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Song J, Yang X, Wu J, Wu Z, Niu S, Zhuo L, Lyu W, Ye J, Fang Y, Zhan Z, Zhang H, Li X, Hong J, Su L. The association analysis between fatigue and body composition loss in patients with nasopharyngeal carcinoma during radiotherapy: An observational longitudinal study. Radiother Oncol 2024; 197:110340. [PMID: 38797492 DOI: 10.1016/j.radonc.2024.110340] [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: 10/06/2023] [Revised: 05/02/2024] [Accepted: 05/12/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE This study aimed to reveal the association of fatigue with weekly changes in the body composition in patients with nasopharyngeal carcinoma (NPC) and identified the independent strength. METHODS Four body composition indexes and fatigue were assessed before treatment (T0, baseline) and once a week throughout radiotherapy (T1-T7). Generalized additive mixed models (GAMMs) were used to explore the trajectories and longitudinal relationships of fatigue and weekly changes in body composition. The marginal structural model (MSM) was used to control the effect of depression and anxiety. RESULTS The trajectories of fatigue in 105 participants reached a peak in the fifth week, and changes in body composition started appearing from the second week. Four body composition indexes, weight, body mass index (BMI), body fat rate, and lean body weight loss weekly were positively associated with fatigue. High magnitude of effects was revealed when anxiety and depression were controlled as time-dependent confounders. The positive associations with fatigue were manifested in patients aged >53 years, those with senior high and above education, no drinking, >5000 Y/month of family inflow, ≥ stage III, or those receiving a dose of ≥70 Gy, ≥3 cycles of induced chemotherapy, and ≤1 cycle of concurrent chemotherapy. CONCLUSIONS Loss of weight, BMI, body fat rate, and lean body weight could be used to independently evaluate the development of fatigue in patients with NPC during radiotherapy. Positive associations between fatigue and weekly body composition loss were found in patients with certain characteristics.
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Affiliation(s)
- Jihong Song
- School of Nursing, Fujian Medical University, Fuzhou, China; School of Nursing, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Xinru Yang
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Jieling Wu
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Zilan Wu
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Sitian Niu
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Litao Zhuo
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Wenlong Lyu
- Department of Radiotherapy, Cancer Center, The First Affiliated Hospital of Fujian Medical University, China; Department of Radiotherapy, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, China; Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, the First Affiliated Hospital, Fujian Medical University, China
| | - Jinru Ye
- Department of Radiotherapy, Cancer Center, The First Affiliated Hospital of Fujian Medical University, China; Department of Radiotherapy, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, China; Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, the First Affiliated Hospital, Fujian Medical University, China
| | - Yan Fang
- Nursing Department, The First Affiliated Hospital of Fujian Medical University, China
| | - Zhiying Zhan
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, China
| | - Hairong Zhang
- Fujian Center for Disease Control and Prevention, China
| | - Xiaomei Li
- School of Nursing, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Jinsheng Hong
- Department of Radiotherapy, Cancer Center, The First Affiliated Hospital of Fujian Medical University, China; Department of Radiotherapy, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, China; Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, the First Affiliated Hospital, Fujian Medical University, China.
| | - Li Su
- Department of Radiotherapy, Cancer Center, The First Affiliated Hospital of Fujian Medical University, China; Department of Radiotherapy, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, China; Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, the First Affiliated Hospital, Fujian Medical University, China.
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Su W, Wu Y, Liao S, Zhang Z, Zhang Y, Ou W, Yu J, Xiang F, Luo C, Zheng F. A Nomogram Including Sarcopenia for Predicting Progression-Free Survival in Patients with Localized Papillary Renal Cell Carcinoma: A Retrospective Cohort Study. Ann Surg Oncol 2024:10.1245/s10434-024-15666-2. [PMID: 38954088 DOI: 10.1245/s10434-024-15666-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/10/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Because of to the removal of subclassification of papillary renal cell carcinoma (pRCC), the survival prognostification of localized pRCC after surgical treatment became inadequate. Sarcopenia was widely evaluated and proved to be a predictive factor for prognosis in RCC patients. Therefore, we comprehensively investigated the survival prediction of the body composition parameters for localized pRCC. METHODS Patients pathologically diagnosed with pRCC between February 2012 and February 2022 in our center were enrolled. The body composition parameters, including skeletal muscle index (SMI), subcutaneous adipose tissue (SAT), and perirenal adipose tissue (PRAT), were measured by the images of preoperative computed tomography (CT). The primary outcome was set as progression-free survival (PFS), and the cutoff values of body composition parameters were calculated by using the Youden from receiver operating characteristic curve (ROC) curves. Univariate and multivariate Cox proportional regression analyses were performed to explore independent risk factors for survival prediction. Then, significant factors were used to construct a prognostic nomogram. The performance of the nomogram was evaluated by Harrell's C-index, calibration curves and time-dependent ROC curves. RESULTS A total of 105 patients were enrolled for analysis. With a median follow-up time of 30.48 months, 25 (23.81%) patients experienced cancer progression. The percentage of sarcopenia was 74.29%. Univariate Cox analysis identified that gender, PRAT, SAT, skeletal muscle (SM), sarcopenia, surgical technique, and tumor diameter were associated with progression. Further multivariate analysis showed that sarcopenia (hazard ratio [HR] 0.15, 95% confidence interval [CI] 0.03-0.66), SAT (HR 6.36, 95% CI 2.39-16.93), PRAT (HR 4.66, 95% CI 1.77-12.27), tumor diameter (HR 0.35, 95% CI 0.14-0.86), and surgical technique (HR 2.85, 95% CI 1.06-7.64) were independent risk factors for cancer progression. Then, a prognostic nomogram based on independent risk factors was constructed and the C-index for progression prediction was 0.831 (95% CI 0.761-0.901), representing a reasonable discrimination, the calibration curves, and the time-dependent ROC curves verified the good performance of the nomogram. CONCLUSIONS A prognostic nomogram, including sarcopenia, SAT, PRAT, tumor diameter, and surgical technique, was constructed to calculate the probability of progression for localized pRCC patients and needs further external validation for clinical use in the future.
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Affiliation(s)
- Wenhui Su
- Department of Urology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yukun Wu
- Department of Urology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shufen Liao
- Department of Anesthesia Surgery Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhiqiang Zhang
- Department of Urology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Yubing Zhang
- Department of Urology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wei Ou
- Department of Urology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jiajie Yu
- Department of Andrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Fangzheng Xiang
- Department of Urology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Cheng Luo
- Department of Urology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Fufu Zheng
- Department of Urology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Pring ET, Gould LE, Malietzis G, Lung P, Mai DVC, Drami I, Athanasiou T, Jenkins JT. Sarcopenia in colorectal cancer is related to socio-economic deprivation and Body Mass Index alone misrepresents underlying muscle loss in the deprived. Clin Nutr ESPEN 2024; 63:13-19. [PMID: 38889008 DOI: 10.1016/j.clnesp.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 05/28/2024] [Accepted: 06/04/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND & AIMS Patients with colorectal cancer who are more socio-economically deprived have worse outcomes; deprivation is also associated with higher obesity rates, defined as a body mass index (BMI) of greater than thirty. Body composition (BC) factors such as sarcopenia and myosteatosis are also known to predispose to poorer outcomes following colorectal cancer surgery. There is limited evidence to date to relate the effect of deprivation upon these host characteristics that are linked to prognosis. We aimed to examine the relationship between deprivation and body composition in colorectal cancer. METHODS Analysis was performed on a prospectively collected database of preoperative primary colorectal cancer patients at St Mark's - The National Bowel Hospital, UK. Body composition characteristics were identified by analysing the L3 axial slices of Computer Tomogram (CT) slices of preoperative staging using Slice-O-Matic software with Automatic Body composition Analyser using Computed tomography image Segmentation (ABACS) L3 plug-in. Deprivation status for each patient was determined using their postal code which was linked to the Index of Multiple Deprivation (IMD). Each domain of the IMD was examined individually in relation to BC characteristics. Binary logistic regression analysis was performed on the data using a model developed from previous published analyses of this dataset. RESULTS Four hundred and nineteen patients were included in the final analysis, the median age was 69 years and 57% of the patient population was male. Patients who were more deprived were significantly more likely to be sarcopenic [OR 1.56 (95% CI 1.01-2.41, p = 0.045)] and myosteatotic [OR 1.69 (95% CI 1.019-2.81, p = 0.042)]. More deprived patients were also more likely to have a lower BMI [OR 0.60 (95% CI 0.38-0.94, p = 0.026)] despite no significant difference in visceral obesity between the most and least deprived. CONCLUSIONS Deprivation is an important independent determinant of sarcopenia in the colorectal cancer population. Identifying these patients early and addressing reversible factors may help improve post-operative surgical outcomes in this poor prognostic group. Sarcopenia may be a premorbid state in the deprived colorectal cancer patient that may not be wholly driven by tumour characteristics.
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Affiliation(s)
- Edward T Pring
- George Davies Research Fellowship, St Mark's Hospital, The National Bowel Hospital, Harrow, UK; Department of Surgery, St Mark's Hospital, The National Bowel Hospital, Watford Road, Harrow HA1 3UJ, UK; Department of Surgery and Cancer, Imperial College London, Paddington, London W2 1NY, UK; The BiCyCLE Research Group, London, UK.
| | - Laura E Gould
- Department of Surgery, St Mark's Hospital, The National Bowel Hospital, Watford Road, Harrow HA1 3UJ, UK; The BiCyCLE Research Group, London, UK
| | - George Malietzis
- Department of Surgery, St Mark's Hospital, The National Bowel Hospital, Watford Road, Harrow HA1 3UJ, UK; Department of Surgery and Cancer, Imperial College London, Paddington, London W2 1NY, UK; The BiCyCLE Research Group, London, UK
| | - Phillip Lung
- Department of Surgery, St Mark's Hospital, The National Bowel Hospital, Watford Road, Harrow HA1 3UJ, UK; The BiCyCLE Research Group, London, UK
| | - Dinh V C Mai
- Department of Surgery, St Mark's Hospital, The National Bowel Hospital, Watford Road, Harrow HA1 3UJ, UK; Department of Surgery and Cancer, Imperial College London, Paddington, London W2 1NY, UK; The BiCyCLE Research Group, London, UK
| | - Ioanna Drami
- Department of Surgery, St Mark's Hospital, The National Bowel Hospital, Watford Road, Harrow HA1 3UJ, UK; Department of Surgery and Cancer, Imperial College London, Paddington, London W2 1NY, UK; The BiCyCLE Research Group, London, UK
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, Paddington, London W2 1NY, UK; The BiCyCLE Research Group, London, UK
| | - John T Jenkins
- Department of Surgery, St Mark's Hospital, The National Bowel Hospital, Watford Road, Harrow HA1 3UJ, UK; Department of Surgery and Cancer, Imperial College London, Paddington, London W2 1NY, UK; The BiCyCLE Research Group, London, UK
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Ji H, Liu B, Jin P, Li Y, Cui L, Jin S, Wu J, Shan Y, Zhang Z, Ming J, Zhang L, Du C. Creatinine-to-cystatin C ratio and body composition predict response to PD-1 inhibitors-based combination treatment in metastatic gastric cancer. Front Immunol 2024; 15:1364728. [PMID: 38665913 PMCID: PMC11043572 DOI: 10.3389/fimmu.2024.1364728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/01/2024] [Indexed: 04/28/2024] Open
Abstract
Background Creatinine-to-cystatin C ratio (CCR) and body composition (BC) parameters have emerged as significant prognostic factors in cancer patients. However, the potential effects of CCR in gastric cancer (GC) remains to be elucidated. This multi-center retrospective study explored the predictive and prognostic value of CCR and BC-parameters in patients with metastatic GC receiving PD-1 inhibitors-based combination therapy. Methods One hundred and thirteen GC patients undergoing PD-1 inhibitors-based combination therapy were enrolled at three academic medical centers from January 2021 to July 2023. A deep-learning platform based on U-Net was developed to automatically segment skeletal muscle index (SMI), subcutaneous adipose tissue index (SATI) and visceral adipose tissue index (VATI). Patients were divided into two groups based on the median of CCR or the upper tertile of BC-parameters. Logistic and Cox regression analysis were used to determine the effect of CCR and BC-parameters in predicting response rates and survival rates. Results The CCR was positively correlated with SMI (r=0.43; P<0.001), but not with SATI or VATI (P>0.05). Multivariable logistic analysis identified that both low CCR (OR=0.423, P=0.066 for ORR; OR=0.026, P=0.005 for DCR) and low SATI (OR=0.270, P=0.020 for ORR; OR=0.149, P=0.056 for DCR) were independently associated with worse objective response rate (ORR) and disease control rate (DCR). Patients with low CCR or low SATI had significantly lower 8-month progression-free survival (PFS) rate and 16-month overall survival (OS) rate than those with high CCR (PFS rate, 37.6% vs. 55.1%, P=0.011; OS rate, 19.4% vs. 44.9%, P=0.002) or those with high SATI (PFS rate, 37.2% vs. 53.8%, P=0.035; OS rate, 8.0% vs. 36.0%, P<0.001). Multivariate Cox analysis showed that low CCR (HR=2.395, 95% CI: 1.234-4.648, P=0.010 for PFS rate; HR=2.528, 95% CI: 1.317-4.854, P=0.005 for OS rate) and low SATI (HR=2.188, 95% CI: 1.050-4.560, P=0.037 for PFS rate; HR=2.818, 95% CI: 1.381-5.752, P=0.004 for OS rate) were both independent prognostic factors of poor 8-month PFS rate and 16-month OS rate. A nomogram based on CCR and BC-parameters showed a good performance in predicting the 12- and 16-month OS, with a concordance index of 0.756 (95% CI, 0.722-0.789). Conclusions Low pre-treatment CCR and SATI were independently associated with lower response rates and worse survival in patients with metastatic GC receiving PD-1 inhibitors-based combination therapy.
