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Han J, Liu X, Wang J, Tang M, Xu J, Tan S, Liu X, Wu G. Prognostic value of body composition in patients with digestive tract cancers: A prospective cohort study of 8,267 adults from China. Clin Nutr ESPEN 2024; 62:192-198. [PMID: 38901941 DOI: 10.1016/j.clnesp.2024.04.017] [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: 08/10/2023] [Revised: 03/05/2024] [Accepted: 04/27/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND & AIMS The characterization and prognostic value of body composition parameter/phenotype based on computed tomography (CT) in patients with digestive tract cancers remain incomplete. This study aimed to investigate the relationship between parameter/phenotype and clinical outcomes in patients with digestive tract cancers. METHODS In this prospective cohort study, 8267 patients with digestive tract cancers were assessed using CT scans to determine body composition. Body composition data, including areas of skeletal muscle (SM), subcutaneous adipose tissue (SAT), and visceral adipose tissue (VAT), were collected at the third lumbar level on CT images obtained within 30 days before surgery. Body composition phenotypes (sarcopenia, cancer cachexia, sarcopenic obesity) were determined based on SM, SAT, and VAT areas. The primary endpoint was overall survival, obtained from electronic medical records and telephone follow-up surveys. Kaplan-Meier and log-rank analyses were employed to compare unadjusted survival, while multivariate survival analyses were conducted using a proportional hazards model adjusted for age, gender, and cancer-node-metastasis (TNM) stages. RESULTS Adjusted hazard ratios (HRs) for all-cause mortality were calculated for the second (Q2), third (Q3), and fourth (Q4) quantiles relative to the first quantile (Q1) for SM areas, revealing adjusted summary HRs of 0.575 (95% CI, 0.361-0.916), 0.419 (95% CI, 0.241-0.729), and 0.384 (95% CI, 0.203-0.726), respectively. Sarcopenia-adjusted summary HRs were 1.795 (95% CI: 1.012-3.181) for male patients and 1.925 (95% CI: 1.065-3.478) for female patients. Cancer cachexia-adjusted summary HRs were 1.542 (95% CI: 1.023-2.324) for male patients and 1.569 (95% CI: 0.820-3.001) for female patients. Sarcopenic obesity-adjusted summary HRs were 1.122 (95% CI: 0.759-1.657) for male patients and 1.303 (95% CI: 0.623-2.725) for female patients. Subgroup analyses indicated varying prognostic values of body composition parameter/phenotype among different cancer types. CONCLUSIONS Our findings suggest a large SM area is a favorable prognostic indicator, while cancer cachexia and sarcopenia signify poor prognosis in patients with digestive tract cancers. These findings have important implications for the personalized preoperative assessment of body composition in patients with digestive tract cancers.
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Affiliation(s)
- Jun Han
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Clinical Nutrition Research Center, Shanghai, China
| | - Xinyang Liu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Junjie Wang
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Min Tang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiahao Xu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shanjun Tan
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Clinical Nutrition Research Center, Shanghai, China
| | - Xin Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China.
| | - Guohao Wu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Clinical Nutrition Research Center, Shanghai, China.
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Mann C, Jezycki T, Berlth F, Hadzijusufovic E, Uzun E, Lang H, Kloeckner R, Grimminger PP. Low psoas muscle index has a negative impact on survival after minimal invasive esophagectomy for cancer in European men. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108533. [PMID: 39094525 DOI: 10.1016/j.ejso.2024.108533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 06/09/2024] [Accepted: 07/04/2024] [Indexed: 08/04/2024]
Abstract
INTRODUCTION Sarcopenia, a key component of frailty in cancer patients, is associated with complicated procedures and worse survival after esophageal resection. The psoas muscle index (PMI) has been implicated as a possible sarcopenia imaging marker. This retrospective study aims to elucidate the effect of PMI and BMI in a cohort in Europe after totally minimally invasive esophagectomy for cancer. METHODS The study included 318 consecutive adult patients (261 men and 57 women) who underwent minimally invasive esophagectomy for cancer between January 2016 and April 2021 in a German University Hospital. The PMI was measured at the third lumbar vertebra in the preoperative CT scan. The endpoints postoperative complication rates and survival rates were analysed and correlated with PMI and BMI according to gender. RESULTS Male patients with low PMI (< 5.3 cm2/ m2) had a significantly higher rate of postoperative pulmonary and cardiac complications (p = 0.016, respectively p = 0.018). Low PMI and low BMI (<25 kg/m2) were associated with decreased survival rates in the univariate (p < 0.001) and multivariate analysis in male patients (p = 0.024, respectively 0.004). Having a low PMI (< 5.3 cm2/ m2) was significantly associated with worse overall survival in normal and underweight men (p < 0.001), but not in obese men with a BMI ≥ 25kg/m2 (p = 0.476). CONCLUSION Preoperative PMI and BMI are valid risk factors regarding postoperative survival after minimal invasive esophagectomy for cancer especially in a male European cohort.
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Affiliation(s)
- C Mann
- Department of General, Visceral and Transplantation Surgery, University Medical Center Mainz, Mainz, Germany
| | - T Jezycki
- Department of Diagnostic and Interventional Radiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - F Berlth
- Department of General, Visceral and Transplantation Surgery, University Medical Center Tübingen, Tübingen, Germany
| | - E Hadzijusufovic
- Department of General, Visceral and Transplantation Surgery, University Medical Center Mainz, Mainz, Germany
| | - E Uzun
- Department of General, Visceral and Transplantation Surgery, University Medical Center Mainz, Mainz, Germany
| | - H Lang
- Department of General, Visceral and Transplantation Surgery, University Medical Center Mainz, Mainz, Germany
| | - R Kloeckner
- Department for Interventional Radiology, University Medical Center Lübeck, Lübeck, Germany
| | - P P Grimminger
- Department of General, Visceral and Transplantation Surgery, University Medical Center Mainz, Mainz, Germany.
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Li S, Zhang H, He J, Li S. Relationship Between Preoperative Nutritional Indicators and Postoperative Complications in Patients with Oesophageal Cancer: A Meta-Analysis. Nutr Cancer 2024; 76:563-572. [PMID: 38764305 DOI: 10.1080/01635581.2024.2350100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 04/26/2024] [Indexed: 05/21/2024]
Abstract
Nutritional status is an essential factor in the occurrence of complications in patients with esophageal cancer. We sought to assess the relationship between malnutrition and complications using various nutritional assessment indicators. We conducted a comprehensive literature search of medical databases for articles published up to July 2023. The primary outcome indicator is the occurrence of complications, for which we combined 95% confidence intervals (CIs) and odds ratios (ORs) for postoperative complications and analyzed them using a random effects model. The analysis was carried out using STATA15.0 software. A total of 33 study groups from 22 publications with 5,675 subjects were included. Pooled results show that nutritional indicators are strongly correlated with the occurrence of postoperative complications (OR = 1.45, 95% CI: 1.30-1.62). In the subgroup analyses, comprehensive indicators and the skeletal muscle index were significantly associated with complications, whereas laboratory indicators were not associated with complications (comprehensive indicators OR = 2.68, 95% CI: 1.80-4.00; skeletal muscle index OR = 2.93, 95% CI: 1.44-5.99; laboratory indicators OR = 1.05, 95% CI: 0.96-1.16). Patients with normal body mass index and hospitalized patients were more likely to develop complications. Malnutrition is strongly associated with the development of complications. Nutritional indicators and patient characteristics influenced this relationship.
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Affiliation(s)
- Shaoxue Li
- School of Nursing, Anhui Medical University, Hefei, China
| | - Haoran Zhang
- School of Nursing, Anhui Medical University, Hefei, China
| | - Jie He
- School of Nursing, Anhui Medical University, Hefei, China
| | - Shuwen Li
- School of Nursing, Anhui Medical University, Hefei, China
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Jang MK, Park S, Raszewski R, Park CG, Doorenbos AZ, Kim S. Prevalence and clinical implications of sarcopenia in breast cancer: a systematic review and meta-analysis. Support Care Cancer 2024; 32:328. [PMID: 38702479 DOI: 10.1007/s00520-024-08532-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 04/27/2024] [Indexed: 05/06/2024]
Abstract
PURPOSE The impact of sarcopenia in oncology is increasingly recognized, yet little is known about its clinical implications in breast cancer. This systematic review and meta-analysis estimates the overall prevalence of sarcopenia in breast cancer, quantifies skeletal muscle index (SMI), and comprehensively evaluates sarcopenia's impact on clinical outcomes. METHODS We systematically searched primary original research published before June 2023 in four databases: the Cochrane Library via Wiley, CINAHL Plus with Full Text, Embase via Elsevier Excerpta Medica, and Medline via Ovid. Standardized mean SMI and 95% confidence interval (CI) were calculated by applying the random-effects model. The methodological quality of the included studies was assessed using the National Institutes of Health quality assessment checklist. RESULTS The systematic review included 17 studies with a total of 9863 patients; the meta-analysis included 12 of these studies. The mean prevalence of sarcopenia in breast cancer (stages I-III) was 32.5%. The mean SMI assessed by CT was 43.94 cm2/m2 (95% CI 42.87, 45.01; p < .01). Overall, low muscle mass was associated with chemotherapy toxicities, dose reductions, dose delays, or treatment discontinuation. Low muscle mass was generally associated with poor survival, but in some studies, this association was not significant or reversed direction. CONCLUSION Sarcopenia is not just a state of muscle mass loss, but an influencing factor on therapeutic effects and survival rates in oncology. It is thus necessary to recognize the risk of sarcopenia throughout the trajectory of cancer treatment, identify low muscle mass early, and manage it from a prehabilitation perspective.
