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Xiao L, Liu Y, Zhang X, Nie X, Bai H, Lyu J, Li T. Prognostic value of sarcopenia and inflammatory indices synergy in patients with esophageal squamous cell carcinoma undergoing chemoradiotherapy. BMC Cancer 2024; 24:860. [PMID: 39026185 PMCID: PMC11256500 DOI: 10.1186/s12885-024-12602-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 07/03/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND AND PURPOSE Sarcopenia has been demonstrated to be adversely correlated with the prognosis of various cancers. Our study aimed to estimate the prognostic value of sarcopenia in conjunction with inflammatory indices [neutrophil-to-lymphocyte ratio (NLR)] for evaluating the prognosis of patients with esophageal squamous cell carcinoma (ESCC) undergoing chemoradiotherapy. MATERIALS AND METHODS This study retrospectively analyzed 255 patients with ESCC who received chemoradiotherapy from January 2012 to December 2018. Multivariate Cox regression analysis was employed to identify prognostic values of assessed factors following a novel prognostic scoring system (SMI-NLR), covering sarcopenia and NLR during different treatment courses. RESULTS Kaplan-Meier analysis revealed significantly greater overall survival (OS) rates in the nonsarcopenia group than in the sarcopenia group (P = 0.011). The low NLR group (< 4.84) demonstrated significantly higher OS rates than the high NLR group (≥ 4.84) (P < 0.001). The SMI-NLR prognostic model was established through multivariate analysis, revealing that Karnofsky performance status [hazard ratio (HR) = 0.285; 95% confidence interval (CI) = 0.117-0.699; P = 0.006], clinical staging (HR = 5.223; 95% CI = 1.879-14.514; P = 0.002), and preSMI-NLR (HR = 0.544; 95% CI = 0.330-0.898; P = 0.017) were independent factors affecting the prognosis of patients with ESCC. Nomograms were constructed based on these data providing more accurate 1-, 3-, and 5-year survival rates for patients with ESCC. CONCLUSION Our study indicates the effectiveness of the combined sarcopenia and NLR prognostic model for the prognostic evaluation of patients with ESCC having undergone chemoradiotherapy.
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Affiliation(s)
- Ling Xiao
- School of Medicine, University of Electronic Science and Technology of China, Sichuan Cancer Hospital, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Yudi Liu
- School of Medicine, University of Electronic Science and Technology of China, Sichuan Cancer Hospital, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Xue Zhang
- School of Medicine, University of Electronic Science and Technology of China, Sichuan Cancer Hospital, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Xinyu Nie
- Department of Radiation Oncology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Hansong Bai
- Department of Radiation Oncology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Jiahua Lyu
- Department of Radiation Oncology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China.
| | - Tao Li
- Department of Radiation Oncology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China.
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Zhang KL, Zhou MM, Wang KH, Weng M, Zhou FX, Cui JW, Li W, Ma H, Guo ZQ, Li SY, Chen JQ, Wu XH, Zhao QC, Li JP, Xu HX, Shi HP, Song CH. Integrated neutrophil-to-lymphocyte ratio and handgrip strength better predict survival in patients with cancer cachexia. Nutrition 2024; 122:112399. [PMID: 38493542 DOI: 10.1016/j.nut.2024.112399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVES Systemic inflammation and skeletal muscle strength play crucial roles in the development and progression of cancer cachexia. In this study we aimed to evaluate the combined prognostic value of neutrophil-to-lymphocyte ratio (NLR) and handgrip strength (HGS) for survival in patients with cancer cachexia. METHODS This multicenter cohort study involved 1826 patients with cancer cachexia. The NLR-HGS (NH) index was defined as the ratio of neutrophil-to-lymphocyte ratio to handgrip strength. Harrell's C index and receiver operating characteristic (ROC) curve analysis were used to assess the prognosis of NH. Kaplan-Meier analysis and Cox regression models were used to evaluate the association of NH with all-cause mortality. RESULTS Based on the optimal stratification, 380 women (NH > 0.14) and 249 men (NH > 0.19) were classified as having high NH. NH has shown greater predictive value compared to other indicators in predicting the survival of patients with cancer cachexia according to the 1-, 3-, and 5-y ROC analysis and Harrell's C index calculation. Multivariate survival analysis showed that higher NH was independently associated with an increased risk of death (hazard ratio = 1.654, 95% confidence interval = 1.389-1.969). CONCLUSION This study demonstrates that the NH index, in combination with NLR and HGS, is an effective predictor of the prognosis of patients with cancer cachexia. It can offer effective prognosis stratification and guidance for their treatment.
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Affiliation(s)
- Kai-Lun Zhang
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Ming-Ming Zhou
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Kun-Hua Wang
- Department of Gastrointestinal Surgery, Institute of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Min Weng
- Department of Clinical Nutrition, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Fu-Xiang Zhou
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jiu-Wei Cui
- Cancer Center of the First Hospital of Jilin University, Changchun, China
| | - Wei Li
- Cancer Center of the First Hospital of Jilin University, Changchun, China
| | - Hu Ma
- Department of Oncology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Zeng-Qing Guo
- Department of Medical Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Su-Yi Li
- Department of Nutrition and Metabolism of Oncology, Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Jun-Qiang Chen
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xiang-Hua Wu
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Qing-Chuan Zhao
- Department of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Ji-Peng Li
- Department of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Hong-Xia Xu
- Department of Nutrition, Daping Hospital & Research Institute of Surgery, Third Military Medical University, Chongqing, China
| | - Han-Ping Shi
- Departments of Gastrointestinal Surgery and Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Chun-Hua Song
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou, China; Henan Key Laboratory of Tumor Epidemiology, Zhengzhou University, Zhengzhou, China; State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, China.
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3
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Borda MG, Lafuente Sanchis P, Patricio Baldera J, Tarazona-Santabalbina FJ, Chavarro-Carvajal DA, Salazar-Londoño S, Bocharova M, Aarsland D, Martín-Marco A. Assessing Neutrophil-to-Lymphocyte Ratio as a Nutritional Indicator in Community-Dwelling Older Adults. Arch Med Res 2024; 55:103003. [PMID: 38795422 DOI: 10.1016/j.arcmed.2024.103003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 04/06/2024] [Accepted: 04/23/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND In an aging population, there is an increasing need for easily accessible nutritional markers. AIMS To determine whether the neutrophil-to-lymphocyte ratio (NLR) can serve as an effective nutritional indicator compared to the Mini-Nutritional Assessment Short Form (MNA-SF) or other common markers such as albumin and body mass index (BMI). METHODS Data were obtained from the SABE study in Ecuador, which included participants aged 60 years or older. This cross-sectional study collected comprehensive data, including demographics, health-related factors, and physical assessments. Neutrophil and lymphocyte counts were measured by complete blood count. Nutritional status was assessed by MNA-SF, and BMI was calculated. Several physical tests were performed to evaluate the participants' functional status. Confounding variables such as age, sex, and comorbidities were considered. RESULTS The final sample consisted of 1790 subjects (48.9% male). The overall median age was 68 years (IQR 64,76). BMI and lymphocytes were higher in females, while NLR was higher in males. MNA-SF showed a negative association with NLR. Similarly, lymphocyte count shows a positive association with MNA-SF. Physical tests, such as the Romberg test and the Five Times Sit-to-Stand test, also showed correlations with NLR and lymphocyte count, respectively. CONCLUSION The study results suggest a significant relationship between NLR and lymphocytes, and nutritional status. The correlation with albumin is stronger with NLR than with BMI. The simplicity and affordability of NLR may make it suitable for routine use in several medical fields, improving our understanding of the complex relationship between nutrition, inflammation, and overall health.
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Affiliation(s)
- Miguel Germán Borda
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway; Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana, Bogotá, Colombia; Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Unidad de Hospitalizacion Domiciliaria, Hospital Universitario de la Ribera, Alzira, Spain.
| | - Pablo Lafuente Sanchis
- Unidad de Hospitalizacion Domiciliaria, Hospital Universitario de la Ribera, Alzira, Spain
| | - Jonathan Patricio Baldera
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway; Escuela de Estadística de la Universidad Autónoma de Santo Domingo, Santo Domingo, República Dominicana
| | - Francisco José Tarazona-Santabalbina
- Geriatric Medicine Department, Hospital Universitario de la Ribera, Alzira, Spain; Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable, Madrid, Spain; Medical School, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain
| | - Diego Andrés Chavarro-Carvajal
- Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Salomón Salazar-Londoño
- Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Mariia Bocharova
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Dag Aarsland
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway; Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Antonio Martín-Marco
- Unidad de Hospitalizacion Domiciliaria, Hospital Universitario de la Ribera, Alzira, Spain
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Arsava EM, Gungor L, Sirin H, Sorgun MH, Aykac O, Batur Caglayan HZ, Kozak HH, Ozturk S, Topcuoglu MA. Muscle mass as a modifier of stress response in acute ischemic stroke patients. Sci Rep 2024; 14:10088. [PMID: 38698153 PMCID: PMC11066052 DOI: 10.1038/s41598-024-60829-6] [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: 10/02/2023] [Accepted: 04/27/2024] [Indexed: 05/05/2024] Open
Abstract
Stroke triggers a systemic inflammatory response over the ensuing days after the cerebral insult. The age and comorbidities of the stroke population make them a vulnerable population for low muscle mass and sarcopenia, the latter being another clinical condition that is closely associated with inflammation, as shown by increased levels of pro-inflammatory biomarkers, including neutrophil-to-lymphocyte ratio (NLR). In this study, we evaluated the relationship between post-stroke NLR changes and muscle mass in a prospective cohort of acute ischemic stroke patients (n = 102) enrolled in the Muscle Assessment in Stroke Study Turkey (MASS-TR). Admission lumbar computed tomography images were used to determine the cross-sectional muscle area of skeletal muscles at L3 vertebra level and calculate the skeletal muscle index (SMI). The median (IQR) SMI was 44.7 (39.1-52.5) cm2/m2, and the NLR at admission and follow-up were 4.2 (3.0-10.5) and 9.4 (5.7-16.2), respectively. While there was no relationship between SMI and admission NLR, a significant inverse correlation was observed between SMI and follow-up NLR (r = - 0.26; P = 0.007). Lower SMI remained significantly associated (P = 0.036) with higher follow-up NLR levels in multivariate analysis. Our findings highlight the importance of muscle mass as a novel factor related to the level of post-stroke stress response.
