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Kumamoto T, Takamizawa Y, Miyake M, Inoue M, Moritani K, Tsukamoto S, Eto K, Kanemitsu Y. Clinical utility of sarcopenia dynamics assessed by psoas muscle volume in patients with colorectal cancer. World J Surg 2024. [PMID: 39095979 DOI: 10.1002/wjs.12302] [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: 02/07/2024] [Accepted: 07/20/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Sarcopenia affects the postoperative prognosis of patients with colorectal cancer (CRC). Recently, it has become possible to measure psoas volume from computed tomography images, and an index called psoas volume index (PVI) has been reported. However, it is unclear whether the dynamics of PVI before and after surgery is associated with clinical outcomes after CRC surgery. This study aimed to evaluate the association between pre- and postoperative PVI dynamics and clinical outcomes after CRC surgery. METHODS This study analyzed 1115 patients diagnosed with primary CRC and operated on for treatment between January 2014 and December 2017. Sarcopenia was defined as PVI below the lowest tertile in the preoperative assessment for each sex. The overall population was divided into four groups according to the dynamics of sarcopenia from preoperative to postoperative: group 1 (pre-to postoperative sarcopenia), group 2 (preoperative nonsarcopenia to postoperative sarcopenia), group 3 (pre-to postoperative nonsarcopenia), and group 4 (pre-to postoperative nonsarcopenia). RESULTS Based on pre- and postoperative sarcopenia dynamics, 343 patients (29.7%) were classified into group 1, 105 patients (9.1%) into group 2, 42 patients (3.6%) into group 3, and 665 patients (57.6%) into group 4. Comparison of overall survival (OS) by the Kaplan-Meier method showed that Group 2 tended to have the worst prognosis (p = 0.007). Multivariate analysis showed an increased OS risk in Group 2 in sarcopenia dynamics (Hazard ratio: 2.103, 95% CI: 1.202-3.681, p = 0.009). CONCLUSIONS Sarcopenia dynamics using PVI is an independent prognostic predictor of OS in patients with CRC.
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Affiliation(s)
- Tomotaka Kumamoto
- Department of Colorectal Surgery, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
- Department of Surgery, The Jikei University School of Medicine, Chuo-ku, Tokyo, Japan
| | - Yasuyuki Takamizawa
- Department of Colorectal Surgery, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Mototaka Miyake
- Department of Diagnostic Radiology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Manabu Inoue
- Department of Colorectal Surgery, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Konosuke Moritani
- Department of Colorectal Surgery, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Shunsuke Tsukamoto
- Department of Colorectal Surgery, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Ken Eto
- Department of Surgery, The Jikei University School of Medicine, Chuo-ku, Tokyo, Japan
| | - Yukihide Kanemitsu
- Department of Colorectal Surgery, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
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Bozzetti F. Evolving concepts on perioperative nutrition of sarcopenic cancer patients. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:106748. [PMID: 36376142 DOI: 10.1016/j.ejso.2022.10.008] [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: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 11/13/2022]
Abstract
The recent recognition of the association of sarcopenia with an increased risk of complications after a surgical procedure calls for rethinking the proper approach of the perioperative care in cancer patients. Sarcopenia is broadly considered in literature according to three different definitions: loss of muscle mass, loss of muscle mass plus reduced muscle function and myosteatosis. The aim of this short review on this issue is to define the excess of risk by type of primary and of surgical procedure, depending on the definition of sarcopenia, to speculate on this association (casual versus causal) and to examine the current therapeutical approaches. The analysis of the data shows that sarcopenia, defined as loss of muscle mass plus reduced muscle function, has the higher predictive power for the occurrence of postoperative complications than the two other definitions, and any definition of sarcopenia works better than the usual indexes or scores of surgical risk. Our analysis supports the concept that: a) sarcopenia is frequently associated with inflammation, but inflammation cannot be considered the only or the absolute cause for sarcopenia, b) sarcopenia is not a simple marker of risk but can have a direct role in the increase of risk. Data on perioperative care of sarcopenic cancer patients are scanty but a correct approach cannot rely on nutritional support alone but on a combined approach of optimized nutrition and exercise, hopefully associated with an anti-inflammatory treatment. This strategy should be applied proactively in keeping with the recent recommendations of the American Society of Clinical Oncology for the medical treatment of advanced cancer patients even if a clear demonstration of effectiveness is still lacking.
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Affiliation(s)
- Federico Bozzetti
- University of Milan, Faculty of Medicine, via Festa del Perdono, 20100, Milano, Italy.
