Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Fernando Vieira Pericole
- Hematology and Blood Transfusion Center, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Carla M Prado
- Human Nutrition Research Unit, Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Maria Carolina Santos Mendes
- Division of Oncology, Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - José Barreto Campello Carvalheira
- Division of Oncology, Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil.
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27
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da Cunha Júnior AD, Silveira MN, Takahashi MES, de Souza EM, Mosci C, Ramos CD, Brambilla SR, Pericole FV, Prado CM, Mendes MCS, Carvalheira JBC. Visceral adipose tissue glucose uptake is linked to prognosis in multiple myeloma patients: An exploratory study. Clin Nutr 2021; 40:4075-4084. [PMID: 33632534 DOI: 10.1016/j.clnu.2021.02.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 01/07/2021] [Accepted: 02/05/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The use of computerized tomography to opportunistically assess body composition has highlighted abnormalities such as low muscle mass and high adiposity may be hidden conditions in cancer patients. However, the role of skeletal muscle (SM), subcutaneous (SAT) and visceral (VAT) adipose tissue glucose uptake measured by 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)-CT on patient prognostication is unclear. METHODS Patients with multiple myeloma (MM) with satisfactory image frame for assessing body composition and for semi-quantification of SM, SAT and VAT glucose uptakes were included. Plasmatic pro-inflammatory cytokine and adipokine levels were measured. RESULTS High VAT mean standardized uptake value (SUV) at baseline was associated with shorter event-free survival (EFS) (hazard ratio [HR]: 7.89; 95% confidence interval [CI], 1.58-39.30; P = 0.012) and overall survival (OS) (HR, 15.24; 95% CI, 2.69-86.30; P = 0.002) among patients with newly diagnosed MM, even after adjustment for covariates. The highest tertile of VAT SUV was significantly correlated with worse MM-EFS (HR for the highest vs the lowest tertile 3.71; 95% CI, 1.22-10.56; Ptrend = 0.035) and mortality (HR, 4.41; 95% CI, 1.28-12.77; Ptrend = 0.019). Notably, patients with higher VAT SUV presented with lower VAT area, VAT index, higher SAT SUV, and higher number of individuals with visceral obesity (all P < 0.01). Additionally, we found a negative correlation between VAT mean SUV with leptin (R2 = 0.20, P = 0.003); no correlations were detected between VAT mean SUV and resistin, tumor necrosis factor (TNF) or interleukin (IL)-6. CONCLUSIONS Functional VAT activity estimated by 18F-FDG PET-CT is a relevant prognostic factor in MM patients, specifically, a higher VAT SUV might be an early biomarker of cancer cachexia in these patients.
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Affiliation(s)
- Ademar Dantas da Cunha Júnior
- Division of Oncology, Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil; Hematology and Oncology Clinics, Cancer Hospital of Cascavel, União Oeste de Estudos e Combate ao Câncer (UOPECCAN), Cascavel, PR, Brazil; Department of Internal Medicine, State University of Western Paraná (UNIOESTE), Cascavel, PR, Brazil
| | - Marina Nogueira Silveira
- Division of Oncology, Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | | | - Edna Marina de Souza
- Center of Biomedical Engineering, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Camila Mosci
- Division of Nuclear Medicine, Department of Radiology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Celso Dario Ramos
- Division of Nuclear Medicine, Department of Radiology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Sandra Regina Brambilla
- Division of Oncology, Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | | | - Carla M Prado
- Human Nutrition Research Unit, Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Maria Carolina Santos Mendes
- Division of Oncology, Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - José Barreto Campello Carvalheira
- Division of Oncology, Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil.