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Affiliation(s)
- Ethem Murat Arsava
- Department of Neurology, Faculty of Medicine, Hacettepe University, 06230, Altindag, Ankara, Turkey.
| | - Levent Gungor
- Department of Neurology, Ondokuz Mayis University, Samsun, Turkey
| | - Hadiye Sirin
- Department of Neurology, Ege University, Izmir, Turkey
| | | | - Ozlem Aykac
- Department of Neurology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | | | | | | | - Mehmet Akif Topcuoglu
- Department of Neurology, Faculty of Medicine, Hacettepe University, 06230, Altindag, Ankara, Turkey
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Nie H, Liu Y, Zeng X, Chen M. Neutrophil-to-lymphocyte ratio is associated with sarcopenia risk in overweight maintenance hemodialysis patients. Sci Rep 2024; 14:3669. [PMID: 38351264 PMCID: PMC10864262 DOI: 10.1038/s41598-024-54056-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/08/2024] [Indexed: 02/16/2024] Open
Abstract
Neutrophil-to-lymphocyte ratio (NLR), a novel inflammatory marker, is strongly associated with the risk of sarcopenia. Notably, being overweight has been found to accelerate the loss of skeletal muscle mass and function in chronic kidney disease (CKD) patients. However, the effect of overweight status on the relationship between NLR and sarcopenia risk has been poorly studied. We conducted a cross-sectional study at a hemodialysis center in Chengdu, China, from September to December 2022. The prevalence of sarcopenia was determined according to the Asian Working Group for Sarcopenia (AWGS). Participants were stratified based on body mass index (BMI) categories for the Asian population (non-overweight < 23 kg/m2 and overweight ≥ 23 kg/m2). 272 participants aged 18-85 years were included, with 144 being male. The overall prevalence of sarcopenia was 32.72% (89/272). After adjusting for covariates, NLR was significantly associated with sarcopenia risk in overweight participants (OR 1.60, 95% CI 1.15-2.24, p = 0.006), whereas it was not significant in the non-overweight group (OR 0.88, 95% CI 0.70-1.10, p = 0.254). Moreover, subgroup analysis showed a significant interactive association between NLR and overweight status with respect to sarcopenia. These findings emphasize the potential significance of regular screening of NLR for the early detection of sarcopenia in overweight patients undergoing maintenance hemodialysis.
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Affiliation(s)
- Huibin Nie
- Department of Nephrology, Chengdu First People's Hospital, Integrated TCM and Western Medicine Hospital Affiliated to Chengdu University of TCM, No. 18 Wanxiang North Street, Chengdu, 610095, Sichuan, China
| | - Yan Liu
- Department of Clinical Nutrition, Chengdu First People's Hospital, Integrated TCM and Western Medicine Hospital Affiliated to Chengdu University of TCM, No. 18 Wanxiang North Street, Chengdu, 610095, Sichuan, China
| | - Xiaoyan Zeng
- Department of Nephrology, Chengdu First People's Hospital, Integrated TCM and Western Medicine Hospital Affiliated to Chengdu University of TCM, No. 18 Wanxiang North Street, Chengdu, 610095, Sichuan, China
| | - Min Chen
- Department of Nephrology, Chengdu First People's Hospital, Integrated TCM and Western Medicine Hospital Affiliated to Chengdu University of TCM, No. 18 Wanxiang North Street, Chengdu, 610095, Sichuan, China.
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Jia QC, Qin L, Niu Y, Liu L, Liu PP, Miao SD, Cui MM, Wang RT. Red blood cell distribution width is associated with sarcopenia risk in early-stage non-small cell lung cancer. BMC Cancer 2024; 24:95. [PMID: 38233827 PMCID: PMC10795386 DOI: 10.1186/s12885-024-11864-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 01/09/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Sarcopenia has received increasing attention in non-small cell lung cancer (NSCLC). Red blood cell distribution width (RDW) is a significant component of the complete blood count and indicates the heterogeneity of erythrocyte volume. Little information is known about RDW in relation to sarcopenia in early-stage (IA-IIIA) NSCLC. The purpose of the present study was to investigate the association between RDW and sarcopenia risk in early-stage NSCLC patients. METHODS This study included 378 patients with pathologically confirmed stage IA-IIIA NSCLC. Sarcopenia was defined by measuring the skeletal muscle index (SMI) at the eleventh thoracic vertebra level. The maximum Youden index on the receiver operating characteristic (ROC) curve was used to estimate the cutoff value for RDW to predict sarcopenia. Logistic regression analyses were carried out to assess the independent risk factors for sarcopenia in NSCLC. RESULTS The ROC curve indicated that the best cutoff point for RDW to predict sarcopenia was 12.9 (sensitivity of 43.80% and specificity of 76.76%, respectively). Moreover, there were significant differences in hemoglobin (p < 0.001), comorbidities (p = 0.001), histological type (p = 0.002), and cancer stage (p = 0.032) between the high RDW and low RDW groups. Logistic regression analyses revealed that high RDW is an independent risk factor for sarcopenia in early-stage NSCLC. CONCLUSION RDW is associated with sarcopenia risk in early-stage NSCLC.
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Affiliation(s)
- Qing-Chun Jia
- Department of Internal Medicine, Harbin Medical University Cancer Hospital, Harbin Medical University, NO.150 Haping ST, Nangang District, Harbin, Heilongjiang, 150081, China
| | - Ling Qin
- Department of Pathology, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, Heilongjiang, 150081, China
| | - Ye Niu
- Department of Internal Medicine, Harbin Medical University Cancer Hospital, Harbin Medical University, NO.150 Haping ST, Nangang District, Harbin, Heilongjiang, 150081, China
| | - Le Liu
- Department of Internal Medicine, Harbin Medical University Cancer Hospital, Harbin Medical University, NO.150 Haping ST, Nangang District, Harbin, Heilongjiang, 150081, China
| | - Ping-Ping Liu
- Department of Internal Medicine, Harbin Medical University Cancer Hospital, Harbin Medical University, NO.150 Haping ST, Nangang District, Harbin, Heilongjiang, 150081, China
| | - Shi-di Miao
- School of Computer Science and Technology, Harbin University of Science and Technology, Harbin, Heilongjiang, 150080, China
| | - Ming-Ming Cui
- Department of Internal Medicine, Harbin Medical University Cancer Hospital, Harbin Medical University, NO.150 Haping ST, Nangang District, Harbin, Heilongjiang, 150081, China.
| | - Rui-Tao Wang
- Department of Internal Medicine, Harbin Medical University Cancer Hospital, Harbin Medical University, NO.150 Haping ST, Nangang District, Harbin, Heilongjiang, 150081, China.
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Lim JY, Kim YM, Lee HS, Kang J. Skeletal muscle gauge prediction by a machine learning model in patients with colorectal cancer. Nutrition 2023; 115:112146. [PMID: 37531791 DOI: 10.1016/j.nut.2023.112146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/22/2023] [Accepted: 06/27/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVES Skeletal muscle gauge (SMG) was recently introduced as an imaging indicator of sarcopenia. Computed tomography is essential for measuring SMG; thus, the use of SMG is limited to patients who undergo computed tomography. We aimed to develop a machine learning algorithm using clinical and inflammatory markers to predict SMG in patients with colorectal cancer. METHODS The least absolute shrinkage and selection operator regression model was applied for variable selection and predictive signature building in the training set. The predictive accuracy of the least absolute shrinkage and selection operator model, defined as linear predictor (LP)-SMG, was compared using the area under the receiver operating characteristic curve and decision curve analysis in the test set. RESULTS A total of 1094 patients with colorectal cancer were enrolled and randomly categorized into training (n = 656) and test (n = 438) sets. Low SMG was identified in 142 (21.6%) and 90 (20.5%) patients in the training and test sets, respectively. According to multivariable analysis of the test sets, LP-SMG was identified as an independent predictor of low SMG (odds ratio = 1329.431; 95% CI, 271.684-7667.996; P < .001). Its predictive performance was similar in the training and test sets (area under the receiver operating characteristic curve = 0.846 versus 0.869; P = .427). In the test set, LP-SMG had better outcomes in predicting SMG than single clinical variables, such as sex, height, weight, and hemoglobin. CONCLUSIONS LP-SMG had superior performance than single variables in predicting low SMG. This machine learning model can be used as a screening tool to detect sarcopenic status without using computed tomography during the treatment period.
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Affiliation(s)
- Jun Young Lim
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Min Kim
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeonghyun Kang
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Deng F, Wu W, Fan X, Zhong X, Wang N, Wang Y, Pan T, Du Y. Dulaglutide Protects Mice against Diabetic Sarcopenia-Mediated Muscle Injury by Inhibiting Inflammation and Regulating the Differentiation of Myoblasts. Int J Endocrinol 2023; 2023:9926462. [PMID: 37584041 PMCID: PMC10425251 DOI: 10.1155/2023/9926462] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/12/2023] [Accepted: 07/28/2023] [Indexed: 08/17/2023] Open
Abstract
Background Type 2 diabetes mellitus increases the risk of sarcopenia, which is characterized by decreased muscle mass, strength, and function. However, there are no effective drugs to treat diabetic sarcopenia, and its underlying mechanism remains unknown. Here, we aimed to determine whether the GLP-1 receptor agonist (GLP-1RA) dulaglutide (Dul) affects the progression of diabetic sarcopenia. Methods db/db mice were injected intraperitoneally with 0.6 mg/kg dulaglutide for 10 weeks. Mouse muscle tissues were then pathologically evaluated and stained with F4/80 or MPO to detect macrophages and neutrophils, respectively. In addition, inflammatory factors and FNDC5 in the muscle tissues were detected using qRT-PCR. Moreover, C2C12 cells were induced to enable their differentiation into skeletal muscle cells, and muscle factor levels were then detected. Furthermore, changes in muscle factor levels were detected at various glucose concentrations (11 mM, 22 mM, and 44 mM). Results In vivo, dulaglutide alleviated muscle tissue injury; reduced levels of the inflammatory factors, IL-1β, IL-6, CCL2, and CXCL1; and reversed the level of FNDC5 in the muscle tissues of db/db mice. In vitro, a C2C12 cell differentiation model was established through the observation of cell morphology and determination of myokine levels. Upon stimulation with high glucose, the differentiation of C2C12 cells was inhibited. Dulaglutide improved this inhibitory state by upregulating the levels of both FNDC5 mRNA and protein. Conclusions Treatment with the GLP-1RA dulaglutide protects db/db mice against skeletal muscle injury by inhibiting inflammation and regulating the differentiation of myoblasts. High glucose inhibited the differentiation of C2C12 cells and decreased the mRNA and protein levels of myokines. Dulaglutide could reverse the differentiation state induced in C2C12 cells by high glucose.