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Affiliation(s)
- Hongjuan Ji
- Department of Oncology, General Hospital of Northern Theater Command, Shenyang, China
| | - Bona Liu
- Department of Oncology, General Hospital of Northern Theater Command, Shenyang, China
| | - Peng Jin
- Department of Oncology, The Second Affiliated Hospital of Shandong First Medical University, Taian, China
| | - Yingchun Li
- Department of Pathology, General Hospital of Northern Theater Command, Shenyang, China
| | - Lili Cui
- Department of Oncology, General Hospital of Northern Theater Command, Shenyang, China
| | - Shanxiu Jin
- Department of Oncology, General Hospital of Northern Theater Command, Dalian Medical University, Shenyang, China
| | - Jingran Wu
- Department of Oncology, General Hospital of Northern Theater Command, Dalian Medical University, Shenyang, China
| | - Yongqi Shan
- Department of General Surgery, General Hospital of Northern Theater Command, Shenyang, China
| | - Zhenyong Zhang
- Department Oncology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jian Ming
- Department of Pathology, General Hospital of Northern Theater Command, Shenyang, China
| | - Liang Zhang
- Department of Gastrointestinal Surgery, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical College, Xuzhou, China
| | - Cheng Du
- Department of Oncology, General Hospital of Northern Theater Command, Shenyang, China
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Furberg H, Bradshaw PT, Knezevic A, Olsson L, Petruzella S, Stein E, Paris M, Scott J, Akin O, Hakimi AA, Russo P, Sanchez A, Caan B, Mourtzakis M. Skeletal muscle and visceral adipose radiodensities are pre-surgical, non-invasive markers of aggressive kidney cancer. J Cachexia Sarcopenia Muscle 2024; 15:726-734. [PMID: 38263932 PMCID: PMC10995262 DOI: 10.1002/jcsm.13429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/15/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024] Open
Abstract
INTRODUCTION Most studies on body composition in kidney cancer have been conducted among patients with metastatic disease. Given that aggressive tumours can adversely impact body composition and even non-metastatic tumours can be aggressive, we evaluated associations between pre-surgical body composition features and tumour pathological features in patients with non-metastatic clear cell renal cell cancer (ccRCC). METHODS The Resolve Cohort consists of 1239 patients with non-metastatic ccRCC who underwent nephrectomy at Memorial Sloan Kettering Cancer Center between 2000 and 2020. The cross-sectional areas and radiodensities of skeletal muscle, visceral adipose, and subcutaneous adipose tissues were determined from pre-surgical computed tomography (CT) scans at the third lumbar vertebrae using Automatica software. Pearson's correlation coefficients describe inter-relationships among BMI and body composition variables, while odds ratios (OR) and 95% confidence intervals (CI) estimate associations between continuous body composition features (per 1-standard deviation) and advanced stage (Stage III vs. Stages I-II) and high Fuhrman grade (Grades 3-4 vs. 1-2) from multivariable logistic regression models that considered the potential impact of biological sex, contrast enhanced CTs, and early age at onset of ccRCC. RESULTS The cohort was predominantly male (69%), white (89%), and had a median age of 58. The proportion of patients presenting with advanced stage and high-grade disease were 31% and 51%, respectively. In models that adjusted for demographics and all body composition variables simultaneously, decreasing skeletal muscle radiodensity (i.e., more fat infiltration) but increasing visceral adipose tissue radiodensity (i.e., more lipid depletion) were associated with advanced tumour features. Per 8.4 HU decrease in skeletal muscle radiodensity, the odds of presenting with advanced stage was 1.61 (95% CI: 1.34-1.93). Per 7.22 HU increase in visceral adipose tissue radiodensity, the odds of presenting with advanced stage was 1.45 (95% CI: 1.22-1.74). Skeletal muscle index (i.e., sarcopenia) was not associated with either tumour feature. Similar associations were observed for Fuhrman grade, a more direct marker of tumour aggressiveness. Associations did not differ by sex, contrast use, or age at onset of ccRCC. CONCLUSIONS Lipid infiltrated skeletal muscle, but lipid depleted visceral adipose tissue were independently associated with advanced tumour features in non-metastatic ccRCC. Findings highlight the importance of evaluating the full range of body composition features simultaneously in multivariable models. Interpreting pre-surgical CTs for body composition for patients may be a novel and non-invasive way to identify patients with aggressive renal tumours, which is clinically relevant as renal biopsies are not routinely performed.
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Affiliation(s)
- Helena Furberg
- Department of Epidemiology and BiostatisticsMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | - Patrick T. Bradshaw
- Division of Epidemiology, School of Public HealthUniversity of California BerkeleyBerkeleyCAUSA
| | - Andrea Knezevic
- Department of Epidemiology and BiostatisticsMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | - Linnea Olsson
- Department of EpidemiologyUniversity of North CarolinaChapel HillNCUSA
| | - Stacey Petruzella
- Department of Epidemiology and BiostatisticsMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | - Emily Stein
- Department of Epidemiology and BiostatisticsMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | - Mike Paris
- Department of KinesiologyUniversity of WaterlooWaterlooCanada
| | - Jessica Scott
- Department of MedicineMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | - Oguz Akin
- Department of RadiologyMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | - A. Ari Hakimi
- Department of MedicineMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | - Paul Russo
- Department of MedicineMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | | | - Bette Caan
- Department of EpidemiologyKaiser PermanenteOaklandCAUSA
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Lambertini L, Mari A, Sandulli A, Amparore D, Antonelli A, Barale M, Bove P, Brunocilla E, Capitanio U, DA Pozzo LF, DI Maida F, Grosso AA, Fiori C, Gontero P, Li Marzi V, Campi R, Longo N, Marchioni M, Montanari E, Montorsi F, Porpiglia F, Porreca A, Schiavina R, Simeone C, Siracusano S, Terrone C, Ficarra V, Minervini A. Minimally invasive transperitoneal partial versus radical nephrectomy in obese patients: perioperative and long-term functional outcomes from a large perspective contemporary series (RECORd2 project). Minerva Urol Nephrol 2024; 76:185-194. [PMID: 38742553 DOI: 10.23736/s2724-6051.24.05692-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
BACKGROUND The aim of this study is to evaluate the perioperative and long-term functional outcomes of laparoscopic (LPN) and robot-assisted partial nephrectomy (RAPN) in comparison to laparoscopic radical nephrectomy (LRN) in obese patients diagnosed with renal cell carcinoma. METHODS Clinical data of 4325 consecutive patients from The Italian REgistry of COnservative and Radical Surgery for cortical renal tumor Disease (RECORD 2 Project) were gathered. Only patients treated with transperitoneal LPN, RAPN, or LRN with Body Mass Index (BMI) ≥30 kg/m2, clinical T1 renal tumor and preoperative estimated glomerular filtration rate (eGFR) ≥60 mL/min, were included. Perioperative, and long-term functional outcomes were examined. RESULTS Overall, 388 patients were included, of these 123 (31.7%), 120 (30.9%) and 145 (37.4%) patients were treated with LRN, LPN, and RAPN, respectively. No significant difference was observed in preoperative characteristics. Overall, intra and postoperative complication rates were comparable among the groups. The LRN group had a significantly increased occurrence of acute kidney injury (AKI) compared to LPN and RAPN (40.6% vs. 15.3% vs. 7.6%, P=0.001). Laparoscopic RN showed a statistically significant higher renal function decline at 60-month follow-up assessment compared to LPN and RAPN. A significant renal function loss was recorded in 30.1% of patients treated with LRN compared to 16.7% and 10.3% of patients treated with LPN and RAPN (P=0.01). CONCLUSIONS In obese patients, both LPN and RAPN showcased comparable complication rates and higher renal function preservation than LRN. These findings highlighted the potential benefits of minimally invasive PN over radical surgery in the context of obese individuals.
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Affiliation(s)
- Luca Lambertini
- Department of Urology, Unit of Oncologic Minimally-Invasive Urology and Andrology, University of Florence, Careggi Hospital, Florence, Italy
| | - Andrea Mari
- Department of Urology, Unit of Oncologic Minimally-Invasive Urology and Andrology, University of Florence, Careggi Hospital, Florence, Italy
| | - Alessandro Sandulli
- Department of Urology, Unit of Oncologic Minimally-Invasive Urology and Andrology, University of Florence, Careggi Hospital, Florence, Italy
| | - Daniele Amparore
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, School of Medicine, Orbassano, Turin, Italy
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata (A.O.U.I.), Verona, Italy
| | - Maurizio Barale
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Pierluigi Bove
- Department of Urology, University Hospital of Tor Vergata, Rome, Italy
| | | | - Umberto Capitanio
- Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Luigi F DA Pozzo
- Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, University Vita-Salute San Raffaele, Milan, Italy
- Department of Urology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Fabrizio DI Maida
- Department of Urology, Unit of Oncologic Minimally-Invasive Urology and Andrology, University of Florence, Careggi Hospital, Florence, Italy
| | - Antonio Andrea Grosso
- Department of Urology, Unit of Oncologic Minimally-Invasive Urology and Andrology, University of Florence, Careggi Hospital, Florence, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, School of Medicine, Orbassano, Turin, Italy
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Vincenzo Li Marzi
- Medicine and Surgery Department, University of Milano-Bicocca, Monza, Italy
| | - Riccardo Campi
- Medicine and Surgery Department, University of Milano-Bicocca, Monza, Italy
| | - Nicola Longo
- Department of Urology, Unit of Urological Minimally Invasive Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | | | | | - Francesco Montorsi
- Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, School of Medicine, Orbassano, Turin, Italy
| | - Angelo Porreca
- Department of Urology, Fondazione IRCCS Ca' Granda, Maggiore Polyclinic Hospital, University of Milan, Milan, Italy
- Veneto Institute of Oncology (IOV) IRCCS, Castelfranco Veneto, Treviso, Italy
| | | | - Claudio Simeone
- Department of Urology, Abano Terme Polyclinic, Abano Terme, Padua, Italy
| | - Salvatore Siracusano
- Department of Urology, Azienda Ospedaliera Universitaria Integrata (A.O.U.I.), Verona, Italy
| | - Carlo Terrone
- Department of Urology, Ospedali Civili, University of Brescia, Brescia, Italy
| | | | - Andrea Minervini
- Department of Urology, Unit of Oncologic Minimally-Invasive Urology and Andrology, University of Florence, Careggi Hospital, Florence, Italy -
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Song J, Yang X, Wu J, Wu Z, Zhuo L, Hong J, Su L, Lyu W, Ye J, Fang Y, Zhan Z, Zhang H, Li X. Could nutrition status predict fatigue one week before in patients with nasopharynx cancer undergoing radiotherapy? Cancer Med 2024; 13:e7191. [PMID: 38659395 PMCID: PMC11043677 DOI: 10.1002/cam4.7191] [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: 11/28/2023] [Revised: 03/15/2024] [Accepted: 04/03/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Patients with nasopharyngeal carcinoma (NPC) undergoing radiotherapy experience significant fatigue, which is frequently underestimated due to the lack of objective indicators for its evaluation. This study aimed to explore the longitudinal association between fatigue and nutrition status 1 week in advance. METHODS From January 2021 to June 2022, a total of 105 NPC patients who received intensity-modulated radiation therapy were enrolled in the observational longitudinal study. The significant outcomes, including the Piper Fatigue Scale-12 (PFS-12), the Scored Patient-Generated Subjective Global Assessment (PG-SGA), four body composition indices, and the Hospital Anxiety and Depression Scale (HADS), were assessed weekly from pre-treatment until the completion of radiotherapy (T0-T7) to explore their relationship. RESULTS The trajectories of PFS-12 and all dimensions for 105 participants reached a peak during the fifth week. Sensory fatigue consistently received the highest scores (T0 = 1.60 ± 2.20, T5 = 6.15 ± 1.57), whereas behavior fatigue exhibited the fastest increase over time (T0 = 1.11 ± 1.86, T5 = 5.47 ± 1.70). Higher PG-SGA scores were found to be weakly explainable for aggravating fatigue (β = 0.02 ~ 0.04). Unlike generalized additive mixed models, marginal structural models (MSM) produced larger effect values (β = 0.12 ~ 0.21). Additionally, body composition indices showed weakly negative relationships with fatigue in MSMs one week in advance. CONCLUSIONS The PG-SGA may be a more accurate predictor of future-week fatigue than individual body composition indicators, particularly when HADS is controlled for as a time-dependent confounder.
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Affiliation(s)
- Jihong Song
- School of NursingHealth Science Center, Xi'an Jiaotong UniversityXi'anChina
- School of NursingFujian Medical UniversityFuzhouChina
| | - Xinru Yang
- School of NursingFujian Medical UniversityFuzhouChina
| | - Jieling Wu
- School of NursingFujian Medical UniversityFuzhouChina
| | - Zilan Wu
- School of NursingFujian Medical UniversityFuzhouChina
| | - Litao Zhuo
- School of NursingFujian Medical UniversityFuzhouChina
| | - Jinsheng Hong
- Department of RadiotherapyCancer Center, the First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
- Department of RadiotherapyNational Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical UniversityFuzhouChina
- Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical UniversityFuzhouChina
| | - Li Su
- Department of RadiotherapyCancer Center, the First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
- Department of RadiotherapyNational Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical UniversityFuzhouChina
- Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical UniversityFuzhouChina
| | - Wenlong Lyu
- Department of RadiotherapyCancer Center, the First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
- Department of RadiotherapyNational Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical UniversityFuzhouChina
- Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical UniversityFuzhouChina
| | - Jinru Ye
- Department of RadiotherapyCancer Center, the First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
- Department of RadiotherapyNational Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical UniversityFuzhouChina
- Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical UniversityFuzhouChina
| | - Yan Fang
- Nursing DepartmentThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
| | - Zhiying Zhan
- Department of Epidemiology and Health StatisticsFujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical UniversityFuzhouChina
| | - Hairong Zhang
- Fujian Center for Disease Control and PreventionFuzhouChina
| | - Xiaomei Li
- School of NursingHealth Science Center, Xi'an Jiaotong UniversityXi'anChina
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8
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Bradshaw PT. Body composition and cancer survival: a narrative review. Br J Cancer 2024; 130:176-183. [PMID: 37891197 PMCID: PMC10803330 DOI: 10.1038/s41416-023-02470-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 10/07/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
Interest in understanding the relationship between body composition and cancer survival has remained strong for decades, with a number of recent systematic reviews on the topic. However, the current state of evidence is based on heterogeneous exposure definitions based on anthropometry, yielding inconsistent findings with regard to this association. Recently the field has taken an exciting direction with the application of radiological assessments to measure specific aspects of body composition, yet reconciliation of findings from these modern assessment tools with those from the historic use of anthropometric data proves challenging. In this paper, I briefly review the biological basis for a link between body composition and cancer survival and summarize the epidemiological evidence with consideration to specific exposure measures. As enthusiasm is building around novel assessments, I conclude with a discussion of issues that researchers should be aware of when interpreting results from these new modalities.