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Affiliation(s)
- Min Kyeong Jang
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, 50-1 Yonsei-Ro, Seodaemun-Gu, 03722, Seoul, Republic of Korea.
| | - Sungwon Park
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Rebecca Raszewski
- Library of the Health Sciences-Chicago, University of Illinois Chicago, Chicago, IL, USA
| | - Chang Gi Park
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Ardith Z Doorenbos
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
- University of Illinois Cancer Center, Chicago, IL, USA
| | - Sue Kim
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, 50-1 Yonsei-Ro, Seodaemun-Gu, 03722, Seoul, Republic of Korea
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Graves JP, Daher GS, Bauman MMJ, Moore EJ, Tasche KK, Price DL, Van Abel KM. Association of sarcopenia with oncologic outcomes of primary treatment among patients with oral cavity cancer: A systematic review and meta-analysis. Oral Oncol 2023; 147:106608. [PMID: 37897858 DOI: 10.1016/j.oraloncology.2023.106608] [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: 08/08/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 10/30/2023]
Abstract
GOAL We performed a systematic review of the literature and meta-analysis to determine how radiographic sarcopenia assessment methods and the presence of pre-treatment sarcopenia impact oncologic outcomes in patients with oral cavity cancer. INTRODUCTION Pre-treatment sarcopenia has been associated with poor outcomes in many different malignancies, including head and neck cancers. However, the impact sarcopenia has on outcomes for oral cavity cancer patients is not well understood. RESULTS Twelve studies met our inclusion criteria, totaling 1007 patients. 359 (36%) of these patients were reported as sarcopenic. The most commonly utilized sarcopenia assessment methods were L3 skeletal muscle index (n = 5) and C3 skeletal muscle index to estimate L3 skeletal muscle index (n = 5). The majority of studies established their sarcopenia cutoffs as the lowest quartile skeletal muscle index in their patient cohorts. Five studies were included in our meta-analysis, totaling 251 sarcopenic and 537 non-sarcopenic patients. Compared to non-sarcopenic patients, sarcopenic patients were found to have significantly poorer overall survival (univariate: HR = 2.24, 95% CI: 1.71-2.93, I2 = 0%; multivariate: HR = 1.93, 95% CI: 1.47-2.52, I2 = 0%) and disease-free survival (univariate: HR = 2.10, 95% CI: 1.50-2.92, I2 = 0%; multivariate: HR = 1.79, 95% CI: 1.29-2.47, I2 = 10%). CONCLUSIONS Over one-third of oral cavity cancer patients may present with sarcopenia. Pre-treatment sarcopenia is associated with significantly worse overall and disease-free survival.
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Affiliation(s)
- Jeffrey P Graves
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA; Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Ghazal S Daher
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Kendall K Tasche
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Kathryn M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA.
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Kong F, Yang X, Lu Z, Liu Z, Yang Y, Wang Z. A novel long noncoding RNA (lncRNA), LINC02657(LASTR), is a prognostic biomarker associated with immune infiltrates of lung adenocarcinoma based on unsupervised cluster analysis. PeerJ 2023; 11:e16167. [PMID: 38047034 PMCID: PMC10691363 DOI: 10.7717/peerj.16167] [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: 04/06/2023] [Accepted: 09/03/2023] [Indexed: 12/05/2023] Open
Abstract
Non-small cell lung cancer (NSCLC) has long been the deadliest malignancy worldwide, with adenocarcinoma (AD) being the most common pathological subtype. Here we focused on the value of LASTR in LUAD. Using expression analysis, enrichment analysis, immune cell infraction analysis, we found that the expression level of LASTR was significantly increased in LUAD tissue. Meanwhile, LASTR was significantly associated with differential infiltration of various immune cells. Kaplan-Meier survival analysis showed that LUAD related with a poor prognosis in terms of OS, PFI, and DSS compared with high-expression LASTR. The enrichment analysis showed that LASTR is related to the pathays like PI3K-AKT signaling pathway. Thus, the present findings could be helpful in a better understand of LASTR in LUAD. RT-PCR was used to verify the high expression of LASTR in LUAD tissues, and the apoptosis of LUAD cell lines was promoted by CCK8 and Transwell experiments to verify the ability of LASTR to promote the migration and invasion of lung cancer cells in vitro.
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Affiliation(s)
- Fanming Kong
- Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xinyu Yang
- Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
| | - Zhichao Lu
- Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
| | - Zongheng Liu
- Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
| | - Yang Yang
- Department of Trauma Center, Affiliated Hospital of Nantong University, Jiangsu, China
| | - Ziheng Wang
- Department of Clinical Bio-bank, Affiliated Hospital of Nantong University, Jiangsu, China
- Centre for Precision Medicine Research and Training, Faculty of Health Sciences, University of Macau, Macau SAR, China
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Ishizaki A, Okuwaki K, Kida M, Imaizumi H, Iwai T, Yamauchi H, Kaneko T, Hasegawa R, Watanabe M, Kurosu T, Ishizaki J, Kusano C. Implication of Skeletal Muscle Loss in the Prognosis of Patients with Pancreatic Ductal Adenocarcinoma Receiving Chemotherapy. Intern Med 2023; 62:2783-2793. [PMID: 36792197 PMCID: PMC10602831 DOI: 10.2169/internalmedicine.0900-22] [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: 08/25/2022] [Accepted: 12/26/2022] [Indexed: 02/16/2023] Open
Abstract
Objective The effect of sarcopenia on the prognosis of patients undergoing chemotherapy for unresectable pancreatic ductal adenocarcinoma remains largely unexplored. In this retrospective study, we investigated the relationship between sarcopenia and the prognosis of patients receiving first-line nanoparticle albumin-bound paclitaxel plus gemcitabine for unresectable pancreatic ductal adenocarcinoma. Methods We enrolled 251 patients with unresectable metastatic or locally advanced pancreatic ductal adenocarcinoma who had received chemotherapy between January 2015 and December 2020 at Kitasato University Hospital. Univariate and multivariate analyses were performed using the stratified Cox proportional hazards model to determine variables significantly associated with the progression-free and overall survival. Propensity score matching was performed to mitigate selection bias effects. Results In the propensity score-matched cohort, the progression-free and overall survival were not significantly different between the sarcopenia and non-sarcopenia groups (p=0.335, and 0.679 respectively). The skeletal muscle index decreased by 4.4% and 6.5% in the sarcopenia and non-sarcopenia groups, respectively, during the early treatment phase (p=0.084). There were no significant differences between groups with regard to major adverse events or drug toxicity occurrences. Both the progression-free and overall survival were significantly shorter in the skeletal muscle index loss group than in the non-skeletal muscle index loss group (p=0.026 and 0.045, respectively). Conclusion Skeletal muscle index loss during the initial treatment phase may be an early marker for the long-term prognosis of patients receiving nanoparticle albumin-bound paclitaxel plus gemcitabine as first-line treatment for unresectable pancreatic ductal adenocarcinoma.