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Affiliation(s)
- Fengyi Deng
- Department of Endocrinology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230061, China
- Research Center for Translational Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei 230061, China
| | - Wenyan Wu
- Department of Endocrinology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230061, China
- Research Center for Translational Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei 230061, China
| | - Xingyu Fan
- Department of Endocrinology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230061, China
- Research Center for Translational Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei 230061, China
| | - Xing Zhong
- Department of Endocrinology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230061, China
- Research Center for Translational Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei 230061, China
| | - Nuojin Wang
- Department of Endocrinology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230061, China
- Research Center for Translational Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei 230061, China
| | - Yue Wang
- Department of Endocrinology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230061, China
- Research Center for Translational Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei 230061, China
| | - Tianrong Pan
- Department of Endocrinology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230061, China
- Research Center for Translational Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei 230061, China
| | - Yijun Du
- Department of Endocrinology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230061, China
- Research Center for Translational Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei 230061, China
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Blood urea nitrogen to creatinine ratio is associated with physical frailty in older-aged Chinese: a cross-sectional study. Aging Clin Exp Res 2023; 35:581-589. [PMID: 36629995 DOI: 10.1007/s40520-022-02332-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/16/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND The relationship between the ratio of blood urea nitrogen to creatinine (BUN/Cr) and physical frailty in elderly patients remains unclear. The study aims to investigate the association between the BUN/Cr ratio and physical frailty in the elderly Chinese population. METHODS In this cross-sectional analysis, the clinical data of 5213 participants from 2015 were selected from the China Health and Retirement Longitudinal Study (CHARLS). The demographic variables (including age and gender) and health behavior (including smoking and drinking history), anthropometric (including systolic and diastolic blood pressure, waist circumference (WC), etc.), physical performances (i.e., grip strength, repeated chair stands, etc.), and biochemical indicators (i.e., blood urea nitrogen (BUN), creatinine(Cr), total cholesterol (TC), triglycerides (TG), etc.) were measured. The association between the BUN/Cr ratio and physical frailty was analyzed. RESULTS After adjusting for potential confounding factors, smooth curve fitting showed a linear relationship between the BUN/Cr ratio and grip strength, a non-linear relationship between the BUN/Cr ratio, and repeated chair-rising time. The fully adjusted linear regression results showed a negative association between the BUN/Cr ratio and grip strength. In the multivariate, piecewise linear regression, when the BUN/Cr ratio was greater than 18.60, the repeated chair-rising time increased with the increase in BUN/Cr ratio (β = 0.046, 95%CI 0.025, 0.066; p < 0.001). However, we did not observe a significant correlation when the BUN/Cr ratio was less than 18.60 (β = -0.007, 95%CI -0.046, 0.032; p = 0.717). CONCLUSION This study demonstrated that the BUN/Cr ratio might be associated with physical frailty in older-aged Chinese, and this association requires further investigation.
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Lobo PCB, de Branco FMS, Pichard C, de Oliveira EP, Pimentel GD. C-reactive protein, but not neutrophil-lymphocyte ratio, is inversely associated with muscle strength only in older men: NHANES 1999-2002. Exp Gerontol 2023; 173:112084. [PMID: 36634720 DOI: 10.1016/j.exger.2023.112084] [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: 06/13/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 01/11/2023]
Abstract
To evaluate the association of inflammation (C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR) levels) with muscle strength in older adults. We also aimed to evaluate whether these associations are sex-specific. A cross-sectional study was performed with data from the National Health and Nutrition Examination Survey (NHANES) 1999-2000 and 2001-2002. A total of 2387 individuals over 50 years of both sexes were evaluated, according to the eligibility criteria for the strength test. Muscle strength was measured by Kinetic Communicator isokinetic dynamometer; while the NLR was obtained by the ratio of the total neutrophil for lymphocyte count and CRP was quantified by latex nephelometry. Linear regression analyses, crude and adjusted for confounders, were used to estimate the coefficients and 95 % confidence intervals for peak strength (muscle strength) by tertiles of NLR and CRP. There was no association between NLR and peak strength for both sexes. CRP levels were inversely associated with peak force in men [2nd tertile β = -3.33 (-15.92; 9.25); 3rd tertile β = -24.69 (-41.18; -8.20), p for trend = 0.005], but not in women [2nd tertile β = -3.22 (-15.00; 8.56); 3rd tertile β = -9.23 (-28.40; -9.94), p for trend = 0.332]. In conclusion, NLR levels were not associated with muscle strength in both sexes. CRP levels were inversely associated with muscle strength in older men, but not in women, suggesting that the association between inflammation and muscle strength in older adults can be sex-specific.
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Affiliation(s)
| | - Flávia M S de Branco
- Laboratory of Nutrition, Exercise and Health (LaNES), School of Medicine, Federal University of Uberlandia, Minas Gerais, Brazil
| | - Claude Pichard
- Nutrition Unit, Geneva University Hospital, Geneva, Switzerland
| | - Erick P de Oliveira
- Laboratory of Nutrition, Exercise and Health (LaNES), School of Medicine, Federal University of Uberlandia, Minas Gerais, Brazil
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11
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Prognostic Impact of Sarcopenia's Occurrence during Radiotherapy in Oropharyngeal Cancer Patients. Cancers (Basel) 2023; 15:cancers15030723. [PMID: 36765681 PMCID: PMC9913355 DOI: 10.3390/cancers15030723] [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: 12/14/2022] [Revised: 01/16/2023] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
The current study aims to profile sarcopenic condition (both at baseline and developed during treatment) in oropharyngeal carcinoma (OPC) patients treated with curative radiotherapy (RT) +/- chemotherapy and to evaluate its impact on oncological outcomes and toxicity. A total of 116 patients were included in this retrospective single-center study. Sarcopenia assessment at baseline and at 50 Gy re-evaluation CT was obtained from two different methodologies: (i) the L3-skeletal muscle index (SMI) derived from the contouring of the cross-sectional area (CSA) of the masticatory muscles (CSA-MM); and (ii) the paravertebral and sternocleidomastoid muscles at the level of the third cervical vertebra (CSA-C3). Based on L3-SMI from CSA-MM, developing sarcopenic condition during RT (on-RT sarcopenia) was associated with worse progression-free survival (PFS) (p = 0.03) on multivariable analysis and a trend of correlation with overall survival (OS) was also evident (p = 0.05). According to L3-SMI derived from CSA-C3, on-RT sarcopenia was associated with worse PFS (p = 0.0096) and OS (p = 0.013) on univariate analysis; these associations were not confirmed on multivariable analysis. A significant association was reported between becoming on-RT sarcopenia and low baseline haemoglobin (p = 0.03) and the activation of nutritional counselling (p = 0.02). No significant associations were found between sarcopenia and worse RT toxicity. Our data suggest that the implementation of prompt nutritional support to prevent the onset of sarcopenia during RT could improve oncological outcomes in OPC setting.
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12
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Deng Y, Zhao L, Huang X, Zeng Y, Xiong Z, Zuo M. Contribution of skeletal muscle to cancer immunotherapy: A focus on muscle function, inflammation, and microbiota. Nutrition 2023; 105:111829. [PMID: 36265324 DOI: 10.1016/j.nut.2022.111829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 08/06/2022] [Accepted: 08/09/2022] [Indexed: 11/17/2022]
Abstract
Sarcopenia, characterized by degenerative and systemic loss of skeletal muscle mass and function, is a multifactorial syndrome commonly observed in individuals with cancer. Additionally, it represents a poor nutritional status and indicates possible presence of cancer cachexia. Recently, with the extensive application of cancer immunotherapy, the effects of sarcopenia/cachexia on cancer immunotherapy, have gained attention. The aim of this review was to summarize the influence of low muscle mass (sarcopenia/cachexia) on the response and immune-related adverse events to immunotherapy from the latest literature. It was revealed that low muscle mass (sarcopenia/cachexia) has detrimental effects on cancer immunotherapy in most cases, although there were results that were not consistent with this finding. This review also discussed potential causes of the paradox, such as different measure methods, research types, muscle indicators, time point, and cancer type. Mechanically, chronic inflammation, immune cells, and microbiota may be critically involved in regulating the efficacy of immunotherapy under the condition of low muscle mass (sarcopenia/cachexia). Thus, nutritional interventions will likely be promising ways for individuals with cancer to increase the efficacy of immunotherapy in the future, for low muscle mass (sarcopenia/cachexia) is an important prognostic factor for cancer immunotherapy.
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Affiliation(s)
- Yuanle Deng
- Department of Clinical Nutrition, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Sichuan, China
| | - Ling Zhao
- Department of Clinical Nutrition, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Sichuan, China
| | - Xuemei Huang
- Department of Clinical Nutrition, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Sichuan, China
| | - Yu Zeng
- Department of Clinical Nutrition, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Sichuan, China
| | - Zhujuan Xiong
- Department of Clinical Nutrition, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Sichuan, China.
| | - Ming Zuo
- Department of Clinical Nutrition, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Sichuan, China
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He X, Song Y, Ma L, Ainsworth BE, Liu Y, Chen N. Prevalence and Factors Influencing Sarcopenia Among Community-Dwelling Older Adults Using the Asian Working Group for Sarcopenia Definition. Clin Interv Aging 2022; 17:1707-1727. [PMID: 36471806 PMCID: PMC9719269 DOI: 10.2147/cia.s388319] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/20/2022] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVE This study aimed to explore the prevalence and impact of related factors for sarcopenia among community-dwelling older people in Chongming district, China, according to the diagnostic criteria of the Asia Working Group for Sarcopenia-2019. METHODS We conducted a cross-sectional study from April 2021 to December 2021. Diagnosis of sarcopenia (non-sarcopenia, possible sarcopenia, sarcopenia, and severe sarcopenia) was based on appendicular skeletal muscle mass index, handgrip strength, gait speed, and the 5-time chair stand test. Staff collected all subjects' clinical and sociodemographic characteristics, cardiovascular disease (CVD) risk factors, inflammatory markers, physical activity (PA), and daily lifestyle activities to identify sarcopenia-related factors. RESULTS A total of 1407 older people aged ≥ 65 years were enrolled into the study (58.7% female). The prevalence of confirmed sarcopenia was 19.6% (17.1% in females and 23.1% in males). The prevalence of possible sarcopenia, sarcopenia, and severe sarcopenia were 19.7% (22.2% in females, 16.2% in males), 11.9% (10.1% in females, 14.5% in males), and 7.7% (7% in females, 8.6% in males), respectively. Increasing age, gender, depression status, and high-fat mass were associated with an increased likelihood of sarcopenia in all subjects. In females, living alone, high-fat mass, lower body mass index (BMI), lower body weight, and have no time spent doing housework increased the likelihood of sarcopenia. In males, depression status, high-fat mass, higher neutrophils-to-lymphocytes ratio (NLR), lower BMI, lower body weight increased the likelihood of sarcopenia. CONCLUSION Our study showed a high prevalence of sarcopenia among community-dwelling older people in the Chongming district. Detection, prevention, and treatment efforts are needed to reduce the impact of sarcopenia in older, rural communities in China.