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28
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Martin A, Freyssenet D. Phenotypic features of cancer cachexia-related loss of skeletal muscle mass and function: lessons from human and animal studies. J Cachexia Sarcopenia Muscle 2021; 12:252-273. [PMID: 33783983 PMCID: PMC8061402 DOI: 10.1002/jcsm.12678] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/22/2020] [Accepted: 12/30/2020] [Indexed: 12/18/2022] Open
Abstract
Cancer cachexia is a complex multi-organ catabolic syndrome that reduces mobility, increases fatigue, decreases the efficiency of therapeutic strategies, diminishes the quality of life, and increases the mortality of cancer patients. This review provides an exhaustive and comprehensive analysis of cancer cachexia-related phenotypic changes in skeletal muscle at both the cellular and subcellular levels in human cancer patients, as well as in animal models of cancer cachexia. Cancer cachexia is characterized by a major decrease in skeletal muscle mass in human and animals that depends on the severity of the disease/model and the localization of the tumour. It affects both type 1 and type 2 muscle fibres, even if some animal studies suggest that type 2 muscle fibres would be more prone to atrophy. Animal studies indicate an impairment in mitochondrial oxidative metabolism resulting from a decrease in mitochondrial content, an alteration in mitochondria morphology, and a reduction in mitochondrial metabolic fluxes. Immuno-histological analyses in human and animal models also suggest that a faulty mechanism of skeletal muscle repair would contribute to muscle mass loss. An increase in collagen deposit, an accumulation of fat depot outside and inside the muscle fibre, and a disrupted contractile machinery structure are also phenotypic features that have been consistently reported in cachectic skeletal muscle. Muscle function is also profoundly altered during cancer cachexia with a strong reduction in skeletal muscle force. Even though the loss of skeletal muscle mass largely contributes to the loss of muscle function, other factors such as muscle-nerve interaction and calcium handling are probably involved in the decrease in muscle force. Longitudinal analyses of skeletal muscle mass by imaging technics and skeletal muscle force in cancer patients, but also in animal models of cancer cachexia, are necessary to determine the respective kinetics and functional involvements of these factors. Our analysis also emphasizes that measuring skeletal muscle force through standardized tests could provide a simple and robust mean to early diagnose cachexia in cancer patients. That would be of great benefit to cancer patient's quality of life and health care systems.
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Affiliation(s)
- Agnès Martin
- Inter‐university Laboratory of Human Movement BiologyUniversité de Lyon, University Jean Monnet Saint‐EtienneSaint‐ÉtienneFrance
| | - Damien Freyssenet
- Inter‐university Laboratory of Human Movement BiologyUniversité de Lyon, University Jean Monnet Saint‐EtienneSaint‐ÉtienneFrance
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29
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Prejac J, Kekez D, Belev B, Prejac M, Pleština S. Frequency of Body Weight Loss is an Independent Prognostic Factor of First-Line Treatment Outcomes in Metastatic Colorectal Cancer. Nutr Cancer 2021; 74:520-526. [PMID: 33739208 DOI: 10.1080/01635581.2021.1900300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
One of the main features of wasting in cancer is an involuntary weight loss which is most pronounced in gastrointestinal tract tumors and leads to worse clinical outcomes. The aim of this study is to analyze the frequency of body weight loss (FBWL) as an additional prognostic factor in the treatment of patients with metastatic colorectal cancer (mCRC).In this observational, single-center study, data were retrieved for 236 patients treated for mCRC. FBWL was defined as a percent of change in weight divided by weeks of therapy. Patients were stratified into two groups according to the median of FBWL which equaled to the loss of 0.05%/week. Patients who lost >0.05%/week (N = 116) had shorter progression-free survival (PFS) in the first-line treatment, then the ones who lost <0.05%/week (N = 120); 28.3 vs 46.3 weeks, respectively. Cox regression model showed that FBWL and sidedness were significant predictors of PFS, while age, sex and ECOG were not. Significantly more patients with stable weight were also eligible for second-line treatment. In conclusion, stabilization of body weight is important and independent predictor of longer PFS in first-line therapy of patients with mCRC.
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Affiliation(s)
- Juraj Prejac
- Department of Oncology, University Hospital Centre Zagreb, Zagreb, Croatia.,School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Domina Kekez
- Department of Oncology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Borislav Belev
- Department of Oncology, University Hospital Centre Zagreb, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Marija Prejac
- Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Stjepko Pleština
- Department of Oncology, University Hospital Centre Zagreb, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
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30
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Xi F, Tan S, Gao T, Ding W, Sun J, Wei C, Li W, Yu W. Low skeletal muscle mass predicts poor clinical outcomes in patients with abdominal trauma. Nutrition 2021; 89:111229. [PMID: 33887547 DOI: 10.1016/j.nut.2021.111229] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/25/2021] [Accepted: 03/01/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The aim of this study was to investigate whether low skeletal muscle mass is associated with clinical outcomes in patients with abdominal trauma. METHODS Patients presenting to our institution with abdominal trauma from January 2010 to April 2020 were retrospectively included. Low skeletal muscle mass was defined, using computed tomography, as skeletal muscle index (SMI) at the third lumbar vertebra below the lowest sex-specific quartile within 1 wk of admission. Clinical outcomes such as complications, hospital stay, and hospital cost were recorded, and univariate and multivariate analyses were performed. RESULTS Among 684 patients, 451 were eligible. Of these, 112 (24.8%) were classified as having low skeletal muscle mass, based on SMI diagnostic cutoff values (42.08 cm2/m2 for men and 37.35 cm2/m2 for women). Low skeletal muscle mass was significantly associated with longer hospital length of stay, longer intensive care length of stay, higher cost, higher frequency of mechanical ventilation, longer duration of vasopressor use, and higher incidence of massive transfusion and overall complications (P < 0.05). Subgroup analysis showed that pneumonia, acute gastrointestinal dysfunction, cholecystitis, digestive tract fistula, gastric fistula, and intestinal fistula were significantly associated with low skeletal muscle mass (P < 0.05). Multivariate analysis showed that low skeletal muscle mass was an independent risk factor for overall complications (odds ratio [OR], 2.44; 95% confidence interval [CI], 1.33-4.49; P = 0.004), hospital length of stay (OR, 3.49; 95% CI, 1.96-6.20; P < 0.001), and hospital cost (OR, 2.67; 95% CI, 1.48-4.80; P = 0.001). CONCLUSIONS Low skeletal muscle mass could be an independent predictor of poor clinical outcomes in patients with abdominal trauma.