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Affiliation(s)
- Patrick T Bradshaw
- School of Public Health, Division of Epidemiology, University of California Berkeley, Berkeley, CA, USA.
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9
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Emir KN, Demirel B, Atasoy BM. An Investigation of the Role of Phase Angle in Malnutrition Risk Evaluation and Clinical Outcomes in Patients with Head and Neck or Brain Tumors Undergoing Radiotherapy. Nutr Cancer 2024; 76:252-261. [PMID: 38185865 DOI: 10.1080/01635581.2023.2300496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/18/2023] [Indexed: 01/09/2024]
Abstract
This cross-sectional study aimed to investigate the role of bioelectrical impedance analysis (BIA) and phase angle measurement in assessing malnutrition in head and neck (n = 37) and brain (n = 63) tumor patients received radiotherapy. Common nutritional screening and assessment tests were used to identify malnutrition in the patients. Each patient underwent these tests once, along with phase angle measurement. Additionally, inflammation parameters, including neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), and systemic inflammatory index (SII), were calculated. All study results were correlated with the phase angle cutoff point of 5.72°. The phase angle demonstrated significant correlations with subjective global assessment (SGA), mini nutritional assessment (MNA) scores, BIA parameters, nutritional index, NLR, and SII (p < 0.05). Moreover, in head and neck tumor patients, those with higher standardized phase angle values exhibited significantly better two-year overall survival (32.1% vs. 87.5%, p = 0.006). The phase angle measurement is a convenient, noninvasive, and reproducible method that can complement existing tools for assessing malnutrition risk in radiotherapy patients. The significant correlations observed between the phase angle and various nutritional, inflammation markers and prognosis highlight its potential utility. Further studies incorporating a larger patient cohort will be beneficial in establishing a standard phase angle reference value for cancer patients.
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Affiliation(s)
- Kubra Nur Emir
- Faculty of Health Science, Department of Nutrition and Dietetics, Istanbul Bilgi University, Istanbul, Turkey
| | - Birsen Demirel
- Faculty of Health Science, Department of Nutrition and Dietetics, Istanbul Bilgi University, Istanbul, Turkey
| | - Beste M Atasoy
- Department of Radiation Oncology, Marmara University School of Medicine, Istanbul, Turkey
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10
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McManus HD, Zhang D, Schwartz FR, Wu Y, Infield J, Ho E, Armstrong AJ, George DJ, Kruse D, Gupta RT, Harrison MR. Relationship Between Pretreatment Body Composition and Clinical Outcomes in Patients With Metastatic Renal Cell Carcinoma Receiving First-Line Ipilimumab Plus Nivolumab. Clin Genitourin Cancer 2023; 21:e429-e437.e2. [PMID: 37271698 DOI: 10.1016/j.clgc.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/03/2023] [Accepted: 05/07/2023] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Biomarkers are needed to identify patients with metastatic renal cell carcinoma (mRCC) most likely to benefit from immune checkpoint inhibitors. We examined associations between radiographically assessed body composition (BC) variables and body mass index (BMI) with clinical outcomes for patients with mRCC receiving first-line ipilimumab + nivolumab (ipi/nivo). PATIENTS AND METHODS We retrospectively reviewed all patients with mRCC treated with first-line ipi/nivo at one institution before June 1, 2021 with an analyzable baseline computed tomography (CT) scan. BC variables (skeletal muscle index [SMI], subcutaneous adipose tissue index [SATI], and visceral adipose tissue index [VATI]) were measured using baseline CT scans. Relationships between BC variables and clinical outcomes were examined using Cox proportional hazard regression models. RESULTS Ninety-nine patients were analyzed (74% male, 64% overweight/obese, 75% low SMI). Controlling for age, IMDC risk, and sex (for BMI analyses), high vs. low SMI (HR=2.433, CI: 1.397-4.238, P=.0017), high vs. low SATI (HR=1.641, CI: 1.023-2.632, P=.0398), and obese BMI (≥ 30 kg/m2) vs. normal/overweight BMI (<30 kg/m2) (HR=1.859, CI: 1.156-2.989, P=.0105) were significantly associated with progression-free survival (PFS). Median overall survival (OS) for low SMI patients was higher (42.74 months, CI: 26.84, NR) than median OS for high SMI patients (27.01 months, CI: 15.28, NR) (adjusted HR=1.728, CI: 0.909-3.285, P=.0952). No BC variables were significantly associated with OS or objective response rate. CONCLUSIONS Low SMI and low SATI were associated with significantly better PFS for patients with mRCC receiving first-line ipi/nivo. Radiographic BC variables may be useful prognostic biomarkers in this setting.
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Affiliation(s)
- Hannah D McManus
- Department of Medicine, Duke University Medical Center, Durham, NC.
| | - Dylan Zhang
- Department of Radiology, Duke University Medical Center, Durham, NC
| | - Fides R Schwartz
- Department of Radiology, Duke University Medical Center, Durham, NC
| | - Yuan Wu
- Department of Biostatics and Bioinformatics, Duke University, Durham, NC
| | - Jordan Infield
- Department of Medicine, Duke University Medical Center, Durham, NC
| | - Ethan Ho
- Department of Biomedical Engineering, Duke University, Durham, NC
| | - Andrew J Armstrong
- Department of Medicine, Duke University Medical Center, Durham, NC; Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC; Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, NC
| | - Daniel J George
- Department of Medicine, Duke University Medical Center, Durham, NC; Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC; Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, NC
| | - Danielle Kruse
- Department of Radiology, Duke University Medical Center, Durham, NC
| | - Rajan T Gupta
- Department of Radiology, Duke University Medical Center, Durham, NC; Department of Surgery, Division of Urology, Duke Cancer Institute, Durham, NC; Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC
| | - Michael R Harrison
- Department of Medicine, Duke University Medical Center, Durham, NC; Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC; Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, NC
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11
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Liguori ADAL, Fayh APT. Computed tomography: an efficient, opportunistic method for assessing body composition and predicting adverse outcomes in cancer patients. Radiol Bras 2023; 56:VIII-IX. [PMID: 38504810 PMCID: PMC10948160 DOI: 10.1590/0100-3984.2023.56.6e3-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Affiliation(s)
- Adriano de Araújo Lima Liguori
- Radiologist for the Liga Norte Riograndense Contra o Câncer, Professor of Radiology at the Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil.
| | - Ana Paula Trussardi Fayh
- Associate Professor III in Nutrition at the Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil
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12
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Liu S, Zou Y, Zhong M, Li T, Cao Y, Wang R, You J, Zhang S, Zhang B. Prognostic significance of MRI-defined sarcopenia in patients with nasopharyngeal carcinoma: A propensity score matched analysis of real-world data. Radiother Oncol 2023; 188:109904. [PMID: 37678624 DOI: 10.1016/j.radonc.2023.109904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/24/2023] [Accepted: 09/01/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND AND PURPOSE Image-defined sarcopenia is linked to increased mortality among patients with cancer. Nevertheless, its effect on patients with nasopharyngeal carcinoma (NPC) is incompletely established. This study's aim was to investigate the prognostic significance of MRI-defined sarcopenia on the survival of patients undergoing concurrent chemoradiotherapy (CCRT) ± inducing chemotherapy (IC) for NPC treatment. METHODS 1,307 patients with stage II-IVa NPC were included in this retrospective study. Sarcopenia was defined using skeletal muscle index (SMI) determined through baseline MRI at the C3 level. The association of sarcopenia with overall survival (OS) and progression-free survival (PFS) was assessed by Cox regression models using 1:1 propensity score matching (PSM) analysis. We also conducted a stratification analysis using BMI and treatment strategies. RESULTS Sarcopenia was an independent risk factor for both OS and PFS (all P < 0.05). However, BMI was not substantially linked to OS and PFS (all P > 0.05). Sarcopenic patients showed lower rates of OS (HR = 2.00, 95% CI: 1.54-2.60, P < 0.001) and PFS (HR = 1.67, 95% CI: 1.35-2.07, P < 0.001) in contrast with nonsarcopenic patients. According to stratification analysis, being overweight was linked to a protective effect in nonsarcopenic patients only. Sarcopenic patients showed similar OS and PFS regardless of the treatment modality. CONCLUSIONS Sarcopenia is underrecognized in NPC patients. Measurement of sarcopenia using routine MRI scans in NPC patients provided significant prognostic information, outperforming BMI. Patients with sarcopenia failed to benefit from an additional IC regimen.
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Affiliation(s)
- Shuyi Liu
- Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China; Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Yujian Zou
- Department of Radiology, Affiliated Dongguan Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan, Guangdong, China
| | - Minying Zhong
- Department of Ultrasound, The First People's Hospital of Foshan, Guangdong, China
| | - Ting Li
- Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yaxian Cao
- Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Rui Wang
- Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jingjing You
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Shuixing Zhang
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.
| | - Bin Zhang
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.
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13
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Salavatizadeh M, Soltanieh S, Radkhah N, Ataei Kachouei AH, Bahrami A, Khalesi S, Hejazi E. The association between skeletal muscle mass index (SMI) and survival after gastrectomy: A systematic review and meta-analysis of cohort studies. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106980. [PMID: 37451925 DOI: 10.1016/j.ejso.2023.07.006] [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: 05/03/2023] [Revised: 06/19/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Low skeletal muscle mass index (SMI) is frequently identified in gastric cancer patients but its association with patient survival rate is not clear. This systematic review and meta-analysis aimed to clarify the association between SMI and overall survival in gastric cancer patients after gastrectomy. METHODS PubMed, Scopus, and Web of Science were searched from database inception until July 2021. Studies were eligible if they included gastric cancer patients, measured the SMI level, reported SMI before gastrectomy, defined sarcopenia according to SMI, and had a cohort or case-control design. Primary outcome was cancer survival rate. The risk of bias of individual studies was assessed using the Newcastle - Ottawa Scale. RESULTS Overall, 22 cohort studies including 7,203 participants were included. The quality of the included studies was moderate to high. A higher overall survival rate was associated with a higher SMI (RR = 1.62, 95% CI: 1.42-1.85). Subgroup analysis suggested a stronger association in overweight or obese patients (RR = 2.39, 95% CI: 1.13-5.09; I2 = 77%; heterogeneity P < 0.01). But no significant differences in the association based on the surgery type (curative surgery vs radical surgery) or the type of gastrectomy (total gastrectomy vs sub-total gastrectomy) were observed. CONCLUSIONS It is suggested that SMI can be a prognostic indicator for overall survival in gastric cancer patients, especially in overweight and obese patients.
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Affiliation(s)
- Marieh Salavatizadeh
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samira Soltanieh
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nima Radkhah
- Nutrition Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amir Hossein Ataei Kachouei
- Department of Clinical Nutrition, School of Nutrition & Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Bahrami
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saman Khalesi
- Physical Activity Research Group, Appleton Institute and School of Health, Medical and Applied Sciences, Central Queensland University, Brisbane, Australia
| | - Ehsan Hejazi
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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14
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Delaye M, Rousseau A, Mailly-Giacchetti L, Assoun S, Sokol H, Neuzillet C. Obesity, cancer, and response to immune checkpoint inhibitors: Could the gut microbiota be the mechanistic link? Pharmacol Ther 2023:108442. [PMID: 37210004 DOI: 10.1016/j.pharmthera.2023.108442] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 04/27/2023] [Accepted: 05/15/2023] [Indexed: 05/22/2023]
Abstract
Immune checkpoint inhibitors (ICI) have deeply changed the therapeutic management of a broad spectrum of solid tumors. Recent observations showed that obese patients receiving ICIs might have better outcomes than those with normal weight, while obesity was historically associated with a worse prognosis in cancer patients. Of note, obesity is associated with alterations in the gut microbiome profile, which interacts with immune and inflammatory pathways, both at the systemic and intratumoral levels. As the influence of the gut microbiota on the response to ICI has been repeatedly reported, a specific gut microbiome profile in obese cancer patients may be involved in their better response to ICI. This review summarizes recent data on the interactions between obesity, gut microbiota, and ICIs. In addition, we highlight possible pathophysiological mechanisms supporting the hypothesis that gut microbiota could be one of the links between obesity and poor response to ICIs.
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Affiliation(s)
- Matthieu Delaye
- Curie Institute, Department of medical oncology, Versailles Saint-Quentin University, Saint-Cloud, France; GERCOR, 75011 Paris, France
| | - Adrien Rousseau
- Department of Medical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Léah Mailly-Giacchetti
- Department of Medical Oncology, Saint-Louis Hospital, AP-HP.Nord - Université de Paris, Paris, France
| | - Sandra Assoun
- Department of Thoracic Oncology & CIC 1425/CLIP2 Paris-Nord, Bichat-Claude Bernard Hospital, APHP, Paris, France
| | - Harry Sokol
- Paris Center for Microbiome Medicine (PaCeMM) FHU, Paris, France; Sorbonne Université, INSERM UMRS-938, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Paris, France; INRAE, AgroParisTech, Micalis Institut, 78350, Jouy-en-Josas, France
| | - Cindy Neuzillet
- Curie Institute, Department of medical oncology, Versailles Saint-Quentin University, Saint-Cloud, France; GERCOR, 75011 Paris, France.