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Affiliation(s)
- Xiangfeng He
- Department of Rehabilitation, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China
- Department of Rehabilitation, Xinhua Hospital Chongming Branch, Shanghai, People’s Republic of China
| | - Yanping Song
- Department of Rehabilitation, Xinhua Hospital Chongming Branch, Shanghai, People’s Republic of China
| | - Lin Ma
- Department of Rehabilitation, Xinhua Hospital Chongming Branch, Shanghai, People’s Republic of China
| | | | - Yu Liu
- School of Kinesiology, Shanghai University of Sport, Shanghai, People’s Republic of China
| | - Nan Chen
- Department of Rehabilitation, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China
- Department of Rehabilitation, Xinhua Hospital Chongming Branch, Shanghai, People’s Republic of China
- School of Kinesiology, Shanghai University of Sport, Shanghai, People’s Republic of China
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Multi-omics profiling reveals Chitinase-3-like protein 1 as a key mediator in the crosstalk between sarcopenia and liver cancer. Redox Biol 2022; 58:102538. [PMID: 36417796 PMCID: PMC9682348 DOI: 10.1016/j.redox.2022.102538] [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: 07/13/2022] [Revised: 10/20/2022] [Accepted: 11/09/2022] [Indexed: 11/14/2022] Open
Abstract
Sarcopenia is prevalent in patients with hepatocellular carcinoma (HCC), and can adversely affect their outcomes. This study aims to explore the key mechanisms in the crosstalk between sarcopenia and HCC based on multi-omics profiling. A total of 136 male patients with HCC were enrolled. Sarcopenia was an independent risk factor for poor outcomes after liver transplantation (p < 0.05). Inflammatory cytokine and metabolomic profiling on these patients identified elevated plasma sTNF-R1/CHI3L1 and dysregulated lipid metabolism as related to sarcopenia and tumor recurrence risk concurrently (p < 0.05). Integrated analysis revealed close relationship between CHI3L1 and fatty acid metabolism. In mouse cachectic models by intraperitoneal injection of H22 cells, CHI3L1 was significantly elevated in the atrophic muscle tissue, as well as in circulation. In-vitro, CHI3L1 was up-regulated in muscle cells to protect itself from inflammatory damage through TNF-α/TNF-R1 signaling. CHI3L1 secreted by the muscle cells promoted the invasion of co-cultured HCC cells. Tumor tissue transcriptome data for 73 out of the 136 patients revealed that CHI3L1 may regulate fatty acid metabolism and oxidative stress. In vitro, CHI3L1 caused ROS and lipid accumulation. Targeted lipid profiling further proved that CHI3L1 was able to activate arachidonic acid metabolism, leading to lipid peroxide (LPO) accumulation. Meanwhile, LPO inhibition could compromise the remarkable pro-cancerous effects of CHI3L1. In conclusion, sarcopenia adversely affects the outcomes of liver transplantation for HCC. In sarcopenic patients, CHI3L1 was up-regulated and secreted by the skeletal muscle to protect itself through TNF-α/TNF-R1 signaling, which, in turn, can promote HCC tumor progression by inducing LPO accumulation.
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Gao H, Wang J, Zou X, Zhang K, Zhou J, Chen M. High blood urea nitrogen to creatinine ratio is associated with increased risk of sarcopenia in patients with chronic obstructive pulmonary disease. Exp Gerontol 2022; 169:111960. [PMID: 36152777 DOI: 10.1016/j.exger.2022.111960] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Sarcopenia has been reported to be a prognostic factor for chronic obstructive pulmonary disease (COPD). However, the relationship between the ratio of blood urea nitrogen to creatinine (BUN/Cr) and sarcopenia in patients with COPD remain unclear. Therefore, the purpose of this study is to explore whether the ratio can be used as a predictor of sarcopenia in hospitalized COPD patients. METHODS The skeletal muscle area index (SMI) at the level of the 12th thoracic vertebra (T12) was used to assess the risk of sarcopenia in patients. This single center cross-sectional study was conducted by analyzing the clinical parameters and identifying the T12 skeletal muscle area (SMA) and density (SMD) on chest CT images of COPD hospitalized patients admitted to the respiratory department of our hospital from March 2018 to August 2021. The study enrolled 265 hospitalized patients. Based on the different statistical properties of the above variables, differences between groups were measured by independent sample Student t-tests, Mann-Whitney U tests, or Chi-Square tests. Multivariable linear regression analysis was used to evaluate the relationship between the value of BUN/Cr and the risk of sarcopenia. RESULTS The serum BUN/Cr ratio was negatively correlated with SMI (r = -0.201, p = 0.001) in COPD patients, and multivariate linear regression analysis showed that this ratio was associated with the risk of sarcopenia (β = -0.109, p = 0.041). The optimal cut-off value of BUN/Cr ratio for identifying COPD patients with sarcopenia was 97.893. There was also a significant negative correlation between serum BUN/Cr ratio and forced vital capacity (FVC; r = -0.235, p < 0.001) and forced expiratory volume in the first second (FEV1; r = -0.219, p < 0.001). CONCLUSION The BUN/Cr ratio can be used to predict sarcopenia and evaluate pulmonary function in hospitalized COPD patients.
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Affiliation(s)
- Hengxing Gao
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, 277#, Yanta West Road, Xi'an, Shaanxi Province 710061, China
| | - Jing Wang
- Department of Pulmonary and Critical Care Medicine, Shaanxi Provincial Second People's Hospital, No. 3 Shangqin Road, Xi'an, Shaanxi Province 710005, China
| | - Xuexue Zou
- Department of Radiology, Binzhou Medical University Hospital, 661 Yellow River Road, Binzhou, Shandong Province 256600, China
| | - Kun Zhang
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, 277#, Yanta West Road, Xi'an, Shaanxi Province 710061, China
| | - Jiejun Zhou
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, 277#, Yanta West Road, Xi'an, Shaanxi Province 710061, China
| | - Mingwei Chen
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, 277#, Yanta West Road, Xi'an, Shaanxi Province 710061, China; Department of Pulmonary and Critical Care Medicine, Shaanxi Provincial Second People's Hospital, No. 3 Shangqin Road, Xi'an, Shaanxi Province 710005, China.
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Liu P, Chen S, Gao X, Liang H, Sun D, Shi B, Zhang Q, Guo H. Preoperative sarcopenia and systemic immune-inflammation index can predict response to intravesical Bacillus Calmette-Guerin instillation in patients with non-muscle invasive bladder cancer. Front Immunol 2022; 13:1032907. [PMID: 36225922 PMCID: PMC9549861 DOI: 10.3389/fimmu.2022.1032907] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/26/2022] [Indexed: 11/15/2022] Open
Abstract
Background To explore the prognostic significance of sarcopenia and systemic immune-inflammation index (SII) for response to intravesical Bacillus Calmette-Guerin (BCG) in patients with intermediate-, and high-risk non-muscle invasive bladder cancer (NMIBC). Methods We retrospectively analyzed 183 consecutive patients treated in Qilu hospital of Shandong University for a first diagnosis of intermediate and high risk NMIBC. Using computed tomography scans at the third lumbar vertebra level, we calculated skeletal muscle index (SMI). Sarcopenia was defined as SMI <43 cm2/m2 for males with BMI < 25 kg/m2, <53 cm2/m2 for males with BMI ≥ 25 kg/m2, and <41 cm2/m2 for females. The response to intravesical BCG immunotherapy and relapse-free survival (RFS) were analyzed. Results Compared with BCG responders, BCG non-responders were associated with sarcopenia (P < 0.001), carcinoma in situ (P < 0.001), T1 stage (P < 0.001), multiple tumor (P < 0.001), tumor diameter >=3cm (P < 0.001), and have a significant increase of neutrophil-to-lymphocyte ratio (NLR) (P < 0.001), platelet to lymphocyte ratio (PLR) (P = 0.004), SII (P < 0.001). The area under the ROC curve (AUC) of the BMI, NLR, PLR, and SII for response to intravesical BCG immunotherapy were 0.425, 0.693, 0.631, and 0.702 respectively. Logistic regression analysis demonstrated that sarcopenia and SII were predictors of response to intravesical BCG immunotherapy. The Kaplan-Meier survival analysis showed that the RFS of patients with BCG response, lower SII and no sarcopenia was significantly increased compared with that of patients with BCG non-response, higher SII and sarcopenia, respectively. Subgroup analysis demonstrated that the RFS of patients with high SII and sarcopenia was significantly decreased compared with those with low SII and no sarcopenia in Ta stage subgroup, T1 stage subgroup, non-Cis subgroup, multiple tumor subgroup, single tumor subgroup, tumor diameter≥3cm subgroup and tumor diameter<3cm subgroup, respectively (P < 0.05). However, there was no significant difference in RFS for patients in CIS subgroup (P > 0.05). Multivariate Cox analysis shown that sarcopenia (p=0.005) and high SII (p = 0.003) were significantly associated with poor RFS. Conclusions Both sarcopenia and high SII are useful predictors of response to intravesical BCG in intermediate- and high-risk NMIBC patients. Patients with intermediate- and high-risk NMIBC that had sarcopenia or high SII at diagnosis were associated with poor RFS, and the combination of sarcopenia and SII may be a better predictor of RFS.
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Affiliation(s)
| | | | | | | | | | | | | | - Hu Guo
- *Correspondence: Hu Guo, ; Qiujie Zhang,
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17
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Song M, Zhang Q, Song C, Liu T, Zhang X, Ruan G, Tang M, Zhang X, Xie H, Zhang H, Ge Y, Li X, Zhang K, Yang M, Li Q, Liu X, Lin S, Xu Y, Li B, Li X, Wang K, Xu H, Li W, Shi H. Handgrip weakness, systemic inflammation indicators, and overall survival in lung cancer patients with well performance status: A large multicenter observational study. Cancer Med 2022; 12:2818-2830. [PMID: 36073671 PMCID: PMC9939150 DOI: 10.1002/cam4.5180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/14/2022] [Accepted: 05/28/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Systemic inflammation and handgrip weakness have been used to predict mortality in many cancers. The purpose of current study was to evaluate the association of co-occurrence of inflammation indicators and handgrip weakness with overall survival (OS) of lung cancer (LC) patients with good performance status. METHODS The cutoff points for handgrip strength (HGS) and the four inflammation indicators were calculated using Maxstat. The time-dependent receiver operating characteristic curve and C-index were used to select optimal inflammation indicator for predicting OS of LC patients. The Cox proportional hazard regression model was used to calculate the hazard ratio (HR) of mortality. Kaplan-Meier curves were constructed to evaluate the association of indicators and the OS of LC patients. RESULTS Among the 1951 patients, the mean ± standard deviation (SD) age was 60.6 ± 9.9 years, and 1300 (66.6%) patients were male. In patients with good performance status (PS), handgrip weakness (HR, 1.49; 95% confidence interval [95% CI], 1.30-1.70, p < 0.001) and low advanced lung cancer inflammation index (ALI) (HR, 2.05; 95%CI, 1.79-2.34, p < 0.001), high systemic immune-inflammation index (SII) (HR, 1.91; 95%CI, 1.66-2.19, p < 0.001), high platelet: lymphocyte ratio (PLR) (HR, 1.60; 95%CI, 1.40-1.82, p < 0.001), or high neutrophil: lymphocyte ratio (NLR) (HR, 2.01; 95%CI, 1.76-2.30, p < 0.001) were associated with increased mortality risk of LC patients. ALI had better C-index (0.624) and time-AUC in the prediction of OS in LC patients with good PS than other three combinations. The co-occurrence of handgrip weakness and low ALI more than doubled the risk of death in LC with good PS (HR, 2.44; 95% CI, 2.06-2.89, p < 0.001). CONCLUSION In LC patients who have good PS, patients with combined handgrip weakness and low ALI have the worst prognosis. THE TRIAL REGISTRATION NUMBER ChiCTR1800020329.
