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Tsukagoshi M, Araki K, Shirabe K. Pancreatic cancer and sarcopenia: a narrative review of the current status. Int J Clin Oncol 2024; 29:1055-1066. [PMID: 38954075 DOI: 10.1007/s10147-024-02576-2] [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: 05/25/2024] [Accepted: 06/19/2024] [Indexed: 07/04/2024]
Abstract
Pancreatic cancer is still a difficult disease to treat, despite recent advances in surgical techniques and chemotherapeutic drugs. Its incidence continues to rise, as does the number of older patients. Sarcopenia is defined as a progressive and generalized loss of skeletal muscle mass and strength. Sarcopenia is present in approximately 40% in patients with pancreatic cancer. Sarcopenia is primarily diagnosed through imaging, and progress is being made in the development of automated methods and artificial intelligence, as well as biomarker research. Sarcopenia has been linked to a poor prognosis in pancreatic cancer patients. However, some studies suggest that sarcopenia is not always associated with a poor prognosis, depending on the resectability of pancreatic cancer and the nature of treatment, such as surgery or chemotherapy. Recent meta-analyses have found that sarcopenia is not linked to postoperative complications. It is still debated whether there is a link between sarcopenia and drug toxicity during chemotherapy. The relationship between sarcopenia and immunity has been investigated, but the mechanism is still unknown.
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Affiliation(s)
- Mariko Tsukagoshi
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi Gunma, 371-8511, Japan
| | - Kenichiro Araki
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi Gunma, 371-8511, Japan
| | - Ken Shirabe
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi Gunma, 371-8511, Japan.
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Wijma AG, Hogenbirk RNM, Driessens H, Kluifhooft DA, Jellema-Betten ES, Tjalsma-de Vries M, Liem MSL, Nieuwenhuijs VB, Manusama EM, Hoogwater FJH, Nijkamp MW, Beijer S, Klaase JM. Nutritional support in pancreatic cancer patients and its effect on nutritional status: an observational regional HPB network study investigating current practice. Support Care Cancer 2024; 32:487. [PMID: 38967804 PMCID: PMC11226478 DOI: 10.1007/s00520-024-08683-0] [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: 11/11/2023] [Accepted: 06/23/2024] [Indexed: 07/06/2024]
Abstract
PURPOSE Preoperative malnutrition is associated with poor postoperative outcomes in patients with pancreatic cancer. This study evaluated the effectiveness of current practice in nutritional support for patients with pancreatic cancer. METHODS Observational multicenter HPB network study conducted at the Isala Clinics Zwolle, Medical Spectrum Twente, Medical Center Leeuwarden, and University Medical Center Groningen between October 2021 and May 2023. Patients with a suspected pancreatic malignancy scheduled for surgery were screened for malnutrition using the Patient-Generated Subjective Global Assessment (PG-SGA) questionnaire and referred to a dedicated dietician for nutritional support comprising pancreatic enzyme replacement therapy, dietary advice, and nutritional supplements to achieve adequate caloric and protein intake. At baseline, 1 day preoperatively, and 3 months postoperatively, the nutritional status and muscle thickness were evaluated. RESULTS The study included 30 patients, of whom 12 (40%) classified as malnourished (PG-SGA ≥ 4) at baseline. Compared to well-nourished patients, malnourished patients were younger, were predominantly female, and had a higher body mass index, despite having lost more body weight in the past 6 months. All malnourished patients and 78% of the well-nourished patients received nutritional support. Consequently, a preoperative increase in caloric and protein intake and body weight were observed. Postoperatively, despite a further increase in caloric intake, a considerable decrease in protein intake, body weight, and muscle thickness was observed. CONCLUSION Malnutrition is prevalent in patients undergoing pancreatic surgery. Nutritional support by a dedicated dietician is effective in enhancing patients' preoperative nutritional status. However, postoperative monitoring of adequate nutritional intake in patients could be improved.
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Affiliation(s)
- Allard G Wijma
- Department of Surgery, Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Rianne N M Hogenbirk
- Department of Surgery, Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Heleen Driessens
- Department of Surgery, Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Ellen S Jellema-Betten
- Department of Surgery, Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marlies Tjalsma-de Vries
- Department of Dietetics and Nutrition, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mike S L Liem
- Department of Surgery, Medical Spectrum Twente, Enschede, The Netherlands
| | | | - Eric M Manusama
- Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Frederik J H Hoogwater
- Department of Surgery, Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Maarten W Nijkamp
- Department of Surgery, Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sandra Beijer
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Joost M Klaase
- Department of Surgery, Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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3
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Qu G, Zhou C, Zhang Y, Lyu SC, Lang R. Influence of sarcopenia on postoperative complications and long-term survival in pancreatic cancer patients undergone pancreaticoduodenectomy. Front Nutr 2024; 11:1434630. [PMID: 39027658 PMCID: PMC11254807 DOI: 10.3389/fnut.2024.1434630] [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: 05/18/2024] [Accepted: 06/24/2024] [Indexed: 07/20/2024] Open
Abstract
Background Sarcopenia has the potential to impact the postoperative results and extended prognosis of various types of tumors. Nevertheless, the specific impact of sarcopenia on the postoperative results and long-term survival of pancreatic cancer (PC) following pancreaticoduodenectomy (PD) remains inadequately elucidated. This study investigates the significance of sarcopenia according to various Asian standards on postoperative complications and long-term prognosis in PC patients who have undergone PD. Methods This retrospective study systematically analyzed patients with PC who underwent PD from January 2015 to December 2022. Sarcopenia was diagnosed by the skeletal muscle index (SMI) obtained by the skeletal muscle area normalized for height squared on the third lumbar vertebra on computed tomography (CT) images. Univariate and multivariate logistic regression analysis were performed to analyze the correlation between sarcopenia and postoperative complications, while Cox regression analysis was utilized to explore the influence of sarcopenia on overall survival (OS) and recurrence-free survival (RFS) in PC patients after PD. Results We enrolled 162 patients with PC after PD (92 males and 70 females, mean age: 63.78 ± 10.27 years), including 83 and 79 patients with sarcopenia and non-sarcopenia, respectively. Compared with non-sarcopenia patients, sarcopenia exhibited higher rates of recurrence rate (75% versus 59%, p = 0.039). Univariate and multivariate logistic regression analysis showed that sarcopenia did not affect the incidence of complications in patients with PC after PD in three Asian sarcopenia criteria. Multivariate Cox regression analysis indicated that sarcopenia was an independent risk factor for OS (hazard ratio [HR]: 2.49, 95% confidence interval [CI]: 1.73-3.60, p < 0.001) and RFS(hazard ratio [HR]: 1.70, 95%confidence interval [CI]: 1.12-2.50, p = 0.012) of PC patients with PD in Japanese Society of Hepatology criteria. Meanwhile, according to the Asian pancreatic cancer population standard, sarcopenia is an independent risk factor affecting the long-term OS (hazard ratio [HR]: 2.59, 95% confidence interval [CI]: 1.80-3.70, p < 0.001) and RFS (hazard ratio [HR]: 2.00, 95% confidence interval [CI]: 1.36-3.00, p < 0.001) of PC after PD. While sarcopenia is recognized as a risk factor for OS (hazard ratio [HR]: 1.81, 95% confidence interval [CI]: 1.08-3.10, p = 0.025) in PC patients based on the Fujiwara criteria, it is not found to be associated with RFS (hazard ratio [HR]: 1.60, 95% confidence interval [CI]: 0.90-3.00, p = 0.10). The model based on sarcopenia and clinical characteristics has high predictive ability for OS and RFS. Conclusion Various Asian diagnostic criteria do not link sarcopenia with postoperative complications in PC patients after PD. Nevertheless, sarcopenia remains a significant independent risk factor for long-term survival, and its combination with clinical characteristics can aid clinicians in predicting long-term survival outcomes.
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Affiliation(s)
- Guangzhen Qu
- Department of Interventional Radiology, Beijing Chao-Yang Hospital Affiliated with Capital Medical University, Beijing, China
| | - Chuanguo Zhou
- Department of Interventional Radiology, Beijing Chao-Yang Hospital Affiliated with Capital Medical University, Beijing, China
| | - Yong Zhang
- Department of Interventional Radiology, Beijing Chao-Yang Hospital Affiliated with Capital Medical University, Beijing, China
| | - Shao-Cheng Lyu
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing Chao-yang Hospital Affiliated with Capital Medical University, Beijing, China
| | - Ren Lang
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing Chao-yang Hospital Affiliated with Capital Medical University, Beijing, China
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Pecchi A, Valoriani F, Cuoghi Costantini R, Squecco D, Spallanzani A, D’Amico R, Dominici M, Di Benedetto F, Torricelli P, Menozzi R. Role of Body Composition in Patients with Resectable Pancreatic Cancer. Nutrients 2024; 16:1834. [PMID: 38931189 PMCID: PMC11206463 DOI: 10.3390/nu16121834] [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: 05/03/2024] [Revised: 05/28/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
This study investigates the role of body composition parameters in patients with pancreatic cancer undergoing surgical treatment. The research involved 88 patients diagnosed with pancreatic cancer who underwent surgery at the Modena Cancer Center between June 2015 and October 2023. Body composition parameters were obtained from CT scans performed before and after surgery. The percentage of sarcopenic patients at the time of diagnosis of pancreatic cancer is 56.82%. Of the patients who died between the first and second CT evaluated, 58% were sarcopenic, thus confirming the role of sarcopenia on outcome. The study found that all body composition parameters (TAMA, SMI, VFI, and SFI) demonstrated a trend towards reduction between two examinations, indicating an overall depletion in muscle and adipose tissue. We then evaluated the relationships between fat-related parameters (VFI, SFI and VSR) and survival outcomes: overall survival and progression-free survival. Cox univariate regression model show significant parameter related to outcomes was adipose tissue, specifically VFI. The study found that higher VFI levels were associated with greater survival rates. This research holds promise for advancing our understanding of the link between body composition and the prognosis of pancreatic cancer patients.
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Affiliation(s)
- Annarita Pecchi
- Radiology Department, Modena University Hospital, University of Modena and Reggio Emilia, 41124 Modena, Italy; (D.S.); (P.T.)
| | - Filippo Valoriani
- Division of Metabolic Diseases and Clinical Nutrition, Department of Specialistic Medicines, Modena University Hospital, 41124 Modena, Italy; (F.V.); (R.M.)
| | | | - Denise Squecco
- Radiology Department, Modena University Hospital, University of Modena and Reggio Emilia, 41124 Modena, Italy; (D.S.); (P.T.)
| | - Andrea Spallanzani
- Oncology Department, Modena University Hospital, University of Modena and Reggio Emilia, 41124 Modena, Italy; (A.S.); (M.D.)
| | - Roberto D’Amico
- Unit of Clinical Statistics, University Hospital of Modena, 41124 Modena, Italy; (R.C.C.); (R.D.)
| | - Massimo Dominici
- Oncology Department, Modena University Hospital, University of Modena and Reggio Emilia, 41124 Modena, Italy; (A.S.); (M.D.)
| | - Fabrizio Di Benedetto
- Hepato-Bilio-Pancreatic Surgery and Liver Transplantation Unit, Modena University Hospital, University of Modena and Reggio Emilia, 41124 Modena, Italy;
| | - Pietro Torricelli
- Radiology Department, Modena University Hospital, University of Modena and Reggio Emilia, 41124 Modena, Italy; (D.S.); (P.T.)
| | - Renata Menozzi
- Division of Metabolic Diseases and Clinical Nutrition, Department of Specialistic Medicines, Modena University Hospital, 41124 Modena, Italy; (F.V.); (R.M.)
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Park JS, Colby M, Seyfi D, Leibman S, Laurence JM, Smith G, Falk GL, Sandroussi C. Sarcopenia impacts perioperative and survival outcomes after esophagectomy for cancer: a multicenter study. J Gastrointest Surg 2024; 28:805-812. [PMID: 38548573 DOI: 10.1016/j.gassur.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/12/2024] [Accepted: 03/02/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND The impact of sarcopenia on outcomes after esophagectomy is controversial. Most data are currently derived from Asian populations. This study aimed to correlate sarcopenia to short-term perioperative complication rates and long-term survival and recurrence outcomes. METHODS A retrospective analysis was performed of patients undergoing esophagectomy for cancer from 3 tertiary referral centers in Australia. Sarcopenia was defined using cutoffs for skeletal muscle index (SMI), assessed on preoperative computed tomography images. Outcomes measured included complications, overall survival (OS), and disease-free survival (DFS). RESULTS Of 462 patients (78.4% male; median age, 67 years), sarcopenia was evident in 276 (59.7%). Patients with sarcopenia had a higher rate of major (Clavien-Dindo ≥ 3b) complications (27.9% vs 14.5%; P < .001), including higher rates of postoperative cardiac arrythmia (16.3% vs 9.7%; P = .042), pneumonia requiring antibiotics (14.5% vs 9.1%; P = .008), and 30-day mortality (5.1% vs 0%; P = .002). In the sarcopenic group, the median OS was lower (37 months [95% CI, 27.1-46.9] vs 114 months [95% CI, 75.8-152.2]; P < .001), as was the median DFS (27 months [95% CI, 18.9-35.1] vs 77 months [95% CI, 36.4-117.6]; P < .001). Sarcopenia was an independent risk factor for lower survival on multivariate analysis (hazard ratio, 1.688; 95% CI, 1.223-2.329; P = .001). CONCLUSION Patients with preoperative sarcopenia based on analysis of SMI are at a higher risk of major complications and have inferior survival and oncologic outcomes after esophagectomy for esophageal cancer.
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Affiliation(s)
- Jin-Soo Park
- Department of Upper Gastrointestinal and Hepatobiliary Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Royal Prince Alfred Institute of Academic Surgery (RPA IAS), Sydney, Australia; School of Medicine, University of Notre Dame, Sydney, Australia; School of Medicine, University of Sydney, Sydney, Australia; Surgical Outcomes Research Centre (SOuRCe), Sydney, Australia.
| | - Maxwell Colby
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, Australia; Department of Radiology, Royal North Shore Hospital, Sydney, Australia
| | - Doruk Seyfi
- Department of Upper Gastrointestinal and Hepatobiliary Surgery, Royal Prince Alfred Hospital, Sydney, Australia; School of Medicine, University of Sydney, Sydney, Australia
| | - Steven Leibman
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, Australia; School of Medicine, University of Sydney, Sydney, Australia
| | - Jerome Martin Laurence
- Department of Upper Gastrointestinal and Hepatobiliary Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Royal Prince Alfred Institute of Academic Surgery (RPA IAS), Sydney, Australia; School of Medicine, University of Sydney, Sydney, Australia; Surgical Outcomes Research Centre (SOuRCe), Sydney, Australia
| | - Garett Smith
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, Australia; School of Medicine, University of Sydney, Sydney, Australia
| | - Gregory Leighton Falk
- Department of Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, Sydney, Australia; School of Medicine, University of Sydney, Sydney, Australia
| | - Charbel Sandroussi
- Department of Upper Gastrointestinal and Hepatobiliary Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Royal Prince Alfred Institute of Academic Surgery (RPA IAS), Sydney, Australia; School of Medicine, University of Sydney, Sydney, Australia; Surgical Outcomes Research Centre (SOuRCe), Sydney, Australia
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Guarneri G, Pecorelli N, Bettinelli A, Campisi A, Palumbo D, Genova L, Gasparini G, Provinciali L, Della Corte A, Abati M, Aleotti F, Crippa S, De Cobelli F, Falconi M. Prognostic value of preoperative CT scan derived body composition measures in resected pancreatic cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:106848. [PMID: 36863915 DOI: 10.1016/j.ejso.2023.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 02/11/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND It remains unclear whether preoperative body composition may affect the prognosis of pancreatic cancer patients undergoing surgery. The aim of the present study was to assess the extent to which preoperative body composition impacts on postoperative complication severity and survival in patients undergoing pancreatoduodenectomy for pancreatic ductal adenocarcinoma (PDAC). METHODS A retrospective cohort study was performed on consecutive patients who underwent pancreatoduodenectomy with preoperative CT scan imaging available. Body composition parameters including total abdominal muscle area (TAMA), visceral fat area (VFA), subcutaneous fat area and liver steatosis (LS) were assessed. Sarcopenic obesity was defined as a high VFA/TAMA ratio. Postoperative complication burden was evaluated with the comprehensive complication index (CCI). RESULTS Overall, 371 patients were included in the study. At 90 days after surgery, 80 patients (22%) experienced severe complications. The median CCI was 20.9 (IQR 0-30). At multivariate linear regression analysis, preoperative biliary drainage, ASA score ≥3, fistula risk score and sarcopenic obesity (37% increase; 95%CI 0.06-0.74; p = 0.046) were associated to an increase in CCI. Patient characteristics associated to sarcopenic obesity were older age, male gender and preoperative LS. At a median follow-up of 25 months (IQR 18-49), median disease-free survival (DFS) was 19 months (IQR 15-22). At cox-regression analysis, only pathological features were associated with DFS, while LS and other body composition measures did not show any prognostic role. CONCLUSION The combination of sarcopenia and visceral obesity was significantly associated with increased complication severity after pancreatoduodenectomy for cancer. Patients' body composition did not affect disease free survival after pancreatic cancer surgery.