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Affiliation(s)
- Fengchan Xi
- Department of Intensive Care Unit, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China; Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Shanjun Tan
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tao Gao
- Department of Intensive Care Unit, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Weiwei Ding
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Jianfeng Sun
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Caiyun Wei
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Weiqin Li
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Wenkui Yu
- Department of Intensive Care Unit, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China.
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Pozzuto L, Silveira MN, Mendes MCS, Macedo LT, Costa FO, Martinez CAR, Coy CSR, da Cunha Júnior AD, Carvalheira JBC. Myosteatosis Differentially Affects the Prognosis of Non-Metastatic Colon and Rectal Cancer Patients: An Exploratory Study. Front Oncol 2021; 11:762444. [PMID: 34858841 PMCID: PMC8632142 DOI: 10.3389/fonc.2021.762444] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/22/2021] [Indexed: 02/05/2023] Open
Abstract
Body composition performed by computed tomography (CT) impacts on cancer patients' prognoses and responses to treatment. Myosteatosis has been related to overall survival (OS) and disease-specific survival in colorectal cancer (CRC); however, the independent impact of the association of myosteatosis with prognosis in colon cancer (CC) and rectal cancer (RC) is still unclear. CT was performed at the L3 level to assess body composition features in 227 patients with CRC. Clinical parameters were collected. Overall survival (OS) was the primary outcome, and the secondary outcome was disease-free survival (DFS). Skeletal muscle attenuation and intramuscular adipose tissue area were associated with DFS (p = 0.003 and p = 0.011, respectively) and OS (p < 0.001 and p < 0.001, respectively) in CC patients but not in RC patients. Only the skeletal muscle area was associated with better prognosis related to OS in RC patients (p = 0.009). When CC and RC were analyzed separately, myosteatosis influenced survival negatively in CC patients, worsening DFS survival (hazard ratio [HR], 2.70; 95% confidence interval [CI], 1.07-6.82; p = 0.035) and OS (HR, 5.76; 95% CI, 1.31-25.40; p = 0.021). By contrast, the presence of myosteatosis did not influence DFS (HR, 1.02; 95% CI, 0.52-2.03; p = 0.944) or OS (HR, 0.76; 95% CI, 0.33-1.77; p = 0.529) in RC patients. Our study revealed the interference of myosteatosis in the therapy and survival of patients with CC but not in those with RC, strengthening the value of grouping the two types of cancer in body composition analyses.