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Affiliation(s)
- Mengmeng Song
- Department of Gastrointestinal Surgery/Clinical NutritionCapital Medical University Affiliated Beijing Shijitan HospitalBeijingChina,National Clinical Research Center for Geriatric Diseases, Xuanwu HospitalCapital Medical UniversityBeijingChina,Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
| | - Qi Zhang
- Department of Gastrointestinal Surgery/Clinical NutritionCapital Medical University Affiliated Beijing Shijitan HospitalBeijingChina,National Clinical Research Center for Geriatric Diseases, Xuanwu HospitalCapital Medical UniversityBeijingChina,Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
| | - Chunhua Song
- Department of Epidemiology and StatisticsHenan Key Laboratory of Tumor Epidemiology College of Public Health, Zhengzhou UniversityZhengzhouHenanChina
| | - Tong Liu
- Department of Gastrointestinal Surgery/Clinical NutritionCapital Medical University Affiliated Beijing Shijitan HospitalBeijingChina,National Clinical Research Center for Geriatric Diseases, Xuanwu HospitalCapital Medical UniversityBeijingChina,Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
| | - Xi Zhang
- Department of Gastrointestinal Surgery/Clinical NutritionCapital Medical University Affiliated Beijing Shijitan HospitalBeijingChina,National Clinical Research Center for Geriatric Diseases, Xuanwu HospitalCapital Medical UniversityBeijingChina,Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
| | - Guotian Ruan
- Department of Gastrointestinal Surgery/Clinical NutritionCapital Medical University Affiliated Beijing Shijitan HospitalBeijingChina,National Clinical Research Center for Geriatric Diseases, Xuanwu HospitalCapital Medical UniversityBeijingChina,Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
| | - Meng Tang
- Department of Gastrointestinal Surgery/Clinical NutritionCapital Medical University Affiliated Beijing Shijitan HospitalBeijingChina,National Clinical Research Center for Geriatric Diseases, Xuanwu HospitalCapital Medical UniversityBeijingChina,Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
| | - Xiaowei Zhang
- Department of Gastrointestinal Surgery/Clinical NutritionCapital Medical University Affiliated Beijing Shijitan HospitalBeijingChina,National Clinical Research Center for Geriatric Diseases, Xuanwu HospitalCapital Medical UniversityBeijingChina,Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
| | - Hailun Xie
- Department of Gastrointestinal Surgery/Clinical NutritionCapital Medical University Affiliated Beijing Shijitan HospitalBeijingChina,National Clinical Research Center for Geriatric Diseases, Xuanwu HospitalCapital Medical UniversityBeijingChina,Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
| | - Heyang Zhang
- Department of Gastrointestinal Surgery/Clinical NutritionCapital Medical University Affiliated Beijing Shijitan HospitalBeijingChina,National Clinical Research Center for Geriatric Diseases, Xuanwu HospitalCapital Medical UniversityBeijingChina,Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
| | - Yizhong Ge
- Department of Gastrointestinal Surgery/Clinical NutritionCapital Medical University Affiliated Beijing Shijitan HospitalBeijingChina,National Clinical Research Center for Geriatric Diseases, Xuanwu HospitalCapital Medical UniversityBeijingChina,Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina,The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical UniversityWenzhouChina
| | - Xiangrui Li
- Department of Gastrointestinal Surgery/Clinical NutritionCapital Medical University Affiliated Beijing Shijitan HospitalBeijingChina,National Clinical Research Center for Geriatric Diseases, Xuanwu HospitalCapital Medical UniversityBeijingChina,Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
| | - Kangping Zhang
- Department of Gastrointestinal Surgery/Clinical NutritionCapital Medical University Affiliated Beijing Shijitan HospitalBeijingChina,National Clinical Research Center for Geriatric Diseases, Xuanwu HospitalCapital Medical UniversityBeijingChina,Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
| | - Ming Yang
- Department of Gastrointestinal Surgery/Clinical NutritionCapital Medical University Affiliated Beijing Shijitan HospitalBeijingChina,Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
| | - Qinqin Li
- Department of Gastrointestinal Surgery/Clinical NutritionCapital Medical University Affiliated Beijing Shijitan HospitalBeijingChina,National Clinical Research Center for Geriatric Diseases, Xuanwu HospitalCapital Medical UniversityBeijingChina,Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina,Liaocheng UniversityLiaochengChina
| | - Xiaoyue Liu
- Department of Gastrointestinal Surgery/Clinical NutritionCapital Medical University Affiliated Beijing Shijitan HospitalBeijingChina,National Clinical Research Center for Geriatric Diseases, Xuanwu HospitalCapital Medical UniversityBeijingChina,Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
| | - Shiqi Lin
- Department of Gastrointestinal Surgery/Clinical NutritionCapital Medical University Affiliated Beijing Shijitan HospitalBeijingChina,National Clinical Research Center for Geriatric Diseases, Xuanwu HospitalCapital Medical UniversityBeijingChina,Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
| | - Yu Xu
- The First Affiliated Hospital of Kunming Medical UniversityYunnanChina
| | - Bo Li
- Affiliated Hospital of Yunnan UniversityKunmingChina
| | - Xiaogang Li
- Affiliated Hospital of Yunnan UniversityKunmingChina
| | - Kunhua Wang
- Yunnan UniversityKunmingChina,General Surgery Clinical Medical Center of Yunnan ProvinceKunmingChina
| | - Hongxia Xu
- Department of NutritionDaping Hospital & Research Institute of Surgery, Third Military Medical UniversityChongqingChina
| | - Wei Li
- Cancer Center of the First Hospital of Jilin UniversityChangchunChina
| | - Hanping Shi
- Department of Gastrointestinal Surgery/Clinical NutritionCapital Medical University Affiliated Beijing Shijitan HospitalBeijingChina,National Clinical Research Center for Geriatric Diseases, Xuanwu HospitalCapital Medical UniversityBeijingChina,Key Laboratory of Cancer FSMP for State Market RegulationBeijingChina,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and NutritionBeijingChina
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Yoshida Y, Iwasa H, Kim H, Suzuki T. Association between Neutrophil-to-Lymphocyte Ratio and Physical Function in Older Adults: A Community-Based Cross-Sectional Study in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19158996. [PMID: 35897367 PMCID: PMC9332416 DOI: 10.3390/ijerph19158996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 12/10/2022]
Abstract
Inflammatory responses contribute to physical decline in older adults. Clinical studies have shown that the neutrophil-to-lymphocyte ratio (NLR), a marker of inflammation, is associated with physical decline. However, its association with physical function in community-dwelling older people is still unclear. Hence, we used cross-sectional data to investigate the relationship between NLR and physical function in community-dwelling older adults. Specifically, we analyzed data corresponding to 818 individuals (336 men and 482 women) aged ≥ 75 years, all of whom participated in comprehensive health examinations, including face-to-face interviews, biochemical analyses, and physical function tests. Using these data, we performed multivariable logistic regression analysis to assess the relationship between NLR and physical function, adjusting for sex, age, education, alcohol consumption, smoking, instrumental activity of daily living, body mass index, chronic disease, physical activity, serum albumin level, and depressive mood. The results showed that a higher NLR was associated with a lower grip strength, lower knee extension strength, and slower walking speed. Importantly, the relationship between NLR and physical function was maintained after adjusting for the confounding factors. Thus, we showed a significant association between NLR and physical function, supporting the use of NLR as a marker of physical function in community-dwelling older adults.
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Affiliation(s)
- Yuko Yoshida
- Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan; (H.I.); (H.K.); (T.S.)
- Correspondence: ; Tel.: +81-3-3964-3241
| | - Hajime Iwasa
- Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan; (H.I.); (H.K.); (T.S.)
- Department of Public Health, School of Medicine, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Hunkyung Kim
- Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan; (H.I.); (H.K.); (T.S.)
| | - Takao Suzuki
- Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan; (H.I.); (H.K.); (T.S.)
- Institute of Gerontology, J. F. Oberlin University, Tokyo 194-0294, Japan
- National Center for Geriatrics and Gerontology, Obu 474-8511, Japan
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Yusufaly TI, Zou J, Nelson TJ, Williamson CW, Simon A, Singhal M, Liu H, Wong H, Saenz CC, Mayadev J, McHale MT, Yashar CM, Eskander R, Sharabi A, Hoh CK, Obrzut S, Mell LK. Improved Prognosis of Treatment Failure in Cervical Cancer with Nontumor PET/CT Radiomics. J Nucl Med 2022; 63:1087-1093. [PMID: 34711618 PMCID: PMC9258568 DOI: 10.2967/jnumed.121.262618] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 10/20/2021] [Indexed: 01/03/2023] Open
Abstract
Radiomics has been applied to predict recurrence in several disease sites, but current approaches are typically restricted to analyzing tumor features, neglecting nontumor information in the rest of the body. The purpose of this work was to develop and validate a model incorporating nontumor radiomics, including whole-body features, to predict treatment outcomes in patients with previously untreated locoregionally advanced cervical cancer. Methods: We analyzed 127 cervical cancer patients treated definitively with chemoradiotherapy and intracavitary brachytherapy. All patients underwent pretreatment whole-body 18F-FDG PET/CT. To quantify effects due to the tumor itself, the gross tumor volume (GTV) was directly contoured on the PET/CT image. Meanwhile, to quantify effects arising from the rest of the body, the planning target volume (PTV) was deformably registered from each planning CT to the PET/CT scan, and a semiautomated approach combining seed-growing and manual contour review generated whole-body muscle, bone, and fat segmentations on each PET/CT image. A total of 965 radiomic features were extracted for GTV, PTV, muscle, bone, and fat. Ninety-five patients were used to train a Cox model of disease recurrence including both radiomic and clinical features (age, stage, tumor grade, histology, and baseline complete blood cell counts), using bagging and split-sample-validation for feature reduction and model selection. To further avoid overfitting, the resulting models were tested for generalization on the remaining 32 patients, by calculating a risk score based on Cox regression and evaluating the c-index (c-index > 0.5 indicates predictive power). Results: Optimal performance was seen in a Cox model including 1 clinical biomarker (whether or not a tumor was stage III-IVA), 2 GTV radiomic biomarkers (PET gray-level size-zone matrix small area low gray level emphasis and zone entropy), 1 PTV radiomic biomarker (major axis length), and 1 whole-body radiomic biomarker (CT bone root mean square). In particular, stratification into high- and low-risk groups, based on the linear risk score from this Cox model, resulted in a hazard ratio of 0.019 (95% CI, 0.004, 0.082), an improvement over stratification based on clinical stage alone, which had a hazard ratio of 0.36 (95% CI, 0.16, 0.83). Conclusion: Incorporating nontumor radiomic biomarkers can improve the performance of prognostic models compared with using only clinical and tumor radiomic biomarkers. Future work should look to further test these models in larger, multiinstitutional cohorts.