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Affiliation(s)
- Giovanni Guarneri
- Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy
| | - Nicolò Pecorelli
- Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| | | | | | - Diego Palumbo
- Vita-Salute San Raffaele University, Milan, Italy; Department of Radiology, San Raffaele Scientific Institute, Milan, Italy
| | - Luana Genova
- Vita-Salute San Raffaele University, Milan, Italy
| | | | | | - Angelo Della Corte
- Vita-Salute San Raffaele University, Milan, Italy; Department of Radiology, San Raffaele Scientific Institute, Milan, Italy
| | - Martina Abati
- Nutrition Service, San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Aleotti
- Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Crippa
- Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco De Cobelli
- Vita-Salute San Raffaele University, Milan, Italy; Department of Radiology, San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Falconi
- Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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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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Matsumoto R, Kikuta K, Takikawa T, Sano T, Hamada S, Sasaki A, Sakano M, Hayashi H, Manaka T, Ikeda M, Miura S, Kume K, Masamune A. Skeletal muscle mass and function are affected by pancreatic atrophy, pancreatic exocrine insufficiency and poor nutritional status in patients with chronic pancreatitis. Pancreatology 2024; 24:197-205. [PMID: 38216352 DOI: 10.1016/j.pan.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 01/14/2024]
Abstract
BACKGROUND/OBJECTIVE Previous studies have demonstrated that sarcopenia is frequently observed in patients with chronic pancreatitis (CP). However, most studies have defined sarcopenia solely based on skeletal muscle (SM) loss, and muscle weakness such as grip strength (GS) reduction has not been considered. We aimed to clarify whether SM loss and reduced GS have different associations with clinical characteristics and pancreatic imaging findings in patients with CP. METHODS One hundred two patients with CP were enrolled. We defined SM loss by the SM index at the third lumbar vertebra on CT (<42 cm2/m2 for males and <38 cm2/m2 for females), and reduced GS by < 28 kg for males and <18 kg for females. RESULTS Fifty-seven (55.9 %) patients had SM loss, 21 (20.6 %) had reduced GS, and 17 (16.7 %) had both. Patients with SM loss had lower body mass index, weaker GS, higher Controlling Nutritional Status score, lower serum lipase level, and lower urinary para-aminobenzoic acid excretion rate, suggesting worse nutritional status and pancreatic exocrine insufficiency. On CT, main pancreatic duct dilatation and parenchymal atrophy were more frequent in patients with SM loss than in those without it. Patients with reduced GS were older and had worse nutritional status than those without it. CONCLUSIONS SM loss was associated with pancreatic exocrine insufficiency, low nutritional status, and pancreatic imaging findings such as parenchymal atrophy and main pancreatic duct dilatation, whereas older age and low nutritional status led to additional reduced GS.
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Affiliation(s)
- Ryotaro Matsumoto
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Sendai, 980-8574, Japan
| | - Kazuhiro Kikuta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Sendai, 980-8574, Japan
| | - Tetsuya Takikawa
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Sendai, 980-8574, Japan
| | - Takanori Sano
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Sendai, 980-8574, Japan
| | - Shin Hamada
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Sendai, 980-8574, Japan
| | - Akira Sasaki
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Sendai, 980-8574, Japan
| | - Misako Sakano
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Sendai, 980-8574, Japan
| | - Hidehiro Hayashi
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Sendai, 980-8574, Japan
| | - Tomoo Manaka
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Sendai, 980-8574, Japan
| | - Mio Ikeda
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Sendai, 980-8574, Japan
| | - Shin Miura
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Sendai, 980-8574, Japan
| | - Kiyoshi Kume
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Sendai, 980-8574, Japan
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Sendai, 980-8574, Japan.
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9
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Liu C, An L, Zhang S, Deng S, Wang N, Tang H. Association between preoperative sarcopenia and prognosis of pancreatic cancer after curative-intent surgery: a updated systematic review and meta-analysis. World J Surg Oncol 2024; 22:38. [PMID: 38287345 PMCID: PMC10825983 DOI: 10.1186/s12957-024-03310-y] [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: 08/11/2023] [Accepted: 01/13/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Sarcopenia is associated with poor outcomes in many malignancies. However, the relationship between sarcopenia and the prognosis of pancreatic cancer has not been well understood. The aim of this meta-analysis was to identify the prognostic value of preoperative sarcopenia in patients with pancreatic cancer after curative-intent surgery. METHODS Database from PubMed, Embase, and Web of Science were searched from its inception to July 2023. The primary outcomes were overall survival (OS), progression-free survival (PFS), and the incidence of major complications. The hazard ratio (HR), odds ratio (OR), and 95% confidence intervals (CIs) were used to assess the relationship between preoperative sarcopenia and the prognosis of patients with pancreatic cancer. All statistical analyses were conducted by Review Manager 5.3 and STATA 17.0 software. RESULTS A total of 23 retrospective studies involving 5888 patients were included in this meta-analysis. The pooled results demonstrated that sarcopenia was significantly associated with worse OS (HR = 1.53, P < 0.00001) and PFS (HR = 1.55, P < 0.00001). However, this association was not obvious in regard to the incidence of major complications (OR = 1.33, P = 0.11). CONCLUSION Preoperative sarcopenia was preliminarily proved to be associated with the terrible prognosis of pancreatic cancer after surgery. However, this relationship needs to be further validated in more prospective studies.
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Affiliation(s)
- Chenming Liu
- Department of Hepatopancreatobiliary Surgery, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Liang An
- Department of Gastrointestinal Surgery, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Siyuan Zhang
- Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, China
| | - Shiqing Deng
- Department of Breast and Thyroid Surgery, General Hospital of Huainan Eastern Hospital Group, Huainan, Anhui, China
| | - Neng Wang
- Department of Hepatopancreatobiliary Surgery, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang, China
| | - Haijun Tang
- Department of Hepatopancreatobiliary Surgery, Shaoxing People's Hospital, Shaoxing, Zhejiang, China.
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10
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Nowak S, Kloth C, Theis M, Marinova M, Attenberger UI, Sprinkart AM, Luetkens JA. Deep learning-based assessment of CT markers of sarcopenia and myosteatosis for outcome assessment in patients with advanced pancreatic cancer after high-intensity focused ultrasound treatment. Eur Radiol 2024; 34:279-286. [PMID: 37572195 PMCID: PMC10791981 DOI: 10.1007/s00330-023-09974-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/21/2023] [Accepted: 05/28/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVES To evaluate the prognostic value of CT-based markers of sarcopenia and myosteatosis in comparison to the Eastern Cooperative Oncology Group (ECOG) score for survival of patients with advanced pancreatic cancer treated with high-intensity focused ultrasound (HIFU). MATERIALS AND METHODS For 142 retrospective patients, the skeletal muscle index (SMI), skeletal muscle radiodensity (SMRD), fatty muscle fraction (FMF), and intermuscular fat fraction (IMFF) were determined on superior mesenteric artery level in pre-interventional CT. Each marker was tested for associations with sex, age, body mass index (BMI), and ECOG. The prognostic value of the markers was examined in Kaplan-Meier analyses with the log-rank test and in uni- and multivariable Cox proportional hazards (CPH) models. RESULTS The following significant associations were observed: Male patients had higher BMI and SMI. Patients with lower ECOG had lower BMI and SMI. Patients with BMI lower than 21.8 kg/m2 (median) also showed lower SMI and IMFF. Patients younger than 63.3 years (median) were found to have higher SMRD, lower FMF, and lower IMFF. In the Kaplan-Meier analysis, significantly lower survival times were observed in patients with higher ECOG or lower SMI. Increased patient risk was observed for higher ECOG, lower BMI, and lower SMI in univariable CPH analyses for 1-, 2-, and 3-year survival. Multivariable CPH analysis for 1-year survival revealed increased patient risk for higher ECOG, lower SMI, lower IMFF, and higher FMF. In multivariable analysis for 2- and 3-year survival, only ECOG and FMF remained significant. CONCLUSION CT-based markers of sarcopenia and myosteatosis show a prognostic value for assessment of survival in advanced pancreatic cancer patients undergoing HIFU therapy. CLINICAL RELEVANCE STATEMENT The results indicate a greater role of myosteatosis for additional risk assessment beyond clinical scores, as only FMF was associated with long-term survival in multivariable CPH analyses along ECOG and also showed independence to ECOG in group analysis. KEY POINTS • This study investigates the prognostic value of CT-based markers of sarcopenia and myosteatosis for patients with pancreatic cancer treated with high-intensity focused ultrasound. • Markers for sarcopenia and myosteatosis showed a prognostic value besides clinical assessment of the physical status by the Eastern Cooperative Oncology Group score. In contrast to muscle size measurements, the myosteatosis marker fatty muscle fraction demonstrated independence to the clinical score. • The results indicate that myosteatosis might play a greater role for additional patient risk assessments beyond clinical assessments of physical status.
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Affiliation(s)
- Sebastian Nowak
- Department of Diagnostic and Interventional Radiology and Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Christoph Kloth
- Department of Diagnostic and Interventional Radiology and Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Maike Theis
- Department of Diagnostic and Interventional Radiology and Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Milka Marinova
- Department of Diagnostic and Interventional Radiology and Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Department of Nuclear Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Ulrike I Attenberger
- Department of Diagnostic and Interventional Radiology and Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Alois M Sprinkart
- Department of Diagnostic and Interventional Radiology and Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology and Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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11
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Branco MG, Mateus C, Capelas ML, Pimenta N, Santos T, Mäkitie A, Ganhão-Arranhado S, Trabulo C, Ravasco P. Bioelectrical Impedance Analysis (BIA) for the Assessment of Body Composition in Oncology: A Scoping Review. Nutrients 2023; 15:4792. [PMID: 38004186 PMCID: PMC10675768 DOI: 10.3390/nu15224792] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
Bioelectrical Impedance Analysis (BIA) is a reliable, non-invasive, objective, and cost-effective body composition assessment method, with high reproducibility. This scoping review aims to evaluate the current scientific and clinical evidence on BIA for body composition assessment in oncology patients, under active treatment. Literature search was conducted through MEDLINE, CINAHL, Scopus and Web of Science databases, following PRISMA-ScR Guidelines. Inclusion criteria comprised studies reporting the use of BIA for body composition evaluation in adults with cancer diagnosis. Studies including non-cancer pathology or only assessing nutritional status were excluded. This scoping review comprised a total of 36 studies: 25 were original studies including 18 prospective studies, six cross-sectional studies and one retrospective study and 11 were systematic reviews. Population size for the included original articles ranged from 18 to 1217 participants, comprising a total of 3015 patients with cancer with a mean baseline Body Mass Index (BMI) ranging from 20.3 to 30.0 kg/m2 and mean age ranging between 47 and 70 years. Review articles included a total of 273 studies, with a total of 78,350 participants. The current review considered studies reporting patients with head and neck cancer (HNC) (n = 8), breast cancer (BC) (n = 4), esophageal cancer (EC) (n = 2), liver cancer (n = 2), pancreatic cancer (PC) (n = 3), gastric cancer (GC) (n = 3), colorectal cancer (CRC) (n = 8), lung cancer (LC) (n = 1), skin cancer (SK) (n = 1) and multiple cancer types (n = 6). BIA is a suitable and valid method for the assessment of body composition in oncology. BIA-derived measures have shown good potential and relevant clinical value in preoperative risk evaluation, in the reduction of postoperative complications and hospital stay and as an important prognostic indicator in persons with cancer. Future research on the diagnostic value and clinical applications of BIA and BIA-derived phase angle (PhA) should be conducted in order to predict its impact on patient survival and other clinical outcomes.
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Affiliation(s)
- Mariana Garcia Branco
- Centre for Interdisciplinary Research in Health (CIIS), Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; (C.M.); (M.L.C.); (N.P.); (S.G.-A.)
- Nutrition and Dietetics, Hospital de Cascais Dr. José de Almeida, 2755-009 Alcabideche, Portugal
| | - Carlota Mateus
- Centre for Interdisciplinary Research in Health (CIIS), Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; (C.M.); (M.L.C.); (N.P.); (S.G.-A.)
| | - Manuel Luís Capelas
- Centre for Interdisciplinary Research in Health (CIIS), Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; (C.M.); (M.L.C.); (N.P.); (S.G.-A.)
- Faculty of Health Sciences and Nursing, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; (T.S.); (C.T.); (P.R.)
| | - Nuno Pimenta
- Centre for Interdisciplinary Research in Health (CIIS), Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; (C.M.); (M.L.C.); (N.P.); (S.G.-A.)
- Polytechnic Institute of Santarém, Sport Sciences School of Rio Maior, 2040-413 Rio Maior, Portugal
- Interdisciplinary Centre for the Study of Human Performance, Faculdade de Motricidade Humana, Universidade de Lisboa, 1495-751 Lisbon, Portugal
| | - Teresa Santos
- Faculty of Health Sciences and Nursing, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; (T.S.); (C.T.); (P.R.)
- Universidade Europeia, 1500-210 Lisbon, Portugal
| | - Antti Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, 00014 Helsinki, Finland;
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska University Hospital, Karolinska Institute, 17176 Stockholm, Sweden
| | - Susana Ganhão-Arranhado
- Centre for Interdisciplinary Research in Health (CIIS), Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; (C.M.); (M.L.C.); (N.P.); (S.G.-A.)
- Atlântica, Instituto Universitário, Fábrica da Pólvora de Barcarena, 2730-036 Barcarena, Portugal
- CINTESIS, Centre for Health Technology and Services Research, 4200-450 Porto, Portugal
| | - Carolina Trabulo
- Faculty of Health Sciences and Nursing, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; (T.S.); (C.T.); (P.R.)
- Medical Oncology, Centro Hospitalar Barreiro-Montijo, 2830-003 Barreiro, Portugal
| | - Paula Ravasco
- Faculty of Health Sciences and Nursing, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; (T.S.); (C.T.); (P.R.)
- Católica Medical School, Universidade Católica Portuguesa, 2635-631 Rio de Mouro, Portugal
- Centre for Interdisciplinary Research in Health Egas Moniz (CiiEM), 2829-511 Almada, Portugal
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12
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Tsukagoshi M, Watanabe A, Araki K, Ishii N, Hagiwara K, Hoshino K, Muranushi R, Harimoto N, Takizawa M, Shirabe K. Usefulness of serum creatinine and cystatin C ratio as a screening tool for predicting prognosis in patients with pancreatic cancer. Ann Gastroenterol Surg 2023; 7:784-792. [PMID: 37663967 PMCID: PMC10472412 DOI: 10.1002/ags3.12671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 02/12/2023] [Accepted: 02/23/2023] [Indexed: 09/05/2023] Open
Abstract
Aim This study aimed to evaluate the usefulness of the serum creatinine/cystatin C (Cr/CysC) ratio as a prognostic factor after pancreatic surgery in patients with pancreatic cancer. Methods We retrospectively analyzed the data of 88 patients with pancreatic ductal carcinoma who underwent pancreatic surgery from January 2017 to December 2020. CysC measured from frozen serum samples and circulating Cr levels were used to calculate the Cr/CysC ratio. The cutoff value of the Cr/CysC ratio was determined using receiver operating characteristic curves. Cox proportional hazards model analysis and survival curves were applied to identify the prognostic factors. Results The optimal cutoff value of the Cr/CysC ratio for predicting mortality after surgery was 1.05. This study included 20 (22.7%) and 68 (77.3%) patients with high and low Cr/CysC ratios, respectively. The low Cr/CysC ratio was significantly associated with female sex (p = 0.020) and higher levels of C-reactive protein (p = 0.020). The postoperative length of stay was significantly longer in patients with low Cr/CysC rates (p = 0.044). Patients with low Cr/CysC ratio showed poorer prognosis in relapse-free survival (hazard ratio [HR] = 3.33; 95% confidence interval [CI]: 1.54-4.20; p = 0.002) and overall survival (HR = 2.52, 95% CI: 1.04-6.10, p = 0.041), respectively, which were significantly worse than in those with high Cr/CysC ratios (p = 0.003 and 0.049, respectively). Conclusion The Cr/CysC ratio could be a useful screening tool for predicting the prognosis of patients with pancreatic ductal carcinoma undergoing pancreatic surgery.