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15
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Olsson LT, Eberle CE, Petruzella S, Robinson WR, Furberg H. A comparison of analytic approaches for investigating the obesity paradox in kidney cancer. Cancer Causes Control 2023; 34:361-370. [PMID: 36786871 PMCID: PMC10448500 DOI: 10.1007/s10552-023-01670-6] [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: 04/15/2022] [Accepted: 01/16/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE Body mass index (BMI) and kidney cancer mortality are inconsistently associated in the scientific literature. To understand how study design affects results, we contrasted associations between pre-diagnosis BMI and mortality under different analytic scenarios in a large, population-based prospective cohort study. METHODS Using data from the NIH-AARP Diet and Health Study (1995-2011), we constructed two cohorts: a "full at-risk" cohort with no kidney cancer history at baseline (n = 252,845) and an "incident cancer" subset who developed kidney cancer during follow-up (n = 1,652). Cox Proportional Hazards models estimated hazard ratios (HR) and 95% confidence intervals (CI) between pre-diagnosis BMI and mortality for different outcomes (all-cause and cancer-specific mortality), in the different cohorts (full at-risk vs. incident cancer cohort), and with different covariates (minimally vs. fully adjusted). For the incident cancer cohort, we also examined time to mortality using different timescales: from enrollment or diagnosis. RESULTS In the full at-risk study population, higher pre-diagnosis BMI was associated with greater cancer-specific mortality in fully adjusted multivariable models, particularly for obese participants [HR, (95% CI): 1.76, (1.38-2.25)]. This association was less pronounced in the incident cancer cohort [1.50, (1.09-2.07)]. BMI was not strongly associated with all-cause mortality in either cohort in fully adjusted models [full cohort: 1.03, (1.01, 1.06); incident cancer cohort: 1.20, (0.97, 1.48)]. CONCLUSIONS Populations characterized by high adult BMI will likely experience greater population burdens of mortality from kidney cancer, partially because of higher rates of kidney cancer diagnosis. Questions regarding overall mortality burden and post-diagnosis cancer survivorship are distinct and require different study designs.
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Affiliation(s)
- Linnea T Olsson
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carolyn E Eberle
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stacey Petruzella
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Whitney R Robinson
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, USA
| | - Helena Furberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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16
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Maurits JSF, Sedelaar JPM, Aben KKH, Kampman E, Kiemeney LALM, Vrieling A. Cohort profile - the Renal cell cancer: Lifestyle, prognosis and quality of life (ReLife) study in the Netherlands. BMJ Open 2023; 13:e066909. [PMID: 36972960 PMCID: PMC10069500 DOI: 10.1136/bmjopen-2022-066909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
PURPOSE The Renal cell cancer: Lifestyle, prognosis and quality of life (ReLife) study is set up to obtain insight into the association of patient and tumour characteristics, lifestyle habits and circulating biomarkers with body composition features in patients with localised renal cell cancer (RCC). Further, it aims to assess the association of body composition features, lifestyle habits and circulating biomarkers with clinical outcomes, including health-related quality of life. PARTICIPANTS The ReLife study is a multicentre prospective cohort study involving 368 patients with newly diagnosed stages I-III RCC recruited from January 2018 to June 2021 from 18 hospitals in the Netherlands. At 3 months, 1 year and 2 years after treatment, participants fill out a general questionnaire and questionnaires about their lifestyle habits (eg, diet, physical activity, smoking and alcohol consumption), medical history and health-related quality of life. At all three time points, patients wear an accelerometer and have blood samples taken. CT scans for body composition analysis are being collected. Permission is asked for collection of tumour samples. Information about disease characteristics, treatment of the primary tumour and clinical outcomes is being collected from medical records by the Netherlands Cancer Registry. FINDINGS TO DATE A total of 836 invited patients were eligible and 368 patients were willing to participate and were included (response rate 44%). The mean age of patients was 62.5±9.0 years and 70% was male. The majority had stage I (65%) disease and were treated with radical nephrectomy (57%). Data collection at 3 months and 1 years after treatment have been finalised. FUTURE PLANS Data collection at 2 years after treatment is expected to be finalised in June 2023 and longitudinal clinical data will continue to be collected. Results of studies based on this cohort are important to develop personalised evidence-based lifestyle advice for patients with localised RCC to enable them to get more control over their disease course.
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Affiliation(s)
- Jake S F Maurits
- Department for Health Evidence, Radboud Univerity Medical Center, Nijmegen, The Netherlands
| | - J P Michiel Sedelaar
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Katja K H Aben
- Department for Health Evidence, Radboud Univerity Medical Center, Nijmegen, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Ellen Kampman
- Department for Health Evidence, Radboud Univerity Medical Center, Nijmegen, The Netherlands
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | | | - Alina Vrieling
- Department for Health Evidence, Radboud Univerity Medical Center, Nijmegen, The Netherlands
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17
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Obesity and main urologic cancers: Current systematic evidence, novel biological mechanisms, perspectives and challenges. Semin Cancer Biol 2023; 91:70-98. [PMID: 36893965 DOI: 10.1016/j.semcancer.2023.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/06/2023] [Accepted: 03/06/2023] [Indexed: 03/09/2023]
Abstract
Urologic cancers (UC) account for 13.1% of all new cancer cases and 7.9% of all cancer-related deaths. A growing body of evidence has indicated a potential causal link between obesity and UC. The aim of the present review is to appraise in a critical and integrative manner evidence from meta-analyses and mechanistic studies on the role of obesity in four prevalent UC (kidney-KC, prostate-PC, urinary bladder-UBC, and testicular cancer-TC). Special emphasis is given on Mendelian Randomization Studies (MRS) corroborating a genetic causal association between obesity and UC, as well as on the role of classical and novel adipocytokines. Furthermore, the molecular pathways that link obesity to the development and progression of these cancers are reviewed. Available evidence indicates that obesity confers increased risk for KC, UBC, and advanced PC (20-82%, 10-19%, and 6-14%, respectively), whereas for TC adult height (5-cm increase) may increase the risk by 13%. Obese females tend to be more susceptible to UBC and KC than obese males. MRS have shown that a higher genetic-predicted BMI may be causally linked to KC and UBC but not PC and TC. Biological mechanisms that are involved in the association between excess body weight and UC include the Insulin-like Growth Factor axis, altered availability of sex hormones, chronic inflammation and oxidative stress, abnormal secretion of adipocytokines, ectopic fat deposition, dysbiosis of the gastrointestinal and urinary tract microbiomes and circadian rhythm dysregulation. Anti-hyperglycemic and non-steroidal anti-inflammatory drugs, statins, and adipokine receptor agonists/antagonists show potential as adjuvant cancer therapies. Identifying obesity as a modifiable risk factor for UC may have significant public health implications, allowing clinicians to tailor individualized prevention strategies for patients with excess body weight.
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Role of Machine Learning-Based CT Body Composition in Risk Prediction and Prognostication: Current State and Future Directions. Diagnostics (Basel) 2023; 13:diagnostics13050968. [PMID: 36900112 PMCID: PMC10000509 DOI: 10.3390/diagnostics13050968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/11/2023] [Accepted: 02/18/2023] [Indexed: 03/08/2023] Open
Abstract
CT body composition analysis has been shown to play an important role in predicting health and has the potential to improve patient outcomes if implemented clinically. Recent advances in artificial intelligence and machine learning have led to high speed and accuracy for extracting body composition metrics from CT scans. These may inform preoperative interventions and guide treatment planning. This review aims to discuss the clinical applications of CT body composition in clinical practice, as it moves towards widespread clinical implementation.
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Body Composition to Define Prognosis of Cancers Treated by Anti-Angiogenic Drugs. Diagnostics (Basel) 2023; 13:diagnostics13020205. [PMID: 36673015 PMCID: PMC9858245 DOI: 10.3390/diagnostics13020205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/28/2022] [Accepted: 01/03/2023] [Indexed: 01/08/2023] Open
Abstract
Background: Body composition could help to better define the prognosis of cancers treated with anti-angiogenics. The aim of this study is to evaluate the prognostic value of 3D and 2D anthropometric parameters in patients given anti-angiogenic treatments. Methods: 526 patients with different types of cancers were retrospectively included. The software Anthropometer3DNet was used to measure automatically fat body mass (FBM3D), muscle body mass (MBM3D), visceral fat mass (VFM3D) and subcutaneous fat mass (SFM3D) in 3D computed tomography. For comparison, equivalent two-dimensional measurements at the L3 level were also measured. The area under the curve (AUC) of the receiver operator characteristics (ROC) was used to determine the parameters’ predictive power and optimal cut-offs. A univariate analysis was performed using Kaplan−Meier on the overall survival (OS). Results: In ROC analysis, all 3D parameters appeared statistically significant: VFM3D (AUC = 0.554, p = 0.02, cutoff = 0.72 kg/m2), SFM3D (AUC = 0.544, p = 0.047, cutoff = 3.05 kg/m2), FBM3D (AUC = 0.550, p = 0.03, cutoff = 4.32 kg/m2) and MBM3D (AUC = 0.565, p = 0.007, cutoff = 5.47 kg/m2), but only one 2D parameter (visceral fat area VFA2D AUC = 0.548, p = 0.034). In log-rank tests, low VFM3D (p = 0.014), low SFM3D (p < 0.0001), low FBM3D (p = 0.00019) and low VFA2D (p = 0.0063) were found as a significant risk factor. Conclusion: automatic and 3D body composition on pre-therapeutic CT is feasible and can improve prognostication in patients treated with anti-angiogenic drugs. Moreover, the 3D measurements appear to be more effective than their 2D counterparts.
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Guo H, Zhang Y, Ma H, Gong P, Shi Y, Zhao W, Wang A, Liu M, Sun Z, Wang F, Wang Q, Ba X. T-stage-specific abdominal visceral fat, haematological nutrition indicators and inflammation as prognostic factors in patients with clear renal cell carcinoma. Adipocyte 2022; 11:133-142. [PMID: 35285399 PMCID: PMC8920171 DOI: 10.1080/21623945.2022.2048546] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Clear cell renal carcinoma (ccRCC) is the most common histological type of renal cancer and has the highest mortality. Several studies have been conducted on the relationship between adipose tissue and ccRCC prognosis, however, the results have been inconsistent to date. The current study aimed at establishing a link between abdominal fat composition and short-term prognosis in patients with ccRCC after T-stage stratification. We retrospectively analysed 250 patients with pathologically confirmed ccRCC (173 low T-stage and 77 high T-stage) in our hospital. The computed tomography (CT) images were evaluated using ImageJ. Then, subcutaneous and visceral fat areas (SFA and VFA), total fat areas (TFA) and the relative VFA (rVFA) were measured and computed. Meanwhile, biochemical indices of blood serum were analysed. The results showed that rVFA in low T-stage cohort who had a history of short-term postoperative complications were significantly lower than those who did not. No such association was observed in the high T-stage cohort. Further investigation revealed that the correlations between biochemical indexes and fat area-related variables varied across T-stage groups. As a result, rVFA is a reliable independent predictor of short-term prognosis in patients with low T-stage ccRCC but not in patients with high T-stage ccRCC.
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Affiliation(s)
- Hao Guo
- Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Shandong province, Jinan, China
- Department of Radiology, Yantai Yuhuangding Hospital, Shandong province, Yantai, China
| | - Yumei Zhang
- Department of Radiology, Lanshan Branch of Yantai Yuhuangding Hospital, Shandong province, Yantai, China
| | - Heng Ma
- Department of Radiology, Yantai Yuhuangding Hospital, Shandong province, Yantai, China
| | - Peiyou Gong
- Department of Radiology, Yantai Yuhuangding Hospital, Shandong province, Yantai, China
| | - Yinghong Shi
- Department of Radiology, Yantai Yuhuangding Hospital, Shandong province, Yantai, China
| | - Wenlei Zhao
- Department of Radiology, Yantai Yuhuangding Hospital, Shandong province, Yantai, China
| | - Aijie Wang
- Department of Radiology, Yaitai Shan Hospital, Shandong province, Yantai, China
| | - Ming Liu
- Department of Radiology, Yantai Yuhuangding Hospital, Shandong province, Yantai, China
| | - Zehua Sun
- Department of Radiology, Yantai Yuhuangding Hospital, Shandong province, Yantai, China
| | - Fang Wang
- Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Shandong province, Jinan, China
| | - Qing Wang
- Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Shandong province, Jinan, China
| | - Xinru Ba
- Department of Radiology, Yaitai Shan Hospital, Shandong province, Yantai, China
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Ged Y, Sanchez A, Patil S, Knezevic A, Stein E, Petruzella S, Weiss K, Duzgol C, Chaim J, Akin O, Mourtzakis M, Paris MT, Scott J, Kuo F, Kotecha R, Hakimi AA, Lee CH, Motzer RJ, Voss MH, Furberg H. Associations between Pretreatment Body Composition Features and Clinical Outcomes among Patients with Metastatic Clear Cell Renal Cell Carcinoma Treated with Immune Checkpoint Blockade. Clin Cancer Res 2022; 28:5180-5189. [PMID: 36190538 PMCID: PMC9793646 DOI: 10.1158/1078-0432.ccr-22-1389] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/24/2022] [Accepted: 09/29/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE High body mass index (BMI) may lead to improved immune-checkpoint blockade (ICB) outcomes in metastatic clear cell renal cell carcinoma (mccRCC). However, BMI is a crude body size measure. We investigated BMI and radiographically assessed body composition (BC) parameters association with mccRCC ICB outcomes. EXPERIMENTAL DESIGN Retrospective study of ICB-treated patients with mccRCC. BMI and BC variables [skeletal muscle index (SMI) and multiple adiposity indexes] were determined using pretreatment CT scans. We examined the associations between BMI and BC variables with ICB outcomes. Therapeutic responses per RECIST v1.1 were determined. We compared whole-transcriptomic patterns with BC variables in a separate cohort of 62 primary tumor samples. RESULTS 205 patients with mccRCC were included in the cohort (74% were male, 71% were overweight/obese, and 53% were classified as low SMI). High-BMI patients experienced longer overall survival (OS) than normal-weight patients [unadjusted HR, 0.66; 95% confidence interval (CI), 0.45-0.97; P = 0.035]. The only BC variable associated with OS was SMI [unadjusted HR comparing low vs. high SMI 1.65 (95% CI: 1.13-2.43); P = 0.009]. However, this OS association became nonsignificant after adjusting for International Metastatic Renal Cell Carcinoma Database Consortium score and line of therapy. No OS association was seen for adiposity and no BC variable was associated with progression-free survival or radiological responses. Tumors from patients with low SMI displayed increased angiogenic, inflammatory, and myeloid signals. CONCLUSIONS Our findings highlight the relevance of skeletal muscle in the BMI paradox. Future studies should investigate if addressing low skeletal muscle in metastatic patients treated with ICB can improve survival.