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Affiliation(s)
- Ayana Ishizaki
- Department of Gastroenterology, Kitasato University School of Medicine, Japan
| | - Kosuke Okuwaki
- Department of Gastroenterology, Kitasato University School of Medicine, Japan
| | - Mitsuhiro Kida
- Department of Gastroenterology, Kitasato University School of Medicine, Japan
| | - Hiroshi Imaizumi
- Department of Gastroenterology, Kitasato University School of Medicine, Japan
| | - Tomohisa Iwai
- Department of Gastroenterology, Kitasato University School of Medicine, Japan
| | - Hiroshi Yamauchi
- Department of Gastroenterology, Kitasato University School of Medicine, Japan
| | - Toru Kaneko
- Department of Gastroenterology, Kitasato University School of Medicine, Japan
| | - Rikiya Hasegawa
- Department of Gastroenterology, Kitasato University School of Medicine, Japan
| | - Masafumi Watanabe
- Department of Gastroenterology, Kitasato University School of Medicine, Japan
| | - Takahiro Kurosu
- Department of Gastroenterology, Kitasato University School of Medicine, Japan
| | - Junro Ishizaki
- Department of Gastroenterology, Kitasato University School of Medicine, Japan
| | - Chika Kusano
- Department of Gastroenterology, Kitasato University School of Medicine, Japan
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Park A, Orlandini MF, Szor DJ, Junior UR, Tustumi F. The impact of sarcopenia on esophagectomy for cancer: a systematic review and meta-analysis. BMC Surg 2023; 23:240. [PMID: 37592262 PMCID: PMC10433615 DOI: 10.1186/s12893-023-02149-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 08/10/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Esophagectomy is the gold-standard treatment for locally advanced esophageal cancer but has high morbimortality rates. Sarcopenia is a common comorbidity in cancer patients. The exact burden of sarcopenia in esophagectomy outcomes remains unclear. Therefore, this systematic review and meta-analysis were performed to establish the impact of sarcopenia on postoperative outcomes of esophagectomy for cancer. METHODS We performed a systematic review and meta-analysis comparing sarcopenic with non-sarcopenic patients before esophagectomy for cancer (Registration number: CRD42021270332). An electronic search was conducted on Embase, PubMed, Cochrane, and LILACS, alongside a manual search of the references. The inclusion criteria were cohorts, case series, and clinical trials; adult patients; studies evaluating patients with sarcopenia undergoing esophagectomy or gastroesophagectomy for cancer; and studies that analyze relevant outcomes. The exclusion criteria were letters, editorials, congress abstracts, case reports, reviews, cross-sectional studies, patients undergoing surgery for benign conditions, and animal studies. The meta-analysis was synthesized with forest plots. RESULTS The meta-analysis included 40 studies. Sarcopenia was significantly associated with increased postoperative complications (RD: 0.08; 95% CI: 0.02 to 0.14), severe complications (RD: 0.11; 95% CI: 0.04 to 0.19), and pneumonia (RD: 0.13; 95% CI: 0.09 to 0.18). Patients with sarcopenia had a lower probability of survival at a 3-year follow-up (RD: -0.16; 95% CI: -0.23 to -0.10). CONCLUSION Preoperative sarcopenia imposes a higher risk for overall complications and severe complications. Besides, patients with sarcopenia had a lower chance of long-term survival.
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Affiliation(s)
- Amanda Park
- Department of Gastroenterology, Universidade de São Paulo (USP), São Paulo, São Paulo, Brazil
- Centre for Evidence-Based Medicine, Centro Universitário Lusíada (UNILUS), Santos, Brazil
| | - Marina Feliciano Orlandini
- Department of Gastroenterology, Universidade de São Paulo (USP), São Paulo, São Paulo, Brazil
- Centre for Evidence-Based Medicine, Centro Universitário Lusíada (UNILUS), Santos, Brazil
| | - Daniel José Szor
- Department of Gastroenterology, Universidade de São Paulo (USP), São Paulo, São Paulo, Brazil
| | - Ulysses Ribeiro Junior
- Department of Gastroenterology, Universidade de São Paulo (USP), São Paulo, São Paulo, Brazil
| | - Francisco Tustumi
- Department of Gastroenterology, Universidade de São Paulo (USP), São Paulo, São Paulo, Brazil.
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Nishi S, Miki Y, Imai T, Nambara M, Miyamoto H, Tamura T, Yoshii M, Toyokawa T, Tanaka H, Lee S, Maeda K. The Evaluation of Sarcopenia before Neoadjuvant Chemotherapy Is Important for Predicting Postoperative Pneumonia in Patients with Esophageal Cancer. Dig Surg 2023; 40:153-160. [PMID: 37497924 DOI: 10.1159/000533185] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 07/11/2023] [Indexed: 07/28/2023]
Abstract
INTRODUCTION Sarcopenia is often observed in patients with esophageal cancer (EC). However, the influence of sarcopenia during neoadjuvant chemotherapy (NAC) on complications has not been fully investigated. Thus, we aimed to investigate the best way of evaluating sarcopenia for predicting complications, especially postoperative pneumonia (PP), in patients with EC undergoing NAC and esophagectomy. METHODS We retrospectively reviewed 113 patients. The skeletal muscle mass index (SMI) was evaluated by bioelectrical impedance analysis and/or computed tomography. Patients were diagnosed with sarcopenia at pre-NAC and preoperative timing. Different criteria were compared in terms of the predictability of PP. Next, we evaluated which factors were related to sarcopenia with the best PP predictability. RESULTS Fifteen (13.2%) patients developed grade III or higher PP. Pre-NAC modified European Working Group on Sarcopenia in Older People (EWGSOP) criteria showed the highest sensitivity (100%) and acceptable specificity (75.8%) for predicting PP. Low pre-NAC body mass index and %VC were significantly associated with sarcopenia by the modified EWGSOP criteria. CONCLUSION Pre-NAC sarcopenia by modified EWGSOP was a significant predictor of PP after esophagectomy. Appropriate interventions for these patients should be explored to prevent PP.
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Affiliation(s)
- Satoshi Nishi
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Yuichiro Miki
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Takumi Imai
- Department of Medical Statistics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Mikio Nambara
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hironari Miyamoto
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Tatsuro Tamura
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Mami Yoshii
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Takahiro Toyokawa
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hiroaki Tanaka
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Shigeru Lee
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Kiyoshi Maeda
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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Ichinohe D, Muroya T, Akasaka H, Hakamada K. Skeletal muscle mass and quality before preoperative chemotherapy influence postoperative long-term outcomes in esophageal squamous cell carcinoma patients. World J Gastrointest Surg 2023; 15:621-633. [PMID: 37206067 PMCID: PMC10190735 DOI: 10.4240/wjgs.v15.i4.621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/08/2023] [Accepted: 03/23/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Previous reports have focused on muscle mass as a prognostic factor in esophageal cancer.
AIM To investigate how preoperative body type influences the prognosis of patients with esophageal squamous cell carcinoma who underwent neoadjuvant chemotherapy (NAC) and surgery.
METHODS The subjects were 131 patients with clinical stage II/III esophageal squamous cell carcinoma who underwent subtotal esophagectomy after NAC. Skeletal muscle mass and quality were calculated based on computed tomography images prior to NAC, and their statistical association with long-term outcomes was examined retrospectively in this case-control study.
RESULTS The disease-free survival rates in the low psoas muscle mass index (PMI) group vs the high PMI group were 41.3% vs 58.8% (P = 0.036), respectively. In the high intramuscular adipose tissue content (IMAC) group vs the low IMAC group, the disease-free survival rates were 28.5% vs 57.6% (P = 0.021), respectively. The overall survival (OS) rates for the low PMI group vs the high PMI group were 41.3% vs 64.5% (P = 0.008), respectively, and for the high IMAC group vs the low IMAC group, they were 29.9% vs 61.9% (P = 0.024), respectively. Analysis of the OS rate revealed significant differences in patients aged 60 years or older (P = 0.018), those with pT3 or above disease (P = 0.021), or those with lymph node metastasis (P = 0.006), aside from PMI and IMAC. Multivariate analysis demonstrated that pT3 or above [hazard ratio (HR): 1.966, 95% confidence interval (CI): 1.089-3.550, P = 0.025), lymph node metastasis (HR: 2.154, 95%CI: 1.118-4.148, P = 0.022), low PMI (HR: 2.266, 95%CI: 1.282-4.006, P = 0.005), and high IMAC (HR: 2.089, 95%CI: 1.036-4.214, P = 0.022) were significant prognostic factors for esophageal squamous cell carcinoma.
CONCLUSION Skeletal muscle mass and quality before NAC in patients with esophageal squamous cell carcinoma are significant prognostic factors for postoperative OS.