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Affiliation(s)
- Tahir I. Yusufaly
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | - Jingjing Zou
- Department of Family Medicine and Public Health and Department of Mathematics, University of California San Diego, La Jolla, California
| | - Tyler J. Nelson
- Center for Precision Radiation Medicine, La Jolla, California
| | - Casey W. Williamson
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Aaron Simon
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | | | - Hannah Liu
- Center for Precision Radiation Medicine, La Jolla, California
| | - Hank Wong
- Center for Precision Radiation Medicine, La Jolla, California
| | - Cheryl C. Saenz
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, University of California San Diego, La Jolla, California; and
| | - Jyoti Mayadev
- Center for Precision Radiation Medicine, La Jolla, California;,Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Michael T. McHale
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, University of California San Diego, La Jolla, California; and
| | - Catheryn M. Yashar
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Ramez Eskander
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, University of California San Diego, La Jolla, California; and
| | - Andrew Sharabi
- Center for Precision Radiation Medicine, La Jolla, California;,Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Carl K. Hoh
- Department of Radiology, Division of Nuclear Medicine, University of California San Diego, La Jolla, California
| | - Sebastian Obrzut
- Department of Radiology, Division of Nuclear Medicine, University of California San Diego, La Jolla, California
| | - Loren K. Mell
- Center for Precision Radiation Medicine, La Jolla, California;,Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
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20
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Impact of hematologic toxicities during concurrent chemoradiation for cervical cancer. Obstet Gynecol Sci 2022; 65:176-187. [PMID: 35189679 PMCID: PMC8942745 DOI: 10.5468/ogs.21308] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 02/03/2022] [Indexed: 11/08/2022] Open
Abstract
Objective To evaluate the prognostic significance of hematological toxicities during cervical cancer treatment. Methods Patients treated for cervical carcinoma with definitive chemoradiation were identified. Toxicities were assessed during weeks 1 to 6 of concurrent external beam radiation and chemotherapy. Outcomes were analyzed using Cox regression analysis. Results One hundred twenty-one patients with Federation of Gynecology and Obstetrics stage I–III disease were eligible for analysis. Median age at diagnosis was 45 years (interquartile range, 40–52) with median follow-up time of 34 months (95% confidence interval, 30.8–37.2). All patients experienced some grade of hematologic toxicity. The most common grade 3+ toxicities were low absolute lymphocyte count (n=115, 95%), low white blood cell count (n=21, 17%), and anemia (n=11, 9%). The most common grade 4 toxicity was lymphopenia, experienced by 36% of patients (n=44). Grade 4 lymphopenia was associated with reduced overall survival (hazard ratio [HR], 4.5; P=0.005), progression-free survival (HR, 3.4; P=0.001), and local control (HR, 4.1; P=0.047). Anemia grade 3, 4 was also associated with reduced overall survival (HR, 4.1; P=0.014). After controlling for disease and treatment variables, grade 4 lymphopenia remained significantly associated with reduced overall survival (HR, 9.85; P=0.007). The association with grade 4 lymphopenia only remained significant in women of Hispanic ethnicity. Conclusion Severe lymphopenia was associated with reduced overall survival and progression-free survival in Hispanic women undergoing definitive chemoradiation for cervical cancer, but not associated with outcomes in non-Hispanic women.
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21
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Association of immunity markers with the risk of incident frailty: the Rugao longitudinal aging study. Immun Ageing 2022; 19:1. [PMID: 34980175 PMCID: PMC8722120 DOI: 10.1186/s12979-021-00257-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 11/30/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and systemic immune-inflammation index (SII) are readily available circulatory immunity markers that are associated with components of frailty. However, few studies have investigated the relationship between these immunity markers and frailty, and it remains unknown whether they are predictive of incident frailty in older adults in general. Hence, we aimed to examine the association of these immunity markers with the risk of incident frailty. RESULTS Overall, 1822 older adults (mean age was 78.03 ± 4.46 years) were included in the Rugao Longitudinal Aging Study. NLR, PLR and SII were calculated from blood cell counts. The frailty definition was based on the Fried phenotype. At baseline, 200 (10.98%) individuals were defined as frailty, and no significant associations of NLR, PLR and SII with frailty were found. During the 2-year follow-up, 180 (15.67%) individuals were new-onset frailty. After adjustment, an increased logNLR (odds ratio [OR] 2.92, 95% confidence interval [CI] 1.20-7.18), logPLR (OR 2.54, 95% CI: 1.01-6.53) and logSII (OR 2.34, 95% CI: 1.16-4.78) were significantly associated with a higher risk of incident frailty in all individuals. Additionally, the associations of logNLR (OR 4.21, 95% CI 1.54-11.62 logPLR (OR 3.38, 95% CI: 1.17-9.91) and logSII (OR 2.56, 95% CI: 1.15-5.72) with incident frailty were remained after excluding individuals with comorbidities. In further analyzed, individuals with higher levels of NLR and SII had higher risk of incident frailty when we stratified individuals by quartiles of these immunity markers. CONCLUSION NLR and SII are easily obtained immunity markers that could be used to predict incident frailty in clinical practice.
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22
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Wan J, Liu G, Xia S, Liu S, Yang Y, Wang D, Hou J, Dai X, Zhou P, Wang P. Association between high-mobility group box 2 and subclinical hypertension-mediated organ damage in young adults. Ther Adv Chronic Dis 2022; 13:20406223221135011. [PMID: 36387760 PMCID: PMC9661567 DOI: 10.1177/20406223221135011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 10/06/2022] [Indexed: 11/11/2022] Open
Abstract
Background: Hypertension-mediated organ damage (HMOD) is an emerging problem among young adults. The potential role of chronic immune-mediated inflammation in the pathogenesis of HMOD is increasingly being recognized. High-mobility group box 2 (HMGB2) is known for its role in the modulation of innate immunity and exerts signaling functions that affect various inflammatory diseases. However, the association between HMGB2 and HMOD in young adults remains unclear. Objectives: The aim of this study was to explore the association between HMGB2 and subclinical HMOD in young adults. Design: This is a cross-sectional study. Methods: Body composition, carotid ultrasound, carotid-femoral PWV (cf-PWV) measures, echocardiography, serum HMGB2 levels, and serum classic cardiometabolic risk factors were measured in 988 untreated young adults. We estimated the risk related to serum HMGB2 using multivariable-adjusted linear and logistic regression models. Then, we conducted a pathway overrepresentation analysis to examine which key biological pathways may be linked to serum HMGB2 in young adults with HMOD. Results: Among the 988 untreated young adults, we identified four distinct hypertension phenotypes: normotension (40.0%), white-coat hypertension (16.0%), masked hypertension (20.9%), and sustained hypertension (23.1%). High levels of serum HMGB2 were related to increased carotid intima-media thickness (cIMT) and left ventricular mass index (LVMI), higher cf-PWV and blood pressure, and a lower estimated glomerular filtration rate (eGFR). Linear regression analysis showed that serum HMGB2 was positively associated with cf-PWV and negatively associated with eGFR in all patients. Multivariate analysis showed that high levels of serum HMGB2 were associated with high odds of subclinical HMOD (damage in at least one organ). Biological pathway analysis indicated that patients with high serum HMGB2 levels had increased activity of pathways, related to endothelial dysfunction, inflammatory processes, and atherosclerosis. Conclusion: High serum concentrations of HMGB2 are associated with an increased risk of subclinical HMOD in untreated young adults.
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Affiliation(s)
- Jindong Wan
- Department of Cardiology, The First Affiliated Hospital, Chengdu Medical College, Chengdu, P.R. China
- Sichuan Clinical Research Center for Geriatrics, The First Affiliated Hospital of Chengdu Medical College, Chengdu, P.R. China
- Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, P.R. China
| | - Gang Liu
- Medical Affair Department, The First Affiliated Hospital, Chengdu Medical College, Chengdu, P.R. China
| | - Siwei Xia
- Department of Cardiology, The First Affiliated Hospital, Chengdu Medical College, Chengdu, P.R. China
- Sichuan Clinical Research Center for Geriatrics, The First Affiliated Hospital of Chengdu Medical College, Chengdu, P.R. China
- Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, P.R. China
| | - Sen Liu
- Department of Cardiology, The First Affiliated Hospital, Chengdu Medical College, Chengdu, P.R. China
- Sichuan Clinical Research Center for Geriatrics, The First Affiliated Hospital of Chengdu Medical College, Chengdu, P.R. China
- Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, P.R. China
| | - Yi Yang
- Department of Cardiology, The First Affiliated Hospital, Chengdu Medical College, Chengdu, P.R. China
- Sichuan Clinical Research Center for Geriatrics, The First Affiliated Hospital of Chengdu Medical College, Chengdu, P.R. China
- Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, P.R. China
| | - Dan Wang
- Department of Cardiology, The First Affiliated Hospital, Chengdu Medical College, Chengdu, P.R. China
- Sichuan Clinical Research Center for Geriatrics, The First Affiliated Hospital of Chengdu Medical College, Chengdu, P.R. China
- Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, P.R. China
| | - Jixin Hou
- Department of Cardiology, The First Affiliated Hospital, Chengdu Medical College, Chengdu, P.R. China
- Sichuan Clinical Research Center for Geriatrics, The First Affiliated Hospital of Chengdu Medical College, Chengdu, P.R. China
- Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, P.R. China
| | - Xiaozhen Dai
- School of Biosciences and Technology, Chengdu Medical College, Chengdu, P.R. China
| | - Peng Zhou
- Department of Cardiology, The First Affiliated Hospital, Chengdu Medical College, Chengdu, P.R. China
- Sichuan Clinical Research Center for Geriatrics, The First Affiliated Hospital of Chengdu Medical College, Chengdu, P.R. China
- Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, P.R. China
| | - Peijian Wang
- Department of Cardiology, The First Affiliated Hospital of Chengdu Medical College, 278 Baoguang Avenue, Xindu District, Chengdu 610500, Sichuan, P.R. China
- Sichuan Clinical Research Center for Geriatrics, The First Affiliated Hospital of Chengdu Medical College, Chengdu, P.R. China
- Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, P.R. China
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Silva J, Giglio BM, Lobo PC, Araújo VA, Pimentel GD. Neutrophil-to-lymphocyte ratio is not associated with risk of sarcopenia in elderly COVID-19 patients. Rev Esp Geriatr Gerontol 2022; 57:325-329. [PMID: 36357231 PMCID: PMC9537255 DOI: 10.1016/j.regg.2022.09.010] [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: 03/03/2022] [Revised: 08/16/2022] [Accepted: 09/27/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND To assess the existence of association between neutrophil to lymphocyte ratio (NLR) and the risk of sarcopenia in COVID-19 patients. METHODS A retrospective cross-sectional study was conducted in a university hospital with patients with an active COVID-19 infection admitted to the nursing ward or intensive care unit (ICU) between September to December 2020. Sarcopenia risk was assessed using the Strength, Assistance for walking, Rise from a chair, Climb stairs and Falls (SARC-F). Biochemical analyses were assessed by circulating of C-reactive protein, D-dimer, neutrophils, lymphocytes count and NLR. Sixty-eight patients were evaluated and divided into tertiles of NLR values and the association between NLR and sarcopenia risk were tested using the linear regression analyses and p<0.05 were considered as significant. RESULTS Sixty-eight patients were evaluated and divided in NLR tertiles being the 1st (men=52.2%; 71.1±9.0 y; NLR: 1.1-3.85), 2nd (women=78.3%; 73.2±9.1 y; NLR: 3.9-6.0) and 3rd (men=72.7%; 71.7±10.4 y; NLR: 6.5-20.0). There was a difference between the tertiles in relation to the first to the biochemical parameters of total neutrophils count (p=0.001), C-reactive protein (p=0.012), and D-dimer (p=0.012). However, no difference was found in linear regression analysis between tertiles of NLR and SARC-F, if in total sample (p=0.054) or divided by sex, if men (p=0.369) or women (p=0.064). CONCLUSION In elderly patients hospitalized with COVID-19, we do not find an association between the risk of sarcopenia and NLR.