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Affiliation(s)
- Mariko Tsukagoshi
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical ScienceGunma University Graduate School of MedicineMaebashi GunmaJapan
| | - Akira Watanabe
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical ScienceGunma University Graduate School of MedicineMaebashi GunmaJapan
| | - Kenichiro Araki
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical ScienceGunma University Graduate School of MedicineMaebashi GunmaJapan
| | - Norihiro Ishii
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical ScienceGunma University Graduate School of MedicineMaebashi GunmaJapan
| | - Kei Hagiwara
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical ScienceGunma University Graduate School of MedicineMaebashi GunmaJapan
| | - Kouki Hoshino
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical ScienceGunma University Graduate School of MedicineMaebashi GunmaJapan
| | - Ryo Muranushi
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical ScienceGunma University Graduate School of MedicineMaebashi GunmaJapan
| | - Norifumi Harimoto
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical ScienceGunma University Graduate School of MedicineMaebashi GunmaJapan
| | - Makiko Takizawa
- Department of Healthcare Quality and SafetyGunma University Graduate School of MedicineMaebashi GunmaJapan
| | - Ken Shirabe
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical ScienceGunma University Graduate School of MedicineMaebashi GunmaJapan
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13
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Thormann M, Hinnerichs M, Barajas Ordonez F, Saalfeld S, Perrakis A, Croner R, Omari J, Pech M, Zamsheva M, Meyer HJ, Wienke A, Surov A. Sarcopenia is an Independent Prognostic Factor in Patients With Pancreatic Cancer - a Meta-analysis. Acad Radiol 2023; 30:1552-1561. [PMID: 36564257 DOI: 10.1016/j.acra.2022.10.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/08/2022] [Accepted: 10/26/2022] [Indexed: 12/24/2022]
Abstract
RATIONALE AND OBJECTIVES Sarcopenia is defined as skeletal muscle loss and can be assessed by cross-sectional imaging. Our aim was to establish the effect of sarcopenia on relevant outcomes in patients with pancreatic ductal adenocarcinoma (PDAC) in curative and palliative settings based on a large patient sample. MATERIALS AND METHODS MEDLINE library, EMBASE and SCOPUS databases were screened for the associations between sarcopenia and mortality in patients with PDAC up to March 2022. The primary endpoint of the systematic review was the hazard ratio of Sarcopenia on survival. 22 studies were included into the present analysis. RESULTS The included 22 studies comprised 3958 patients. The prevalence of sarcopenia was 38.7%. Sarcopenia was associated with a higher prevalence in the palliative setting (OR 53.23, CI 39.00-67.45, p<0.001) compared to the curative setting (OR 36.73, CI 27.81-45.65, p<0.001). Sarcopenia was associated with worse OS in the univariable (HR 1.79, CI 1.41-2.28, p<0.001) and multivariable analysis (HR 1.62, CI 1.27-2.07, p<0.001) in the curative setting. For the palliative setting the pooled hazards ratio showed that sarcopenia was associated with overall survival (HR 1.56, CI 1.21-2.02, p<0.001) as well as in multivariable analysis (HR 1.77, CI 1.39-2.26, p<0.001). Sarcopenia was not associated with a higher rate of post-operative complications in univariable analysis (OR 1.10, CI 0.70-1.72, p = 0.69). CONCLUSION Sarcopenia occurs in 38.7% of patients with pancreatic cancer, significantly more in the palliative setting. Sarcopenia is associated with overall survival in both settings. The assessment of sarcopenia is therefore relevant for personalized oncology. Sarcopenia is not associated with postoperative complications.
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Affiliation(s)
- Maximilian Thormann
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Str. 44,Magdeburg, Germany, 39120.
| | - Mattes Hinnerichs
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Str. 44,Magdeburg, Germany, 39120
| | - Felix Barajas Ordonez
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Str. 44,Magdeburg, Germany, 39120
| | - Sylvia Saalfeld
- Research Campus STIMULATE, Otto-von-Guericke University Magdeburg, Magdeburg, Germany; Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | - Aristoteles Perrakis
- Department of General - Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Roland Croner
- Department of General - Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Jazan Omari
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Str. 44,Magdeburg, Germany, 39120
| | - Maciej Pech
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Str. 44,Magdeburg, Germany, 39120
| | - Marina Zamsheva
- Institute of Medical Epidemiology, Biometry, and Informatics, Martin Luther University, Germany
| | - Hans-Jonas Meyer
- Department for Radiology, University Clinic Leipzig, Leipzig, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biometry, and Informatics, Martin Luther University, Germany
| | - Alexey Surov
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Str. 44,Magdeburg, Germany, 39120
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14
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Mękal D, Sobocki J, Badowska-Kozakiewicz A, Sygit K, Cipora E, Bandurska E, Czerw A, Deptała A. Evaluation of Nutritional Status and the Impact of Nutritional Treatment in Patients with Pancreatic Cancer. Cancers (Basel) 2023; 15:3816. [PMID: 37568634 PMCID: PMC10417457 DOI: 10.3390/cancers15153816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/17/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
Patients with pancreatic cancer who develop irreversible cancer cachexia have a life expectancy of less than 3 months. Therefore, it is extremely important to evaluate the patient's nutritional status as early as possible and to implement an appropriate nutritional intervention in order to reduce the risk of further weight loss and/or muscle loss, which affect the outcomes of cancer treatment and the correct nutritional treatment in patients with pancreatic cancer. A literature review was performed by using the PubMed and Cochrane quick search methodology. The main purpose of this review was to present the current approach to nutritional treatment in pancreatic cancer. The review included publications, most of which concerned clinical nutrition as part of the phase of treatment of patients with pancreatic cancer, nutritional and metabolic disorders in pancreatic cancer, and the period after pancreatic resection. Some of the publications concerned various nutritional interventions in patients with pancreatic cancer undergoing chemotherapy or surgical treatment (nutritional support before surgery, after surgery, or during palliative treatment). There is an unmet need for integrated nutritional therapy as a key part of the comprehensive care process for PC patients. Nutritional counseling is the first line of nutritional treatment for malnourished cancer patients, but pancreatic enzyme replacement therapy also constitutes the cornerstone of nutritional treatment for relieving symptoms of indigestion and maintaining or improving nutritional status.
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Affiliation(s)
- Dominika Mękal
- Department of Oncology Propaedeutics, Medical University of Warsaw, 01-445 Warsaw, Poland; (A.B.-K.); (A.D.)
| | - Jacek Sobocki
- Department of General Surgery and Clinical Nutrition, Centre for Postgraduate Medical Education, 01-813 Warsaw, Poland;
| | - Anna Badowska-Kozakiewicz
- Department of Oncology Propaedeutics, Medical University of Warsaw, 01-445 Warsaw, Poland; (A.B.-K.); (A.D.)
| | - Katarzyna Sygit
- Faculty of Health Sciences, Calisia University, 62-800 Kalisz, Poland;
| | - Elżbieta Cipora
- Medical Institute, Jan Grodek State University, 38-500 Sanok, Poland;
| | - Ewa Bandurska
- Center for Competence Development, Integrated Care and e-Health, Medical University of Gdansk, 80-204 Gdansk, Poland;
| | - Aleksandra Czerw
- Department of Health Economics and Medical Law, Medical University of Warsaw, 01-445 Warsaw, Poland;
- Department of Economic and System Analyses, National Institute of Public Health NIH-National Research Institute, 00-791 Warsaw, Poland
| | - Andrzej Deptała
- Department of Oncology Propaedeutics, Medical University of Warsaw, 01-445 Warsaw, Poland; (A.B.-K.); (A.D.)
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15
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Sandini M, Paiella S, Cereda M, Angrisani M, Capretti G, Famularo S, Giani A, Roccamatisi L, Fontani A, Malleo G, Salvia R, Roviello F, Zerbi A, Bassi C, Gianotti L. Independent effect of fat-to-muscle mass ratio at bioimpedance analysis on long-term survival in patients receiving surgery for pancreatic cancer. Front Nutr 2023; 10:1118616. [PMID: 37384108 PMCID: PMC10298166 DOI: 10.3389/fnut.2023.1118616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/05/2023] [Indexed: 06/30/2023] Open
Abstract
Introduction Malnutrition and alteration of body composition are early features in pancreatic cancer and appear to be predictors of advanced stages and dismal overall survival. Whether specific patient characteristics measured at the preoperative bioimpedance analysis (BIA) could be associated with long-term outcomes following curative resection has not been yet described. Methods In a prospective multicenter study, all histologically proven resected pancreatic cancer patients were included in the analysis. BIA was measured for all patients on the day before surgery. Demographics, perioperative data, and postoperative outcomes were prospectively collected. Patients who experienced 90-day mortality were excluded from the analysis. Survival data were obtained through follow-up visits and phone interviews. Bioimpedance variables were analyzed according to the overall survival using the Kaplan-Meier curves and the univariate and multivariate Cox regression model. Results Overall, 161 pancreatic cancer patients were included. The median age was 66 (60-74) years, and 27.3% received systemic neoadjuvant treatment. There were 23 (14.3%) patients malnourished in the preoperative evaluation. Median OS was 34.0 (25.7-42.3) months. Several bioimpedance variables were associated with OS at the univariate analysis, namely the phase angle [HR 0.85, 95% CI 0.74-0.98)], standardized phase angle [HR 0.91, 95% CI 0.82-0.99)], and an increased ratio between the fat and lean mass (FM/FFM) [HR 4.27, 95% CI 1.10-16.64)]. At the multivariate analysis, the FM/FFM ratio was a confirmed independent predictor of OS following radical resection, together with a positive lymph nodal status. Conclusion Alteration of body composition at the preoperative bioimpedance vector analysis (BIVA) can predict dismal oncologic outcomes following pancreatic resection for cancer.
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Affiliation(s)
- Marta Sandini
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Salvatore Paiella
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Marco Cereda
- Department of Surgery, San Gerardo Hospital, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Marco Angrisani
- Department of General, Hepatobiliary and Pancreatic Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital, Rome, Italy
| | - Giovanni Capretti
- Pancreatic Surgery Unit, Department of Biomedical Sciences, Humanitas Clinical and Research Center-IRCCS Rozzano, Humanitas University, Milan, Italy
| | - Simone Famularo
- Pancreatic Surgery Unit, Department of Biomedical Sciences, Humanitas Clinical and Research Center-IRCCS Rozzano, Humanitas University, Milan, Italy
- Department of Hepatobiliary and General Surgery, Humanitas Clinical and Research Center, Humanitas University, Milan, Italy
| | - Alessandro Giani
- Department of Surgery, San Gerardo Hospital, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Linda Roccamatisi
- Department of Surgery, San Gerardo Hospital, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Andrea Fontani
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Giuseppe Malleo
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Roberto Salvia
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Franco Roviello
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Alessandro Zerbi
- Pancreatic Surgery Unit, Department of Biomedical Sciences, Humanitas Clinical and Research Center-IRCCS Rozzano, Humanitas University, Milan, Italy
| | - Claudio Bassi
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Luca Gianotti
- Department of Surgery, San Gerardo Hospital, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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Li L, He J. Prognostic Role of Geriatric Nutritional Risk Index in Patients with Pancreatic Cancer: A Meta-Analysis. Nutr Cancer 2023:1-10. [PMID: 37162261 DOI: 10.1080/01635581.2023.2209345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Background: The Geriatric Nutritional Risk Index (GNRI) is used to assess the prognosis of patients with pancreatic cancer. Therefore, this meta-analysis was conducted to evaluate the association between the GNRI and prognosis in pancreatic cancer.Methods: We performed a pooled analysis of the hazard ratios (HRs) and 95% confidence intervals (CIs) of the GNRI for survival in pancreatic cancer. Using pooled odds ratios (ORs) and 95% CIs, we investigated the association between the GNRI and clinicopathological characteristics of pancreatic cancer.Results: Six studies were included in this meta-analysis, totaling 1,513 patients. A low GNRI was significantly associated with a poorer overall survival (OS) in the pooled results (HR, 1.95; 95% CI, 1.29-2.94; p = 0.002) in pancreatic cancer. However, GNRI was not significantly associated with progression-free survival (PFS) in pancreatic cancer (HR, 1.57; 95% CI, 0.90-2.73; p = 0.114). The pooled results indicated that a low GNRI was significantly associated with tumor location of pancreas head (OR, 2.18; 95% CI, 1.45-3.29; p < 0.001).Conclusions: This meta-analysis showed that low GNRI was significantly associated with poor OS but not with poor PFS in patients with pancreatic cancer. The GNRI is a novel and effective risk factor and a potential biomarker for the prognosis of pancreatic cancer.
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Affiliation(s)
- Lili Li
- Clinical Laboratory, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Huzhou, Zhejiang, China
| | - Junjun He
- Clinical Laboratory, Traditional Chinese Medical Hospital of Huzhou Affiliated to Zhejiang Chinese Medical University, Huzhou, Zhejiang, China
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Menozzi R, Valoriani F, Ballarin R, Alemanno L, Vinciguerra M, Barbieri R, Cuoghi Costantini R, D'Amico R, Torricelli P, Pecchi A. Impact of Nutritional Status on Postoperative Outcomes in Cancer Patients following Elective Pancreatic Surgery. Nutrients 2023; 15:nu15081958. [PMID: 37111175 PMCID: PMC10141114 DOI: 10.3390/nu15081958] [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: 03/07/2023] [Revised: 03/31/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Pancreatic surgery has been associated with important postoperative morbidity, mortality and prolonged length of hospital stay. In pancreatic surgery, the effect of poor preoperative nutritional status and muscle wasting on postsurgery clinical outcomes still remains unclear and controversial. MATERIALS AND METHODS A total of 103 consecutive patients with histologically proven carcinoma undergoing elective pancreatic surgery from June 2015 through to July 2020 were included and retrospectively studied. A multidimensional nutritional assessment was performed before elective surgery as required by the local clinical pathway. Clinical and nutritional data were collected in a medical database at diagnosis and after surgery. RESULTS In the multivariable analysis, body mass index (OR 1.25, 95% CI 1.04-1.59, p = 0.039) and weight loss (OR 1.16, 95% CI 1.06-1.29, p = 0.004) were associated with Clavien score I-II; weight loss (OR 1.13, 95% CI 1.02-1.27, p = 0.027) affected postsurgery morbidity/mortality, and reduced muscle mass was identified as an independent, prognostic factor for postsurgery digestive hemorrhages (OR 0.10, 95% CI 0.01 0.72, p = 0.03) and Clavien score I-II (OR 7.43, 95% CI 1.53-44.88, p = 0.018). No association was identified between nutritional status parameters before surgery and length of hospital stay, 30 days reintervention, 30 days readmission, pancreatic fistula, biliary fistula, Clavien score III-IV, Clavien score V and delayed gastric emptying. CONCLUSIONS An impaired nutritional status before pancreatic surgery affects many postoperative outcomes. Assessment of nutritional status should be part of routine preoperative procedures in order to achieve early and appropriate nutritional support in pancreatic cancer patients. Further studies are needed to better understand the effect of preoperative nutritional therapy on short-term clinical outcomes in patients undergoing pancreatic elective surgery.
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Affiliation(s)
- Renata Menozzi
- Division of Metabolic Diseases and Clinical Nutrition, Department of Specialistic Medicines, University Hospital of Modena, 41100 Modena, Italy
| | - Filippo Valoriani
- Division of Metabolic Diseases and Clinical Nutrition, Department of Specialistic Medicines, University Hospital of Modena, 41100 Modena, Italy
| | - Roberto Ballarin
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, Policlinico Modena Hospital, 41125 Modena, Italy
| | - Luca Alemanno
- Department of Radiology, University Hospital of Modena, 41224 Modena, Italy
- Department of Medical and Surgical Sciences of Children and Adults, University Hospital of Modena, 41224 Modena, Italy
| | - Martina Vinciguerra
- Division of Metabolic Diseases and Clinical Nutrition, Department of Specialistic Medicines, University Hospital of Modena, 41100 Modena, Italy
| | - Riccardo Barbieri
- Division of Metabolic Diseases and Clinical Nutrition, Department of Specialistic Medicines, University Hospital of Modena, 41100 Modena, Italy
| | | | - Roberto D'Amico
- Unit of Clinical Statistics, University Hospital of Modena, 41224 Modena, Italy
| | - Pietro Torricelli
- Department of Radiology, University Hospital of Modena, 41224 Modena, Italy
- Department of Medical and Surgical Sciences of Children and Adults, University Hospital of Modena, 41224 Modena, Italy
| | - Annarita Pecchi
- Department of Radiology, University Hospital of Modena, 41224 Modena, Italy
- Department of Medical and Surgical Sciences of Children and Adults, University Hospital of Modena, 41224 Modena, Italy
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Impact of Sarcopenia on Survival in Patients Treated with FOLFIRINOX in a First-Line Setting for Metastatic Pancreatic Carcinoma. J Clin Med 2023; 12:jcm12062211. [PMID: 36983212 PMCID: PMC10056206 DOI: 10.3390/jcm12062211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/20/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023] Open
Abstract
Sarcopenia, defined as decreased muscle mass and strength, can be evaluated by a computed tomography (CT) examination and might be associated with reduced survival in patients with carcinoma. The prognosis of patients with metastatic pancreatic carcinoma is poor. The FOLFIRINOX (a combination of 5-fluorouracil, irinotecan, and oxaliplatin) chemotherapy regimen is a validated first-line treatment option. We investigated the impact of sarcopenia on overall survival (OS) and progression-free survival (PFS) in patients with metastatic pancreatic carcinoma. Clinical data and CT examinations of patients treated with FOLFIRINOX were retrospectively reviewed. Sarcopenia was estimated using baseline CT examinations. Seventy-five patients were included. Forty-three (57.3%) were classified as sarcopenic. The median OS of non-sarcopenic and sarcopenic patients were 15.6 and 14.1 months, respectively (p = 0.36). The median PFS was 10.3 in non-sarcopenic patients and 9.3 in sarcopenic patients (p = 0.83). No differences in toxicity of FOLFIRINOX were observed. There was a trend towards a higher probability of short-term death (within 4 months of diagnosis) in sarcopenic patients. In this study, the detection of sarcopenia failed to predict a longer OS or PFS in selected patients deemed eligible by a physician for triplet chemotherapy and receiving the FOLFIRINOX regimen in a first-line setting, confirming the major importance of a comprehensive patient assessment by physicians in selecting the best treatment option.