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Affiliation(s)
- Lara Pozzuto
- Division of Oncology, Department of Anesthesiology, Oncology and Radiology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Marina Nogueira Silveira
- Division of Oncology, Department of Anesthesiology, Oncology and Radiology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Maria Carolina Santos Mendes
- Division of Oncology, Department of Anesthesiology, Oncology and Radiology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Lígia Traldi Macedo
- Division of Oncology, Department of Anesthesiology, Oncology and Radiology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Felipe Osório Costa
- Division of Oncology, Department of Anesthesiology, Oncology and Radiology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Carlos Augusto Real Martinez
- Division of Gatrointestinal Surgery, Department of Surgery, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Cláudio Saddy Rodrigues Coy
- Division of Gatrointestinal Surgery, Department of Surgery, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Ademar Dantas da Cunha Júnior
- Hematology and Oncology Clinics, Cancer Hospital of Cascavel, União Oeste de Estudos e Combate ao Câncer (UOPECCAN), Cascavel, Brazil
- Department of Internal Medicine, State University of Western Paraná (UNIOESTE), Cascavel, Brazil
| | - José Barreto Campello Carvalheira
- Division of Oncology, Department of Anesthesiology, Oncology and Radiology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
- *Correspondence: José Barreto Campello Carvalheira,
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Kim EY, Jun KH, Kim SY, Chin HM. Body mass index and skeletal muscle index are useful prognostic factors for overall survival after gastrectomy for gastric cancer: Retrospective cohort study. Medicine (Baltimore) 2020; 99:e23363. [PMID: 33217879 PMCID: PMC7676598 DOI: 10.1097/md.0000000000023363] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Among patients undergoing gastrectomy for gastric cancer, the impact of anthropometric indices on surgical outcomes is not well-established. The aim of this study was to evaluate the prognostic significance of the skeletal muscle index (SMI) and body mass index (BMI) on overall survival (OS) in patients with gastric cancer.A total of 305 patients who underwent curative gastrectomy for gastric adenocarcinoma between January 2005 and March 2008 were enrolled. Patients were classified into groups based on the SMI and BMI. The SMI was measured by preoperative abdominal computed tomography (CT). The SMI groups were classified based on gender-specific cut-off values obtained by means of optimum stratification. BMI groups were divided according to the World Health Organization definition of obesity for Asians.The mean SMI was 58.2 cm/m and the mean BMI was 23.2 kg/m. One hundred fifteen (37.7%) patients had sarcopenia based on the diagnostic cut-off values (56.2 cm/m for men and 53.6 cm/m for women). Apart from gender, there were no significant differences in patient characteristics or surgical outcomes between the SMI groups. In the underweight group, tumor (T) stage, tumor-node-metastasis (TNM) stage, number of retrieved lymph nodes, D2 dissection, and hospital stay were significantly increased compared with the overweight/obese group. High and low BMI, and low SMI, were independent prognostic factors for OS (hazard ratio [HR] = 2.355, 1.736, and 1.607, respectively; P = .009, .023, and .033, respectively).SMI and BMI did not impact perioperative morbidity in patients undergoing gastrectomy for gastric cancer. Both SMI and BMI are useful prognostic factors for OS in gastric cancer patients after gastrectomy.
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Affiliation(s)
| | - Kyong Hwa Jun
- Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Shinn Young Kim
- Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyung Min Chin
- Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Lee CM, Kang J. Prognostic impact of myosteatosis in patients with colorectal cancer: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle 2020; 11:1270-1282. [PMID: 32483936 PMCID: PMC7567135 DOI: 10.1002/jcsm.12575] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 03/09/2020] [Accepted: 03/11/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Myosteatosis has been reported to be a novel biomarker that could predict survival outcomes in patients with colorectal cancer. However, results have been conflicting. This systematic review and meta-analysis aimed to evaluate the long-term impact of myosteatosis on the survival of these patients. METHODS A systematic search of PubMed, Embase, and Cochrane up to 27 November 2019 generated 7022 records. Studies that reported hazard ratio (HR) for overall survival, cancer-specific survival, or disease-free survival based on myosteatosis or radiodensity were included. A total of 110 full-text articles were considered for inclusion, and 14 were selected for qualitative analysis. Inverse variance method was used with random effects model for data analysis. RESULTS The total number of enrolled patients included in the meta-analysis was 6518 for univariate and 8572 for multivariate HR analysis, from 12 and 10 studies, respectively. Patients with myosteatosis had a significant increase in overall mortality compared with non-myosteatosis patients by both univariate analysis [HR 1.38, 95% confidence interval (CI) 1.21 to 1.58, P < 0.00001] and multivariate analysis (HR 1.55, 95% CI 1.23 to 1.96, P < 0.00001). In subgroup analysis based on studies that reported HRs of both sarcopenia and myosteatosis, the negative effect of myosteatosis on overall survival was independent of sarcopenia using univariate values (sarcopenia HR 1.48, 95% CI 1.14 to 1.91, P = 0.003 vs. myosteatosis HR 1.51, 95% CI 1.17 to 1.96, P = 0.002) and multivariate values (sarcopenia HR 1.28, 95% CI 1.09 to 1.49, P = 0.002 vs. myosteatosis HR 1.38, 95% CI 1.07 to 1.80, P = 0.001). CONCLUSIONS This meta-analysis demonstrates that myosteatosis is associated with worse overall survival in patients with colorectal cancer. More investigation is needed to standardize the measurement protocol for myosteatosis and to further optimize its prognostic power for colorectal cancer patients.