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Nagarajan G, Doshi P, Bardeskar NS, Kulkarni A, Punamiya A, Tongaonkar H. Association between sarcopenia and postoperative complications in patients undergoing surgery for gastrointestinal or hepato-pancreatico-biliary cancer. J Surg Oncol 2023; 128:682-691. [PMID: 37183521 DOI: 10.1002/jso.27315] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/02/2023] [Accepted: 05/03/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND AND OBJECTIVES Despite surgical advances, postoperative complications persist, affecting oncologic outcomes and increasing treatment costs. It is important to identify a marker that can predict postoperative complications, which can help prehabilitate patients before surgery. This study evaluated sarcopenia as a predictive marker of postoperative complications in patients undergoing surgery for gastrointestinal (GI) or hepato-pancreatico-biliary (HPB) cancer. METHODS Sarcopenia was assessed using the skeletal muscle index at the third lumbar vertebra on abdominal computed tomography. The predictive ability of sarcopenia was evaluated by adjusting for other clinicopathological factors. RESULTS Of the 210 patients, 81 (38.57%) were sarcopenic. The overall morbidity and mortality were 33.81% and 2.86%, respectively. Major complications (Clavien-Dindo Grade ≥ III) were observed in 10.95% patients and sarcopenic patients were significantly more likely to develop major complications (p = 1.42 × 10-10 ). Sarcopenia (p = 6.13 × 10-6 ; odds ratio = 12.29) independently predicted postoperative complications and prolonged hospital stay (p = 0.01). CONCLUSION Sarcopenia objectively predicted the development of postoperative complications and prolonged hospital stay in patients undergoing surgery for GI or HPB cancer. This may facilitate the prehabilitation of patients planned for surgery to reduce the risk of complications.
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Affiliation(s)
- Ganesh Nagarajan
- Department of Surgical Oncology, P.D. Hinduja Hospital and Medical Research Centre, Mumbai, India
- Nanavati Max Institute of Cancer Care, Nanavati Max Super Speciality Hospital, Mumbai, India
| | - Pratik Doshi
- Department of Surgical Oncology, P.D. Hinduja Hospital and Medical Research Centre, Mumbai, India
| | - Nikhil S Bardeskar
- Nanavati Max Institute of Cancer Care, Nanavati Max Super Speciality Hospital, Mumbai, India
| | - Aniruddha Kulkarni
- Department of Interventional Radiology, P.D. Hinduja Hospital and Medical Research Centre, Mumbai, India
| | - Aditya Punamiya
- Department of Surgical Oncology, P.D. Hinduja Hospital and Medical Research Centre, Mumbai, India
| | - Hemant Tongaonkar
- Department of Surgical Oncology, P.D. Hinduja Hospital and Medical Research Centre, Mumbai, India
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Couderc AL, Liuu E, Boudou-Rouquette P, Poisson J, Frelaut M, Montégut C, Mebarki S, Geiss R, ap Thomas Z, Noret A, Pierro M, Baldini C, Paillaud E, Pamoukdjian F. Pre-Therapeutic Sarcopenia among Cancer Patients: An Up-to-Date Meta-Analysis of Prevalence and Predictive Value during Cancer Treatment. Nutrients 2023; 15:nu15051193. [PMID: 36904192 PMCID: PMC10005339 DOI: 10.3390/nu15051193] [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: 02/03/2023] [Revised: 02/18/2023] [Accepted: 02/21/2023] [Indexed: 03/08/2023] Open
Abstract
This study will address the prevalence of pre-therapeutic sarcopenia (PS) and its clinical impact during cancer treatment among adult cancer patients ≥ 18 years of age. A meta-analysis (MA) with random-effect models was performed via a MEDLINE systematic review, according to the PRISMA statement, focusing on articles published before February 2022 that reported observational studies and clinical trials on the prevalence of PS and the following outcomes: overall survival (OS), progression-free survival (PFS), post-operative complications (POC), toxicities (TOX), and nosocomial infections (NI). A total of 65,936 patients (mean age: 45.7-85 y) with various cancer sites and extensions and various treatment modes were included. Mainly defined by CT scan-based loss of muscle mass only, the pooled prevalence of PS was 38.0%. The pooled relative risks were 1.97, 1.76, 2.70, 1.47, and 1.76 for OS, PFS, POC, TOX, and NI, respectively (moderate-to-high heterogeneity, I2: 58-85%). Consensus-based algorithm definitions of sarcopenia, integrating low muscle mass and low levels of muscular strength and/or physical performance, lowered the prevalence (22%) and heterogeneity (I2 < 50%). They also increased the predictive values with RRs ranging from 2.31 (OS) to 3.52 (POC). PS among cancer patients is prevalent and strongly associated with poor outcomes during cancer treatment, especially when considering a consensus-based algorithm approach.