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Nakajima H, Yamaguchi J, Takami H, Hayashi M, Kodera Y, Nishida Y, Watanabe N, Onoe S, Mizuno T, Yokoyama Y, Ebata T. Impact of skeletal muscle mass on the prognosis of patients undergoing neoadjuvant chemotherapy for resectable or borderline resectable pancreatic cancer. Int J Clin Oncol 2023; 28:688-697. [PMID: 36872415 DOI: 10.1007/s10147-023-02321-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 02/21/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Neoadjuvant chemotherapy is a common therapeutic procedure for patients with pancreatic cancer. This study aimed to investigate the association between the total psoas area (TPA) and prognosis in patients undergoing neoadjuvant chemotherapy for resectable or borderline resectable pancreatic cancer. STUDY DESIGN This retrospective study included patients who underwent neoadjuvant chemotherapy for pancreatic cancer. TPA was measured at the level of the L3 vertebra using computed tomography. The patients were divided into low-TPA and normal-TPA groups. These dichotomizations were separately performed in patients with resectable and those with borderline resectable pancreatic cancer. RESULTS In total, 44 patients had resectable pancreatic cancer and 71 patients had borderline resectable pancreatic cancer. Overall survival among patients with resectable pancreatic cancer did not differ between the normal- and low-TPA groups (median, 19.8 vs. 21.8 months, p = 0.447), whereas among patients with borderline resectable pancreatic cancer, the low-TPA group had shorter overall survival than the normal-TPA group (median, 21.8 vs. 32.9 months, p = 0.006). Among patients with borderline resectable pancreatic cancer, the low-TPA group was predictive of poor overall survival (adjusted hazard ratio, 2.57, p = 0.037). CONCLUSION Low TPA is a risk factor of poor survival in patients undergoing neoadjuvant chemotherapy for borderline resectable pancreatic cancer. TPA evaluation could potentially suggest the treatment strategy in this disease.
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Affiliation(s)
- Hiroki Nakajima
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showaku, Nagoya, Aichi, 466-8550, Japan
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Junpei Yamaguchi
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showaku, Nagoya, Aichi, 466-8550, Japan
| | - Hideki Takami
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Hospital, Nagoya, Japan
| | - Masamichi Hayashi
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Hospital, Nagoya, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Hospital, Nagoya, Japan
| | - Yoshihiro Nishida
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Nobuyuki Watanabe
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showaku, Nagoya, Aichi, 466-8550, Japan
| | - Shunsuke Onoe
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showaku, Nagoya, Aichi, 466-8550, Japan
| | - Takashi Mizuno
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showaku, Nagoya, Aichi, 466-8550, Japan
| | - Yukihiro Yokoyama
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showaku, Nagoya, Aichi, 466-8550, Japan.
| | - Tomoki Ebata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showaku, Nagoya, Aichi, 466-8550, Japan
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Troschel FM, Troschel BO, Kloss M, Troschel AS, Pepper NB, Wiewrodt RG, Stummer W, Wiewrodt D, Theodor Eich H. Cervical body composition on radiotherapy planning computed tomography scans predicts overall survival in glioblastoma patients. Clin Transl Radiat Oncol 2023; 40:100621. [PMID: 37008514 PMCID: PMC10063381 DOI: 10.1016/j.ctro.2023.100621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 03/20/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
Background and purpose Glioblastoma (GBM) patients face a strongly unfavorable prognosis despite multimodal therapy regimens. However, individualized mortality prediction remains imprecise. Harnessing routine radiation planning cranial computed tomography (CT) scans, we assessed cervical body composition measures as novel biomarkers for overall survival (OS) in GBM patients. Materials and methods We performed threshold-based semi-automated quantification of muscle and subcutaneous fat cross-sectional area (CSA) at the levels of the first and second cervical vertebral body. First, we tested this method's validity by correlating cervical measures to established abdominal body composition in an open-source whole-body CT cohort. We then identified consecutive patients undergoing radiation planning for recent GBM diagnosis at our institution from 2010 to 2020 and quantified cervical body composition on radiation planning CT scans. Finally, we performed univariable and multivariable time-to-event analyses, adjusting for age, sex, body mass index, comorbidities, performance status, extent of surgical resection, extent of tumor at diagnosis, and MGMT methylation. Results Cervical body composition measurements were well-correlated with established abdominal markers (Spearman's rho greater than 0.68 in all cases). Subsequently, we included 324 GBM patients in our study cohort (median age 63 years, 60.8% male). 293 (90.4%) patients died during follow-up. Median survival time was 13 months. Patients with below-average muscle CSA or above-average fat CSA demonstrated shorter survival. In multivariable analyses, continuous cervical muscle measurements remained independently associated with OS. Conclusion This exploratory study establishes novel cervical body composition measures routinely available on cranial radiation planning CT scans and confirms their association with OS in patients diagnosed with GBM.
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Affiliation(s)
- Fabian M. Troschel
- Department of Radiation Oncology, Münster University Hospital, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
- Corresponding author at: Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany.
| | - Benjamin O. Troschel
- Department of Radiation Oncology, Münster University Hospital, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Maren Kloss
- Department of Neurosurgery, Münster University Hospital, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Amelie S. Troschel
- Department of Medicine II, Klinikum Wolfsburg, Sauerbruchstraße 7, 38440 Wolfsburg, Germany
| | - Niklas B. Pepper
- Department of Radiation Oncology, Münster University Hospital, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Rainer G. Wiewrodt
- Pulmonary Research Division, Münster University, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
- Department of Pulmonary Medicine, Mathias Foundation, Hospitals Rheine and Ibbenbueren, Frankenburgsstrasse 31, 48431 Rheine, Germany
| | - Walter Stummer
- Department of Neurosurgery, Münster University Hospital, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Dorothee Wiewrodt
- Department of Neurosurgery, Münster University Hospital, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Hans Theodor Eich
- Department of Radiation Oncology, Münster University Hospital, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
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Brown D, Loeliger J, Stewart J, Graham KL, Goradia S, Gerges C, Lyons S, Connor M, Stewart S, Di Giovanni A, D'Angelo S, Kiss N. Relationship between global leadership initiative on malnutrition (GLIM) defined malnutrition and survival, length of stay and post-operative complications in people with cancer: A systematic review. Clin Nutr 2023; 42:255-268. [PMID: 36716618 DOI: 10.1016/j.clnu.2023.01.012] [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: 10/25/2022] [Revised: 12/11/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND & AIMS The predictive validity of the GLIM criteria for survival, length of hospital stay (LOHS) and post-operative complications among people with cancer have not been systematically reviewed. This systematic review aims to determine whether GLIM malnutrition is predictive of these outcomes, and whether the predictive validity is affected by how phenotypic and etiologic criteria are assessed. METHODS Cohort studies published after 2018 were systematically reviewed according to PRISMA guidelines from Embase, Medline Complete and CINAHL Complete. Risk of bias and methodologic quality were assessed using the Journal of the Academy of Nutrition and Dietetics' Quality Criteria Checklist tool for Primary research. RESULTS In total, 21 studies were included, including 28,726 participants. All studies investigated survival, where 18 reported GLIM malnutrition is associated with decreased survival. LOHS was investigated in six studies, with all finding an association between GLIM malnutrition and longer LOHS. Post-operative complications were assessed in seven studies, of which five reported GLIM malnutrition was predictive of increased post-operative complications. Methods to assess the GLIM phenotypic and etiologic criteria varied, with consistent predictive ability for survival regardless of method of assessing reduced muscle mass. However, predictive ability was more variable across different measures of inflammation and reduced intake. CONCLUSION GLIM malnutrition was consistently predictive of worse clinical outcomes. Different measures of reduced muscle mass did not affect the predictive ability of GLIM for survival. However, variation in assessment of the etiologic criteria resulted in varying predictive ability of the GLIM diagnosis for survival.
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Affiliation(s)
- Dylan Brown
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Jenelle Loeliger
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia; Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Jane Stewart
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Kate L Graham
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Sunita Goradia
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Chantal Gerges
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Shania Lyons
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Molly Connor
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Sam Stewart
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Adrian Di Giovanni
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Sarah D'Angelo
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia; Allied Health Department, Peter MacCallum Cancer Centre, Melbourne, Australia.
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22
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Powell-Brett S, Hodson J, Pande R, Mann S, Freer A, Wyrko Z, Hughes C, Isaac J, Sutcliffe RP, Roberts K. Are physical performance and frailty assessments useful in targeting and improving access to adjuvant therapy in patients undergoing resection for pancreatic cancer? Langenbecks Arch Surg 2023; 408:88. [PMID: 36787026 PMCID: PMC9928938 DOI: 10.1007/s00423-023-02828-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 02/02/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Many patients fail to receive adjuvant chemotherapy following pancreatic cancer surgery. This study implemented a multimodal, multidisciplinary approach to improving recovery after pancreatoduodenectomy (the 'Fast Recovery' programme) and measured its impact on adjuvant chemotherapy uptake and nutritional decline. The predictive accuracies of a bundle of frailty and physical performance assessments, with respect to the recipient of adjuvant chemotherapy, were also evaluated. RESULTS The N = 44 patients treated after the introduction of the 'Fast Recovery' programme were not found to have a significantly higher adjuvant chemotherapy uptake than the N = 409 treated before the pathway change (80.5 vs. 74.3%, p = 0.452), but did have a significantly lower average weight loss at six weeks post-operatively (mean: 4.3 vs. 6.9 kg, p = 0.013). Of the pre-operative frailty and physical performance assessments tested, the 6-min walk test was found to be the strongest predictor of the receipt of adjuvant chemotherapy (area under the ROC curve: 0.91, p = 0.001); all patients achieving distances ≥ 360 m went on to receive adjuvant chemotherapy, compared to 33% of those walking < 360 m. CONCLUSIONS The multimodal 'Fast Recovery' programme was not found to significantly improve access to adjuvant chemotherapy, but did appear to have benefits in reducing nutritional decline. Pre-operative assessments were found to be useful in identifying patients at risk of non-receipt of adjuvant therapies, with markers of physical performance appearing to be the best predictors. As such, these markers could be useful in targeting pre- and post-habilitation measures, such as physiotherapy and improved dietetic support.
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Affiliation(s)
- S Powell-Brett
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Queen Elizabeth Hospital, Birmingham, B15 2TH, Birmingham, UK.
| | - J Hodson
- Research Development and Innovation, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - R Pande
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Queen Elizabeth Hospital, Birmingham, B15 2TH, Birmingham, UK
| | - S Mann
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Queen Elizabeth Hospital, Birmingham, B15 2TH, Birmingham, UK
| | - Alice Freer
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Queen Elizabeth Hospital, Birmingham, B15 2TH, Birmingham, UK
| | - Zoe Wyrko
- Department of Geriatric Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Clare Hughes
- Department of Geriatric Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - J Isaac
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Queen Elizabeth Hospital, Birmingham, B15 2TH, Birmingham, UK
| | - R P Sutcliffe
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Queen Elizabeth Hospital, Birmingham, B15 2TH, Birmingham, UK
| | - K Roberts
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Queen Elizabeth Hospital, Birmingham, B15 2TH, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
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23
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Paiella S, Azzolina D, Trestini I, Malleo G, Nappo G, Ricci C, Ingaldi C, Vacca PG, De Pastena M, Secchettin E, Zamboni G, Maggino L, Corciulo MA, Sandini M, Cereda M, Capretti G, Casadei R, Bassi C, Mansueto G, Gregori D, Milella M, Zerbi A, Gianotti L, Salvia R. Body composition parameters, immunonutritional indexes, and surgical outcome of pancreatic cancer patients resected after neoadjuvant therapy: A retrospective, multicenter analysis. Front Nutr 2023; 10:1065294. [PMID: 36860690 PMCID: PMC9968808 DOI: 10.3389/fnut.2023.1065294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 01/23/2023] [Indexed: 02/17/2023] Open
Abstract
Background and aims Body composition parameters and immunonutritional indexes provide useful information on the nutritional and inflammatory status of patients. We sought to investigate whether they predict the postoperative outcome in patients with pancreatic cancer (PC) who received neoadjuvant therapy (NAT) and then pancreaticoduodenectomy. Methods Data from locally advanced PC patients who underwent NAT followed by pancreaticoduodenectomy between January 2012 and December 2019 in four high-volume institutions were collected retrospectively. Only patients with two available CT scans (before and after NAT) and immunonutritional indexes (before surgery) available were included. Body composition was assessed and immunonutritional indexes collected were: VAT, SAT, SMI, SMA, PLR, NLR, LMR, and PNI. The postoperative outcomes evaluated were overall morbidity (any complication occurring), major complications (Clavien-Dindo ≥ 3), and length of stay. Results One hundred twenty-one patients met the inclusion criteria and constituted the study population. The median age at the diagnosis was 64 years (IQR16), and the median BMI was 24 kg/m2 (IQR 4.1). The median time between the two CT-scan examined was 188 days (IQR 48). Skeletal muscle index (SMI) decreased after NAT, with a median delta of -7.8 cm2/m2 (p < 0.05). Major complications occurred more frequently in patients with a lower pre-NAT SMI (p = 0.035) and in those who gained in subcutaneous adipose tissue (SAT) compartment during NAT (p = 0.043). Patients with a gain in SMI experienced fewer major postoperative complications (p = 0.002). The presence of Low muscle mass after NAT was associated with a longer hospital stay [Beta 5.1, 95%CI (1.5, 8.7), p = 0.006]. An increase in SMI from 35 to 40 cm2/m2 was a protective factor with respect to overall postoperative complications [OR 0.43, 95% (CI 0.21, 0.86), p < 0.001]. None of the immunonutritional indexes investigated predicted the postoperative outcome. Conclusion Body composition changes during NAT are associated with surgical outcome in PC patients who receive pancreaticoduodenectomy after NAT. An increase in SMI during NAT should be favored to ameliorate the postoperative outcome. Immunonutritional indexes did not show to be capable of predicting the surgical outcome.