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Affiliation(s)
- Yasser Ged
- Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY,Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Alejandro Sanchez
- Department of Surgery, MSKCC, New York,Department of Surgery, Division of Urology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Sujata Patil
- Department of Biostatistics, Cleveland Clinic, Cleveland, OH,Department of Epidemiology and Biostatistics, MSKCC, New York, NY
| | - Andrea Knezevic
- Department of Epidemiology and Biostatistics, MSKCC, New York, NY
| | - Emily Stein
- Department of Epidemiology and Biostatistics, MSKCC, New York, NY
| | | | - Kate Weiss
- Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY
| | | | | | - Oguz Akin
- Department of Radiology, MSKCC, New York, NY
| | | | - Michael T. Paris
- Department of Kinesiology, University of Waterloo, Waterloo Canada
| | - Jessica Scott
- Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY
| | | | - Ritesh Kotecha
- Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY
| | | | - Chung-Han Lee
- Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY
| | - Robert J. Motzer
- Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY
| | - Martin H. Voss
- Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY
| | - Helena Furberg
- Department of Epidemiology and Biostatistics, MSKCC, New York, NY
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22
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A hint for the obesity paradox and the link between obesity, perirenal adipose tissue and Renal Cell Carcinoma progression. Sci Rep 2022; 12:19956. [PMID: 36402906 PMCID: PMC9675816 DOI: 10.1038/s41598-022-24418-9] [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: 02/04/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022] Open
Abstract
Increasing evidence supports a role for local fat depots in cancer outcomes. Despite the robust positive association of obesity with renal cell carcinoma (RCCa) diagnosis, increased adiposity is inversely related to RCCa oncological outcomes. Here, we sought to ascertain whether imagiologically assessed local fat depots associate with RCCa progression and survival and account for this apparent paradox. A retrospective cohort of renal carcinoma patients elective for nephrectomy (n = 137) were included. Beyond baseline clinicopathological characteristics, computed tomography (CT)-scans at the level of renal hilum evaluated areas and densities of different adipose tissue depots (perirenal, subcutaneous, visceral) and skeletal muscle (erector spinae, psoas and quadratus lumborum muscles) were analyzed. Univariate and multivariable Cox proportional hazards models were estimated following empirical analysis using stepwise Cox regression. Age, visceral adipose tissue (VAT) area and body mass index (BMI) predicted tumour-sided perirenal fat area (R2 = 0.584), which presented upregulated UCP1 expression by 27-fold (P = 0.026) and smaller adipocyte areas, compared with subcutaneous depot. Multivariate analyses revealed that increased area of perirenal adipose tissue (PRAT) on the contralateral and tumour side associate with improved progression-free survival (HR = 0.3, 95CI = 0.1-0.8, P = 0.019) and overall survival (HR = 0.3, 95CI = 0.1-0.7, P = 0.009). PRAT measurements using CT, might become a possible tool, well correlated with other measures of obesity such as VAT and BMI, that will improve determination of obesity and contribute to assess the risk for disease progression and mortality in renal cancer patients. Present data supports the obesity paradox in RCCa, assumed that larger PRAT areas seem to protect from disease progression and death.
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Ning K, Li Z, Liu H, Tian X, Wang J, Wu Y, Xiong L, Zou X, Peng Y, Zhou Z, Zhou F, Yu C, Luo J, Zhang H, Dong P, Zhang Z. Perirenal Fat Thickness Significantly Associated with Prognosis of Metastatic Renal Cell Cancer Patients Receiving Anti-VEGF Therapy. Nutrients 2022; 14:nu14163388. [PMID: 36014894 PMCID: PMC9412489 DOI: 10.3390/nu14163388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/06/2022] [Accepted: 08/14/2022] [Indexed: 11/16/2022] Open
Abstract
Although high body mass index (BMI) was reported to associate with a better prognosis for metastatic renal cell cancer (mRCC) patients receiving anti-vascular endothelial growth factor (anti-VEGF) therapy, it is an imperfect proxy for the body composition, especially in Asian patients with a lower BMI. The role of visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and perirenal fat thickness (PRFT) in mRCC patients was still unknown. Therefore, a multicenter retrospective study of 358 Chinese mRCC patients receiving anti-VEGF therapy was conducted and their body composition was measured via computed tomography. We parameterized VAT, SAT and PRFT according to their median value and BMI according to Chinese criteria (overweight: BMI ≥ 24). We found VAT, SAT, and PRFT (all p < 0.05) but not BMI, significantly associated with overall survival (OS) and progression-free survival (PFS). Multivariate Cox analysis identified PRFT was the independent predictor of OS and PFS, and IMDC expanded with PRFT showed the highest C-index in predicting OS (OS:0.71) compared with VAT, SAT, and BMI. PRFT could increase the area under the curve of the traditional International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) model in OS (70.54% increase to 74.71%) and PFS (72.22% increase to 75.03%). PRFT was introduced to improve the IMDC model and PRFT-modified IMDC demonstrated higher AIC in predicting OS and PFS compared with the traditional IMDC model. Gene sequencing analysis (n = 6) revealed that patients with high PRFT had increased angiogenesis gene signatures (NES = 1.46, p = 0.04) which might explain why better drug response to anti-VEGF therapy in mRCC patients with high PRFT. The main limitation is retrospective design. This study suggests body composition, especially PRFT, is significantly associated with prognosis in Chinese mRCC patients receiving anti-VEGF therapy. PRFT-modified IMDC model proposed in this study has better clinical predictive value.
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Affiliation(s)
- Kang Ning
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou 510080, China
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Zhen Li
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou 510080, China
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Huiming Liu
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, Guangzhou 510080, China
| | - Xi Tian
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai 201102, China
| | - Jun Wang
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou 510080, China
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Yi Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510080, China
| | - Longbin Xiong
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou 510080, China
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Xiangpeng Zou
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou 510080, China
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Yulu Peng
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou 510080, China
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Zhaohui Zhou
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou 510080, China
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Fangjian Zhou
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou 510080, China
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Chunping Yu
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou 510080, China
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Junhang Luo
- Department of Urology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Hailiang Zhang
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai 201102, China
- Correspondence: (H.Z.); (P.D.); (Z.Z.); Tel.: +86-13512738496 (P.D.); +86-13929527746 (Z.Z.); Fax: +86-87342318 (P.D.); +020-8734-3952 (Z.Z.)
| | - Pei Dong
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou 510080, China
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
- Correspondence: (H.Z.); (P.D.); (Z.Z.); Tel.: +86-13512738496 (P.D.); +86-13929527746 (Z.Z.); Fax: +86-87342318 (P.D.); +020-8734-3952 (Z.Z.)
| | - Zhiling Zhang
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou 510080, China
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
- Correspondence: (H.Z.); (P.D.); (Z.Z.); Tel.: +86-13512738496 (P.D.); +86-13929527746 (Z.Z.); Fax: +86-87342318 (P.D.); +020-8734-3952 (Z.Z.)
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Salas S, Cottet V, Dossus L, Fassier P, Ginhac J, Latino-Martel P, Romieu I, Schneider S, Srour B, Touillaud M, Touvier M, Ancellin R. Nutritional Factors during and after Cancer: Impacts on Survival and Quality of Life. Nutrients 2022; 14:2958. [PMID: 35889914 PMCID: PMC9323157 DOI: 10.3390/nu14142958] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 02/04/2023] Open
Abstract
The French National Cancer Institute conducted a collective expertise study with researchers and clinical experts from the French Network for Nutrition And Cancer Research (NACRe Network). The objective was to update the state of knowledge on the impacts of nutritional factors on clinical endpoints during or after cancer. Data from 150 meta-analyses, pooled analyses or intervention trials and 93 cohort studies were examined; they concerned 8 nutritional factors, 6 clinical events and 20 cancer locations. This report shows that some nutritional factors have impacts on mortality and on the risks of recurrence or second primary cancer in cancer patients. Therefore, high-risk nutritional conditions can be encountered for certain cancer sites: from the diagnosis and throughout the health care pathways, weight loss (lung and esophageal cancers), malnutrition (lung, esophageal, colorectal, pancreatic, gastric and liver cancers), weight gain (colorectal, breast and kidney cancers) and alcohol consumption (upper aerodigestive cancers) should be monitored; and after cancer treatments, excess weight should be detected (colorectal, breast and kidney cancers). These situations require nutritional assessments, and even support or management by health care professionals, in the context of tertiary prevention. This report also highlights some limitations regarding the existing literature and some needs for future research.
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Affiliation(s)
- Sébastien Salas
- AP-HM, Timone Hospital, Aix Marseille University, 13000 Marseille, France;
- The French Network for Nutrition and Cancer Research (NACRe Network), 78350 Jouy-en-Josas, France; (L.D.); (P.F.); (J.G.); (P.L.-M.); (I.R.); (S.S.); (B.S.); (M.T.); (M.T.)
| | - Vanessa Cottet
- The French Network for Nutrition and Cancer Research (NACRe Network), 78350 Jouy-en-Josas, France; (L.D.); (P.F.); (J.G.); (P.L.-M.); (I.R.); (S.S.); (B.S.); (M.T.); (M.T.)
- INSERM UMR1231/CIC 1432, University Hospital, LabEx LipSTIC ANR-11-LABX-0021, University of Burgundy-Franche-Comté, 21000 Dijon, France
| | - Laure Dossus
- The French Network for Nutrition and Cancer Research (NACRe Network), 78350 Jouy-en-Josas, France; (L.D.); (P.F.); (J.G.); (P.L.-M.); (I.R.); (S.S.); (B.S.); (M.T.); (M.T.)
- International Agency for Research on Cancer, 69000 Lyon, France
| | - Philippine Fassier
- The French Network for Nutrition and Cancer Research (NACRe Network), 78350 Jouy-en-Josas, France; (L.D.); (P.F.); (J.G.); (P.L.-M.); (I.R.); (S.S.); (B.S.); (M.T.); (M.T.)
- Gustave Roussy Institute, 94800 Villejuif, France
| | - Julie Ginhac
- The French Network for Nutrition and Cancer Research (NACRe Network), 78350 Jouy-en-Josas, France; (L.D.); (P.F.); (J.G.); (P.L.-M.); (I.R.); (S.S.); (B.S.); (M.T.); (M.T.)
- Nutritional Epidemiology Research Team (EREN), Sorbonne Paris Nord University, INSERM, INRAE, CNAM, Epidemiology and Statistics Research Centre (CRESS), University of Paris, 93022 Bobigny, France
| | - Paule Latino-Martel
- The French Network for Nutrition and Cancer Research (NACRe Network), 78350 Jouy-en-Josas, France; (L.D.); (P.F.); (J.G.); (P.L.-M.); (I.R.); (S.S.); (B.S.); (M.T.); (M.T.)
- Nutritional Epidemiology Research Team (EREN), Sorbonne Paris Nord University, INSERM, INRAE, CNAM, Epidemiology and Statistics Research Centre (CRESS), University of Paris, 93022 Bobigny, France
| | - Isabelle Romieu
- The French Network for Nutrition and Cancer Research (NACRe Network), 78350 Jouy-en-Josas, France; (L.D.); (P.F.); (J.G.); (P.L.-M.); (I.R.); (S.S.); (B.S.); (M.T.); (M.T.)
- International Agency for Research on Cancer, 69000 Lyon, France
| | - Stéphane Schneider
- The French Network for Nutrition and Cancer Research (NACRe Network), 78350 Jouy-en-Josas, France; (L.D.); (P.F.); (J.G.); (P.L.-M.); (I.R.); (S.S.); (B.S.); (M.T.); (M.T.)
- University Hospital, University of Côte d’Azur, 06000 Nice, France
| | - Bernard Srour
- The French Network for Nutrition and Cancer Research (NACRe Network), 78350 Jouy-en-Josas, France; (L.D.); (P.F.); (J.G.); (P.L.-M.); (I.R.); (S.S.); (B.S.); (M.T.); (M.T.)
- Nutritional Epidemiology Research Team (EREN), Sorbonne Paris Nord University, INSERM, INRAE, CNAM, Epidemiology and Statistics Research Centre (CRESS), University of Paris, 93022 Bobigny, France
| | - Marina Touillaud
- The French Network for Nutrition and Cancer Research (NACRe Network), 78350 Jouy-en-Josas, France; (L.D.); (P.F.); (J.G.); (P.L.-M.); (I.R.); (S.S.); (B.S.); (M.T.); (M.T.)
- Léon-Bérard Cancer Centre, UA8 Inserm, 69000 Lyon, France
| | - Mathilde Touvier
- The French Network for Nutrition and Cancer Research (NACRe Network), 78350 Jouy-en-Josas, France; (L.D.); (P.F.); (J.G.); (P.L.-M.); (I.R.); (S.S.); (B.S.); (M.T.); (M.T.)
- Nutritional Epidemiology Research Team (EREN), Sorbonne Paris Nord University, INSERM, INRAE, CNAM, Epidemiology and Statistics Research Centre (CRESS), University of Paris, 93022 Bobigny, France
| | - Raphaëlle Ancellin
- The French National Cancer Institute (INCa), 92012 Boulogne-Billancourt, France;
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Özdemir BC, Gerard CL, Espinosa da Silva C. Sex and Gender Differences in Anticancer Treatment Toxicity: A Call for Revisiting Drug Dosing in Oncology. Endocrinology 2022; 163:bqac058. [PMID: 35560216 PMCID: PMC9113364 DOI: 10.1210/endocr/bqac058] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Indexed: 11/27/2022]
Abstract
The practice of oncology has dramatically changed in the last decade with the introduction of molecular tumor profiling into routine tumor diagnostics and the extraordinary progress in immunotherapies. However, there remains an unmet need to explore personalized dosing strategies that take into account the patient's sex and gender to optimize the balance between efficacy and toxicity for each individual patient. In this mini-review, we summarize the evidence on sex and gender differences in toxicity of anticancer therapies and present data on dose reduction and dose discontinuation rates for selected chemotherapies and targeted therapies. Finally, we propose the investigation of body composition (specifically fat-free muscle mass) as a viable approach for personalized treatment dosage.