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Affiliation(s)
- Chan Mi Lee
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve UniversityClevelandOHUSA
| | - Jeonghyun Kang
- Department of SurgeryGangnam Severance Hospital, Yonsei University College of MedicineGangnam‐guSeoulKorea
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Olson B, Edwards J, Stone L, Jiang A, Zhu X, Holland J, Li R, Andersen P, Krasnow S, Marks DL, Clayburgh D. Association of Sarcopenia With Oncologic Outcomes of Primary Surgery or Definitive Radiotherapy Among Patients With Localized Oropharyngeal Squamous Cell Carcinoma. JAMA Otolaryngol Head Neck Surg 2020; 146:714-722. [PMID: 32525518 PMCID: PMC7290710 DOI: 10.1001/jamaoto.2020.1154] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 04/18/2020] [Indexed: 02/05/2023]
Abstract
Importance The negative association of low lean muscle mass (sarcopenia) with survival outcomes in head and neck cancers, including oropharyngeal carcinoma, is established. However, it is not known whether the choice of primary treatment modality (surgery or radiotherapy) is associated with oncologic outcomes of patients with sarcopenia and oropharyngeal squamous cell carcinoma (OPSCC). Objective To examine whether primary surgical resection or definitive radiotherapy is associated with improved survival for patients with sarcopenia and localized OPSCC. Design, Setting, and Participants A cohort study was conducted of patients with clinically staged T1 to T2, N0 to N2 OPSCC with cross-sectional abdominal imaging within 60 days prior to treatment and treated between January 1, 2005, and December 31, 2017. Skeletal muscle mass was measured at the third lumbar vertebra using previously defined techniques and sarcopenia was defined as less than 52.4 cm2/m2 of muscle for men and less than 38.5 cm2/m2 for women. In addition, associated patient demographic characteristics, cancer data, treatment information, and survival outcomes were assessed. Statistical analysis was performed from December 3, 2018, to August 28, 2019. Main Outcomes and Measures Primary outcomes were overall survival and disease-specific survival. Results Among the 245 patients who met study inclusion criteria, 209 were men (85.3%) and the mean (SD) age was 62.3 (7.8) years. Sarcopenia was detected in 135 patients (55.1%), while normal skeletal muscle mass was detected in 110 patients (44.9%). For the 110 patients without sarcopenia, primary treatment modality was not associated with improved survival. For patients with sarcopenia at diagnosis, primary surgical resection was associated with improved overall survival (hazard ratio [HR], 0.37; 95% CI, 0.17-0.82) and disease-specific survival (HR, 0.22; 95% CI, 0.07-0.68). This association persisted after propensity score matching, as up-front surgery was associated with improved overall survival (HR, 0.33; 95% CI, 0.12-0.91) and disease-specific survival (HR, 0.17; 95% CI, 0.04-0.75) survival. Conclusions and Relevance This study suggests that sarcopenia has a negative association with survival for patients with OPSCC. Primary surgery and radiotherapy confer similar survival associations for patients with normal skeletal muscle mass and localized OPSCC. However, up-front surgical resection may be associated with improved survival outcomes for patients with sarcopenia.
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Affiliation(s)
- Brennan Olson
- School of Medicine, Oregon Health & Science University, Portland
| | - Jared Edwards
- School of Medicine, Oregon Health & Science University, Portland
| | - Lucas Stone
- School of Medicine, Oregon Health & Science University, Portland
| | - Angie Jiang
- School of Medicine, Oregon Health & Science University, Portland
| | - Xinxia Zhu
- Papé Family Pediatric Research Institute, Oregon Health & Science University, Portland
| | - John Holland
- Department of Radiation Oncology, Oregon Health & Science University, Portland
| | - Ryan Li
- Department of Otolaryngology–Head and Neck Surgery, Oregon Health & Science University, Portland
| | - Peter Andersen
- Department of Otolaryngology–Head and Neck Surgery, Oregon Health & Science University, Portland
| | - Stephanie Krasnow
- Papé Family Pediatric Research Institute, Oregon Health & Science University, Portland
| | - Daniel L. Marks
- Papé Family Pediatric Research Institute, Oregon Health & Science University, Portland
- Brenden-Colson Center for Pancreatic Care, Oregon Health & Science University, Portland
| | - Daniel Clayburgh
- Department of Otolaryngology–Head and Neck Surgery, Oregon Health & Science University, Portland
- Operative Care Division, Portland Veterans Affairs Health Care System, Portland, Oregon
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Rayhel LH, Quimby JM, Green EM, Parker VJ, Bai S. Intra- and inter-rater reliability in the cross-sectional area of feline lumbar epaxial musculature evaluated via abdominal CT scan. J Feline Med Surg 2020; 22:721-728. [PMID: 31660772 PMCID: PMC10814493 DOI: 10.1177/1098612x19880997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the intra- and inter-rater reliability of epaxial muscle cross-sectional area measurement on feline CT images and to determine the relationship between normalized epaxial muscle area (EMA) and subjective muscle condition score (MCS). METHODS Feline transverse CT images including the junction of the 13th thoracic vertebrae/13th rib head were retrospectively reviewed. Right and left epaxial muscle circumference and vertebral body height were measured and an average normalized EMA (ratio of epaxial area:vertebral height) was calculated for each