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Affiliation(s)
- Salvatore Paiella
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy,*Correspondence: Salvatore Paiella ✉
| | - Danila Azzolina
- Department of Environmental and Preventive Science, University of Ferrara, Ferrara, Italy
| | - Ilaria Trestini
- Dietetics Services, Hospital Medical Direction, University Hospital Trust of Verona, Verona, Italy
| | - Giuseppe Malleo
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy
| | - Gennaro Nappo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy,IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Claudio Ricci
- Pancreatic Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, University of Bologna, Bologna, Italy,Department of Internal Medicine and Surgery (DIMEC), S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Carlo Ingaldi
- Pancreatic Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, University of Bologna, Bologna, Italy,Department of Internal Medicine and Surgery (DIMEC), S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Pier Giuseppe Vacca
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy
| | - Matteo De Pastena
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy
| | - Erica Secchettin
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy
| | - Giulia Zamboni
- Radiology Unit, Pancreas Institute, University of Verona, Verona, Italy
| | - Laura Maggino
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy
| | - Maria Assunta Corciulo
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Marta Sandini
- General Surgery Unit, University of Siena, Siena, Italy
| | - Marco Cereda
- School of Medicine and Surgery, University of Milano-Bicocca and HPB Unit, San Gerardo Hospital Monza, Monza, Italy
| | - Giovanni Capretti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy,IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Riccardo Casadei
- Pancreatic Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, University of Bologna, Bologna, Italy,Department of Internal Medicine and Surgery (DIMEC), S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Claudio Bassi
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy
| | | | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Michele Milella
- Section of Oncology, Department of Medicine, University of Verona Hospital Trust, Verona, Italy
| | - Alessandro Zerbi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy,IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Luca Gianotti
- School of Medicine and Surgery, University of Milano-Bicocca and HPB Unit, San Gerardo Hospital Monza, Monza, Italy
| | - Roberto Salvia
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy,Roberto Salvia ✉
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Cintoni M, Grassi F, Palombaro M, Rinninella E, Pulcini G, Di Donato A, Salvatore L, Quero G, Tortora G, Alfieri S, Gasbarrini A, Mele MC. Nutritional Interventions during Chemotherapy for Pancreatic Cancer: A Systematic Review of Prospective Studies. Nutrients 2023; 15:nu15030727. [PMID: 36771433 PMCID: PMC9920549 DOI: 10.3390/nu15030727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/19/2023] [Accepted: 01/28/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Pancreatic cancer incidence is growing, but the prognosis for survival is still poor. Patients with pancreatic cancer often suffer from malnutrition and sarcopenia, two clinical conditions that negatively impact oncological clinical outcomes. The aim of this systematic review was to analyze the impact of different nutritional interventions on clinical outcomes in patients with pancreatic cancer during chemotherapy. METHODS A systematic review of MedLine, EMBASE, and Web of Science was carried out in December 2022, identifying 5704 articles. Titles and abstracts of all records were screened for eligibility based on inclusion criteria, and nine articles were included. RESULTS All nine articles included were prospective studies, but a meta-analysis could not be performed due to heterogenicity in nutritional intervention. This Systematic Review shows an improvement in Quality of Life, nutritional status, body composition, oral intake, and Karnofsky Performance Status, following nutritional interventions. CONCLUSIONS This Systematic Review in pancreatic cancer patients during chemotherapies does not allow one to draw firm conclusions. However, nutritional support in pancreatic cancer patients is advisable to ameliorate oncological care. Further well-designed prospective studies are needed to identify nutritional support's real impact and to establish a reliable way to improve nutritional status of pancreatic cancer patients during chemotherapy.
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Affiliation(s)
- Marco Cintoni
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Futura Grassi
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Marta Palombaro
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-06-3015-3410
| | - Emanuele Rinninella
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Gabriele Pulcini
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Agnese Di Donato
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Lisa Salvatore
- Comprehensive Cancer Center, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Giuseppe Quero
- Digestive Surgery Unit, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Giampaolo Tortora
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Comprehensive Cancer Center, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Sergio Alfieri
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Digestive Surgery Unit, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Antonio Gasbarrini
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- UOC Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Maria Cristina Mele
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Osteosarcopenia predicts poor prognosis for patients with intrahepatic cholangiocarcinoma after hepatic resection. Surg Today 2023; 53:82-89. [PMID: 35831486 DOI: 10.1007/s00595-022-02550-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/24/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE The concept of osteosarcopenia, which is concomitant osteopenia and sarcopenia, has been proposed as a prognostic indicator for cancer patients. The aim of this study was to evaluate the prognostic significance of osteosarcopenia in patients with intrahepatic cholangiocarcinoma (IHCC). METHODS The subjects of this retrospective study were 41 patients who underwent hepatic resection for IHCC. Osteopenia was assessed with pixel density in the mid-vertebral core of the 11th thoracic vertebra and sarcopenia was assessed by the psoas muscle areas at the third lumbar vertebra. Osteosarcopenia was defined as the concomitant occurrence of osteopenia and sarcopenia. We analyzed the association of osteosarcopenia with disease-free and overall survival and evaluated clinicopathologic variables in relation to the osteosarcopenia. RESULTS Eighteen (44%) of the 41 patients had osteosarcopenia. Multivariate analysis identified osteosarcopenia (hazard ratio 3.38, 95% confidence interval: 1.49-7.68, p < 0.01) as an independent predictor of disease-free survival, and age ≥ 65 years (p = 0.03) and osteosarcopenia (hazard ratio 6.46, 95% confidence interval: 1.76-23.71, p < 0.01) as independent predictors of overall survival. CONCLUSIONS Preoperative osteosarcopenia may be a predictor of adverse prognosis for patients undergoing hepatic resection for IHCC, suggesting that preoperative management to maintain muscle and bone intensity could improve the prognosis.
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Surov A, Kardas H, Besutti G, Pellegrini M, Ottone M, Onur MR, Atak F, Erdemir AG, Hocaoglu E, Yıldız Ö, Inci E, Cingöz E, Cingöz M, Dursun M, Korkmaz İ, Orhan Ç, Strobel A, Wienke A, Pech M. Prognostic Role of the Pectoralis Musculature in Patients with COVID-19. A Multicenter Study. Acad Radiol 2023; 30:77-82. [PMID: 35667979 PMCID: PMC9108033 DOI: 10.1016/j.acra.2022.05.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 01/28/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate the impact of low skeletal muscle mass in patients with COVID-19 on relevant outcomes like 30-day mortality, need for intubation and need for intensive care unit admission. MATERIALS AND METHODS For this study, data from six centers were acquired. The acquired sample comprises 1138 patients. There were 547 women (48.1%) and 591 men (51.9%) with a mean age of 54.5 ± 18.8 years; median age, 55 years; range, 18-84 years). In every case, thoracic CT without intravenous application of contrast medium was performed. The following parameters of the pectoralis muscles were estimated: muscle area as a sum of the bilateral areas of the pectoralis major and minor muscles, muscle density, muscle index (PMI) (pectoralis muscle area divided by the patient's body height square) as a ratio pectoralis major and minor muscles divided by the patient's body height2, and muscle gauge as PMI x muscle density. RESULTS Overall, 220 patients (19.33%) were admitted to the intensive care unit. In 171 patients (15.03%), mechanical lung ventilation was performed. Finally, 154 patients (13.53%) died within the observation time of 30-day. All investigated parameters of pectoralis muscle were lower in the patients with unfavorable courses of Covid-19. All pectoralis muscle parameters were associated with 30-day mortality in multivariate analyses adjusted for age and sex: pectoralis muscle area, HR = 0.93 CI 95% (0.91-0.95) p < 0.001; pectoralis muscle density, HR = 0.94 CI 95% (0.93-0.96) p < 0.001; pectoralis muscle index, HR = 0.79 CI 95% (0.75-0.85) p < 0.001, pectoralis muscle gauge, HR = 0.995 CI 95% (0.99-0.996) p < 0.001. CONCLUSION in COVID-19, survivors have larger areas and higher index, gauge and density of the pectoralis muscles in comparison to nonsurvivors. However, the analyzed muscle parameters cannot be used for prediction of disease courses.
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Affiliation(s)
- Alexey Surov
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University Magdeburg (A.S., H.K., M.P.).
| | - Hakan Kardas
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University Magdeburg (A.S., H.K., M.P.)
| | - Giulia Besutti
- Radiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy (G.B., M.P., M.O.)
| | - Massimo Pellegrini
- Radiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy (G.B., M.P., M.O.)
| | - Marta Ottone
- Radiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy (G.B., M.P., M.O.)
| | - Mehmet Ruhi Onur
- Department of Radiology, University of Hacettepe School of Medicine, Ankara, Turkey (M.R.O., F.A., A.G.E.)
| | - Firat Atak
- Department of Radiology, University of Hacettepe School of Medicine, Ankara, Turkey (M.R.O., F.A., A.G.E.)
| | - Ahmet Gurkan Erdemir
- Department of Radiology, University of Hacettepe School of Medicine, Ankara, Turkey (M.R.O., F.A., A.G.E.)
| | - Elif Hocaoglu
- Department of Radiology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Research and Training Hospital, Radiology (E.H., O.Y., E.I.)
| | - Ömer Yıldız
- Department of Radiology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Research and Training Hospital, Radiology (E.H., O.Y., E.I.)
| | - Ercan Inci
- Department of Radiology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Research and Training Hospital, Radiology (E.H., O.Y., E.I.)
| | - Eda Cingöz
- İstanbul Medical Faculty Radiology Department, Istanbul Turkey (E.C., M.C., M.D.)
| | - Mehmet Cingöz
- İstanbul Medical Faculty Radiology Department, Istanbul Turkey (E.C., M.C., M.D.),Basaksehir Cam and Sakura City Hospital Radiology Department (M.C.)
| | - Memduh Dursun
- İstanbul Medical Faculty Radiology Department, Istanbul Turkey (E.C., M.C., M.D.)
| | - İnan Korkmaz
- Hatay Mustafa Kemal University, Faculty of Medicine, Department of Radiology, Antakya, Hatay, Turkey (I.K., C.O.)
| | - Çağrı Orhan
- Hatay Mustafa Kemal University, Faculty of Medicine, Department of Radiology, Antakya, Hatay, Turkey (I.K., C.O.)
| | - Alexandra Strobel
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Profile Area Clinical Studies & Biostatistics, Martin-Luther-University Halle-Wittenberg, Halle, Germany (A.S., A.W.)
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Profile Area Clinical Studies & Biostatistics, Martin-Luther-University Halle-Wittenberg, Halle, Germany (A.S., A.W.)
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University Magdeburg (A.S., H.K., M.P.)
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Choi MH, Yoon SB. Sarcopenia in pancreatic cancer: Effect on patient outcomes. World J Gastrointest Oncol 2022; 14:2302-2312. [PMID: 36568942 PMCID: PMC9782618 DOI: 10.4251/wjgo.v14.i12.2302] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/29/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
Pancreatic cancer is a challenging disease with an increasing incidence and extremely poor prognosis. The clinical outcomes of pancreatic cancer depend on tumor biology, responses to treatments, and malnutrition or cachexia. Sarcopenia represents a severe catabolic condition defined by the age-related loss of muscle mass and strength and affects as much as 70% of malnourished pancreatic cancer patients. The lumbar skeletal muscle index, defined as the total abdominal muscle area at the L3 vertebral level adjusted by the square of the height, is widely used for assessing sarcopenia in patients with pancreatic cancer. Several studies have suggested that sarcopenia may be a risk factor for perioperative complications and decreased recurrence-free or overall survival in patients with pancreatic cancer undergoing surgery. Sarcopenia could also intensify chemotherapy-induced toxicities and worsen the quality of life and survival in the neoadjuvant or palliative chemotherapy setting. Sarcopenia, not only at the time of diagnosis but also during treatment, decreases survival in patients with pancreatic cancer. Theoretically, multimodal interventions may improve sarcopenia and clinical outcomes; however, no study has reported positive results. Further prospective studies are needed to confirm the prognostic role of sarcopenia and the effects of multimodal interventions in patients with pancreatic cancer.
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Affiliation(s)
- Moon Hyung Choi
- Department of Radiology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, South Korea
| | - Seung Bae Yoon
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 03312, South Korea
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28
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Anyene I, Caan B, Williams GR, Popuri K, Lenchik L, Giri S, Chow V, Beg MF, Cespedes Feliciano EM. Body composition from single versus multi-slice abdominal computed tomography: Concordance and associations with colorectal cancer survival. J Cachexia Sarcopenia Muscle 2022; 13:2974-2984. [PMID: 36052755 PMCID: PMC9745558 DOI: 10.1002/jcsm.13080] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/06/2022] [Accepted: 08/14/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Computed tomography (CT) scans are routinely obtained in oncology and provide measures of muscle and adipose tissue predictive of morbidity and mortality. Automated segmentation of CT has advanced past single slices to multi-slice measurements, but the concordance of these approaches and their associations with mortality after cancer diagnosis have not been compared. METHODS A total of 2871 patients with colorectal cancer diagnosed during 2012-2017 at Kaiser Permanente Northern California underwent abdominal CT scans as part of routine clinical care from which mid-L3 cross-sectional areas and multi-slice T12-L5 volumes of skeletal muscle (SKM), subcutaneous adipose (SAT), visceral adipose (VAT) and intermuscular adipose (IMAT) tissues were assessed using Data Analysis Facilitation Suite, an automated multi-slice segmentation platform. To facilitate comparison between single-slice and multi-slice measurements, sex-specific z-scores were calculated. Pearson correlation coefficients and Bland-Altman analysis were used to quantify agreement. Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for death adjusting for age, sex, race/ethnicity, height, and tumour site and stage. RESULTS Single-slice area and multi-slice abdominal volumes were highly correlated for all tissues (SKM R = 0.92, P < 0.001; SAT R = 0.97, P < 0.001; VAT R = 0.98, P < 0.001; IMAT R = 0.89, P < 0.001). Bland-Altman plots had a bias of 0 (SE: 0.00), indicating high average agreement between measures. The limits of agreement were narrowest for VAT ( ± 0.42 SD) and SAT ( ± 0.44 SD), and widest for SKM ( ± 0.78 SD) and IMAT ( ± 0.92 SD). The HRs had overlapping CIs, and similar magnitudes and direction of effects; for example, a 1-SD increase in SKM area was associated with an 18% decreased risk of death (HR = 0.82; 95% CI: 0.72-0.92), versus 15% for volume from T12 to L5 (HR = 0.85; 95% CI: 0.75-0.96). CONCLUSIONS Single-slice L3 areas and multi-slice T12-L5 abdominal volumes of SKM, VAT, SAT and IMAT are highly correlated. Associations between area and volume measures with all-cause mortality were similar, suggesting that they are equivalent tools for population studies if body composition is assessed at a single timepoint. Future research should examine longitudinal changes in multi-slice tissues to improve individual risk prediction.
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Affiliation(s)
- Ijeamaka Anyene
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Bette Caan
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Grant R Williams
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA.,Division of Hematology/Oncology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Karteek Popuri
- School of Engineering Science, Simon Fraser University, Burnaby, BC, Canada
| | - Leon Lenchik
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Smith Giri
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA.,Division of Hematology/Oncology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Vincent Chow
- School of Engineering Science, Simon Fraser University, Burnaby, BC, Canada
| | - Mirza Faisal Beg
- School of Engineering Science, Simon Fraser University, Burnaby, BC, Canada
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Chan KS, Junnarkar SP, Wang B, Tan YP, Low JK, Huey CWT, Shelat VG. Outcomes of an outpatient home-based prehabilitation program before pancreaticoduodenectomy: A retrospective cohort study. Ann Hepatobiliary Pancreat Surg 2022; 26:375-385. [PMID: 36245070 PMCID: PMC9721255 DOI: 10.14701/ahbps.22-028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/27/2022] [Accepted: 08/01/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUNDS/AIMS Prehabilitation aims for preoperative optimisation to reduce postoperative complications. However, there is a paucity of data on its use in patients undergoing pancreaticoduodenectomy (PD). Thus, this study aims to evaluate the outcomes of a home-based outpatient prehabilitation program (PP) versus no-PP in patients undergoing PD. METHODS This retrospective cohort study compared patients who underwent PP versus no-PP before elective PD from January 2016 to December 2020. Inclusion criteria for PP were < 65 years or 65-74 years with FRAIL score < 3. No-PP included dietician, case manager and anesthesia review. PP included additional physiotherapy sessions, caregiver training and interim phone consultation. Univariate and multivariate analysis were used to evaluate length of stay (LOS), morbidity, 30-day readmission, and 90-day mortality. RESULTS Seventy-one patients (PP: n = 50 [70.4%]; no-PP: n = 21 [29.6%]) were included in this study. Median age was 65 years (interquartile range [IQR]: 58-72 years). Majority (n = 58 [81.7%]) of patients underwent open surgery. Ductal adenocarcinoma was the most common histology (49.3%). Patient demographics were comparable between both groups. Overall median LOS was 11.0 days (IQR: 8.0-17.0 days). Compared to no-PP, PP was not independently associated with reduced intra-abdominal collections (odds ratio [OR]: 0.43; 95% confidence interval [CI]: 0.03-6.11, p = 0.532), major morbidity (OR: 1.31; 95% CI: 0.09-19.47; p = 0.845) or 30-day readmission (OR: 3.16; 95% CI: 0.26-38.27; p = 0.365). There was one (1.4%) 30-day mortality. CONCLUSIONS Our outpatient PP with unsupervised exercise regimes did not improve postoperative outcomes following elective PD.