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Hu Q, Mao W, Wu T, Xu Z, Yu J, Wang C, Chen S, Chen S, Xu B, Xu Y, Chen M. High Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Are Associated With Sarcopenia Risk in Hospitalized Renal Cell Carcinoma Patients. Front Oncol 2021; 11:736640. [PMID: 34760698 PMCID: PMC8573165 DOI: 10.3389/fonc.2021.736640] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/28/2021] [Indexed: 01/04/2023] Open
Abstract
Purpose This study aimed i) to identify the best cutoff points of neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) that predict sarcopenia and ii) to illustrate the association between sarcopenia risk and NLR or PLR in renal cell carcinoma (RCC) patients undergoing laparoscopic partial or radical nephrectomy. Methods A total of 343 RCC patients who underwent laparoscopic partial or radical nephrectomy between 2014 and 2019 were enrolled in our study. Sarcopenia was assessed by lumbar skeletal muscle index (SMI). Receiver operating characteristic (ROC) curve was used to identify the best cutoff point of NLR or PLR to predict sarcopenia risk. Univariate and multivariate logistic regression and dose–response analysis curves of restricted cubic spline function were conducted to assess the relationship between sarcopenia and NLR or PLR. Results The best cutoff points of NLR >2.88 or PLR >135.63 were confirmed by the ROC curve to predict sarcopenia risk. Dose–response curves showed that the risk of sarcopenia increased with raising NLR and PLR. Patients with NLR >2.88 or PLR >135.63 had a higher sarcopenia risk than those in the NLR ≤2.8 or PLR ≤135.63 group, respectively. By adjusting for all variables, we found that patients with NLR >2.88 and PLR >135.63 had 149% and 85% higher risk to develop sarcopenia, respectively, than those with NLR ≤2.8 (aOR = 2.49; 95% CI = 1.56–3.98; p < 0.001) or PLR ≤135.63 (aOR = 1.85; 95% CI = 1.16–2.95; p = 0.010). Conclusion In RCC patients receiving laparoscopic partial or radical nephrectomy, NLR and PLR, which were biomarkers of systemic inflammation, were associated with sarcopenia risk.
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Affiliation(s)
- Qiang Hu
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Weipu Mao
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Tiange Wu
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Zhipeng Xu
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Junjie Yu
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Can Wang
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Saisai Chen
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Shuqiu Chen
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, China.,Surgical Research Center, Institute of Urology, Southeast University Medical School, Nanjing, China
| | - Bin Xu
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, China.,Surgical Research Center, Institute of Urology, Southeast University Medical School, Nanjing, China.,Department of Clinical Research, Southeast University Medical School, Nanjing, China
| | - Yueshuang Xu
- Department of Pathology, School of Medicine, Southeast University, Nanjing, China
| | - Ming Chen
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, China.,Surgical Research Center, Institute of Urology, Southeast University Medical School, Nanjing, China.,Department of Urology, Nanjing Lishui District People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
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25
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Inflammation and sarcopenia: A focus on circulating inflammatory cytokines. Exp Gerontol 2021; 154:111544. [PMID: 34478826 DOI: 10.1016/j.exger.2021.111544] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 12/26/2022]
Abstract
Sarcopenia is an aged-related syndrome that is progressive and can be accelerated by other concomitant disease states. Sarcopenia, characterized by loss of skeletal muscle mass, reduced muscle strength, and/or reduced physical performance, is one of the main reasons for limitation of daily activities in the elderly. It is associated with an increased incidence of many adverse events, such as dysfunction, falls, weakness, hospitalization, disability and even death. Sarcopenia justifies one of the most widely accepted theories that low-grade chronic inflammation associated with aging, known as inflammatory aging, is important to the pathogenesis of many age-related diseases. Currently, the diagnosis of sarcopenia is based on a comprehensive assessment of three aspects: muscle mass, muscle strength and physical performance. The measurement of muscle mass is complicated, as the measurement of muscle strength and gait speed is easily affected by the physical conditions of the subjects. This makes the measurements inaccurate and prospective, and it is difficult to achieve continuous, purposeful monitoring. In addition, serum levels of inflammatory cytokines change as inflammatory states develop in the elderly population. This manuscript focuses on the correlation between serum inflammatory cytokines and sarcopenia in recent years, plus the possible underlying mechanisms.
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26
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Siqueira JM, Soares JDP, Borges TC, Gomes TLN, Pimentel GD. High neutrophil to lymphocytes ratio is associated with nutritional risk in hospitalised, unselected cancer patients: a cross-sectional study. Sci Rep 2021; 11:17120. [PMID: 34429466 PMCID: PMC8384836 DOI: 10.1038/s41598-021-96586-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/12/2021] [Indexed: 02/06/2023] Open
Abstract
Cancer patients possess metabolic and pathophysiological changes and an inflammatory environment that leads to malnutrition. This study aimed to (i) determine whether there is an association between neutrophil-to-lymphocyte ratio (NLR) and nutritional risk, and (ii) identify the cut-off value of NLR that best predicts malnutrition by screening for nutritional risk (NRS 2002). This cross-sectional study included 119 patients with unselected cancer undergoing chemotherapy and/or surgery. The NRS 2002 was applied within 24 h of hospitalisation to determine the nutritional risk. Systemic inflammation was assessed by blood collection, and data on C-reactive protein (CRP), neutrophils, and lymphocytes were collected for later calculation of NLR. A receiver operating characteristic (ROC) curve was used to identify the best cut-point for NLR value that predicted nutritional risk. Differences between the groups were tested using the Student's t-, Mann-Whitney U and Chi-Square tests. Logistic regression analyses were performed to assess the association between NLR and nutritional risk. The ROC curve showed the best cut-point for predicting nutritional risk was NLR > 5.0 (sensitivity, 60.9%; specificity, 76.4%). The NLR ≥ 5.0 group had a higher prevalence of nutritional risk than the NLR < 5.0 group (NLR ≥ 5.0: 73.6% vs. NLR < 5.0: 37.9%, p = 0.001). The NLR group ≥ 5.0 showed higher values of CRP and NLR than the NLR < 5.0 group. In addition, patients with NLR ≥ 5.0 also had higher NRS 2002 values when compared to the NLR < 5.0 group (NLR ≥ 5.0: 3.0 ± 1.1 vs. NLR < 5.0: 2.3 ± 1.2, p = 0.0004). Logistic regression revealed an association between NRS and NLR values. In hospitalised unselected cancer patients, systemic inflammation measured by NLR was associated with nutritional risk. Therefore, we highlight the importance of measuring the NLR in clinical practice, with the aim to detect nutritional risk.
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Affiliation(s)
- Jéssika M Siqueira
- Faculty of Nutrition, Federal University of Goiás, Rua 227, Quadra 68 s/n°, Setor Leste Universitário, Goiânia, GO, 74605080, Brasil
| | - Jéssika D P Soares
- Faculty of Nutrition, Federal University of Goiás, Rua 227, Quadra 68 s/n°, Setor Leste Universitário, Goiânia, GO, 74605080, Brasil
| | - Thaís C Borges
- Faculty of Nutrition, Federal University of Goiás, Rua 227, Quadra 68 s/n°, Setor Leste Universitário, Goiânia, GO, 74605080, Brasil
| | - Tatyanne L N Gomes
- Faculty of Nutrition, Federal University of Goiás, Rua 227, Quadra 68 s/n°, Setor Leste Universitário, Goiânia, GO, 74605080, Brasil
| | - Gustavo D Pimentel
- Faculty of Nutrition, Federal University of Goiás, Rua 227, Quadra 68 s/n°, Setor Leste Universitário, Goiânia, GO, 74605080, Brasil.
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27
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Zhang X, Zhang Q, Feng LJ, Zhang KP, Tang M, Song MM, Ruan GT, Zhang XW, Li W, Zhou FX, Cong MH, Shi HP. The Application of Fat-Free Mass Index for Survival Prediction in Cancer Patients With Normal and High Body Mass Index. Front Nutr 2021; 8:714051. [PMID: 34422885 PMCID: PMC8371389 DOI: 10.3389/fnut.2021.714051] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/12/2021] [Indexed: 12/20/2022] Open
Abstract
Background: Fat-free mass (FFM) depletion can be masked by a stable body weight or weight gain in the presence of a normal or high body mass index (BMI). This study investigated the prognostic value of low fat-free mass index (FFMI) in cancer patients with normal or high BMI. Methods: This multicenter retrospective cohort study included 1,602 cancer patients with normal/high BMI. The association of FFMI with patients' overall survival (OS) was analyzed by the Kaplan-Meier method and a Cox model. Results: In this analysis, there were 974 (60.8%) females and 628 (39.2%) males. Low FFMI was associated with worse OS when compared with those patients with normal FFMI. After multivariate adjustment, low FFMI was demonstrated to be an independent unfavorable prognostic factor (HR: 1.69; 95% CI: 1.28, 2.23; P < 0.001) in cancer patients with normal/high BMI. For specific tumor type, low FFMI was found to be associated with worse prognosis in patients with lung cancer, breast cancer and upper gastrointestinal cancer. In subgroup analysis, the association of low FFMI with worse survival was significantly modified by weight loss (P for interaction = 0.012), and those patients with concurrent low FFMI and weight loss showed the worst prognosis (HR: 3.53; 95% CI: 2.04, 6.11; P < 0.001). Conclusion: Low FFMI was associated with worse prognosis in cancer patients with normal/high BMI. This study highlights the usefulness of FFMI for prognostic estimation in these patients.