image. Measurements were performed by three individuals blinded to the clinical data and were repeated 1 month later. Intra- and inter-rater reliability of EMA was assessed with concordance correlation coefficient (CCC), and Bland-Altman analysis was performed to assess bias and limits of agreement (LoA) between and within observers at different time points. In cats for which MCS data were available, EMA was compared between differing MCSs via the Kruskal-Wallis test, with Bonferroni-corrected Wilcoxon rank-sum post-hoc analysis. RESULTS In total, 101 CT scans met the inclusion criteria for reliability analysis, 29 of which had muscle condition information available for analysis. Intra-rater EMA CCC ranged from 0.84 to 0.99 with minimal bias (range -0.16 to 0.08) and narrow LoA. Inter-rater EMA CCC ranged from 0.87 to 0.94, bias was larger (range -0.46 to 0.66) and LoA were wider when assessed between observers. Median EMA was significantly lower in cats with severe muscle atrophy (2.76, range 1.28-3.96) than in all other MCS groups (P <0.0001 for all comparisons). CONCLUSIONS AND RELEVANCE Measurement of EMA on CT showed strong intra-rater reliability, and median EMA measurements were significantly lower in cats with severe muscle wasting, as assessed on physical examination. Further studies correlating EMA to lean muscle mass in cats are needed to determine whether this method may be useful to quantify muscle mass in patients undergoing a CT scan.
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Affiliation(s)
- Laura H Rayhel
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, USA
| | - Jessica M Quimby
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, USA
| | - Eric M Green
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, USA
| | - Valerie J Parker
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, USA
| | - Shasha Bai
- Center for Biostatistics, The Ohio State University, Columbus, OH, USA
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Zanetti M, Gortan Cappellari G, Barazzoni R, Sanson G. The Impact of Protein Supplementation Targeted at Improving Muscle Mass on Strength in Cancer Patients: A Scoping Review. Nutrients 2020; 12:nu12072099. [PMID: 32708527 PMCID: PMC7400018 DOI: 10.3390/nu12072099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/15/2020] [Accepted: 07/03/2020] [Indexed: 12/25/2022] Open
Abstract
Deterioration of muscle strength during cancer results in functional limitation, poor quality of life and reduced survival. The indirect effects on muscle strength of nutritional interventions based on protein and amino acid derivatives targeted at improving muscle mass are poorly documented. A scoping review was performed to examine the available evidence on the effects of proteins, amino acids and their derivatives on muscle strength in adult cancer patients. Pubmed and Scopus databases were searched to identify research articles published in the last 10 years. Fourteen studies met the inclusion criteria, showing that changes in muscle strength following protein or amino acid supplementation are generally concordant with those in muscle mass in cancer patients. Administration of both energy and proteins in the presence of reduced oral intakes results in more robust effects on both muscle strength and mass. It is not clear whether this is due to the correction of the energy deficit or to an interaction between proteins and other macronutrients. The optimal mixture, type, and dose of amino acid/protein supplementation alone or in combination with other anabolic strategies should be determined to provide the best nutritional approach in cancer.
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Yoshikawa N, Shirakawa A, Yoshida K, Tamauchi S, Suzuki S, Kikkawa F, Kajiyama H. Sarcopenia as a Predictor of Survival Among Patients With Organ Metastatic Cervical Cancer. Nutr Clin Pract 2020; 35:1041-1046. [PMID: 32253779 DOI: 10.1002/ncp.10482] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND This study was conducted to investigate the prognostic significance of sarcopenia in patients with organ metastatic cervical cancer. METHODS Accordingly, the data of 40 patients with organ metastatic cervical cancer treated at our institute from December 2004 to December 2017 were retrospectively analyzed. The correlation between clinicopathological characteristics and survival was then evaluated using univariate and multivariate analyses. Psoas muscle index (PMI), calculated from the psoas muscle area at the L3 vertebral-body level using computed tomography images obtained for pretreatment evaluation, was adopted as an index of sarcopenia. RESULTS The median follow-up period was 14 months (range, 1-91 months). Kaplan-Meier analysis showed a 3- and 5-year overall survival (OS) rate of 46.1% and 35.8% for all patients, respectively. Receiver operating characteristic curve maximizing the area under the curve showed that the optimal PMI for predicting 1-year survival was 3.72 cm2 /m2 . Patients with a PMI > 3.72 cm2 /m2 had significantly better OS than those with a PMI ≤ 3.72 cm2 /m2 (P = .046). Multivariate analysis revealed that only PMI was significantly associated with OS in patients with organ metastatic cervical cancer. Furthermore, patients with a PMI > 3.72 cm2 /m2 who underwent concurrent chemoradiotherapy (CCRT) had a longer OS than those receiving other therapies (P < .001). CONCLUSIONS High PMI was determined to be a favorable prognostic factor for patients with organ metastatic cervical cancer. Moreover, patients with organ metastatic cervical cancer who have a PMI > 3.72 cm2 /m2 may benefit from CCRT as an initial treatment.