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Affiliation(s)
- Kai Siang Chan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
- Corresponding author: Kai Siang Chan, MBBS Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433 Singapore Tel: +65-91389343, E-mail: ORCID: https://orcid.org/0000-0001-9533-801X
| | | | - Bei Wang
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Yen Pin Tan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Jee Keem Low
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | | | - Vishalkumar Girishchandra Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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30
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Tozuka Y, Ueno M, Kobayashi S, Morimoto M, Fukushima T, Sano Y, Kawano K, Hanaoka A, Tezuka S, Asama H, Moriya S, Morinaga S, Ohkawa S, Maeda S. Prognostic significance of sarcopenia as determined by bioelectrical impedance analysis in patients with advanced pancreatic cancer receiving gemcitabine plus nab‑paclitaxel: A retrospective study. Oncol Lett 2022; 24:375. [PMID: 36238838 PMCID: PMC9494620 DOI: 10.3892/ol.2022.13495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/05/2022] [Indexed: 11/23/2022] Open
Abstract
Sarcopenia often affects patients with various types of cancer, and has been reported to affect patient prognosis and therapeutic effects. However, to the best of our knowledge, there are no reports on the relationship between gemcitabine plus nab-paclitaxel combination therapy (GnP) and sarcopenia in patients with unresectable pancreatic cancer. The present study analyzed the relationship between overall survival (OS), progression-free survival (PFS), response rate, disease control rate, adverse events (AEs) and sarcopenia in patients with pancreatic cancer treated with GnP. A total of 121 consecutive patients with advanced pancreatic cancer who received GnP as first-line chemotherapy between January 2015 and December 2017 were retrospectively analyzed. GnP consisted of 1,000 mg/m2 gemcitabine and 125 mg/m2 nab-paclitaxel, which were administered on days 1, 8 and 15 every 4 weeks. The skeletal muscle index (SMI) was calculated using bioimpedance analysis (BIA) as an index of sarcopenia prior to GnP. The patients were divided into sarcopenia (n=41) and non-sarcopenia (n=80) groups using cutoff values of 8.87 and 6.42 kg/m2 for male and female patients, respectively. The sarcopenia and non-sarcopenia groups had a median OS of 8.1 and 13.9 months, respectively [hazard ratio (HR) 0.79; 95% confidence interval (CI) 0.53-1.20], and a median PFS of 4.3 and 6.3 months, respectively (HR 0.63; 95% CI 0.42-0.95). The response and disease controls rate were not statistically different between the groups (20 vs. 32%, P=0.20; 81 vs. 80%, P=1.0). In addition, comparison of common grade 3 and 4 AEs between the two groups revealed no statistically significant differences. In conclusion, the results of the present study indicated that SMI obtained by BIA may be a predictor of treatment response and prognosis in patients with advanced pancreatic cancer who undergo GnP.
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Affiliation(s)
- Yuichiro Tozuka
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa 236‑0004, Japan
| | - Makoto Ueno
- Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, Yokohama, Kanagawa 241‑8515, Japan
| | - Satoshi Kobayashi
- Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, Yokohama, Kanagawa 241‑8515, Japan
| | - Manabu Morimoto
- Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, Yokohama, Kanagawa 241‑8515, Japan
| | - Taito Fukushima
- Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, Yokohama, Kanagawa 241‑8515, Japan
| | - Yusuke Sano
- Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, Yokohama, Kanagawa 241‑8515, Japan
| | - Kuniyuki Kawano
- Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, Yokohama, Kanagawa 241‑8515, Japan
| | - Akane Hanaoka
- Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, Yokohama, Kanagawa 241‑8515, Japan
| | - Shun Tezuka
- Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, Yokohama, Kanagawa 241‑8515, Japan
| | - Hiroyuki Asama
- Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, Yokohama, Kanagawa 241‑8515, Japan
| | - Satoshi Moriya
- Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, Yokohama, Kanagawa 241‑8515, Japan
| | - Soichiro Morinaga
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa 241‑8515, Japan
| | - Shinichi Ohkawa
- Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, Yokohama, Kanagawa 241‑8515, Japan
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa 236‑0004, Japan
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Rigiroli F, Zhang D, Molinger J, Wang Y, Chang A, Wischmeyer PE, Inman BA, Gupta RT. Automated versus manual analysis of body composition measures on computed tomography in patients with bladder cancer. Eur J Radiol 2022; 154:110413. [PMID: 35732083 PMCID: PMC9398959 DOI: 10.1016/j.ejrad.2022.110413] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/11/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Manual measurement of body composition on computed tomography (CT) is time-consuming, limiting its clinical use. We validate a software program, Automatic Body composition Analyzer using Computed tomography image Segmentation (ABACS), for the automated measurement of body composition by comparing its performance to manual segmentation in a cohort of patients with bladder cancer. METHOD We performed a retrospective analysis of 285 patients treated for bladder cancer at the Duke University Health System from 1996 to 2017. Abdominal CT images were manually segmented at L3 using Slice-O-Matic. Automated segmentation was performed with ABACS on the same L3-level images. Measures of interest were skeletal muscle (SM) area, subcutaneous adipose tissue (SAT) area, and visceral adipose tissue (VAT) area. SM index, SAT index, and VAT index were calculated by dividing component areas by patient height2 (m2). Patients were dichotomized as sarcopenic, having excessive subcutaneous fat, or having excessive visceral fat using published cut-off values. Agreement between manual and automated segmentation was assessed using the Pearson product-moment correlation coefficient (PPMCC), the interclass correlation coefficient (ICC3), and the kappa statistic (κ). RESULTS There was strong agreement between manual and automatic segmentation, with PPMCCs > 0.90 and ICC3s > 0.90 for SM, SAT, and VAT areas. Categorization of patients as sarcopenic (κ = 0.73), having excessive subcutaneous fat (κ = 0.88), or having excessive visceral fat (κ = 0.90) displayed high agreement between methods. CONCLUSIONS Automated segmentation of body composition measures on CT using ABACS performs similarly to manual analysis and may expedite data collection in body composition research.
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Affiliation(s)
- Francesca Rigiroli
- Department of Radiology, Duke University Medical Center, Durham, NC, USA; Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - Dylan Zhang
- Department of Radiology, Duke University Medical Center, Durham, NC, USA.
| | - Jeroen Molinger
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.
| | - Yingqi Wang
- Division of Urology, Duke Cancer Institute, Durham, NC, USA.
| | - Andrew Chang
- Division of Urology, Duke Cancer Institute, Durham, NC, USA.
| | - Paul E Wischmeyer
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.
| | - Brant A Inman
- Division of Urology, Duke Cancer Institute, Durham, NC, USA; Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA.
| | - Rajan T Gupta
- Department of Radiology, Duke University Medical Center, Durham, NC, USA; Division of Urology, Duke Cancer Institute, Durham, NC, USA; Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA.
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Gunesch AN, Sutton TL, Krasnow SM, Deig CR, Sheppard BC, Marks DL, Grossberg AJ. Validation of automated body composition analysis using diagnostic computed tomography imaging in patients with pancreatic cancer. Am J Surg 2022; 224:742-746. [PMID: 35396132 PMCID: PMC9308682 DOI: 10.1016/j.amjsurg.2022.03.025] [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: 11/15/2021] [Revised: 02/19/2022] [Accepted: 03/22/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Sarcopenia is associated with complications and inferior oncologic outcomes in solid tumors. Axial computed tomography (CT) scans can be used to evaluate sarcopenia, however manual quantification is laborious. We sought to validate an automated method of quantifying muscle cross-sectional area (CSA) in patients with pancreatic adenocarcinoma (PDAC). METHODS Mid-L3 CT images from patients with PDAC were analyzed: CSAs of skeletal muscle (SM) were measured using manual segmentation and the software AutoMATiCA, and then compared with linear regression. RESULTS Five-hundred-twenty-five unique scans were analyzed. There was robust correlation between manual and automated segmentation for L3 CSA (R2 0.94, P < 0.001). Bland-Altman analysis demonstrated a consistent overestimation of muscle CSA by AutoMATiCA with a mean difference of 5.7%. A correction factor of 1.06 was validated using a unique test dataset of 36 patients with non-PDAC peripancreatic malignancies. CONCLUSIONS Automated muscle CSA measurement with AutoMATiCA is highly efficient and yields results highly correlated with manual measurement. These findings support the potential use of high-throughput sarcopenia analysis with abdominal CT scans for both clinical and research purposes.
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Affiliation(s)
- Ali N Gunesch
- School of Medicine, Oregon Health & Science University, Portland, OR, 97239, USA
| | | | | | | | | | - Daniel L Marks
- Department of Pediatrics, OHSU, Portland, OR, 97239, USA; Brenden Colson Center for Pancreatic Care, OHSU, Portland, OR, 97239, USA
| | - Aaron J Grossberg
- Brenden Colson Center for Pancreatic Care, OHSU, Portland, OR, 97239, USA; Department of Radiation Medicine, OHSU, Portland, OR, 97239, USA.
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Logan K, Pearson F, Kenny RP, Pandanaboyana S, Sharp L. Are older patients less likely to be treated for pancreatic cancer? A systematic review and meta-analysis. Cancer Epidemiol 2022; 80:102215. [PMID: 35901624 DOI: 10.1016/j.canep.2022.102215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/28/2022] [Accepted: 07/08/2022] [Indexed: 11/27/2022]
Abstract
Pancreatic cancer is the seventh commonest cause of cancer-related death worldwide. Although prognosis is poor, both surgery and adjuvant chemotherapy improve survival. However, it has been suggested that not all pancreatic cancer patients who may benefit from treatment receive it. This systematic review and meta-analysis investigated the existence of age-related inequalities in receipt of first-line pancreatic cancer treatment. Medline, Embase, Cochrane Library and grey literature were searched for population-based studies investigating treatment receipt, reported by age, for patients with primary pancreatic cancer from inception until 4th June 2020, and updated 5th August 2021. Studies from countries with universal healthcare were included, to minimise influence of health system-related economic factors. A modified version of the Newcastle-Ottawa Scale was used to assess risk of bias. Random-effects meta-analysis was undertaken comparing likelihood of treatment receipt in older versus younger patients. Sensitivity and subgroup analyses were conducted. Eighteen papers were included; 12 independent populations were eligible for meta-analysis. In most studies, < 10% of older patients were treated. Older age (generally ≥65) was significantly associated with reduced receipt of any treatment (OR=0.14, 95% CI 0.10-0.21, n = 12 studies), surgery (OR=0.15, 95% CI 0.09-0.24, n = 9 studies) and chemotherapy as a primary treatment (OR=0.13, 95% CI 0.07-0.24, n = 5 studies). The effect of age was independent of methodological quality, patient population or time-period of patient diagnosis and remained in studies with confounder adjustment. The mean quality score of included studies was 6/8. Inequalities in receipt of healthcare interventions across social groups is a recognised concern internationally. This review shows that older age is significantly, and consistently, associated with non-receipt of treatment in pancreatic cancer. However, there are risks and side-effects associated with pancreatic cancer treatment. Further research on what influences patient and professional treatment decision-making is required to better understand these apparent inequalities.
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Affiliation(s)
- Kirsty Logan
- Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Fiona Pearson
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
| | - Ryan Pw Kenny
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
| | - Sanjay Pandanaboyana
- Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom; HPB and Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom.
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Bundred J, Thakkar RG, Pandanaboyana S. Systematic review of sarcopenia in chronic pancreatitis: prevalence, impact on surgical outcomes, and survival. Expert Rev Gastroenterol Hepatol 2022; 16:665-672. [PMID: 35712996 DOI: 10.1080/17474124.2022.2091544] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Chronic pancreatitis (CP) is characterized by progressive inflammatory changes to the pancreas, leading to loss of endocrine and exocrine function. Emerging literature suggests sarcopenia may adversely affect outcomes for chronic pancreatitis patients. This systematic review examines the evidence surrounding the impact of sarcopenia on patients with CP. AREAS COVERED A systematic literature search of MEDLINE (via PUBMED), Cochrane and EMBASE databases was undertaken to identify articles describing body composition assessment in patients with CP. Data collected included definitions of sarcopenia, sarcopenia assessment methodology, baseline demographics, surgical outcomes, and short- and long-term outcomes. EXPERT OPINION In total, nine studies reported on 977 patients with a sarcopenia prevalence of 32.3% (95% CI 22.9-42.6%). CT remains the primary modality to assess for sarcopenia, due to ease of access. None of the studies reporting on post-operative outcomes for patients with chronic pancreatitis found a significant increase in complications among those with sarcopenia. Mortality within 1 year in the outpatient setting from one study of patients with CP was 16% in sarcopenic patients versus 3% (HR: 6.69 (95% CI: 1.79-24.9), p < 0.001) in those with no sarcopenia.Sarcopenia is prevalent in patients with CP occurring in approximately a third of patients. Sarcopenia is associated with an adverse impact on long-term survival.
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Affiliation(s)
- James Bundred
- Leeds Teaching Hospitals NHS Trust, Saint James University Hospital, Leeds, UK
| | - Rohan G Thakkar
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Sanjay Pandanaboyana
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK.,Population Health Sciences Institute, Newcastle University, Newcastle, UK
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Thormann M, Omari J, Pech M, Damm R, Croner R, Perrakis A, Strobel A, Wienke A, Surov A. Low skeletal muscle mass and post-operative complications after surgery for liver malignancies: a meta-analysis. Langenbecks Arch Surg 2022; 407:1369-1379. [PMID: 35583832 PMCID: PMC9283156 DOI: 10.1007/s00423-022-02541-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 04/29/2022] [Indexed: 12/03/2022]
Abstract
Purpose To assess the influence of low skeletal muscle mass (LSMM) on post-operative complications in patients with hepatic malignancies grade (Clavien Dindo ≥ 3) undergoing resection. Methods MEDLINE, Cochrane, and SCOPUS databases were screened for associations between sarcopenia and major post-operative complications (≥ grade 3 according to Clavien-Dindo classification) after resection of different malignant liver tumors. RevMan 5.3 software was used to perform the meta-analysis. The methodological quality of the included studies was assessed according to the QUIPS instrument. Results The analysis included 17 studies comprising 3157 patients. Subgroup analyses were performed for cholangiocarcinoma (CCC), colorectal cancer (CRC) liver metastases, and hepatocellular carcinoma (HCC). LSMM as identified on CT was present in 1260 patients (39.9%). Analysis of the overall sample showed that LSMM was associated with higher post-operative complications grade Clavien Dindo ≥ 3 (OR 1.56, 95% CI 1.25–1.95, p < 0.001). In the subgroup analysis, LSMM was associated with post-operative complications in CRC metastases (OR 1.60, 95% CI 1.11–2.32, p = 0.01). In HCC and CCC sub-analyses, LSMM was not associated with post-operative complications in simple regression analysis. Conclusion LSMM is associated with major post-operative complications in patients undergoing surgery for hepatic metastases and it does not influence major post-operative complications in patients with HCC and CCC.
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Affiliation(s)
- Maximilian Thormann
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Jazan Omari
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Maciej Pech
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Robert Damm
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Roland Croner
- Department of General-, Visceral-, Vascular- and Transplantation Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Aristotelis Perrakis
- Department of General-, Visceral-, Vascular- and Transplantation Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Alexandra Strobel
- Institute of Medical Epidemiology, Biometry, and Informatics, Martin Luther University, Halle-Wittenberg, Germany
- Profile Area Clinical Studies & Biostatistics, Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University, Halle-Wittenberg, Halle, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biometry, and Informatics, Martin Luther University, Halle-Wittenberg, Germany
- Profile Area Clinical Studies & Biostatistics, Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University, Halle-Wittenberg, Halle, Germany
| | - Alexey Surov
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
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Yang L, He Y, Li X. Sarcopenia Predicts Relevant Clinical Outcomes in Biliary Tract Cancer Patients: A Systematic Review and Meta-Analysis. Nutr Cancer 2022; 74:3274-3283. [PMID: 35542968 DOI: 10.1080/01635581.2022.2074063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The purpose of this meta-analysis was to analyze the influences of sarcopenia on clinical outcomes in patients with biliary tract cancer (BTC). A systematic literature search was performed in November 2021. Some studies that reported the impacts of sarcopenia on the prognosis of patients with BTC were included. The overall hazard ratios (HRs), overall survival (OS), recurrence-free survival (RFS), and odds ratio (OR) for major postoperative complications were calculated using a fixed- or random effects. In the 18 studies, 3261 patients were enrolled for analysis. Based on defining sarcopenia by muscle mass, sarcopenia predicted OS, and based on defining sarcopenia by muscle density, HR was 2.10 (95% CI 1.72-2.56) and HR was 2.12 (95% CI 1.46- 3.10). Patients with sarcopenia had poorer RFS, and HR was 2.18 (95% CI 1.75-2.71). The incidence rate of major postoperative complication increased compared with those without sarcopenia (OR, 1.45; 95% Cl, 1.07-1.96). Sarcopenia is an independent risk factor for poor OS and RFS in patients with BTC. Sarcopenia is associated with the occurrence of major postoperative complications. This study provides advice that clinicians should provide importance to the assessment of skeletal muscle status and provide suitable nutritional supports and exercise program to reduce the sarcopenia in patients with BTC.