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Affiliation(s)
- Anne-Laure Couderc
- Internal Medicine Geriatrics and Therapeutic Unit, APHM, 13009 Marseille, France
- CNRS, EFS, ADES, Aix-Marseille University, 13015 Marseille, France
| | - Evelyne Liuu
- Department of Geriatrics, CHU Poitiers, 86000 Poitiers, France
- CIC1402 INSERM Unit, Poitiers University Hospital, 86000 Poitiers, France
| | - Pascaline Boudou-Rouquette
- Ariane Program, Department of Medical Oncology, Cochin Hospital, Paris Cancer Institute CARPEM, APHP, 75014 Paris, France
- INSERM U1016-CNRS UMR8104, Cochin Institute, Paris Cancer Institute CARPEM, Paris Cité University, 75015 Paris, France
| | - Johanne Poisson
- Department of Geriatrics, Georges Pompidou European Hospital, Paris Cancer Institute CARPEM, APHP, 75015 Paris, France
- Faculty of Health, Paris Cité University, 75006 Paris, France
| | - Maxime Frelaut
- Department of Medical Oncology, Gustave Roussy Institute, 94805 Villejuif, France
| | - Coline Montégut
- Internal Medicine Geriatrics and Therapeutic Unit, APHM, 13009 Marseille, France
- Coordination Unit for Geriatric Oncology (UCOG), PACA West, 13009 Marseille, France
| | - Soraya Mebarki
- Department of Geriatrics, Georges Pompidou European Hospital, Paris Cancer Institute CARPEM, APHP, 75015 Paris, France
| | - Romain Geiss
- Department of Medical Oncology, Curie Institute, 92210 Saint-Cloud, France
| | - Zoé ap Thomas
- Department of Cancer Medicine, Gustave Roussy Institute, 94805 Villejuif, France
| | - Aurélien Noret
- Department of Geriatrics, Georges Pompidou European Hospital, Paris Cancer Institute CARPEM, APHP, 75015 Paris, France
| | - Monica Pierro
- Department of Geriatrics, Georges Pompidou European Hospital, Paris Cancer Institute CARPEM, APHP, 75015 Paris, France
| | - Capucine Baldini
- Drug Development Department, Gustave Roussy Institute, 94805 Villejuif, France
| | - Elena Paillaud
- Department of Geriatrics, Georges Pompidou European Hospital, Paris Cancer Institute CARPEM, APHP, 75015 Paris, France
- INSERM, IMRB, Clinical, Epidemiology and Ageing, Université Paris-Est Creteil, 94010 Creteil, France
| | - Frédéric Pamoukdjian
- Department of Geriatrics, Avicenne Hospital, APHP, 93000 Bobigny, France
- INSERM UMR_S942 Cardiovascular Markers in Stressed Conditions MASCOT, Sorbonne Paris Nord University, 93000 Bobigny, France
- Correspondence:
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Xiao Y, Xiao-Yue Z, Yue W, Ruo-Tao L, Xiang-Jie L, Xing-Yuan W, Qian W, Xiao-Hua Q, Zhen-Yi J. Use of computed tomography for the diagnosis of surgical sarcopenia: Review of recent research advances. Nutr Clin Pract 2022; 37:583-593. [PMID: 35191086 DOI: 10.1002/ncp.10847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 12/14/2021] [Accepted: 01/22/2022] [Indexed: 11/12/2022] Open
Abstract
Sarcopenia, also known as muscle decay, is associated with high morbidity among surgical patients. It is highly correlated with adverse clinical outcomes, such as increased postoperative complications, prolonged hospital stay, and increased mortality. Computed tomography (CT) is one of the main methods for diagnosing sarcopenia, which has the advantages of intuitiveness, rapidity, and accuracy. Clinical studies have shown that CT-defined sarcopenia can help predict the clinical outcomes and prognosis of surgical patients and provide an important reference for the formulation of antitumor treatment protocols. In recent years, some scholars have tried to construct an intelligent CT-based diagnostic model, which is expected to improve the diagnostic efficiency and establish standardized diagnostic criteria for CT-defined sarcopenia. In this review, we summarize the recent progress in the understanding of the diagnosis of sarcopenia and its potential prognostic value in surgery.
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Affiliation(s)
- Yu Xiao
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhou Xiao-Yue
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wu Yue
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liu Ruo-Tao
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | | | - Wang Qian
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Qian Xiao-Hua
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jia Zhen-Yi
- Department of Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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