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Affiliation(s)
- Daichi Ichinohe
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki 0368562, Aomori, Japan
| | - Takahiro Muroya
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki 0368562, Aomori, Japan
| | - Harue Akasaka
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki 0368562, Aomori, Japan
| | - Kenichi Hakamada
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki 0368562, Aomori, Japan
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11
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Zang Z, Shao Y, Nakyeyune R, Shen Y, Niu C, Zhu L, Ruan X, Wei T, Wei P, Liu F. Association of Body Mass Index and the Risk of Gastro-Esophageal Cancer: A Mendelian Randomization Study in a Japanese Population. Nutr Cancer 2023; 75:542-551. [PMID: 36205542 DOI: 10.1080/01635581.2022.2132266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2022]
Abstract
There are growing concerns that body mass index (BMI) is related to cancer risk at various anatomical sites, including the upper gastrointestinal tract, and the existence of a causal relationship remains unclear. The Mendelian randomization (MR) method uses instrumental genetic variables of risk factors to explore whether a causal relationship exists while preventing confounding. In our study, genome-wide association study (GWAS) data from the BioBank Japan (BBJ) project were used. Genetic variants were chosen as instrumental variables using inverse-variance weighting (IVW), MR-Egger regression and weighted-median methods to estimate the causal relationship between BMI and the risk of gastro-esophageal cancer. We found no evidence to support a causal association between BMI and risk of gastric cancer [odds ratio (OR) =0.99 per standard deviation (SD) increase in BMI; 95% confidence interval (CI): (0.76-1.30); P = 0.96] or esophageal cancer [0.78(0.50-1.22); P = 0.28] using the IVW method. Sensitivity analysis did not reveal any sign of horizontal pleiotropy. Additionally, in the gender-stratified analysis, no causal association was found. Findings from this study do not support a causal effect of BMI on gastro-esophageal cancer risk. However, we cannot rule out a modest or nonlinear effect of BMI.
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Affiliation(s)
- Zhaoping Zang
- Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Yi Shao
- Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Rena Nakyeyune
- Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Yi Shen
- Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Chen Niu
- Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Lingyan Zhu
- Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Xiaoli Ruan
- Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Tong Wei
- Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Ping Wei
- Department of Medical Immunology, Basic Medical College, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Fen Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
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12
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Sarcopenia and Patient's Body Composition: New Morphometric Tools to Predict Clinical Outcome After Ivor Lewis Esophagectomy: a Multicenter Study. J Gastrointest Surg 2023:10.1007/s11605-023-05611-1. [PMID: 36750544 DOI: 10.1007/s11605-023-05611-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 12/06/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND The impact of preoperative body composition as independent predictor of prognosis for esophageal cancer patients after esophagectomy is still unclear. The aim of the study was to explore such a relationship. METHODS This is a multicenter retrospective study from a prospectively maintained database. We enrolled consecutive patients who underwent Ivor-Lewis esophagectomy in four Italian high-volume centers from May 2014. Body composition parameters including total abdominal muscle area (TAMA), visceral fat area (VFA), and subcutaneous fat area (SFA) were determined based on CT images. Perioperative variables were systematically collected. RESULTS After exclusions, 223 patients were enrolled and 24.2% had anastomotic leak (AL). Sixty-eight percent of patients were sarcopenic and were found to be more vulnerable in terms of postoperative 90-day mortality (p = 0.028). VFA/TAMA and VFA/SFA ratios demonstrated a linear correlation with the Clavien-Dindo classification (R = 0.311 and 0.239, respectively); patients with anastomotic leak (AL) had significantly higher VFA/TAMA (3.56 ± 1.86 vs. 2.75 ± 1.83, p = 0.003) and VFA/SFA (1.18 ± 0.68 vs. 0.87 ± 0.54, p = 0.002) ratios. No significant correlation was found between preoperative BMI and subsequent AL development (p = 0.159). Charlson comorbidity index correlated significantly with AL (p = 0.008): these patients had a significantly higher index (≥ 5). CONCLUSION Analytical morphometric assessment represents a useful non-invasive tool for preoperative risk stratification. The concurrent association of sarcopenia and visceral obesity seems to be the best predictor of AL, far better than simple BMI evaluation, and potentially modifiable if targeted with prehabilitation programs.
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13
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Merboth F, Nebelung H, Wotschel N, Liebscher H, Eckert F, von Renesse J, Hasanovic J, Welsch T, Fritzmann J, Stange DE, Plodeck V, Hoffmann RT, Distler M, Weitz J, Kirchberg J. Robotic Esophagectomy Compared With Open Esophagectomy Reduces Sarcopenia within the First Postoperative Year: A Propensity Score-Matched Analysis. J Thorac Oncol 2023; 18:232-244. [PMID: 36343921 DOI: 10.1016/j.jtho.2022.10.018] [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: 05/04/2022] [Revised: 10/04/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Sarcopenia is a known risk factor for adverse outcomes after esophageal cancer (EC) surgery. Robot-assisted minimally invasive esophagectomy (RAMIE) offers numerous advantages, including reduced morbidity and mortality. However, no evidence exists to date comparing the development of sarcopenia after RAMIE and open esophagectomy (OE). The objective was to evaluate whether the development of sarcopenia within the first postoperative year after esophagectomy is associated with the surgical approach: RAMIE versus OE. METHODS A total of 168 patients with EC were analyzed who either underwent total robotic or fully open Ivor Lewis esophagectomy in a propensity score-matched analysis. Sarcopenia was assessed using the skeletal muscle index (cm2/m2) and psoas muscle thickness per height (mm/m) on axial computed tomography scans during the first postoperative year; in total 540 computed tomography scans were evaluated. RESULTS After 1-to-1 propensity score matching for confounders, 67 patients were allocated to RAMIE and OE groups, respectively. Skeletal muscle index in the OE group was significantly lower compared with the RAMIE group at the third (43.2 ± 7.6 cm2/m2 versus 49.1 ± 6.9 cm2/m2, p = 0.001), sixth (42.7 ± 7.8 cm2/m2 versus 51.5 ± 8.2 cm2/m2, p < 0.001) and ninth (43.0 ± 7.0 cm2/m2 versus 49.9 ± 6.6 cm2/m2, p = 0.015) postoperative month. Similar results were recorded for psoas muscle thickness per height. CONCLUSIONS To our knowledge, this study is the first to suggest a substantial benefit of RAMIE compared with open esophagectomy in terms of postoperative sarcopenia. These results add further evidence to support the implementation of the robotic approach in multimodal therapy of EC.
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Affiliation(s)
- Felix Merboth
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; National Center for Tumor Diseases (NCT/UCC), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | - Heiner Nebelung
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany; Institute and Polyclinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Natalie Wotschel
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany; Institute and Polyclinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Hendrik Liebscher
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany; Institute and Polyclinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Franziska Eckert
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; National Center for Tumor Diseases (NCT/UCC), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | - Janusz von Renesse
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; National Center for Tumor Diseases (NCT/UCC), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | - Jasmin Hasanovic
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; National Center for Tumor Diseases (NCT/UCC), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | - Thilo Welsch
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; National Center for Tumor Diseases (NCT/UCC), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany; Current Address: Department of General, Visceral, and Thoracic Surgery, St. Elisabethen-Klinikum Ravensburg, Academic Teaching Hospital of the University of Ulm, Ulm, Germany
| | - Johannes Fritzmann
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; National Center for Tumor Diseases (NCT/UCC), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | - Daniel E Stange
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; National Center for Tumor Diseases (NCT/UCC), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | - Verena Plodeck
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany; Institute and Polyclinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Ralf-Thorsten Hoffmann
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany; Institute and Polyclinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Marius Distler
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; National Center for Tumor Diseases (NCT/UCC), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | - Jürgen Weitz
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; National Center for Tumor Diseases (NCT/UCC), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | - Johanna Kirchberg
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; National Center for Tumor Diseases (NCT/UCC), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany.
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14
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CT-derived body composition measurements as predictors for neoadjuvant treatment tolerance and survival in gastroesophageal adenocarcinoma. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:211-219. [PMID: 36209446 DOI: 10.1007/s00261-022-03695-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/21/2022] [Accepted: 09/26/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE Treatment for gastroesophageal adenocarcinomas can result in significant morbidity and mortality. The purpose of this study is to supplement methods for choosing treatment strategy by assessing the relationship between CT-derived body composition, patient, and tumor features, and clinical outcomes in this population. METHODS Patients with neoadjuvant treatment, biopsy-proven gastroesophageal adenocarcinoma, and initial staging CTs were retrospectively identified from institutional clinic encounters between 2000 and 2019. Details about patient, disease, treatment, and outcomes (including therapy tolerance and survival) were extracted from electronic medical records. A deep learning semantic segmentation algorithm was utilized to measure cross-sectional areas of skeletal muscle (SM), visceral fat (VF), and subcutaneous fat (SF) at the L3 vertebra level on staging CTs. Univariate and multivariate analyses were performed to assess the relationships between predictors and outcomes. RESULTS 142 patients were evaluated. Median survival was 52 months. Univariate and multivariate analysis showed significant associations between treatment tolerance and SM and VF area, SM to fat and VF to SF ratios, and skeletal muscle index (SMI) (p = 0.004-0.04). Increased survival was associated with increased body mass index (BMI) (p = 0.01) and increased SMI (p = 0.004). A multivariate Cox model consisting of BMI, SMI, age, gender, and stage demonstrated that patients in the high-risk group had significantly lower survival (HR = 1.77, 95% CI = 1.13-2.78, p = 0.008). CONCLUSION CT-based measures of body composition in patients with gastroesophageal adenocarcinoma may be independent predictors of treatment complications and survival and can supplement methods for assessing functional status during treatment planning.