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Affiliation(s)
- Li Yang
- Department of Hematology, Affiliated Hospital of Southwest Medical University, Sichuan, China
| | - Yanwei He
- Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Sichuan, China
| | - Xiaoming Li
- Department of Hematology, Affiliated Hospital of Southwest Medical University, Sichuan, China
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Sarcopenia in Children with Solid Organ Tumors: An Instrumental Era. Cells 2022; 11:cells11081278. [PMID: 35455957 PMCID: PMC9024674 DOI: 10.3390/cells11081278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/22/2022] [Accepted: 04/05/2022] [Indexed: 11/17/2022] Open
Abstract
Sarcopenia has recently been studied in both adults and children and was found to be a prognostic marker for adverse outcome in a variety of patient groups. Our research showed that sarcopenia is a relevant marker in predicting outcome in children with solid organ tumors, such as hepatoblastoma and neuroblastoma. This was especially true in very ill, high-risk groups. Children with cancer have a higher likelihood of ongoing loss of skeletal muscle mass due to a mismatch in energy intake and expenditure. Additionally, the effects of cancer therapy, hormonal alterations, chronic inflammation, multi-organ dysfunction, and a hypermetabolic state all contribute to a loss of skeletal muscle mass. Sarcopenia seems to be able to pinpoint this waste to a high degree in a new and objective way, making it an additional tool in predicting and improving outcome in children. This article focuses on the current state of sarcopenia in children with solid organ tumors. It details the pathophysiological mechanisms behind sarcopenia, highlighting the technical features of the available methods for measuring muscle mass, strength, and function, including artificial intelligence (AI)-based techniques. It also reviews the latest research on sarcopenia in children, focusing on children with solid organ tumors.
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Gastrointestinal Cancer Patient Nutritional Management: From Specific Needs to Novel Epigenetic Dietary Approaches. Nutrients 2022; 14:nu14081542. [PMID: 35458104 PMCID: PMC9024975 DOI: 10.3390/nu14081542] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/28/2022] [Accepted: 04/05/2022] [Indexed: 02/06/2023] Open
Abstract
Nutritional habits impinge on the health of the gastrointestinal (GI) tract, contributing to GI disorder progression. GI cancer is a widespread and aggressive tumor sensitive to nutritional changes. Indeed, specific nutritional expedients can be adopted to prevent GI cancer onset and to slow down disease activity. Moreover, the patient’s nutritional status impacts prognosis, quality of life, and chemotherapy tolerance. These patients encounter the highest frequency of malnourishment risk, a condition that can progressively evolve into cachexia. Clinical studies dealing with this topic stressed the importance of nutritional counseling and put under the spotlight nutrient delivery, the type of nutrient supplementation, and timing for the start of nutritional management. A medical practitioner well-prepared on the topic of nutrition and cancer should operate in the clinical team dedicated to these oncological patients. This specific expertise needs to be implemented as soon as possible to adopt nutritional interventions and establish a proper patient-tailored dietary regimen. The nutritional gap closure should be prompt during anticancer treatment to stabilize weight loss, improve treatment tolerability, and ameliorate survival rate. Recently, novel nutritional approaches were investigated to target the bidirectional link between epigenetics and metabolism, whose alteration supports the onset, progression, and therapeutic response of GI cancer patients.
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O'Brien SJ, Bhutiani N, Young JI, Phillips P, Weaver KH, Kline D, Vitale GC. Impact of myopenia and myosteatosis in patients undergoing abdominal surgery for chronic pancreatitis. Surgery 2022; 172:310-318. [PMID: 35246331 DOI: 10.1016/j.surg.2022.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 01/09/2022] [Accepted: 01/15/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Surgery for chronic pancreatitis is associated with major morbidity and mortality. The aim of this study is to examine the role of preoperative muscle volume and quality on postoperative outcomes in patients with chronic pancreatitis. METHODS All patients who underwent abdominal surgery for chronic pancreatitis between 2011 and 2018 were identified from an institutional surgical database. Patient demographics, clinical indices, and perioperative computed tomography scans were collected. Myopenia and myosteatosis were measured at the L3 vertebral level. Regression analysis was used to identify risk factors for major complications (Clavien-Dindo ≥3a) and length of stay. RESULTS Seventy-five patients were identified. Toxic-metabolic or obstructive causes were the main underlying etiologies. Thirty patients were myopenic (40%), and 36 patients were myosteatotic (48%). Sixteen patients (21%) had a major complication. Median length of stay was 10 days. Both myopenia and myosteatosis were associated with major complications (hazard ratio = 7.85, 95% confidence interval: 1.91-32.29, P = .004 and hazard ratio = 4.351, 95% confidence interval: 1.22-15.52, P = .023). Myosteatosis was associated with increased length of stay (parameter estimate = 0.297, 95% confidence interval: 0.012-0.583, P = .041). CONCLUSION Myopenia and myosteatosis were common and significant risk factors for adverse postoperative events. Preoperative muscle assessment may help in the risk stratification of surgical patients and identify patients that require preoperative nutritional and physical optimization.
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Affiliation(s)
- Stephen J O'Brien
- Hiram C. Polk Jr. MD Department of Surgery, University of Louisville School of Medicine, KY; Department of Surgery, Cork University Hospital, Wilton, Cork, Ireland.
| | - Neal Bhutiani
- Hiram C. Polk Jr. MD Department of Surgery, University of Louisville School of Medicine, KY
| | - J Isaac Young
- Hiram C. Polk Jr. MD Department of Surgery, University of Louisville School of Medicine, KY
| | - Prejesh Phillips
- Hiram C. Polk Jr. MD Department of Surgery, University of Louisville School of Medicine, KY
| | - Kalyn H Weaver
- Hiram C. Polk Jr. MD Department of Surgery, University of Louisville School of Medicine, KY
| | - David Kline
- Hiram C. Polk Jr. MD Department of Surgery, University of Louisville School of Medicine, KY
| | - Gary C Vitale
- Hiram C. Polk Jr. MD Department of Surgery, University of Louisville School of Medicine, KY
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Jia J, Zhang L, Wang T, Yang W, Lyu J, Zeng X, Li X, Zeng X, Liu W, Tao K, Zhang P. The association between preoperative skeletal muscle mass depletion and poor relapse-free survival in patients with gastrointestinal stromal tumors following complete resection. Nutrition 2022; 98:111636. [DOI: 10.1016/j.nut.2022.111636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/09/2022] [Accepted: 02/17/2022] [Indexed: 11/30/2022]
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Tranoulis A, Kwong FLA, Lakhiani A, Georgiou D, Yap J, Balega J. Prevalence of computed tomography-based sarcopenia and the prognostic value of skeletal muscle index and muscle attenuation amongst women with epithelial ovarian malignancy: A systematic review and meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:1441-1454. [DOI: 10.1016/j.ejso.2022.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 02/16/2022] [Accepted: 02/21/2022] [Indexed: 12/21/2022]
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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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Lere-Chevaleyre A, Bernadach M, Lambert C, Cassagne L, Puechmaille M, Mom T, Gilain L, Lapeyre M, Boirie Y, Biau J, Saroul N. Toxicity of induction chemotherapy in head and neck cancer: The central role of skeletal muscle mass. Head Neck 2021; 44:681-690. [PMID: 34918416 DOI: 10.1002/hed.26954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 11/17/2021] [Accepted: 12/03/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND To assess the impact of nutritional status on tolerance to induction chemotherapy by docetaxel, cisplatin and 5-fluorouracil (ICT) in head and neck cancer (HNC). METHODS Ninety-two HNC patients were included. Toxicity was assessed according to common terminology criteria for adverse events. Nutritional status was assessed by body mass index (BMI), serum albumin, nutritional risk index (NRI), and CT scan (skeletal muscle mass index [SMI] at the first lumbar vertebral level). RESULTS Before treatment, average BMI was 22.7 ± 4.6 kg/m2 , serum albumin 38.7 ± 5.8 g/L, NRI 97.6 ± 10.6, and SMI 36.4 ± 7.9 cm2 /m2 . After treatment, BMI was 23 ± 4.5, serum albumin 30.2 ± 7.1, and NRI 88.1 ± 9.2. During ICT, 52 (62%) patients developed at least one toxicity ≥ Grade 3. Pre-treatment SMI was the only predictive factor of toxicity irrespective of BMI (p = 0.04). CONCLUSION Low skeletal muscle mass is a predictive factor of toxicity to ICT in HNC.
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Affiliation(s)
- Alexane Lere-Chevaleyre
- Department of Otolaryngology-Head and Neck Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Maureen Bernadach
- Medical Oncology Department, Centre Jean Perrin, Clermont-Ferrand, France
| | - Céline Lambert
- Biostatistics Unit (DRCI), Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Lucie Cassagne
- Department of Radiology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Mathilde Puechmaille
- Department of Otolaryngology-Head and Neck Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Thierry Mom
- Department of Otolaryngology-Head and Neck Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Laurent Gilain
- Department of Otolaryngology-Head and Neck Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Michel Lapeyre
- Radiation Oncology Department, Centre Jean Perrin, Clermont-Ferrand, France
| | - Yves Boirie
- UNH, Unité de Nutrition Humaine, CRNH, Université Clermont Auvergne, INRA, Auvergne, Clermont-Ferrand, France.,Clinical Nutrition Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Julian Biau
- Radiation Oncology Department, Centre Jean Perrin, Clermont-Ferrand, France
| | - Nicolas Saroul
- Department of Otolaryngology-Head and Neck Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France.,UNH, Unité de Nutrition Humaine, CRNH, Université Clermont Auvergne, INRA, Auvergne, Clermont-Ferrand, France
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Watanabe J, Matsui R, Sasanuma H, Ishizaki Y, Fukunaga T, Kotani K, Sata N. Body composition assessment and sarcopenia in patients with biliary tract cancer: A systematic review and meta-analysis. Clin Nutr 2021; 41:321-328. [PMID: 34999326 DOI: 10.1016/j.clnu.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/17/2021] [Accepted: 12/04/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Sarcopenia, as assessed by body composition, can affect morbidity and survival in several gastrointestinal cancer. However, the impact of sarcopenia, referring to both quantity and quality of skeletal muscle, in biliary tract cancer (BTC) is debatable. We aimed to investigate the impact of sarcopenia on morbidity and mortality in patients with BTC. METHODS Electronic databases and trial registries were searched through July 2021 to perform random-effects meta-analyses. Study selection, data abstraction and quality assessment were independently performed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. RESULTS Twenty-nine studies (4443 patients) were included; 28 used computed tomography and one used dual-energy X-ray absorptiometry to assess body composition. Eighteen studies reported the impact of pre-operative sarcopenia on postoperative outcomes; namely, sarcopenia increased postoperative complications (risk ratio = 1.23, 95% confidence interval [CI] = 1.07 to 1.41; I2 = 2%), and decreased recurrence-free survival (hazard ratio [HR] = 2.20, 95% CI = 1.75 to 2.75; I2 = 0%) in multivariable analyses. Low muscle quantity (HR = 2.26, 95% CI = 1.75 to 2.92; I2 = 66%) and quality (HR = 1.75, 95% CI = 1.33 to 2.29; I2 = 50%) decreased overall survival in multivariable analyses. The certainty of the evidence was low because of heterogeneity and imprecision. CONCLUSIONS In sarcopenia, low muscle quantity and quality by body composition conferred an independent risk of morbidity and mortality in patients with BTC. Further studies are needed to confirm these findings and mitigate risk.
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Affiliation(s)
- Jun Watanabe
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan; Division of Community and Family Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan.
| | - Ryota Matsui
- Department of Surgery, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan.
| | - Hideki Sasanuma
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan.
| | - Yoichi Ishizaki
- Department of Surgery, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan.
| | - Tetsu Fukunaga
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University Hospital, Tokyo, Japan.
| | - Kazuhiko Kotani
- Division of Community and Family Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan.
| | - Naohiro Sata
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan.
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Rovesti G, Valoriani F, Rimini M, Bardasi C, Ballarin R, Di Benedetto F, Menozzi R, Dominici M, Spallanzani A. Clinical Implications of Malnutrition in the Management of Patients with Pancreatic Cancer: Introducing the Concept of the Nutritional Oncology Board. Nutrients 2021; 13:nu13103522. [PMID: 34684523 PMCID: PMC8537095 DOI: 10.3390/nu13103522] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 12/12/2022] Open
Abstract
Pancreatic cancer represents a very challenging disease, with an increasing incidence and an extremely poor prognosis. Peculiar features of this tumor entity are represented by pancreatic exocrine insufficiency and an early and intense nutritional imbalance, leading to the highly prevalent and multifactorial syndrome known as cancer cachexia. Recently, also the concept of sarcopenic obesity has emerged, making the concept of pancreatic cancer malnutrition even more multifaceted and complex. Overall, these nutritional derangements play a pivotal role in contributing to the dismal course of this malignancy. However, their relevance is often underrated and their assessment is rarely applied in clinical daily practice with relevant negative impact for patients' outcome in neoadjuvant, surgical, and metastatic settings. The proper detection and management of pancreatic cancer-related malnutrition syndromes are of primary importance and deserve a specific and multidisciplinary (clinical nutrition, oncology, etc.) approach to improve survival, but also the quality of life. In this context, the introduction of a "Nutritional Oncology Board" in routine daily practice, aimed at assessing an early systematic screening of patients and at implementing nutritional support from the time of disease diagnosis onward seems to be the right path to take.
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Affiliation(s)
- Giulia Rovesti
- Division of Oncology, Department of Medical and Surgical Sciences of Children and Adults, University Hospital of Modena and Reggio Emilia, Largo del Pozzo 71, 41125 Modena, Italy; (M.R.); (C.B.); (M.D.)
- Correspondence: (G.R.); (A.S.)
| | - Filippo Valoriani
- Division of Metabolic Diseases and Clinical Nutrition, Department of Specialistic Medicines, University Hospital of Modena and Reggio Emilia, Largo del Pozzo 71, 41125 Modena, Italy; (F.V.); (R.M.)
| | - Margherita Rimini
- Division of Oncology, Department of Medical and Surgical Sciences of Children and Adults, University Hospital of Modena and Reggio Emilia, Largo del Pozzo 71, 41125 Modena, Italy; (M.R.); (C.B.); (M.D.)
| | - Camilla Bardasi
- Division of Oncology, Department of Medical and Surgical Sciences of Children and Adults, University Hospital of Modena and Reggio Emilia, Largo del Pozzo 71, 41125 Modena, Italy; (M.R.); (C.B.); (M.D.)
| | - Roberto Ballarin
- Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Department of General Surgery, University Hospital of Modena and Reggio Emilia, Largo del Pozzo 71, 41125 Modena, Italy; (R.B.); (F.D.B.)
| | - Fabrizio Di Benedetto
- Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Department of General Surgery, University Hospital of Modena and Reggio Emilia, Largo del Pozzo 71, 41125 Modena, Italy; (R.B.); (F.D.B.)
| | - Renata Menozzi
- Division of Metabolic Diseases and Clinical Nutrition, Department of Specialistic Medicines, University Hospital of Modena and Reggio Emilia, Largo del Pozzo 71, 41125 Modena, Italy; (F.V.); (R.M.)
| | - Massimo Dominici
- Division of Oncology, Department of Medical and Surgical Sciences of Children and Adults, University Hospital of Modena and Reggio Emilia, Largo del Pozzo 71, 41125 Modena, Italy; (M.R.); (C.B.); (M.D.)
| | - Andrea Spallanzani
- Division of Oncology, Department of Medical and Surgical Sciences of Children and Adults, University Hospital of Modena and Reggio Emilia, Largo del Pozzo 71, 41125 Modena, Italy; (M.R.); (C.B.); (M.D.)
- Correspondence: (G.R.); (A.S.)
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Trestini I, Cintoni M, Rinninella E, Grassi F, Paiella S, Salvia R, Bria E, Pozzo C, Alfieri S, Gasbarrini A, Tortora G, Milella M, Mele MC. Neoadjuvant treatment: A window of opportunity for nutritional prehabilitation in patients with pancreatic ductal adenocarcinoma. World J Gastrointest Surg 2021; 13:885-903. [PMID: 34621468 PMCID: PMC8462076 DOI: 10.4240/wjgs.v13.i9.885] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/28/2021] [Accepted: 07/20/2021] [Indexed: 02/06/2023] Open
Abstract
Patients affected by pancreatic ductal adenocarcinoma (PDAC) frequently present with advanced disease at the time of diagnosis, limiting an upfront surgical approach. Neoadjuvant treatment (NAT) has become the standard of care to downstage non-metastatic locally advanced PDAC. However, this treatment increases the risk of a nutritional status decline, which in turn, may impact therapeutic tolerance, postoperative outcomes, or even prevent the possibility of surgery. Literature on prehabilitation programs on surgical PDAC patients show a reduction of postoperative complications, length of hospital stay, and readmission rate, while data on prehabilitation in NAT patients are scarce and randomized controlled trials are still missing. Particularly, appropriate nutritional management represents an important therapeutic strategy to promote tissue healing and to enhance patient recovery after surgical trauma. In this regard, NAT may represent a new interesting window of opportunity to implement a nutritional prehabilitation program, aiming to increase the PDAC patient's capacity to complete the planned therapy and potentially improve clinical and survival outcomes. Given these perspectives, this review attempts to provide an in-depth view of the nutritional derangements during NAT and nutritional prehabilitation program as well as their impact on PDAC patient outcomes.