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Affiliation(s)
- Xi Zhang
- Department of Gastrointestinal Surgery, Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.,Department of Radiotherapy, Affiliated Hospital of Hebei University, Baoding, China.,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
| | - Qi Zhang
- Department of Gastrointestinal Surgery, Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
| | - Li-Jin Feng
- Department of Pathology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Kang-Ping Zhang
- Department of Gastrointestinal Surgery, Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
| | - Meng Tang
- Department of Gastrointestinal Surgery, Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
| | - Meng-Meng Song
- Department of Gastrointestinal Surgery, Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
| | - Guo-Tian Ruan
- Department of Gastrointestinal Surgery, Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
| | - Xiao-Wei Zhang
- Department of Gastrointestinal Surgery, Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
| | - Wei Li
- Cancer Center of the First Hospital of Jilin University, Changchun, China
| | - Fu-Xiang Zhou
- Department of Oncology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Ming-Hua Cong
- Department of Comprehensive Oncology, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Han-Ping Shi
- Department of Gastrointestinal Surgery, Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
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28
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Neutrophil-lymphocyte ratio as a predictor of slow gait speed in older adults: The Rugao Longitudinal Aging Study. Exp Gerontol 2021; 152:111439. [PMID: 34098010 DOI: 10.1016/j.exger.2021.111439] [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: 04/26/2021] [Revised: 05/28/2021] [Accepted: 06/01/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Few studies have investigated the association of the neutrophil-to-lymphocyte ratio (NLR) with gait speed, but whether the NLR is predictive of slow gait speed in older adults remains unknown. The aim of this study is to examine the association of NLR levels with risk of slow gait speed development in older adults. METHODS Overall, 1753 participants (53.11% male, aged 60-92 years, with a mean age of 77.01 ± 4.27 years) from the second wave of the Rugao Longitudinal Aging Study were included. The second wave was recognized as the baseline in this study. Gait speed was measured using a 5-m walk test at baseline and at the 3.5-year follow-up. A slow gait speed was considered a walking speed less than 0.8 m/s. The NLR was calculated based on absolute blood neutrophil and lymphocyte counts. Logistic regression models were used to investigate the association between NLR levels and slow gait speed. RESULTS In the cross-sectional analysis, 394 individuals were identified as having slow gait speed. We found that increased NLR levels were associated with a higher risk of slow gait speed in older adults with and without comorbidities (P-value <0.05). During the 3.5-year follow-up period, 440 individuals had developed new-onset slowness. After confounding factors were controlled, increased NLR levels were significantly and independently associated with an increased risk of slow gait speed among older adults with (odds ratio [OR] 3.82, 95% confidence interval [CI] 1.87-7.89) and without (OR 3.29, 95% CI: 1.54-7.10) comorbidities. CONCLUSION The NLR is an inexpensive and easily obtainable inflammatory biomarker that robustly and independently predicts slow gait speed risk in older adults.
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29
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Chang SW, Tsai YH, Hsu CM, Huang EI, Chang GH, Tsai MS, Tsai YT. Masticatory muscle index for indicating skeletal muscle mass in patients with head and neck cancer. PLoS One 2021; 16:e0251455. [PMID: 33970954 PMCID: PMC8109770 DOI: 10.1371/journal.pone.0251455] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/27/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND A typical assessment for sarcopenia involves the use of abdominal computed tomography (CT) for calculating the skeletal muscle index (SMI) at the level of the third lumbar vertebra (L3). However, abdominal CT is not regularly performed on patients with head and neck cancer (HNC). We investigated whether masticatory SMI (M-SMI) measurements based on head and neck CT scans can be used to conduct sarcopenia assessments by evaluating whether M-SMI is correlated with L3-SMI. METHODS Abdominal and head and neck CT images of patients with trauma (n = 50) and HNC (n = 52) were analyzed retrospectively. Both manual delineation and threshold selection methods were used to measure cross-sectional areas of masticatory muscles and those of muscles at the L3 level on CT images. Muscle cross-sectional areas were normalized to height squared to calculate SMI, and a multivariate linear regression model was established to evaluate the correlation between the M-SMI and L3-SMI. Receiver operating characteristic curve analysis was used to assess the ability of the M-SMI to identify sarcopenia, and Cox logistic regression was used to identify predictors of sarcopenia. RESULTS Patients with HNC had significantly lower M-SMI and L3-SMI than did patients with trauma (p = 0.011 and 0.03, respectively). M-SMI and L3-SMI were strongly correlated (r = 0.901, p < 0.001); in the multivariate model that included sex, the correlation was stronger (r = 0.913, p < 0.001). The associations of sarcopenia with a lower M-SMI (p < 0.001), male sex (p = 0.028), and advanced age (p = 0.011) were significant, and multivariate logistic analysis demonstrated that an M-SMI of <5.5 was an independent predictor of sarcopenia (hazard ratio = 5.37, p < 0.001). CONCLUSIONS M-SMI assessment in routine head and neck CT scans is feasible and can be an alternative for detecting sarcopenia in patients with HNC.
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Affiliation(s)
- Sheng-Wei Chang
- Department of Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yuan-Hsiung Tsai
- Department of Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Cheng-Ming Hsu
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ethan I. Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Geng-He Chang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ming-Shao Tsai
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yao-Te Tsai
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
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30
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Silveira EA, da Silva Filho RR, Spexoto MCB, Haghighatdoost F, Sarrafzadegan N, de Oliveira C. The Role of Sarcopenic Obesity in Cancer and Cardiovascular Disease: A Synthesis of the Evidence on Pathophysiological Aspects and Clinical Implications. Int J Mol Sci 2021; 22:4339. [PMID: 33919368 PMCID: PMC8122649 DOI: 10.3390/ijms22094339] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/14/2021] [Accepted: 04/18/2021] [Indexed: 12/20/2022] Open
Abstract
Obesity is globally a serious public health concern and is associated with a high risk of cardiovascular disease (CVD) and various types of cancers. It is important to evaluate various types of obesity, such as visceral and sarcopenic obesity. The evidence on the associated risk of CVD, cancer and sarcopenic obesity, including pathophysiological aspects, occurrence, clinical implications and survival, needs further investigation. Sarcopenic obesity is a relatively new term. It is a clinical condition that primarily affects older adults. There are several endocrine-hormonal, metabolic and lifestyle aspects involved in the occurrence of sarcopenic obesity that affect pathophysiological aspects that, in turn, contribute to CVD and neoplasms. However, there is no available evidence on the role of sarcopenic obesity in the occurrence of CVD and cancer and its pathophysiological interplay. Therefore, this review aims to describe the pathophysiological aspects and the clinical and epidemiological evidence on the role of sarcopenic obesity related to the occurrence and mortality risk of various types of cancer and cardiovascular disease. This literature review highlights the need for further research on sarcopenic obesity to demonstrate the interrelation of these various associations.
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Affiliation(s)
- Erika Aparecida Silveira
- Postgraduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiânia 74605-050, Brazil;
- Department of Epidemiology & Public Health, Institute of Epidemiology & Health Care University College London, London WC1E 6BT, UK;
| | | | - Maria Claudia Bernardes Spexoto
- Postgraduate Program in Food, Nutrition and Health, Faculty of Health Sciences, Federal University of Grande Dourados, Dourados 79.804-970, Brazil;
| | - Fahimeh Haghighatdoost
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Science, Isfahan 815838899, Iran;
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan 8158388994, Iran
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Cesar de Oliveira
- Department of Epidemiology & Public Health, Institute of Epidemiology & Health Care University College London, London WC1E 6BT, UK;
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Prognostic value of neutrophil-to-lymphocyte ratio in advanced cancer patients receiving immunotherapy. Clin Transl Oncol 2020; 23:1185-1192. [DOI: 10.1007/s12094-020-02509-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/28/2020] [Indexed: 02/06/2023]
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Sarcopenia Severity Based on Computed Tomography Image Analysis in Patients with Cirrhosis. Nutrients 2020; 12:nu12113463. [PMID: 33187310 PMCID: PMC7696263 DOI: 10.3390/nu12113463] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/25/2020] [Accepted: 11/09/2020] [Indexed: 12/15/2022] Open
Abstract
Standardized sex-specific cut-offs for sarcopenia in cirrhosis are needed to identify the risk of clinical complications and to discriminate the severity of sarcopenia. We aimed to compare clinical characteristics between patients with cirrhosis categorized according to the severity of sarcopenia. Computed tomography images were taken at the 3rd lumbar vertebra from 603 patients with cirrhosis and 129 adult donors for living liver transplantation. Patients with skeletal muscle index (SMI) two standard deviations (SD) below the sex-specific mean value of young donors (18-40 years old) were categorized as having severe sarcopenia whereas patients with SMI between -1 and -2 SD of the sex-specific young adult mean values were categorized as having sarcopenia. In the cirrhosis group, 408 patients (68%) were male with the mean age of 57 ± 0.4 years, and MELD score of 14 ± 0.4. Patients were divided into three groups: severe-sarcopenic (SMI < 30 cm2/m2 in females and <42 cm2/m2 in males), sarcopenic (30 ≤ SMI < 37 cm2/m2 in females and 42 ≤ SMI < 50 cm2/m2 in males) and non-sarcopenic (SMI ≥ 37 cm2/m2 in females and ≥50 cm2/m2 in males). Patients with cirrhosis and severe sarcopenia had lower muscle radiodensity and higher plasma neutrophil as well as neutrophil to lymphocyte ratio levels than both non- and sarcopenic groups. The frequency of alcohol-induced cirrhosis, refractory ascites, hepatic encephalopathy, CRP > 20 mg/mL, and severe malnutrition was also higher in severe-sarcopenic patients. The interval between sarcopenia and severe sarcopenia may reflect a window of opportunity in which to intervene and mitigate muscle wasting to improve patient outcomes.
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High neutrophil to lymphocyte ratio as a prognostic marker in COVID-19 patients. Clin Nutr ESPEN 2020; 40:101-102. [PMID: 33183520 PMCID: PMC7427597 DOI: 10.1016/j.clnesp.2020.08.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/04/2020] [Accepted: 08/07/2020] [Indexed: 12/13/2022]
Abstract
Systemic inflammation has been reported as a new predictor for COVID-19 outcomes. Thus, we highlight in this viewpoint the importance of the neutrophil to lymphocyte ratio in COVID-19 pandemic-infected patients.
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34
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Profiles Combining Muscle Atrophy and Neutrophil-to-Lymphocyte Ratio Are Associated with Prognosis of Patients with Stage IV Gastric Cancer. Nutrients 2020; 12:nu12061884. [PMID: 32599747 PMCID: PMC7353220 DOI: 10.3390/nu12061884] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/14/2020] [Accepted: 06/20/2020] [Indexed: 12/13/2022] Open
Abstract
We aimed to investigate the impact of muscle atrophy and the neutrophil-to-lymphocyte ratio (NLR), a sub-clinical biomarker of inflammation and nutrition, on the prognosis of patients with unresectable advanced gastric cancer. We retrospectively enrolled 109 patients with stage IV gastric cancer (median age 69 years; female/male 22%/78%; median observational period 261 days). Independent factors and profiles for overall survival (OS) were determined by Cox regression analysis and decision-tree analysis, respectively. OS was calculated using the Kaplan–Meier method. The prevalence of muscle atrophy was 82.6% and the median NLR was 3.15. In Cox regression analysis, none of factors were identified as an independent factor for survival. The decision-tree analysis revealed that the most favorable prognostic profile was non-muscle atrophy (OS rate 36.8%). The most unfavorable prognostic profile was the combination of muscle atrophy and high NLR (OS rate 19.6%). The OS rate was significantly lower in patients with muscle atrophy and high NLR than in patients with non-muscle atrophy (1-year survival rate 28.5% vs. 54.7%; log-rank test p = 0.0014). In conclusion, “muscle atrophy and high NLR” was a prognostic profile for patients with stage IV gastric cancer. Thus, the assessment of muscle mass, subclinical inflammation, and malnutrition may be important for the management of patients with stage IV gastric cancer.
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