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15
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McGovern J, Delaney J, Forshaw MJ, McCabe G, Crumley AB, McIntosh D, Laird BJ, Horgan PG, McMillan DC, McSorley ST, Dolan RD. The relationship between computed tomography‐derived sarcopenia, cardiopulmonary exercise testing performance, systemic inflammation, and survival in good performance status patients with oesophago‐gastric cancer undergoing neoadjuvant treatment. JCSM CLINICAL REPORTS 2022. [DOI: 10.1002/crt2.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Josh McGovern
- Academic Unit of Surgery, School of Medicine University of Glasgow G31 2ER Glasgow Level 2, New Lister Building, Glasgow Royal Infirmary UK
| | - Jenna Delaney
- Academic Unit of Surgery, School of Medicine University of Glasgow G31 2ER Glasgow Level 2, New Lister Building, Glasgow Royal Infirmary UK
| | | | - Gerard McCabe
- Academic Unit of Surgery, School of Medicine University of Glasgow G31 2ER Glasgow Level 2, New Lister Building, Glasgow Royal Infirmary UK
| | - Andrew B. Crumley
- Academic Unit of Surgery, School of Medicine University of Glasgow G31 2ER Glasgow Level 2, New Lister Building, Glasgow Royal Infirmary UK
| | - David McIntosh
- Academic Unit of Surgery, School of Medicine University of Glasgow G31 2ER Glasgow Level 2, New Lister Building, Glasgow Royal Infirmary UK
| | - Barry J. Laird
- Institute of Genetics and Molecular Medicine University of Edinburgh Edinburgh UK
| | - Paul G. Horgan
- Academic Unit of Surgery, School of Medicine University of Glasgow G31 2ER Glasgow Level 2, New Lister Building, Glasgow Royal Infirmary UK
| | - Donald C. McMillan
- Academic Unit of Surgery, School of Medicine University of Glasgow G31 2ER Glasgow Level 2, New Lister Building, Glasgow Royal Infirmary UK
| | - Stephen T. McSorley
- Academic Unit of Surgery, School of Medicine University of Glasgow G31 2ER Glasgow Level 2, New Lister Building, Glasgow Royal Infirmary UK
| | - Ross D. Dolan
- Academic Unit of Surgery, School of Medicine University of Glasgow G31 2ER Glasgow Level 2, New Lister Building, Glasgow Royal Infirmary UK
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16
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Jogiat UM, Bédard ELR, Sasewich H, Turner SR, Eurich DT, Filafilo H, Baracos V. Sarcopenia reduces overall survival in unresectable oesophageal cancer: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle 2022; 13:2630-2636. [PMID: 36151845 PMCID: PMC9745498 DOI: 10.1002/jcsm.13082] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 08/02/2022] [Accepted: 08/18/2022] [Indexed: 12/24/2022] Open
Abstract
Sarcopenia measured through body composition analysis is emerging as an important prognosticator among various malignancies, including oesophageal cancer. Skeletal muscle index (SMI) as determined by the third lumbar vertebrae on cross-sectional CT images has been demonstrated as a predictor of overall survival in oesophageal cancer, using pre-defined cut off values for sarcopenia. However, this is largely within the setting of resectable disease. The primary objective of this systematic review and meta-analysis was to determine the effect of sarcopenia defined by SMI on overall-survival in patients with unresectable oesophageal cancer. On 30 January 2021, a systematic search of the literature was conducted to identify the role of SMI among patients with unresectable oesophageal cancer, with overall survival as the primary outcome. Databases included MEDLINE, EMBASE, Scopus, Web of Science, and Cochrane Library. Inclusion criteria included age >18, diagnosis of oesophageal cancer, and non-operative management. A meta-analysis was conducted using RevMan 5.4.1 using an inverse variance, random effects model. After the removal of duplicates, 2755 unique search results were obtained. Manual screening of titles and abstracts resulted in 287 full text articles that were reviewed. Of these, five studies met the inclusion criteria with data evaluating the effect of sarcopenia defined by SMI on overall survival. A total of 783 patients, the majority of which were male (n = 638, 81%), with a mean age of 68 ± 2.3 years were included. 641 (82%) patients were diagnosed with squamous cell carcinoma. Sarcopenia, as determined by SMI using pre-defined cut-off values, was reported in 517 patients (66%). Meta-analysis demonstrated decreased overall survival in the sarcopenia group compared with the non-sarcopenia group (HR = 1.51; 95% CI 1.21-1.89; P = 0.0003; I2 = 0%; Figure 1). No significant publication bias was noted on assessment of funnel plot and Egger's test (P = 0.295). Sarcopenia as defined by SMI is predictive of overall survival among patients with nonoperative oesophageal cancer. Further analysis on the effect of sarcopenia on treatment related adverse effects and complications, particularly related to chemotherapy, radiotherapy, and oesophageal stenting, is needed to identify the degree of prognostication offered by body composition analysis. Studies on the modifiability of sarcopenia will help determine the utility of nutritional interventions.
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Affiliation(s)
- Uzair M Jogiat
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Eric L R Bédard
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Hannah Sasewich
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Simon R Turner
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Heather Filafilo
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Vickie Baracos
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
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17
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Xu SJ, Lin LQ, Chen TY, You CX, Chen C, Chen RQ, Chen SC. Nomogram for prognosis of patients with esophageal squamous cell cancer after minimally invasive esophagectomy established based on non-textbook outcome. Surg Endosc 2022; 36:8326-8339. [PMID: 35556169 DOI: 10.1007/s00464-022-09290-y] [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: 12/15/2021] [Accepted: 04/18/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Non-textbook outcome (non-TO) represents a new prognostic evaluation index for surgical oncology. The present study aimed to develop new nomograms based on non-TO to predict the mortality and recurrence rate in patients with esophageal squamous cell cancer (ESCC) after minimally invasive esophagectomy (MIE). METHODS The study involved a retrospective analysis of 613 ESCC patients, from the prospectively maintained database from January 2011 to December 2018. All the included ESCC patients underwent MIE, and they were randomly (1:1) assigned to the training cohort (307 patients) and the validation cohort (306 patients). Kaplan-Meier survival analysis was used to analyze the differences recorded between overall survival (OS) and disease-free survival (DFS). In the case of the training cohort, the nomograms based on non-TO were developed using Cox regression, and the performance of these nomograms was calibrated and evaluated in the validation cohort. RESULTS Significant differences were recorded for 5-year OS and DFS between non-TO and TO groups (p < 0.05). Multivariate cox analysis revealed that non-TO, intraoperative bleeding, T stage, and N stage acted as independent risk factors that affected OS and DFS (p < 0.05). The results for multivariate regression were used to build non-TO-based nomograms to predict OS and DFS of patients with ESCC, the t-AUC curve analysis showed that the nomograms predicting OS and DFS were more accurate as compared to TNM staging, during the follow-up period in the training cohort and validation cohort. Further, the nomogram score was used to divide ESCC patients into low-, middle-, and high-risk groups and significant differences were recorded for OS and DFS between these three groups (p < 0.001). CONCLUSIONS Non-TO was identified as an independent prognostic factor for ESCC patients. The nomograms based on non-TO could availably predict OS and DFS in ESCC patients after MIE.
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Affiliation(s)
- Shao-Jun Xu
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, No. 29 Xin quan Road, Fuzhou, 350001, Fujian Province, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
- Fujian Provincial Key Laboratory of Cardiothoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Lan-Qin Lin
- Department of Operation, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Ting-Yu Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, No. 29 Xin quan Road, Fuzhou, 350001, Fujian Province, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
- Fujian Provincial Key Laboratory of Cardiothoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Cheng-Xiong You
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, No. 29 Xin quan Road, Fuzhou, 350001, Fujian Province, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
- Fujian Provincial Key Laboratory of Cardiothoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Chao Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, No. 29 Xin quan Road, Fuzhou, 350001, Fujian Province, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
- Fujian Provincial Key Laboratory of Cardiothoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Rui-Qin Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, No. 29 Xin quan Road, Fuzhou, 350001, Fujian Province, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
- Fujian Provincial Key Laboratory of Cardiothoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Shu-Chen Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, No. 29 Xin quan Road, Fuzhou, 350001, Fujian Province, China.
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China.
- Fujian Provincial Key Laboratory of Cardiothoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.