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Affiliation(s)
- Nobuhisa Yoshikawa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Akira Shirakawa
- Center for Postgraduate Clinical Training and Career Development, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Kosuke Yoshida
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Satoshi Tamauchi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shiro Suzuki
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Fumitaka Kikkawa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Vergara-Fernandez O, Trejo-Avila M, Salgado-Nesme N. Sarcopenia in patients with colorectal cancer: A comprehensive review. World J Clin Cases 2020; 8:1188-1202. [PMID: 32337193 PMCID: PMC7176615 DOI: 10.12998/wjcc.v8.i7.1188] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/06/2020] [Accepted: 03/14/2020] [Indexed: 02/05/2023] Open
Abstract
Colorectal cancer (CRC) is the third most commonly diagnosed cancer globally and the second cancer in terms of mortality. The prevalence of sarcopenia in patients with CRC ranges between 12%-60%. Sarcopenia comes from the Greek "sarx" for flesh, and "penia" for loss. Sarcopenia is considered a phenomenon of the aging process and precedes the onset of frailty (primary sarcopenia), but sarcopenia may also result from pathogenic mechanisms and that disorder is termed secondary sarcopenia. Sarcopenia diagnosis is confirmed by the presence of low muscle quantity or quality. Three parameters need to be measured: muscle strength, muscle quantity and physical performance. The standard method to evaluate muscle mass is by analyzing the tomographic total cross-sectional area of all muscle groups at the level of lumbar 3rd vertebra. Sarcopenia may negatively impact on the postoperative outcomes of patients with colorectal cancer undergoing surgical resection. It has been described an association between sarcopenia and numerous poor short-term CRC outcomes like increased perioperative mortality, postoperative sepsis, prolonged length of stay, increased cost of care and physical disability. Sarcopenia may also negatively impact on overall survival, disease-free survival, recurrence-free survival, and cancer-specific survival in patients with non-metastatic and metastatic colorectal cancer. Furthermore, patients with sarcopenia seem prone to toxic effects during chemotherapy, requiring dose deescalations or treatment delays, which seems to reduce treatment efficacy. A multimodal approach including nutritional support (dietary intake, high energy, high protein, and omega-3 fatty acids), exercise programs and anabolic-orexigenic agents (ghrelin, anamorelin), could contribute to muscle mass preservation. Addition of sarcopenia screening to the established clinical-pathological scores for patients undergoing oncological treatment (chemotherapy, radiotherapy or surgery) seems to be the next step for the best of care of CRC patients.
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Affiliation(s)
- Omar Vergara-Fernandez
- Department of Colorectal Surgery, Instituto Nacional de Ciencias Medicas y Nutrición “Salvador Zubirán”, Mexico 14080, Mexico
| | - Mario Trejo-Avila
- Department of Colorectal Surgery, Instituto Nacional de Ciencias Medicas y Nutrición “Salvador Zubirán”, Mexico 14080, Mexico
| | - Noel Salgado-Nesme
- Department of Colorectal Surgery, Instituto Nacional de Ciencias Medicas y Nutrición “Salvador Zubirán”, Mexico 14080, Mexico
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Gabiatti CTB, Martins MCL, Miyazaki DL, Silva LP, Lascala F, Macedo LT, Mendes MCS, Carvalheira JBC. Myosteatosis in a systemic inflammation-dependent manner predicts favorable survival outcomes in locally advanced esophageal cancer. Cancer Med 2019; 8:6967-6976. [PMID: 31571402 PMCID: PMC6853837 DOI: 10.1002/cam4.2593] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/08/2019] [Accepted: 09/15/2019] [Indexed: 02/05/2023] Open
Abstract
Increased adiposity and its attendant metabolic features as well as systemic inflammation have been associated with prognosis in locally advanced esophageal cancer (LAEC). However, whether myosteatosis and its combination with systemic inflammatory markers are associated with prognosis of esophageal cancer is unknown. Our study aimed to investigate the influence of myosteatosis and its association with systemic inflammation on progression-free survival (PFS) and overall survival (OS) in LAEC patients treated with definitive chemoradiotherapy (dCRT). We retrospectively gathered information on 123 patients with LAEC submitted to dCRT at the University of Campinas Hospital. Computed tomography (CT) images at the level of L3 were analyzed to assess muscularity and adiposity. Systemic inflammation was mainly measured by calculating the neutrophil-to-lymphocyte ratio (NLR). Median PFS for patients with myosteatosis (n = 72) was 11.0 months vs 4.0 months for patients without myosteatosis (n = 51) (hazard ratio [HR]: 0.53; 95% confidence interval [CI], 0.34-0.83; P = .005). Myosteatosis was also independently associated with a favorable OS. Systemic inflammation (NLR > 2.8) was associated with a worse prognosis. The combination of myosteatosis with systemic inflammation revealed that the subgroup of patients with myosteatosis and without inflammation presented less than half the risk of disease progression (HR: 0.47; 95% CI: 0.26-0.85; P = .013) and death (HR: 0.39; 95% CI, 0.21-0.72; P = .003) compared with patients with inflammation. This study demonstrated that myosteatosis without systemic inflammation was independently associated with favorable PFS and OS in LAEC patients treated with dCRT.