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Affiliation(s)
- Berna C Özdemir
- Department of Medical Oncology, Bern University Hospital and University of Bern, Bern 3011, Switzerland
- International Cancer Prevention Institute, Epalinges 1066, Switzerland
| | - Camille L Gerard
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne 1011, Switzerland
- The Francis Crick Institute, London, United Kingdom
| | - Cristina Espinosa da Silva
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California San Diego, San Diego 92093, USA
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, USA
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Liu Z, Lu S, Wang Y, Lin X, Ran P, Zhou X, Fu W, Wang H. Impact of Body Composition During Neoadjuvant Chemoradiotherapy on Complications, Survival and Tumor Response in Patients With Locally Advanced Rectal Cancer. Front Nutr 2022; 9:796601. [PMID: 35155538 PMCID: PMC8830534 DOI: 10.3389/fnut.2022.796601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 01/06/2022] [Indexed: 01/05/2023] Open
Abstract
Background To explore the impact of body composition before neoadjuvant chemoradiotherapy (pre-NCRT) and after neoadjuvant chemoradiotherapy (post-NCRT) on complications, survival, and tumor response in patients with locally advanced rectal cancer (LARC). Methods Patients with LARC who underwent radical surgery after NCRT between Ja 22nuary 2012 and March 2019 were studied. Body composition parameters, including skeletal muscle area (SMA), muscle density (MD), visceral fat area (VFA), total abdominal fat area (TAFA), and subcutaneous fat area (SFA), was identified at the third lumbar vertebra level on computed tomography (CT). The patients were divided into two groups based on the sex-specific quartile values of SMA, MD, VFA, TAFA, SFA, and body composition change. Patient characteristics, short- and long-term postoperative complications, survival, and tumor response were analyzed. Results A total of 122 eligible patients were enrolled. Body composition parameters, except MD, were strongly correlated with BMI (p < 0.001). Pre-NCRT low MD (p = 0.04) and TAFA loss (p = 0.02) were significantly correlated with short- and long-term ileus, respectively. Pre-NCRT low SMA was a significant prognostic factor for both disease-free survival (DFS) (HR 2.611, 95% CI 1.129–6.040, p = 0.025) and cancer-specific survival (CSS) (HR 3.124, 95% CI 1.030–9.472, p = 0.044) in the Cox regression multivariate analysis. Multivariate logistic regression analysis identified post-NCRT SFA (OR 3.425, 95% CI 1.392–8.427, p = 0.007) and SFA loss (OR 3.358, 95% CI 1.214–9.289, p = 0.02) as independent risk factors for tumor regression grade (TRG) and downstaging, respectively. Conclusion Pre-NCRT low MD and TAFA loss were related to a high incidence of short- and long-term ileus, respectively. Pre-NCRT low SMA was a significant prognostic factor for CSS and DFS. Post-NCRT SFA and SFA loss were independent risk factors for TRG and downstaging, respectively.
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Affiliation(s)
- Zhenzhen Liu
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Siyi Lu
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Yuxia Wang
- Department of Radiotherapy, Peking University Third Hospital, Beijing, China
| | - Xinyi Lin
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Peng Ran
- Department of Radiotherapy, Peking University Third Hospital, Beijing, China
| | - Xin Zhou
- Department of General Surgery, Peking University Third Hospital, Beijing, China
- *Correspondence: Xin Zhou
| | - Wei Fu
- Department of General Surgery, Peking University Third Hospital, Beijing, China
- Wei Fu
| | - Hao Wang
- Department of Radiotherapy, Peking University Third Hospital, Beijing, China
- Hao Wang
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Guo H, Zhao W, Wang A, Li M, Ma H, Wang F, Wang Q, Ba X. The value of sex-specific abdominal visceral fat as measured via CT as a predictor of clear renal cell carcinoma T stage. Adipocyte 2021; 10:285-292. [PMID: 34014795 PMCID: PMC8143252 DOI: 10.1080/21623945.2021.1924957] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Although much is known about how adipose tissue affects the development of clear cell renal carcinoma (ccRCC), little information is available for the utility of sex-specific abdominal visceral fat composition as a predictor of clear cell renal carcinoma (ccRCC) T stage. We conducted CT-based sex-specific abdominal fat measurements in ccRCC patients to assess whether VFA distribution could predict the ccRCC T stage. In total, 253 patients (182 males and 71 females) from our hospital with pathologically confirmed ccRCC (178 low T-stage and 75 high T-stage) were retrospectively reviewed for the present study. Computed tomography (CT) scans were assessed using ImageJ to differentiate between the visceral and subcutaneous fat areas (VFA and SFA), after which the relative VFA (rVFA) and total fat area (TFA) were computed. The relationships between these fat area-related variables, patient age, sex, and BMI, and ccRCC T stage were then evaluated through univariate and multivariate logistic regression analysis to clarify the association between general or sex-specific abdominal visceral fat and T stage. Following adjustment for age, males with high T stage ccRCC exhibited an increased rVFA as compared to males with low T stage ccRCC, with the same relationship being observed among females. This association between rVFA and high T stage was confirmed through both univariate and multivariate models. As thus, sex-specific visceral fat composition is a reliable independent predictor that can identify both male and female patients with high T stage ccRCC.
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Affiliation(s)
- Hao Guo
- Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Radiology, Yuhuangding Hospital, Qingdao University School of Medicine, Yantai, China
| | - Wenlei Zhao
- Department of Radiology, Yuhuangding Hospital, Qingdao University School of Medicine, Yantai, China
| | - Aijie Wang
- Department of Radiology, Yaitai Shan Hospital, Yantai, China
| | - Mingzhuo Li
- Center for Big Data Research in Health and Medicine, The First Affilicated Hospital of Shandong First Medical University, Jinan, China
| | - Heng Ma
- Department of Radiology, Yuhuangding Hospital, Qingdao University School of Medicine, Yantai, China
| | - Fang Wang
- Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qing Wang
- Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xinru Ba
- Department of Radiology, Yaitai Shan Hospital, Yantai, China
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Maurits JSF, Sedelaar JPM, Mulders PFA, Aben KKH, Kiemeney LALM, Vrieling A. Skeletal muscle radiodensity and visceral adipose tissue index are associated with survival in renal cell cancer - A multicenter population-based cohort study. Clin Nutr 2021; 41:131-143. [PMID: 34872047 DOI: 10.1016/j.clnu.2021.11.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 11/01/2021] [Accepted: 11/12/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Body composition has been associated with disease outcome in several cancer types. Results for localized and metastatic renal cell cancer (RCC) are limited and inconsistent. Our aim was to examine the association between body composition and survival in RCC. METHODS We conducted a population-based historical cohort study including patients diagnosed with RCC from 2008 to 2012. Diagnostic Computed Tomography images at the third lumbar vertebra (L3) were assessed for skeletal muscle index (SMI), skeletal muscle density (SMD), visceral adipose tissue index (VATI) and subcutaneous adipose tissue index (SATI). Clinical data was retrieved from medical records. Multivariable Cox regressions with restricted cubic splines were used to determine hazard ratios (HRs) and 95% confidence intervals (95%CIs) for 10-unit increases in body composition features with overall survival (OS) and recurrence-free survival (RFS). RESULTS We included 719 stage I-III (of whom 254 (35.3%) died and 148 (21.9%) experienced recurrence) and 320 stage IV RCC patients (of whom 298 (93.1%) died). Median follow-up was 6.35 years (interquartile range; 1.41-8.23). For stage I-III, higher SMD was associated with better OS (men: HR 0.86; 95% CI 0.68-1.08; women: HR 0.69; 95% CI 0.50-0.95). Lower compared to median VATI was associated with worse OS for both men (HR 1.38; 95%CI 1.05-1.83 for VATI = 25) and women (HR 1.67; 95%CI 1.01-2.78 for VATI = 20). For stage IV, higher SMD and higher VATI were associated with better OS among men (HR 0.74; 95% CI 0.59-0.94 and HR 0.93; 95% CI 0.88-0.99, respectively). Results for women were similar but non-significant. No statistically significant associations were found for SMI or SATI. CONCLUSION Higher SMD and higher VATI were marginally associated with better survival in RCC patients and might be useful for better prognostication. However, the added value to current prognostic scores needs to be investigated.
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Affiliation(s)
- Jake S F Maurits
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - J P Michiel Sedelaar
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Peter F A Mulders
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Katja K H Aben
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Lambertus A L M Kiemeney
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Alina Vrieling
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands.
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Scopel Poltronieri T, de Paula NS, Chaves GV. Skeletal muscle radiodensity and cancer outcomes: A scoping review of the literature. Nutr Clin Pract 2021; 37:1117-1141. [PMID: 34752653 DOI: 10.1002/ncp.10794] [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] [Indexed: 11/08/2022] Open
Abstract
Patients with cancer are more prone to experience myosteatosis than healthy individuals. The aim of this review was to summarize the methodologies applied for low skeletal muscle radiodensity (SMD) assessment in oncology patients, as well as to describe the major findings related to SMD and cancer outcomes. This scoping review included studies that were published until November 2020 in English, Portuguese, or Spanish; were performed in humans diagnosed with cancer, adult and/or elderly, of both sexes; investigated SMD through computed tomography of the region between the third and fifth lumbar vertebrae, considering at least two muscular groups; and evaluated clinical and/or surgical outcomes. Eighty-eight studies met the inclusion criteria (n = 37,583 patients). Survival was the most evaluated outcome. Most studies reported a significant association between low SMD and unfavorable outcomes. However, this relationship was not clear for survival, antineoplastic treatment, and surgical complications, potentially because of the unstandardized approaches for the assessment of SMD and inadequate study design. Future studies should address these issues to provide an in-depth understanding of the clinical relevance of SMD in cancer outcomes as well as how SMD is influenced by individuals and tumor-related characteristics in patients with cancer.
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Affiliation(s)
- Taiara Scopel Poltronieri
- Department of Nutrition, Cancer Hospital II, National Cancer Institute José Alencar Gomes da Silva (INCA), Rio de Janeiro, Rio de Janeiro, Brazil.,Postgraduate Program in Medical Sciences, Endocrinology, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Nathália Silva de Paula
- Department of Nutrition, Cancer Hospital II, National Cancer Institute José Alencar Gomes da Silva (INCA), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gabriela Villaça Chaves
- Department of Nutrition, Cancer Hospital II, National Cancer Institute José Alencar Gomes da Silva (INCA), Rio de Janeiro, Rio de Janeiro, Brazil
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Darbas T, Forestier G, Leobon S, Pestre J, Jesus P, Lachatre D, Tubiana-Mathieu N, Descazeaud A, Deluche E. Impact of Body Composition in Overweight and Obese Patients With Localised Renal Cell Carcinoma. In Vivo 2021; 34:2873-2881. [PMID: 32871827 DOI: 10.21873/invivo.12115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND/AIM To investigate the impact of body composition on morbidity and mortality at the initial diagnosis of localised renal cell carcinoma (RCC) in patients with overweight or obesity. PATIENTS AND METHODS Sarcopenia was defined using sex-specific cut-off points and other body composition parameters by median values with computed tomography imaging. RESULTS Among the 96 patients, 40 had sarcopenia (43.0%) at diagnosis. Body composition had no effect on morbidity and 5-year disease-free survival contrary to the classic factors (p<0.05). In the subgroup of obese patients, those with sarcopenia had a poor prognosis (p=0.04) but not in the population with overweight (p=0.9). CONCLUSION Sarcopenia was frequently associated with localised RCC at the initial diagnosis. Body composition did not affect morbidity or outcomes. BMI was involved in morbidity and there was paradoxically longer survival in the obesity group.
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Affiliation(s)
- Tiffany Darbas
- Department of Medical Oncology, Limoges University Hospital, Limoges, France
| | - Geraud Forestier
- Department of Radiology, Limoges University Hospital, Limoges, France
| | - Sophie Leobon
- Department of Medical Oncology, Limoges University Hospital, Limoges, France
| | - Julia Pestre
- Department of Medical Oncology, Limoges University Hospital, Limoges, France
| | - Pierre Jesus
- Nutrition Unit, Limoges University Hospital, Limoges, France
| | - Denis Lachatre
- Department of Radiology, Limoges University Hospital, Limoges, France
| | | | | | - Elise Deluche
- Department of Medical Oncology, Limoges University Hospital, Limoges, France
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Ancellin R, Cottet V, Dossus L, Fassier P, Gaillot de Saintignon J, Ginhac J, Romieu I, Salas S, Schneider S, Srour B, Touillaud M, Touvier M, Latino-Martel P. [Impact of nutritional factors during and after cancer]. Bull Cancer 2021; 108:455-464. [PMID: 33836862 DOI: 10.1016/j.bulcan.2021.03.001] [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: 02/02/2021] [Accepted: 03/07/2021] [Indexed: 02/07/2023]
Abstract
Nutritional factors (diet, weight, alcohol, physical activity) are identified as factors having an impact on the onset of several cancer sites. Less abundant scientific data also underline their impact on the tumor progression. A review of the scientific literature was carried out by a group of experts established by the French National Cancer Institute (INCa) to better document the influence of nutritional factors during and after cancer on outcomes such as overall mortality, cancer specific mortality, recurrence, second primary cancers and quality of life. This analysis of the literature completes messages of reduction of alcohol consumption, prevention of undernutrition or excess weight and adherence to dietary recommendations, avoiding the use of dietary supplements, fasting or restrictive diets and strengthens messages promoting the practice of physical activity and the fight against sedentary lifestyle.