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Affiliation(s)
- Ilaria Trestini
- Section of Oncology, Department of Medicine, Pancreas Institute, University of Verona Hospital Trust, Verona 37126, Italy
| | - Marco Cintoni
- Scuola di Specializzazione in Scienza dell’Alimentazione, Università di Roma Tor Vergata, Roma 00133, Italy
| | - Emanuele Rinninella
- UOC Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico A. Gemelli IRCCS, Roma 00168, Italy
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma 00168, Italy
| | - Futura Grassi
- UOC Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico A. Gemelli IRCCS, Roma 00168, Italy
| | - Salvatore Paiella
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital Trust, Verona 37126, Italy
| | - Roberto Salvia
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital Trust, Verona 37126, Italy
| | - Emilio Bria
- Oncologia Medica Unit, Comprehensive Cancer Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma 00167, Italy
- Oncologia Medica Unit, Università Cattolica del Sacro Cuore, Roma 00168, Italy
| | - Carmelo Pozzo
- Oncologia Medica Unit, Comprehensive Cancer Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma 00167, Italy
- Oncologia Medica Unit, Università Cattolica del Sacro Cuore, Roma 00168, Italy
| | - Sergio Alfieri
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma 00168, Italy
- Digestive Surgery Unit and Pancreatic Surgery Gemelli Center Director, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma 00167, Italy
| | - Antonio Gasbarrini
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma 00168, Italy
- UOC di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma 00167, Italy
| | - Giampaolo Tortora
- Oncologia Medica Unit, Comprehensive Cancer Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma 00167, Italy
- Oncologia Medica Unit, Università Cattolica del Sacro Cuore, Roma 00168, Italy
| | - Michele Milella
- Section of Oncology, Department of Medicine, Pancreas Institute, University of Verona Hospital Trust, Verona 37126, Italy
| | - Maria Cristina Mele
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma 00168, Italy
- UOSD Nutrizione Avanzata in Oncologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma 00167, Italy
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Preoperative computed tomography-assessed sarcopenia as a predictor of complications and long-term prognosis in patients with colorectal cancer: a systematic review and meta-analysis. Langenbecks Arch Surg 2021; 406:1775-1788. [PMID: 34406490 DOI: 10.1007/s00423-021-02274-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 07/12/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND The relationship between computed tomography (CT)-assessed sarcopenia and colorectal cancer (CRC) prognosis varies in different studies. This systematic review aimed to examine the impact of preoperative CT-assessed sarcopenia on complications and long-term survival in CRC patients. METHODS The PubMed, Web of Science, Cochrane Library, and Embase databases were searched for relevant literature up to September 10, 2020. Data and characteristics for each study were extracted. Long-term outcomes were assessed using a comprehensive HR with a 95% CI. Complications were assessed using a comprehensive OR with 95% CI. The heterogeneity and publication bias were also investigated, and subgroup and sensitivity analyses were performed. RESULTS A total of 19 studies comprising 15,889 patients were included. The comprehensive results demonstrated that sarcopenia is significantly associated with overall survival of CRC patients (HR = 1.40, 95% CI = 1.25-1.58, p < 0.001). Patients with sarcopenia have a higher risk of complications compared to those without sarcopenia. In addition, sarcopenia is strongly associated with poor cancer-specific survival (HR = 1.49, 95% CI = 1.32-1.68, p < 0.001) and disease-free survival (HR = 1.59, 95% CI = 1.32-1.92, p < 0.001) in CRC patients. There is no significant relationship between sarcopenia and recurrence-free survival (HR = 1.32, 95% CI = 0.92-1.89, p = 0.126). CONCLUSIONS Preoperative CT-assessed sarcopenia can be employed as an effective predictor of complications and long-term prognosis in CRC patients. Standardization of CT-assessed sarcopenia requires comprehensive consideration of race, muscle mass index, body mass index, and gender.
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Tsukagoshi M, Harimoto N, Araki K, Kubo N, Watanabe A, Igarashi T, Ishii N, Yamanaka T, Hagiwara K, Hoshino K, Muranushi R, Yajima T, Shirabe K. Skeletal Muscle Loss and Octogenarian Status Are Associated with S-1 Adjuvant Therapy Discontinuation and Poor Prognosis after Pancreatectomy. Cancers (Basel) 2021; 13:cancers13164105. [PMID: 34439259 PMCID: PMC8391507 DOI: 10.3390/cancers13164105] [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: 08/01/2021] [Accepted: 08/13/2021] [Indexed: 01/06/2023] Open
Abstract
Simple Summary Significant advances in surgical techniques and perioperative care, together with adjuvant chemotherapy, have contributed to the increasing number of patients with pancreatic cancer undergoing surgery. However, the results of some studies suggest that the postoperative complications and mortality might be higher in elderly patients undergoing pancreatectomy. We aimed to identify the utility of S-1 adjuvant chemotherapy in elderly patients with resected pancreatic cancer. In our cohort of 80 patients, including 16 octogenarians, univariate and multivariate analyses revealed that S-1 adjuvant chemotherapy was associated with improved prognosis in patients with pancreatic cancer. However, we also observed that skeletal muscle loss and age of 80 years or older predicted the failure to complete adjuvant chemotherapy with S-1. We propose that evaluation of skeletal muscle mass should be considered as a useful preoperative assessment approach for determining feasibility of adjuvant chemotherapy in elderly patients. Abstract The efficacy and prognosis of adjuvant chemotherapy for resected pancreatic cancer remain unclear. We investigated the utility and risk factors of S-1 adjuvant chemotherapy in patients with pancreatic cancer undergoing pancreatectomy. This study comprised 80 patients, including 58 patients who received S-1 adjuvant chemotherapy. Skeletal muscle loss was defined using cutoff values of skeletal muscle mass index. In total, 16 (20%) octogenarian patients underwent pancreatectomy. Skeletal muscle loss was present in 56 (70%) patients. The entire course of S-1 adjuvant chemotherapy for 6 months was completed in 33 patients (41%). S-1 adjuvant chemotherapy <6 months was an independent prognostic indicator of poor overall survival. Patients who completed S-1 adjuvant chemotherapy exhibited significantly longer overall and relapse-free survival rates than those did not complete the chemotherapy (p < 0.0001 and p = 0.0003, respectively). Being an octogenarian and skeletal muscle loss were independent variables associated with the discontinuation of S-1 adjuvant chemotherapy. Finally, the S-1 adjuvant chemotherapy rates were 6.3% (1/16) and 28.6% (16/56) in octogenarian patients and those with skeletal muscle loss, respectively. S-1 adjuvant chemotherapy completion was associated with improved prognosis in patients with pancreatic cancer. Skeletal muscle loss and octogenarian status predicted the failure of S-1 adjuvant chemotherapy completion.
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Affiliation(s)
- Mariko Tsukagoshi
- Department of Innovative Cancer Immunotherapy, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi 371-8511, Japan; (M.T.); (T.Y.)
- Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-Machi, Maebashi 371-8511, Japan; (K.A.); (N.K.); (A.W.); (T.I.); (N.I.); (T.Y.); (K.H.); (K.H.); (R.M.); (K.S.)
| | - Norifumi Harimoto
- Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-Machi, Maebashi 371-8511, Japan; (K.A.); (N.K.); (A.W.); (T.I.); (N.I.); (T.Y.); (K.H.); (K.H.); (R.M.); (K.S.)
- Correspondence: ; Tel.: +81-27-220-8224
| | - Kenichiro Araki
- Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-Machi, Maebashi 371-8511, Japan; (K.A.); (N.K.); (A.W.); (T.I.); (N.I.); (T.Y.); (K.H.); (K.H.); (R.M.); (K.S.)
| | - Norio Kubo
- Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-Machi, Maebashi 371-8511, Japan; (K.A.); (N.K.); (A.W.); (T.I.); (N.I.); (T.Y.); (K.H.); (K.H.); (R.M.); (K.S.)
| | - Akira Watanabe
- Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-Machi, Maebashi 371-8511, Japan; (K.A.); (N.K.); (A.W.); (T.I.); (N.I.); (T.Y.); (K.H.); (K.H.); (R.M.); (K.S.)
| | - Takamichi Igarashi
- Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-Machi, Maebashi 371-8511, Japan; (K.A.); (N.K.); (A.W.); (T.I.); (N.I.); (T.Y.); (K.H.); (K.H.); (R.M.); (K.S.)
| | - Norihiro Ishii
- Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-Machi, Maebashi 371-8511, Japan; (K.A.); (N.K.); (A.W.); (T.I.); (N.I.); (T.Y.); (K.H.); (K.H.); (R.M.); (K.S.)
| | - Takahiro Yamanaka
- Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-Machi, Maebashi 371-8511, Japan; (K.A.); (N.K.); (A.W.); (T.I.); (N.I.); (T.Y.); (K.H.); (K.H.); (R.M.); (K.S.)
| | - Kei Hagiwara
- Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-Machi, Maebashi 371-8511, Japan; (K.A.); (N.K.); (A.W.); (T.I.); (N.I.); (T.Y.); (K.H.); (K.H.); (R.M.); (K.S.)
| | - Kouki Hoshino
- Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-Machi, Maebashi 371-8511, Japan; (K.A.); (N.K.); (A.W.); (T.I.); (N.I.); (T.Y.); (K.H.); (K.H.); (R.M.); (K.S.)
| | - Ryo Muranushi
- Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-Machi, Maebashi 371-8511, Japan; (K.A.); (N.K.); (A.W.); (T.I.); (N.I.); (T.Y.); (K.H.); (K.H.); (R.M.); (K.S.)
| | - Toshiki Yajima
- Department of Innovative Cancer Immunotherapy, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi 371-8511, Japan; (M.T.); (T.Y.)
| | - Ken Shirabe
- Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-Machi, Maebashi 371-8511, Japan; (K.A.); (N.K.); (A.W.); (T.I.); (N.I.); (T.Y.); (K.H.); (K.H.); (R.M.); (K.S.)
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Pierobon ES, Moletta L, Zampieri S, Sartori R, Brazzale AR, Zanchettin G, Serafini S, Capovilla G, Valmasoni M, Merigliano S, Sperti C. The Prognostic Value of Low Muscle Mass in Pancreatic Cancer Patients: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10143033. [PMID: 34300199 PMCID: PMC8306134 DOI: 10.3390/jcm10143033] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/02/2021] [Accepted: 07/03/2021] [Indexed: 02/05/2023] Open
Abstract
Low muscle mass is associated with reduced survival in patients with different cancer types. The interest in preoperative sarcopenia and pancreatic cancer has risen in the last decade as muscle mass loss seems to be associated with poorer survival, higher postoperative morbidity, and mortality. The aim of the present study was to review the literature to compare the impact of low muscle mass on the outcomes of patients undergoing surgery for pancreatic adenocarcinoma. An extensive literature review was conducted according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and 10 articles were analyzed in detail and included in the meta-analysis. Data were retrieved on 2811 patients undergoing surgery for pancreatic cancer. Meta-analysis identified that patients with low muscle mass demonstrated a significantly reduced OS when compared to patients without alterations of the muscle mass (ROM 0.86; 95% CI: 0.81-0.91, p < 0.001), resulting in a 14% loss for the former. Meta-analysis failed to identify an increase in the postoperative complications and length of stay of patients with low muscle mass. Our analysis confirms the role of low muscle mass in influencing oncologic outcomes in pancreatic cancer. Its role on surgical outcomes remains to be established.
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Affiliation(s)
- Elisa Sefora Pierobon
- Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, Via Giustiniani 2, 35128 Padua, Italy; (E.S.P.); (L.M.); (S.Z.); (G.Z.); (S.S.); (G.C.); (M.V.); (S.M.); (C.S.)
| | - Lucia Moletta
- Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, Via Giustiniani 2, 35128 Padua, Italy; (E.S.P.); (L.M.); (S.Z.); (G.Z.); (S.S.); (G.C.); (M.V.); (S.M.); (C.S.)
| | - Sandra Zampieri
- Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, Via Giustiniani 2, 35128 Padua, Italy; (E.S.P.); (L.M.); (S.Z.); (G.Z.); (S.S.); (G.C.); (M.V.); (S.M.); (C.S.)
- Department of Biomedical Sciences, University of Padua, Via U. Bassi 58/B, 35121 Padua, Italy
| | - Roberta Sartori
- Department of Biomedical Sciences, University of Padua, Via U. Bassi 58/B, 35121 Padua, Italy
- Veneto Institute of Molecular Medicine (VIMM), Via Orus 2, 35129 Padua, Italy
- Correspondence: ; Tel.: +39-(0)-4-9792-3268
| | | | - Gianpietro Zanchettin
- Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, Via Giustiniani 2, 35128 Padua, Italy; (E.S.P.); (L.M.); (S.Z.); (G.Z.); (S.S.); (G.C.); (M.V.); (S.M.); (C.S.)
| | - Simone Serafini
- Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, Via Giustiniani 2, 35128 Padua, Italy; (E.S.P.); (L.M.); (S.Z.); (G.Z.); (S.S.); (G.C.); (M.V.); (S.M.); (C.S.)
| | - Giovanni Capovilla
- Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, Via Giustiniani 2, 35128 Padua, Italy; (E.S.P.); (L.M.); (S.Z.); (G.Z.); (S.S.); (G.C.); (M.V.); (S.M.); (C.S.)
| | - Michele Valmasoni
- Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, Via Giustiniani 2, 35128 Padua, Italy; (E.S.P.); (L.M.); (S.Z.); (G.Z.); (S.S.); (G.C.); (M.V.); (S.M.); (C.S.)
| | - Stefano Merigliano
- Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, Via Giustiniani 2, 35128 Padua, Italy; (E.S.P.); (L.M.); (S.Z.); (G.Z.); (S.S.); (G.C.); (M.V.); (S.M.); (C.S.)
| | - Cosimo Sperti
- Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, Via Giustiniani 2, 35128 Padua, Italy; (E.S.P.); (L.M.); (S.Z.); (G.Z.); (S.S.); (G.C.); (M.V.); (S.M.); (C.S.)
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Youn S, Chen A, Ha V, Chambers C, Eurich DT, McCall M, Sawyer MB. An exploratory study of body composition as a predictor of dose-limiting toxicity in metastatic pancreatic cancer treated with gemcitabine plus nab-paclitaxel. Clin Nutr 2021; 40:4888-4892. [PMID: 34358833 DOI: 10.1016/j.clnu.2021.06.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/29/2021] [Accepted: 06/24/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Body composition is increasingly being studied as a method of predicting chemotherapy toxicity. Our study aimed to evaluate associations of body composition with treatment toxicity in a group of pancreatic cancer patients treated with gemcitabine plus nab-paclitaxel. METHODS A retrospective review was performed for all patients who received first-line gemcitabine plus nab-paclitaxel for metastatic pancreatic cancer at a northern Alberta cancer institute (Canada) from 2014 to 2017. Total lean body mass (LBM) was derived from measurements of muscle surface area at L3 on baseline computed tomography (CT) scans. Optimal stratification, or minimal p-value analysis, was used to assess for a threshold of nab-paclitaxel dose per LBM (mg/kg) associated with a higher risk of dose-limiting toxicity (DLT). RESULTS 152 patients were included in the study, of whom 62 (40.8%) experienced DLT. nab-Paclitaxel dose/LBM ranged from 0.98 to 8.76 mg/kg. A threshold for nab-paclitaxel dose/LBM that optimally predicted risk of DLT was identified at 5.83 mg/kg. Above this cut-off, 18/31 (58.1%) patients experienced DLT, compared to 44/121 (36.4%) patients below (p = 0.028). Patients above this cut-off had a higher incidence of peripheral neuropathy compared to those below, though this was not statistically significant based on an adjusted p-value threshold (48.4 vs. 29.8% respectively, p = 0.050). Body mass index, body surface area, and absolute initial doses of nab-paclitaxel or gemcitabine did not significantly impact likelihood of DLT. CONCLUSIONS nab-Paclitaxel dose normalized to LBM, based on CT-derived measures of skeletal muscle, has potential to predict risk of chemotherapy toxicity. Chemotherapy dosing based on body composition, rather than conventional anthropometric measures, may be effective in reducing treatment toxicity.
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Affiliation(s)
- Susie Youn
- Department of Surgery, University of Alberta, Edmonton, AB, Canada.
| | - Angela Chen
- Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Vincent Ha
- Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Carole Chambers
- Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Michael McCall
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Michael B Sawyer
- Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada.
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