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Affiliation(s)
- Camila T. B. Gabiatti
- Division of OncologyDepartment of Internal MedicineFaculty of Medical SciencesState University of Campinas (UNICAMP)CampinasSPBrazil
| | - Mariane C. L. Martins
- Division of OncologyDepartment of Internal MedicineFaculty of Medical SciencesState University of Campinas (UNICAMP)CampinasSPBrazil
| | - Daniela L. Miyazaki
- Division of OncologyDepartment of Internal MedicineFaculty of Medical SciencesState University of Campinas (UNICAMP)CampinasSPBrazil
| | - Leandro P. Silva
- Division of OncologyDepartment of Internal MedicineFaculty of Medical SciencesState University of Campinas (UNICAMP)CampinasSPBrazil
| | - Fabiana Lascala
- Division of OncologyDepartment of Internal MedicineFaculty of Medical SciencesState University of Campinas (UNICAMP)CampinasSPBrazil
| | - Ligia T. Macedo
- Division of OncologyDepartment of Internal MedicineFaculty of Medical SciencesState University of Campinas (UNICAMP)CampinasSPBrazil
| | - Maria Carolina Santos Mendes
- Division of OncologyDepartment of Internal MedicineFaculty of Medical SciencesState University of Campinas (UNICAMP)CampinasSPBrazil
| | - José Barreto Campello Carvalheira
- Division of OncologyDepartment of Internal MedicineFaculty of Medical SciencesState University of Campinas (UNICAMP)CampinasSPBrazil
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Associations between skeletal muscle mass index, nutritional and functional status of patients with oesophago-gastric cancer. Clin Nutr ESPEN 2019; 34:61-67. [PMID: 31677713 DOI: 10.1016/j.clnesp.2019.08.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/23/2019] [Accepted: 08/26/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIMS Cancer patients frequently suffer from disease-related malnutrition and functional decline. The aim of the current study is to investigate the association between traditional methods of nutritional assessment (unintentional weight loss, Patient Generated-Subjective Global Assessment, anthropometric measurements), functional assessment and muscle mass assessment in oesophago-gastric cancer patients prior to surgery. METHODS A cross-sectional study was performed in 108 consecutive patients with oesophageal and gastric cancer who were admitted for surgery in the First Department of Surgery, Laikon General Hospital, Athens, Greece. The assessment of muscle mass was based on preoperative Skeletal Muscle Mass Index (SMI) values. The assessment of malnutrition was based on the Patient Generated Subjective Global Assessment, whereas laboratory markers and anthropometric measurements were also recorded. Muscle strength and physical performance were evaluated by measuring patients' handgrip strength and gait speed respectively. RESULTS 76.8% of the study sample were severely malnourished and moderately or suspected of being malnourished, while the prevalence of low muscle mass was 49.1%. Age was significantly higher in low SMI patients compared to normal SMI individuals (67.2 ± 9.2 vs 60 ± 10.8, p < 0.001). Albumin was significantly lower in low SMI compared to normal SMI patients, as well as BMI, mid-upper arm circumference, calf circumference and corrected mid arm muscle area. Moreover, malnourished patients exhibited higher rates of low muscle mass (57.8% vs 42.2%, p = 0.022) than well-nourished patients. SMI was also significantly correlated with patients' handgrip strength and gait speed. CONCLUSIONS Low muscle mass is strongly correlated with malnutrition and should be taken into consideration when evaluating the nutritional status of patients with oesophago-gastric cancer.
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