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18
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Bossi P, De Luca R, Ciani O, D’Angelo E, Caccialanza R. Malnutrition management in oncology: An expert view on controversial issues and future perspectives. Front Oncol 2022; 12:910770. [PMID: 36276153 PMCID: PMC9579941 DOI: 10.3389/fonc.2022.910770] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 09/13/2022] [Indexed: 12/05/2022] Open
Abstract
Cancer and anticancer treatments can lead to several negative side effects, including malnutrition. Despite the recognized need for adequate nutritional support in cancer patients, in daily clinical practice, nutrition is still not considered one of the first aspects to be considered. Malnutrition negatively affects the clinical outcomes, treatment response, and overall survival of cancer patients. In this study, three of the most controversial issues related to malnutrition, which emerged during an Italian Consensus Conference, were addressed specifically for patients with head and neck as well as gastrointestinal cancer. The timing of nutritional evaluation and intervention, extension of the Enhanced Recovery after Surgery (ERAS®) protocols, and cost-effectiveness of nutritional interventions have been considered. This study aimed to illustrate the state-of-the art of each issue and hypothesize future perspectives and actions to be taken, trying to suggest a new nutritional management model for cancer patients in Italy that overcomes the critical issues encountered. Of note, the timely diagnosis of nutritional issue appears to be essential to ensure the correct management of malnourished cancer patients as well as those who are at high risk of malnutrition. Standardized protocols, screening tests, and the inclusion of nutritional parameters in patient medical records would help to achieve good clinical outcomes. Finally, appropriate nutritional support is also associated with cost savings, and it seems necessary to promote its clinical and economic value to obtain improvements in both outcomes and management costs.
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Affiliation(s)
- Paolo Bossi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Università degli Studi di Brescia, Brescia, Italy
| | - Raffaele De Luca
- Department of Surgical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Tumori “Giovanni Paolo II”, Bari, Italy
- *Correspondence: Raffaele De Luca,
| | - Oriana Ciani
- Centre for Research on Health and Social Care Management (CERGAS), Scuola di Direzione Aziendale (SDA) Bocconi School of Management, Bocconi University, Milan, Italy
| | - Elisa D’Angelo
- Radiotherapy Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
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19
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Chen F, Chi J, Zhao B, Mei F, Gao Q, Zhao L, Ma B. Impact of preoperative sarcopenia on postoperative complications and survival outcomes of patients with esophageal cancer: a meta-analysis of cohort studies. Dis Esophagus 2022; 35:6514799. [PMID: 35077542 DOI: 10.1093/dote/doab100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/21/2021] [Accepted: 12/31/2021] [Indexed: 12/11/2022]
Abstract
The effects of preoperative sarcopenia on postoperative complications and survival outcomes of patients undergoing esophageal cancer resection are controversial. From database establishment to 16 May 2021, we systematically searched PubMed, Embase, the Cochrane Library, Web of Science, and Chinese Biomedical Literature Database to collect relevant studies investigating the effects of preoperative sarcopenia on postoperative complications, survival outcomes, and the risk of a poor prognosis of patients undergoing esophagectomy. The Newcastle-Ottawa scale was used to evaluate the quality of the included literature, and RevMan 5.3 software was used for the meta-analysis. A total of 26 studies (3 prospective cohort studies and 23 retrospective cohort studies), involving 4,515 patients, were included. The meta-analysis showed that preoperative sarcopenia significantly increased the risk of overall complications (risk ratio [RR]: 1.15; 95% confidence interval [CI]: 1.08-1.22), pulmonary complications (RR: 1.78; 95% CI: 1.48-2.14), and anastomotic leakage (RR: 1.29; 95% CI: 1.04-1.59) and reduced the overall survival rate (hazard ratio: 1.12; 95% CI: 1.04-1.20) following esophageal cancer resection. Preoperative sarcopenia increased the risks of overall postoperative and pulmonary complications in patients undergoing esophageal cancer resection. For patients with esophageal cancer, assessing the preoperative risk of preoperative sarcopenia is necessary.
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Affiliation(s)
- Fei Chen
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China.,Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Junting Chi
- Department of Nursing, The First People's Hospital of Yunnan Province, Kunming, China.,The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Bing Zhao
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Fan Mei
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China.,Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Qianqian Gao
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China.,Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Li Zhao
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China.,Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Bin Ma
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China.,Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
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20
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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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21
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Sucandy I, Shapera E, Syblis CC, Crespo K, Przetocki VA, Ross SB, Rosemurgy AS. Propensity score matched comparison of robotic and open major hepatectomy for malignant liver tumors. Surg Endosc 2022; 36:6724-6732. [PMID: 34981238 DOI: 10.1007/s00464-021-08948-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/06/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Outcome data on robotic major hepatectomy are lacking. This study was undertaken to compare robotic vs. 'open' major hepatectomy utilizing patient propensity score matching (PSM). METHODS With institutional review board approval, we prospectively followed 183 consecutive patients who underwent robotic or 'open' major hepatectomy, defined as removal of three or more Couinaud segments. 42 patients who underwent 'open' approach were matched with 42 patients who underwent robotic approach. The criteria for PSM were age, resection type, tumor size, tumor type, and BMI. Survival was individually stratified for hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (IHCC), and colorectal liver metastases (CLM). The data are presented as: median (mean ± SD). RESULTS Operative duration for the robotic approach was 293 (302 ± 131.5) vs. 280 (300 ± 115.6) minutes for the 'open' approach (p = NS). Estimated Blood Loss (EBL) was 200 (239 ± 183.6) vs. 300 (491 ± 577.1) ml (p = 0.01). There were zero postoperative complications with a Clavien-Dindo classification ≥ III for the robotic approach and three for the 'open' approach (p = NS). ICU length of stay (LOS) was 1 (1 ± 0) vs. 2 (3 ± 2.0) days (p = 0.0001) and overall LOS was 4 (4 ± 3.3) vs. 6 (6 ± 2.7) days (p = 0.003). In terms of long-term oncological outcomes, overall survival was similar for patients with IHCC and CLM regardless of the approach. However, patients with HCC who underwent robotic resection lived significantly longer (p = 0.05). CONCLUSION Utilizing propensity score matched analysis, the robotic approach was associated with a lower EBL, shorter ICU LOS, and shorter overall LOS while maintaining similar operative duration and promoting survival in patients with HCC. We believe that the robotic approach is safe and efficacious and should be considered a preferred alternative approach for major hepatectomy.
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Affiliation(s)
- Iswanto Sucandy
- Digestive Health Institute, AdventHealth Tampa, 3000 Medical Park Drive, Suite 500, Tampa, FL, 33613, USA.
| | - Emanuel Shapera
- Digestive Health Institute, AdventHealth Tampa, 3000 Medical Park Drive, Suite 500, Tampa, FL, 33613, USA
| | - Cameron C Syblis
- Digestive Health Institute, AdventHealth Tampa, 3000 Medical Park Drive, Suite 500, Tampa, FL, 33613, USA
| | - Kaitlyn Crespo
- Digestive Health Institute, AdventHealth Tampa, 3000 Medical Park Drive, Suite 500, Tampa, FL, 33613, USA
| | - Valerie A Przetocki
- Digestive Health Institute, AdventHealth Tampa, 3000 Medical Park Drive, Suite 500, Tampa, FL, 33613, USA
| | - Sharona B Ross
- Digestive Health Institute, AdventHealth Tampa, 3000 Medical Park Drive, Suite 500, Tampa, FL, 33613, USA
| | - Alexander S Rosemurgy
- Digestive Health Institute, AdventHealth Tampa, 3000 Medical Park Drive, Suite 500, Tampa, FL, 33613, USA
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22
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Zhang C, Hu LW, Qiang Y, Cong ZZ, Zheng C, Gu WF, Luo C, Xie K, Shen Y. Home enteral nutrition for patients with esophageal cancer undergoing esophagectomy: A systematic review and meta-analysis. Front Nutr 2022; 9:895422. [PMID: 35967793 PMCID: PMC9366554 DOI: 10.3389/fnut.2022.895422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 06/16/2022] [Indexed: 12/09/2022] Open
Abstract
Introduction Home enteral nutrition (HEN) is a relatively new nutritional intervention that provides patients with EN support at home through jejunostomy or nasogastric feeding tubes. We conducted this systematic review and meta-analysis to explore the safety and effect of HEN compared with normal oral diet (NOD) in postoperative patients with esophageal cancer (EC). Methods EMBASE, Medline, Web of Science, and the Cochrane Library were used to search articles in English-language journals. The intervention effect was expressed using risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous outcome measures, with 95% confidence intervals (95% CIs). The chi-square test and I-square test were used to test heterogeneity among studies. Results Four studies were eventually included in this meta-analysis. Compared with NOD, HEN has a favorable impact on postoperative body mass index (BMI) (weighted mean difference [WMD] = 0.70, 95% CI: 0.09–1.30, P = 0.02), lean body mass (LBM) (WMD = 0.76, 95% CI: 0.04–1.48, P = 0.04), and appendicular skeletal muscle mass index (ASMI) (WMD = 0.30, 95% CI: 0.02–0.58, P = 0.03). Physical function (WMD = 9.26, 95% CI: 8.00–10.53, P < 0.001), role function (WMD = 9.96, 95% CI: 8.11–11.82, P < 0.001), and social function (WMD = 8.51, 95% CI: 3.48–13.54, P = 0.001) of the HEN group were better than those of the NOD group at 3 months, and HEN could reduce the fatigue of patients (WMD = −12.73, 95% CI: −14.8 to −10.66, P < 0.001) and the incidence of postoperative pneumonia (RR = 0.53, 95% CI: 0.34–0.81, P = 0.004). There was no significant difference in albumin between HEN and NOD groups (WMD = 0.05, 95% CI: −0.03 to 0.13, P = 0.20). Conclusion HEN improved nutritional status and quality of life (QOL) in postoperative patients with EC and reduced fatigue and the incidence of postoperative pneumonia. All in all, the results of our meta-analysis support the use of HEN after esophagectomy.