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Affiliation(s)
- Raphaëlle Ancellin
- Institut national du cancer, 52, avenue André-Morizet, 92100 Boulogne-Billancourt, France.
| | - Vanessa Cottet
- CHU de Dijon, université de Bourgogne-Franche-Comté, Inserm UMR1231 & CIC1432, 7, boulevard Jeanne-d'Arc, 21079 Dijon, France
| | - Laure Dossus
- Centre international de recherche sur le cancer (CIRC), 150, cours Albert-Thomas, 69008 Lyon, France
| | | | | | - Julie Ginhac
- Cellule de coordination, domaine de Vilvert, réseau national alimentation cancer recherche (Réseau NACRe), 78350 Jouy-en-Josas, France
| | - Isabelle Romieu
- Center for Research on Population Health, National Institute of Public Health, Mexico, Mexique; Emory University, Hubert Department of Global Health, Atlanta, Georgia, États-Unis
| | - Sébastien Salas
- CHU de Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Stéphane Schneider
- Université Côte d'Azur, CHU de Nice, Hôpital de l'Archet, 151, route de Saint-Antoine, 06200 Nice, France
| | - Bernard Srour
- Cellule de coordination, domaine de Vilvert, réseau national alimentation cancer recherche (Réseau NACRe), 78350 Jouy-en-Josas, France; Université Sorbonne Paris Nord, université de Paris (CRESS), Inrae U1125, Cnam, équipe de recherche en épidémiologie nutritionnelle (EREN), centre de recherche en épidémiologie et statistiques, Inserm U1153, 74, rue Marcel-Cachin, 93017 Bobigny, France
| | - Marina Touillaud
- Centre Léon-Bérard, Inserm UA8 « Radiations : défense, santé et environnement », 28, rue Laennec, 69008 Lyon, France
| | - Mathilde Touvier
- Université Sorbonne Paris Nord, université de Paris (CRESS), Inrae U1125, Cnam, équipe de recherche en épidémiologie nutritionnelle (EREN), centre de recherche en épidémiologie et statistiques, Inserm U1153, 74, rue Marcel-Cachin, 93017 Bobigny, France
| | - Paule Latino-Martel
- Cellule de coordination, domaine de Vilvert, réseau national alimentation cancer recherche (Réseau NACRe), 78350 Jouy-en-Josas, France
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Park JS, Jang WS, Kim J, Lee SH, Rha KH, Ham WS. Association between visceral adiposity and DDX11 as a predictor of aggressiveness of small clear-cell renal-cell carcinoma: a prospective clinical trial. Cancer Metab 2021; 9:15. [PMID: 33823929 PMCID: PMC8025550 DOI: 10.1186/s40170-021-00251-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 03/15/2021] [Indexed: 12/27/2022] Open
Abstract
Background Visceral fat produces several hormones and cytokines associated with carcinogenesis and tumor progression. Herein, we investigated the association between visceral adiposity and target-gene mRNA expression in patients with localized small clear-cell renal-cell carcinoma (ccRCC). Methods We included 200 patients with localized clinical T1a stage ccRCC who had undergone nephrectomy from November 2018 to November 2020 in a prospective clinical trial (NCT03694912). Visceral, subcutaneous, and total adipose tissue in these patients was measured via preoperative computerized tomography of the mid-third lumbar vertebra region. We then examined the association between adiposity and the mRNA levels of PBRM1, BAP1, SETD2, KDM5C, FOXC2, CLIP4, AQP1, DDX11, BAIAP2L1, and TMEM38B in matched frozen tumor tissues and plasma samples. Results Upon the stratification of patients into quartiles according to their relative visceral adiposity, high visceral adiposity was found to be significantly associated with low ISUP grade (P = 0.004). Multivariate logistic regression analysis revealed a significant association between frozen tissue DDX11 expression and high visceral adiposity (OR 0.676, 95% CI 0.587–0.779, P < 0.001). Moreover, frozen tissue DDX11 expression was significantly associated with high ISUP grade (OR 1.556, 95% CI 1.223–1.981, P < 0.001). The frozen tissue mRNA expression of DDX11 was identified as a biomarker for visceral adiposity and cancer aggressiveness. Conclusions The results obtained herein will aid in inferring the aggressiveness of small ccRCCs, represented by ISUP nuclear grade, in clinical practice. Our findings indicated that DDX11 and visceral fat play active roles in small ccRCC. These roles should be examined in future studies for the possible use of DDX11 and visceral fat as prognostic biomarkers in the treatment of patients with ccRCC. Trial registration ClinicalTrials.gov, NCT03694912, Registered 3 October 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s40170-021-00251-y.
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Affiliation(s)
- Jee Soo Park
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won Sik Jang
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jongchan Kim
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Hwan Lee
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Koon Ho Rha
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won Sik Ham
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Visceral Adiposity as a Significant Predictor of Sunitinib-Induced Dose-Limiting Toxicities and Survival in Patients with Metastatic Clear Cell Renal Cell Carcinoma. Cancers (Basel) 2020; 12:cancers12123602. [PMID: 33276522 PMCID: PMC7761595 DOI: 10.3390/cancers12123602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/29/2020] [Accepted: 11/30/2020] [Indexed: 12/15/2022] Open
Abstract
Sunitinib is a first-line treatment for metastatic renal cell carcinoma (mRCC). Little is known about the predictive factors of sunitinib-induced dose-limiting toxicity (DLT) in Asian populations. We investigated whether body composition predicts sunitinib-induced DLT. We retrospectively reviewed sunitinib-treated Korean patients with clear cell mRCC from eight institutions. Body composition was measured using computed tomography. DLT was defined as any adverse event leading to dose reduction or treatment discontinuation. Univariate analysis was used to compare body composition indices, and logistic regression analyses were performed for factors predicting early DLT. Overall, 111/311 (32.5%) of patients experienced DLT. Significant differences were observed in the subcutaneous adipose tissue index (SATI; p = 0.001) and visceral adipose tissue index (VATI; p < 0.001) between patients with and without DLT. Multivariate analyses revealed that VATI (odds ratio: 1.013; p = 0.029) was significantly associated with early DLT. Additionally, 20% of patients who had a body mass index (BMI) greater than 23 kg/m2 and a low VATI experienced DLT, whereas 34.3% of the remaining groups had DLT (p = 0.034). Significant differences were observed for median progression-free survival (13.0 vs. 26.0 months, respectively; p = 0.006) between patients with low and high VATI. Visceral adiposity was a significant predictor of sunitinib-associated DLT and survival. Patients with a low VATI and a BMI greater than 23 kg/m2 experienced lower DLTs.
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Mishra A, Bigam KD, Extermann M, Faramand R, Thomas K, Pidala JA, Baracos VE. Sarcopenia and low muscle radiodensity associate with impaired FEV 1 in allogeneic haematopoietic stem cell transplant recipients. J Cachexia Sarcopenia Muscle 2020; 11:1570-1579. [PMID: 32729255 PMCID: PMC7749567 DOI: 10.1002/jcsm.12604] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 04/10/2020] [Accepted: 05/28/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Quantification of skeletal muscle using computed tomography (CT) is accessible using cancer patients' standard oncologic images. Reduced muscle mass may be related to reduced respiratory muscle strength; however, the impact of this on lung functional parameters is not characterized in adult allogeneic haematopoietic stem cell transplant (alloHCT) recipients. METHODS A consecutive retrospective series (n = 296) of patients who had alloHCT at a comprehensive cancer centre between March 2005 and April 2015 were included. Pre-transplant CT scans were used to quantify skeletal muscle and adipose tissue at the fourth thoracic (T4) and/or third lumbar (L3) level. Tumour and patient characteristics were recorded, including forced expiratory volume in 1 second (FEV1 ) by spirometry. Regression models were created to characterize predictive relationships. RESULTS A total of 296 patients (♂n = 161; ♀n = 135) were included, all of whom had chest CT as part of standard care; a subset of these (n = 215, 72.6%) also had abdominal CT. Diagnoses were non-Hodgkins lymphoma (n = 165), acute myeloid leukaemia (n = 66), Hodgkin's disease (n = 14), acute lymphocytic leukaemia (n = 14), myelodysplastic syndromes (n = 18), and other (n = 19). In multivariable linear regression adjusted for sex (P < 0.0001), age (P < 0.0001), haematopoietic cell transplantation-specific co-morbidity index (P = 0.010), and parameters of pulmonary function testing (defined by spirometry, P < 0.0001), both T4 muscle index [β 0.127 (95% confidence interval 0.019; 0.252), P < 0.0001] and T4 muscle radiodensity [β 0.132 (95% confidence interval 0.087; 0.505), P = 0.006] were independently associated with FEV1 ; disease risk index (P = 0.877) and Karnofsky performance status (P = 0.548) were not associated with FEV1 . Similar conclusions were obtained when L3 muscle index and radiodensity were considered. Unlike T4, L3 muscle index values can be compared with published cut-off values for sarcopenia. Overall rates of sarcopenia were uniformly higher in the HCT population than in age-matched and sex-matched patients with solid tumours [alloHCT ♂64.7% vs. solid tumour ♂56.6% (P < 0.001); alloHCT ♀57.6% vs. solid tumour ♀36.0% (P < 0.001)]. Significant but moderate correlations (P < 0.001) were found for muscle area and radiodensity between L3 and T4, for both men and women; adipose tissue quantity also correlated significantly (P < 0.001) between L3 and T4 for both men and women. CONCLUSIONS Lumbar or thoracic CT images are useful for body composition assessment in this population and reveal high rates of sarcopenia, similar to those reported in very elderly patients. Reduced muscle mass and radiodensity associate with impaired FEV1 even after adjustment for clinical covariables including co-morbidities, performance status, disease risk, and mild intrinsic pulmonary disease (chronic obstructive pulmonary disease) defined by spirometry.
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Affiliation(s)
- Asmita Mishra
- Blood and Marrow TransplantationH. Lee Moffitt Cancer Center and Research InstituteTampaFLUSA
| | - Kevin D. Bigam
- Department of OncologyUniversity of AlbertaEdmontonAlbertaCanada
| | - Martine Extermann
- Senior Adult Oncology ProgramH. Lee Moffitt Cancer Center and Research InstituteTampaFLUSA
| | - Rawan Faramand
- Blood and Marrow TransplantationH. Lee Moffitt Cancer Center and Research InstituteTampaFLUSA
| | - Kerry Thomas
- Diagnostic Imaging and Interventional RadiologyH. Lee Moffitt Cancer Center and Research InstituteTampaFLUSA
| | - Joseph A. Pidala
- Blood and Marrow TransplantationH. Lee Moffitt Cancer Center and Research InstituteTampaFLUSA
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Impact of musculoskeletal degradation on cancer outcomes and strategies for management in clinical practice. Proc Nutr Soc 2020; 80:73-91. [PMID: 32981540 DOI: 10.1017/s0029665120007855] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The prevalence of malnutrition in patients with cancer is one of the highest of all patient groups. Weight loss (WL) is a frequent manifestation of malnutrition in cancer and several large-scale studies have reported that involuntary WL affects 50-80% of patients with cancer, with the degree of WL dependent on tumour site, type and stage of disease. The study of body composition in oncology using computed tomography has unearthed the importance of both low muscle mass (sarcopenia) and low muscle attenuation as important prognostic indications of unfavourable outcomes including poorer tolerance to chemotherapy; significant deterioration in performance status and quality of life (QoL), poorer post-operative outcomes and shortened survival. While often hidden by excess fat and high BMI, muscle abnormalities are highly prevalent in patients with cancer (ranging from 10 to 90%). Early screening to identify individuals with sarcopenia and decreased muscle quality would allow for earlier multimodal interventions to attenuate adverse body compositional changes. Multimodal therapies (combining nutritional counselling, exercise and anti-inflammatory drugs) are currently the focus of randomised trials to examine if this approach can provide a sufficient stimulus to prevent or slow the cascade of tissue wasting and if this then impacts on outcomes in a positive manner. This review will focus on the aetiology of musculoskeletal degradation in cancer; the impact of sarcopenia on chemotherapy tolerance, post-operative complications, QoL and survival; and outline current strategies for attenuation of muscle loss in clinical practice.
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Hemke R, Buckless C, Torriani M. Quantitative Imaging of Body Composition. Semin Musculoskelet Radiol 2020; 24:375-385. [PMID: 32992366 DOI: 10.1055/s-0040-1708824] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Body composition refers to the amount and distribution of lean tissue, adipose tissue, and bone in the human body. Lean tissue primarily consists of skeletal muscle; adipose tissue comprises mostly abdominal visceral adipose tissue and abdominal and nonabdominal subcutaneous adipose tissue. Hepatocellular and myocellular lipids are also fat pools with important metabolic implications. Importantly, body composition reflects generalized processes such as increased adiposity in obesity and age-related loss of muscle mass known as sarcopenia.In recent years, body composition has been extensively studied quantitatively to predict overall health. Multiple imaging methods have allowed precise estimates of tissue types and provided insights showing the relationship of body composition to varied pathologic conditions. In this review article, we discuss different imaging methods used to quantify body composition and describe important anatomical locations where target tissues can be measured.
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Affiliation(s)
- Robert Hemke
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Colleen Buckless
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Martin Torriani
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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He WZ, Jiang C, Liu LL, Yin CX, Rong YM, Hu WM, Yang L, Wang L, Jin YN, Lin XP, Liu SS, Huang JS, He SS, Liang YQ, Qiu HJ, Zhang B, Fan W, Guo GF, Yang QX, Xia LP. Association of body composition with survival and inflammatory responses in patients with non-metastatic nasopharyngeal cancer. Oral Oncol 2020; 108:104771. [PMID: 32485608 DOI: 10.1016/j.oraloncology.2020.104771] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES It is unknown whether or not the body composition is correlated with the prognosis and inflammatory response in patients with nasopharyngeal cancer (NPC). MATERIALS AND METHODS This cohort included 1767 patients with NPC. Visceral, subcutaneous and intra muscular adipose tissues (VAT, SAT and IMAT), and skeletal muscle index were quantified with computed tomography. We used the optimal stratification to select cut points for VAT, SAT and IMAT. We defined sarcopenia according to a widely used cut-point. The primary endpoint was overall survival (OS). The association between body composition and inflammatory response was also examined. RESULTS Low VAT, SAT, IMAT and sarcopenia were observed in 260 (14.7%), 451 (25.5%), 773 (43.7%) and 683 (38.7%) patients, respectively. Low VAT (P < 0.001, hazard ratio [HR], 1.884; 95% confidence interval [CI], 1.436-2.473,) and SAT (P = 0.022, HR, 1.334, 95%CI, 1.043-1.706) were both associated worse survival. IMAT and sarcopenia were not with prognostic value. In multivariate analysis, we found the prognostic value of the VAT (HR: 1.544, 95% CI: 1.128-2.114; P = 0.007) was independent of T stage, N stage, disease stage, lactic dehydrogenase, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), the systemic immune-inflammation index (SII), EBV-DNA and body mass index. We observed higher NLR (P = 0.028) and PLR (P < 0.001) in patients with low SAT. Both low VAT (P = 0.009) and SAT (P = 0.005) were associated with decreased stromal lymphocyte infiltrating intensity. CONCLUSIONS Among body composition parameters, VAT was an independent prognostic factor, especially in patients with locally advanced NPC.