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Affiliation(s)
- Chi Zhang
- Department of Cardiothoracic Surgery, Medical School of Nanjing University, Jinling Hospital, Nanjing, China
| | - Li-Wen Hu
- Department of Cardiothoracic Surgery, Medical School of Nanjing University, Jinling Hospital, Nanjing, China
| | - Yong Qiang
- Department of Cardiothoracic Surgery, School of Medicine, Jinling Hospital, Southeast University, Nanjing, China
| | - Zhuang-Zhuang Cong
- Department of Cardiothoracic Surgery, Medical School of Nanjing University, Jinling Hospital, Nanjing, China
| | - Chao Zheng
- Department of Cardiothoracic Surgery, School of Medicine, Jinling Hospital, Southeast University, Nanjing, China
| | - Wen-Feng Gu
- Department of Cardiothoracic Surgery, Medical School of Nanjing University, Jinling Hospital, Nanjing, China
| | - Chao Luo
- Department of Cardiothoracic Surgery, School of Clinical Medicine, Jinling Hospital, Southern Medical University, Guangzhou, China
| | - Kai Xie
- Department of Cardiothoracic Surgery, School of Clinical Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Yi Shen
- Department of Cardiothoracic Surgery, Medical School of Nanjing University, Jinling Hospital, Nanjing, China.,Department of Cardiothoracic Surgery, School of Medicine, Jinling Hospital, Southeast University, Nanjing, China.,Department of Cardiothoracic Surgery, School of Clinical Medicine, Jinling Hospital, Southern Medical University, Guangzhou, China.,Department of Cardiothoracic Surgery, School of Clinical Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China
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23
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Salas S, Cottet V, Dossus L, Fassier P, Ginhac J, Latino-Martel P, Romieu I, Schneider S, Srour B, Touillaud M, Touvier M, Ancellin R. Nutritional Factors during and after Cancer: Impacts on Survival and Quality of Life. Nutrients 2022; 14:2958. [PMID: 35889914 PMCID: PMC9323157 DOI: 10.3390/nu14142958] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 02/04/2023] Open
Abstract
The French National Cancer Institute conducted a collective expertise study with researchers and clinical experts from the French Network for Nutrition And Cancer Research (NACRe Network). The objective was to update the state of knowledge on the impacts of nutritional factors on clinical endpoints during or after cancer. Data from 150 meta-analyses, pooled analyses or intervention trials and 93 cohort studies were examined; they concerned 8 nutritional factors, 6 clinical events and 20 cancer locations. This report shows that some nutritional factors have impacts on mortality and on the risks of recurrence or second primary cancer in cancer patients. Therefore, high-risk nutritional conditions can be encountered for certain cancer sites: from the diagnosis and throughout the health care pathways, weight loss (lung and esophageal cancers), malnutrition (lung, esophageal, colorectal, pancreatic, gastric and liver cancers), weight gain (colorectal, breast and kidney cancers) and alcohol consumption (upper aerodigestive cancers) should be monitored; and after cancer treatments, excess weight should be detected (colorectal, breast and kidney cancers). These situations require nutritional assessments, and even support or management by health care professionals, in the context of tertiary prevention. This report also highlights some limitations regarding the existing literature and some needs for future research.
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Affiliation(s)
- Sébastien Salas
- AP-HM, Timone Hospital, Aix Marseille University, 13000 Marseille, France;
- The French Network for Nutrition and Cancer Research (NACRe Network), 78350 Jouy-en-Josas, France; (L.D.); (P.F.); (J.G.); (P.L.-M.); (I.R.); (S.S.); (B.S.); (M.T.); (M.T.)
| | - Vanessa Cottet
- The French Network for Nutrition and Cancer Research (NACRe Network), 78350 Jouy-en-Josas, France; (L.D.); (P.F.); (J.G.); (P.L.-M.); (I.R.); (S.S.); (B.S.); (M.T.); (M.T.)
- INSERM UMR1231/CIC 1432, University Hospital, LabEx LipSTIC ANR-11-LABX-0021, University of Burgundy-Franche-Comté, 21000 Dijon, France
| | - Laure Dossus
- The French Network for Nutrition and Cancer Research (NACRe Network), 78350 Jouy-en-Josas, France; (L.D.); (P.F.); (J.G.); (P.L.-M.); (I.R.); (S.S.); (B.S.); (M.T.); (M.T.)
- International Agency for Research on Cancer, 69000 Lyon, France
| | - Philippine Fassier
- The French Network for Nutrition and Cancer Research (NACRe Network), 78350 Jouy-en-Josas, France; (L.D.); (P.F.); (J.G.); (P.L.-M.); (I.R.); (S.S.); (B.S.); (M.T.); (M.T.)
- Gustave Roussy Institute, 94800 Villejuif, France
| | - Julie Ginhac
- The French Network for Nutrition and Cancer Research (NACRe Network), 78350 Jouy-en-Josas, France; (L.D.); (P.F.); (J.G.); (P.L.-M.); (I.R.); (S.S.); (B.S.); (M.T.); (M.T.)
- Nutritional Epidemiology Research Team (EREN), Sorbonne Paris Nord University, INSERM, INRAE, CNAM, Epidemiology and Statistics Research Centre (CRESS), University of Paris, 93022 Bobigny, France
| | - Paule Latino-Martel
- The French Network for Nutrition and Cancer Research (NACRe Network), 78350 Jouy-en-Josas, France; (L.D.); (P.F.); (J.G.); (P.L.-M.); (I.R.); (S.S.); (B.S.); (M.T.); (M.T.)
- Nutritional Epidemiology Research Team (EREN), Sorbonne Paris Nord University, INSERM, INRAE, CNAM, Epidemiology and Statistics Research Centre (CRESS), University of Paris, 93022 Bobigny, France
| | - Isabelle Romieu
- The French Network for Nutrition and Cancer Research (NACRe Network), 78350 Jouy-en-Josas, France; (L.D.); (P.F.); (J.G.); (P.L.-M.); (I.R.); (S.S.); (B.S.); (M.T.); (M.T.)
- International Agency for Research on Cancer, 69000 Lyon, France
| | - Stéphane Schneider
- The French Network for Nutrition and Cancer Research (NACRe Network), 78350 Jouy-en-Josas, France; (L.D.); (P.F.); (J.G.); (P.L.-M.); (I.R.); (S.S.); (B.S.); (M.T.); (M.T.)
- University Hospital, University of Côte d’Azur, 06000 Nice, France
| | - Bernard Srour
- The French Network for Nutrition and Cancer Research (NACRe Network), 78350 Jouy-en-Josas, France; (L.D.); (P.F.); (J.G.); (P.L.-M.); (I.R.); (S.S.); (B.S.); (M.T.); (M.T.)
- Nutritional Epidemiology Research Team (EREN), Sorbonne Paris Nord University, INSERM, INRAE, CNAM, Epidemiology and Statistics Research Centre (CRESS), University of Paris, 93022 Bobigny, France
| | - Marina Touillaud
- The French Network for Nutrition and Cancer Research (NACRe Network), 78350 Jouy-en-Josas, France; (L.D.); (P.F.); (J.G.); (P.L.-M.); (I.R.); (S.S.); (B.S.); (M.T.); (M.T.)
- Léon-Bérard Cancer Centre, UA8 Inserm, 69000 Lyon, France
| | - Mathilde Touvier
- The French Network for Nutrition and Cancer Research (NACRe Network), 78350 Jouy-en-Josas, France; (L.D.); (P.F.); (J.G.); (P.L.-M.); (I.R.); (S.S.); (B.S.); (M.T.); (M.T.)