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Affiliation(s)
- Wen-Zhuo He
- VIP Region, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China
| | - Chang Jiang
- VIP Region, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China
| | - Li-Li Liu
- Department of Pathology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China
| | - Chen-Xi Yin
- Intensive Care Unit, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China
| | - Yu-Ming Rong
- VIP Region, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China
| | - Wan-Ming Hu
- Intensive Care Unit, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China
| | - Lin Yang
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510060, PR China
| | - Lei Wang
- VIP Region, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China
| | - Ya-Nan Jin
- VIP Region, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China
| | - Xiao-Ping Lin
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China
| | - Shou-Sheng Liu
- VIP Region, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China
| | - Jin-Sheng Huang
- VIP Region, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China
| | - Sha-Sha He
- Department of Radiation Oncology, The first affiliated hospital of Sun Yat-sen University, Guangzhou, Guangdong 510060, PR China
| | - Yu-Qing Liang
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China
| | - Hui-Juan Qiu
- VIP Region, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China
| | - Bei Zhang
- VIP Region, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China
| | - Wei Fan
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China.
| | - Gui-Fang Guo
- VIP Region, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China.
| | - Qiu-Xia Yang
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China.
| | - Liang-Ping Xia
- VIP Region, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China.
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Anderson LJ, Chong N, Migula D, Sauer A, Garrison M, Wu P, Dash A, Garcia JM. Muscle mass, not radiodensity, predicts physical function in cancer patients with or without cachexia. Oncotarget 2020; 11:1911-1921. [PMID: 32499874 PMCID: PMC7244015 DOI: 10.18632/oncotarget.27594] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/27/2020] [Indexed: 12/28/2022] Open
Abstract
Background: There is a need to better understand the relationship between functional impairment and muscle mass in cancer cachexia. This study aimed to establish the relationship between computed tomography (CT)-derived muscle cross-sectional area (CSA), radiodensity, and skeletal muscle index (SMI) and dual energy X-ray absorptiometry (DXA) parameters with functional performance in cancer patients. Materials and Methods: Handgrip strength, stair climb power (SCP), one-repetition maximum (1RM) strength, and body composition (CT and DXA) were compared across cancer patients with cachexia (CAC; N = 28), without cachexia (CNC; N = 28), and non-cancer patients (CON; N = 19). Multivariate regression was performed to find predictors of function. Results: CAC had lower CT muscle CSA and SMI and lower DXA appendicular lean mass (ALM) than CNC or CON (p ≤ 0.011). Muscle radiodensity was not different across groups despite larger proportion of low CT SMI in CAC, and CAC performed worse in SCP than CON (p = 0.018). In cancer patients, DXA ALM and CT muscle CSA each predicted physical function (p ≤ 0.05); muscle radiodensity did not, and DXA ALM explained more variability in SCP and 1RM than CT muscle CSA. Conclusions: Stair climb power was reduced in cancer cachexia; muscle radiodensity was not. Muscle mass by CT or DXA, but not radiodensity, predicted functional performance in cancer patients.
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Affiliation(s)
- Lindsey J Anderson
- Geriatric Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
| | - Nicole Chong
- Geriatric Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
| | - Dorota Migula
- Geriatric Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
| | - Adam Sauer
- Geriatric Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
| | - Michelle Garrison
- Department of Health Services, University of Washington, Seattle, Washington, USA
| | - Peter Wu
- Department of Surgery, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA.,Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Atreya Dash
- Department of Urology, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA.,Department of Urology, University of Washington, Seattle, Washington, USA
| | - Jose M Garcia
- Geriatric Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA.,Gerontology and Geriatric Medicine-Department of Medicine, University of Washington, Seattle, Washington, USA
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39
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Paris MT, Tandon P, Heyland DK, Furberg H, Premji T, Low G, Mourtzakis M. Automated body composition analysis of clinically acquired computed tomography scans using neural networks. Clin Nutr 2020; 39:3049-3055. [PMID: 32007318 DOI: 10.1016/j.clnu.2020.01.008] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 01/07/2020] [Accepted: 01/12/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS The quantity and quality of skeletal muscle and adipose tissue is an important prognostic factor for clinical outcomes across several illnesses. Clinically acquired computed tomography (CT) scans are commonly used for quantification of body composition, but manual analysis is laborious and costly. The primary aim of this study was to develop an automated body composition analysis framework using CT scans. METHODS CT scans of the 3rd lumbar vertebrae from critically ill, liver cirrhosis, pancreatic cancer, and clear cell renal cell carcinoma patients, as well as renal and liver donors, were manually analyzed for body composition. Ninety percent of scans were used for developing and validating a neural network for the automated segmentation of skeletal muscle and adipose tissues. Network accuracy was evaluated with the remaining 10 percent of scans using the Dice similarity coefficient (DSC), which quantifies the overlap (0 = no overlap, 1 = perfect overlap) between human and automated segmentations. RESULTS Of the 893 patients, 44% were female, with a mean (±SD) age and body mass index of 52.7 (±15.8) years old and 28.0 (±6.1) kg/m2, respectively. In the testing cohort (n = 89), DSC scores indicated excellent agreement between human and network-predicted segmentations for skeletal muscle (0.983 ± 0.013), and intermuscular (0.900 ± 0.034), visceral (0.979 ± 0.019), and subcutaneous (0.986 ± 0.016) adipose tissue. Network segmentation took ~350 milliseconds/scan using modern computing hardware. CONCLUSIONS Our network displayed excellent ability to analyze diverse body composition phenotypes and clinical cohorts, which will create feasible opportunities to advance our capacity to predict health outcomes in clinical populations.
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Affiliation(s)
- Michael T Paris
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Puneeta Tandon
- Department of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Daren K Heyland
- Department of Critical Care, Kingston General Hospital, Kingston, ON, Canada; Clinical Evaluation Research Unit, Queens University, Kingston, ON, Canada
| | - Helena Furberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tahira Premji
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Gavin Low
- Department of Radiology, University of Alberta, Edmonton, AB, Canada
| | - Marina Mourtzakis
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada.
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40
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Aleixo GFP, Shachar SS, Nyrop KA, Muss HB, Malpica L, Williams GR. Myosteatosis and prognosis in cancer: Systematic review and meta-analysis. Crit Rev Oncol Hematol 2019; 145:102839. [PMID: 31877534 DOI: 10.1016/j.critrevonc.2019.102839] [Citation(s) in RCA: 158] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/20/2019] [Accepted: 11/22/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The evidence that body composition parameters influence multiple cancer outcomes is rapidly expanding. Excess adiposity deposits in muscle tissue, termed myosteatosis, can be detected in CT scans through variations in the density of muscle tissues (Hounsfield Units). Patients with similar muscle mass but different amounts of intramuscular adipose infiltration have increased chemotherapy toxicity, time to tumor progression and other adverse outcomes among different cancer types. Our review examines the impact of myosteatosis on overall survival (OS) in patients with cancer. METHODS A systematic search of the literature was conducted on PubMed/ MEDLINE, Cochrane CENTRAL, and EMBASE. Meta-analysis was conducted using a random-effects model. Risk of bias was evaluated using the Newcastle-Ottawa Quality assessment for cohort studies, funnel plot (publication bias), and GRADE summary of findings tool from Cochrane. RESULTS A total of 4880 articles were screened from which 40 articles selected, including 21,222 patients. The overall mean proportion of patients with myosteatosis was 48 % (range 11-85 %). Using skeletal muscle density (SMD), patients classified as having myosteatosis had 75 % greater mortality risk compared to non-myosteatosis patients (HR 1.75 95 % CI 1.60-1.92, 40 studies) (p < .00001) (i2 = 62 %). Specifically, myosteatosis was prognostic for worse OS in patients with gynecological, renal, periampullary/pancreatic, hepatocellular, gastroesophageal, and colorectal carcinoma, and lymphomas. CONCLUSION Our analysis of the literature shows that cancer patients with myosteatosis have shorter survival. Our findings suggest that in oncological practice, muscle density assessment is valuable as a prognostic parameter.
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Affiliation(s)
- G F P Aleixo
- Division of Hematology-Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Unoeste Universidade do Oeste Paulista, Presidente Prudente, SP, Brazil.
| | - S S Shachar
- Oncology Institute, Rambam Health Care Campus, Haifa, Israel
| | - K A Nyrop
- Division of Hematology-Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - H B Muss
- Division of Hematology-Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Luis Malpica
- Division of Hematology-Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - G R Williams
- Division of Hematology/Oncology, The University of Alabama at Birmingham, Birmingham, AL, United States
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41
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Paris MT. Body Composition Analysis of Computed Tomography Scans in Clinical Populations: The Role of Deep Learning. Lifestyle Genom 2019; 13:28-31. [PMID: 31822001 DOI: 10.1159/000503996] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 10/04/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Body composition is increasingly being recognized as an important prognostic factor for health outcomes across cancer, liver cirrhosis, and critically ill patients. Computed tomography (CT) scans, when taken as part of routine care, provide an excellent opportunity to precisely measure the quantity and quality of skeletal muscle and adipose tissue. However, manual analysis of CT scans is costly and time-intensive, limiting the widespread adoption of CT-based measurements of body composition. SUMMARY Advances in deep learning have demonstrated excellent success in biomedical image analysis. Several recent publications have demonstrated excellent accuracy in comparison to human raters for the measurement of skeletal muscle, visceral adipose, and subcutaneous adipose tissue from the lumbar vertebrae region, indicating that analysis of body composition may be successfully automated using deep neural networks. Key Messages: The high accuracy and drastically improved speed of CT body composition analysis (<1 s/scan for neural networks vs. 15 min/scan for human analysis) suggest that neural networks may aid researchers and clinicians in better understanding the role of body composition in clinical populations by enabling cost-effective, large-scale research studies. As the role of body composition in clinical settings and the field of automated analysis advance, it will be critical to examine how clinicians interact with these systems and to evaluate whether these technologies are beneficial in improving treatment and health outcomes for patients.
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Affiliation(s)
- Michael T Paris
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada,
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42
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Hopkins JJ, Skubleny D, Bigam DL, Baracos VE, Eurich DT, Sawyer MB. Barriers to the Interpretation of Body Composition in Colorectal Cancer: A Review of the Methodological Inconsistency and Complexity of the CT-Defined Body Habitus. Ann Surg Oncol 2018; 25:1381-1394. [PMID: 29488190 DOI: 10.1245/s10434-018-6395-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Measurement of body composition by computed tomography (CT) is an advancing field. Sarcopenia, myosteatosis, and visceral obesity (VO) have been identified as predictive of survival in colorectal cancer (CRC). We performed a systematic review of contemporary studies to characterize this association and highlight methodological inconsistencies. METHODS MEDLINE and PubMed were queried for articles published from January 2000 on, with populations of resectable CRC and with CT-measured body composition and survival data. The study quality was assessed by two independent reviewers using the Newcastle-Ottawa Scale. RESULTS Twenty studies met inclusion criteria, with a total of 8895 patients. Only two of the studies scored as high quality and nine as moderate quality. The remaining nine studies scored as low quality. Ten studies considered sarcopenia and 12 considered visceral obesity (VO). Cutoff points to define sarcopenia, myosteatosis, and VO were identified by optimal stratification, quartiles, or median values. The prevalence of sarcopenia varied from 15 to 60%, which based on study population and cutoff value used. Sarcopenia was associated with worse overall and disease-free survival in eight of the included studies. Myosteatosis was considered in three studies with a prevalence of 19-78%. It was significantly predictive of worse overall and disease-free survival in all three studies. VO had a prevalence of 14-70% and was inconsistently predictive of survival outcomes. CONCLUSIONS There is a lack of methodological consistency within the currently published literature. Despite this, sarcopenia and myosteatosis, but not VO, are consistently associated with worse survival outcomes, when population and cancer-specific cutoffs are utilized.
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Affiliation(s)
- Jessica J Hopkins
- Department of Surgery, University of Alberta, Edmonton, AB, Canada. .,School of Public Health, University of Alberta, Edmonton, AB, Canada.
| | - Daniel Skubleny
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - David L Bigam
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Vickie E Baracos
- Department of Medical Oncology, Cross Cancer Institute, Edmonton, AB, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Michael B Sawyer
- Department of Medical Oncology, Cross Cancer Institute, Edmonton, AB, Canada
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Paris MT, Furberg HF, Petruzella S, Akin O, Hötker AM, Mourtzakis M. Influence of Contrast Administration on Computed Tomography-Based Analysis of Visceral Adipose and Skeletal Muscle Tissue in Clear Cell Renal Cell Carcinoma. JPEN J Parenter Enteral Nutr 2018; 42:1148-1155. [PMID: 29350403 DOI: 10.1002/jpen.1067] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 10/24/2017] [Accepted: 11/13/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Computed tomography (CT) scans are being utilized to examine the influence of skeletal muscle and visceral adipose quantity and quality on health-related outcomes in clinical populations. However, little is known about the influence of contrast administration on these parameters. METHODS Precontrast, arterial, and 3-minute postcontrast CT images of 45 patients with clear cell renal cell carcinoma were downloaded from The Cancer Imaging Archive and retrospectively analyzed for visceral adipose cross-sectional area (CSA) and density, and muscle CSA and density at the third lumbar vertebrae. Low muscle CSA index was defined as ≤38.9 cm2 /m2 for women and ≤55.4 cm2 /m2 for men. Low muscle density was defined as <41 Hounsfield units (HU) for body mass index (BMI) <24.9 kg/m2 and <33 HU for BMI ≥25.0 kg/m2 . RESULTS In both the arterial and 3-minute phases, contrast administration decreased visceral adipose CSA (-20.9 and -20.9 cm2 ; P < .001) and increased visceral adipose density (4.8 and 5.8 HU; P < .001), relative to precontrast images. Muscle CSA index marginally increased in the arterial (0.6 cm2 /m2 ; P = .007) and 3-minute phases (0.8 cm2 /m2 ; P < .001). This likely represents clinically insignificant changes because it does not alter the identification of low muscle CSA (44.4% vs 42.2%; P = 1.00). Skeletal muscle density increased in the arterial (6.4 HU; P < .001) and 3-minute phases (8.7 HU; P < .001), which altered the identification of low muscle density (6.7% vs 31.1%; P < .001). CONCLUSIONS Future analyses should consider the phase of contrast during CT imaging because it may alter the interpretations of several parameters.
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Affiliation(s)
- Michael T Paris
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Helena F Furberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Stacey Petruzella
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Oguz Akin
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Andreas M Hötker
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Marina Mourtzakis
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
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