- Nutritional Epidemiology Research Team (EREN), Sorbonne Paris Nord University, INSERM, INRAE, CNAM, Epidemiology and Statistics Research Centre (CRESS), University of Paris, 93022 Bobigny, France
| | - Raphaëlle Ancellin
- The French National Cancer Institute (INCa), 92012 Boulogne-Billancourt, France;
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24
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Halliday LJ, Boshier PR, Doganay E, Wynter-Blyth V, Buckley JP, Moorthy K. The effects of prehabilitation on body composition in patients undergoing multimodal therapy for esophageal cancer. Dis Esophagus 2022; 36:6632930. [PMID: 35795994 PMCID: PMC9885737 DOI: 10.1093/dote/doac046] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/22/2022] [Accepted: 06/13/2022] [Indexed: 02/02/2023]
Abstract
Prehabilitation aims to optimize a patient's functional capacity in preparation for surgery. Esophageal cancer patients have a high incidence of sarcopenia and commonly undergo neoadjuvant therapy, which is associated with loss of muscle mass. This study examines the effects of prehabilitation on body composition during neoadjuvant therapy in esophageal cancer patients. In this cohort study, changes in body composition were compared between esophageal cancer patients who participated in prehabilitation during neoadjuvant therapy and controls who did not receive prehabilitation. Assessment of body composition was performed from CT images acquired at the time of diagnosis and after neoadjuvant therapy. Fifty-one prehabilitation patients and 28 control patients were identified. There was a significantly greater fall in skeletal muscle index (SMI) in the control group compared with the prehabilitation patients (Δ SMI mean difference = -2.2 cm2/m2, 95% CI -4.3 to -0.1, p=0.038). Within the prehabilitation cohort, there was a smaller decline in SMI in patients with ≥75% adherence to exercise in comparison to those with lower adherence (Δ SMI mean difference = -3.2, 95% CI -6.0 to -0.5, P = 0.023). A greater decrease in visceral adipose tissue (VAT) was seen with increasing volumes of exercise completed during prehabilitation (P = 0.046). Loss of VAT during neoadjuvant therapy was associated with a lower risk of post-operative complications (P = 0.017). By limiting the fall in SMI and promoting VAT loss, prehabilitation may have multiple beneficial effects in patients with esophageal cancer. Multi-center, randomized studies are needed to further explore these findings.
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Affiliation(s)
- Laura J Halliday
- Address correspondence to: Miss Laura Halliday, Academic Surgical Unit, 10th Floor, QEQM Building, St Mary’s Hospital, London W2 1NY. Tel: 0203 312 1427 Fax: 0203 312 1810.
| | - Piers R Boshier
- Department of Surgery and Cancer, Imperial College London, UK
| | - Emre Doganay
- Department of Surgery and Cancer, Imperial College London, UK
| | - Venetia Wynter-Blyth
- Oesophago-Gastric Cancer Surgery Unit, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - John P Buckley
- Centre for Active Living, University Centre Shrewsbury/University of Chester, Shrewsbury, UK
| | - Krishna Moorthy
- Department of Surgery and Cancer, Imperial College London, UK
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25
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Chargi N, Bril SI, Smid EJ, de Jong PA, de Bree R. Cut-off values for low skeletal muscle mass at the level of the third cervical vertebra (C3) in patients with head and neck cancer. Quant Imaging Med Surg 2022; 12:3024-3033. [PMID: 35655816 PMCID: PMC9131345 DOI: 10.21037/qims-21-911] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 01/19/2022] [Indexed: 11/19/2023]
Abstract
BACKGROUND Low skeletal muscle mass is associated with adverse outcomes in patients with cancer. For patients with head and neck cancer (HNC), skeletal muscle mass is often assessed at the third cervical vertebra on head and neck imaging. Due to the unavailability of standardized cut-off values for low skeletal muscle mass in patients with head and cancer, there is heterogeneousness of cut-off values for low skeletal muscle mass described in literature. Therefore, we aim to provide standardized cut-off values for low skeletal muscle mass in HNC patients. METHODS A retrospective cohort study was performed. Between 2008 and 2018, HNC patients with head and neck imaging were included. Skeletal muscle area (SMA) was manually delineated at the level of the third cervical vertebra and corrected for patients squared height to obtain the cervical skeletal muscle mass index. Gender and body-mass index specific cut-off values for low skeletal muscle mass were calculated based on mean cervical skeletal muscle mass index minus 2 standard deviations as suggested in literature. RESULTS Of the 1,415 included patients, the majority was male (69.8%) and had a body mass index below 25 kg/m2 (59.2%). A primary tumor localization in the oropharynx (35.3%) and a tumor, node, metastasis stage IV tumor (60.5%) were most frequently observed. Cervical skeletal muscle mass index was significantly correlated with gender (r2=0.4, P<0.01) and body mass index (r2=0.4, P<0.01). For male patients with a body mass index <25 and ≥25 kg/m2, a cervical skeletal muscle mass index of respectively ≤6.8 and ≤8.5 cm2/m2 was defined for low skeletal muscle mass. For female patients with a body mass index <25 and ≥25 kg/m2, a cervical skeletal muscle mass index of respectively ≤5.3 and ≤6.4 cm2/m2 was defined for low skeletal muscle mass. CONCLUSIONS This study is the first to provide standardized cut-off values for low skeletal muscle mass at the level of the third cervical vertebra in patients with HNC. This information may aid in the uniformity of low skeletal muscle mass definition in research.
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Affiliation(s)
- Najiba Chargi
- Department of Head and Neck Surgical Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sandra I. Bril
- Department of Head and Neck Surgical Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ernst J. Smid
- Department of Radiation Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pim A. de Jong
- Department of Radiology and Nuclear Medicine, Division of Imaging and Oncology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
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26
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Boshier PR, Klevebro F, Schmidt A, Han S, Jenq W, Puccetti F, Seesing MFJ, Baracos VE, Low DE. Impact of Early Jejunostomy Tube Feeding on Clinical Outcome and Parameters of Body Composition in Esophageal Cancer Patients Receiving Multimodal Therapy. Ann Surg Oncol 2022; 29:5689-5697. [PMID: 35616747 DOI: 10.1245/s10434-022-11754-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 03/27/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Malnutrition commonly affects patients with esophageal cancer and has the potential to negatively influence treatment outcomes. The aim of this study was to investigate the impact of early (preoperative) jejunostomy tube feeding (JTF) in nutritionally 'high risk' patients receiving multimodal therapy for esophageal cancer. METHODS Patients were selected to undergo early JTF during neoadjuvant chemoradiotherapy (nCRT) in accordance with European Society for Clinical Nutrition and Metabolism (ESPEN) and Enhanced Recovery after Surgery (ERAS®) Society guidelines. Clinical outcomes were compared with patients who received routine JTF from the time of esophagectomy. Body composition was determined from computed tomography (CT) images acquired at diagnosis, after nCRT, and ≥ 3 months after surgery. RESULTS In total, 81 patients received early JTF and 91 patients received routine JTF. Patients who received early JTF had lower body mass index (BMI; 26.1 ± 4.6 vs. 28.4 ± 4.9; p = 0.002), greater weight loss, and worse performance status at diagnosis. Groups were otherwise well-matched for baseline characteristics. Rate of re-intubation (8.8% vs. 1.1%; p = 0.027), pulmonary embolism (5.0% vs. 0.0%; p = 0.046), and 90-day mortality (10.0% vs. 1.1%; p = 0.010) were worse in the early JTF group; however, overall survival was equivalent for both the early and routine JTF groups (p = 0.053). Wide variation in the degree of preoperative muscle loss and total adipose tissue loss was observed across the entire study cohort. Relative preoperative muscle and adipose tissue loss in patients with early and routine JTF was equivalent. CONCLUSIONS In patients determined to be at 'high risk' of malnutrition, early JTF may prevent excess morbidity after esophagectomy with an associated relative preservation of parameters of body composition.
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Affiliation(s)
- Piers R Boshier
- Department of Thoracic Surgery and Surgical Oncology, Virginia Mason Medical Center, Seattle, WA, USA.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Fredrik Klevebro
- Department of Thoracic Surgery and Surgical Oncology, Virginia Mason Medical Center, Seattle, WA, USA
| | - Amy Schmidt
- Department of Thoracic Surgery and Surgical Oncology, Virginia Mason Medical Center, Seattle, WA, USA
| | - Shiwei Han
- Department of Thoracic Surgery and Surgical Oncology, Virginia Mason Medical Center, Seattle, WA, USA
| | - Wesley Jenq
- Department of Thoracic Surgery and Surgical Oncology, Virginia Mason Medical Center, Seattle, WA, USA
| | - Francesco Puccetti
- Department of Thoracic Surgery and Surgical Oncology, Virginia Mason Medical Center, Seattle, WA, USA
| | - Maarten F J Seesing
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Vickie E Baracos
- Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Donald E Low
- Department of Thoracic Surgery and Surgical Oncology, Virginia Mason Medical Center, Seattle, WA, USA.
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Hong S, Kim KW, Park HJ, Ko Y, Yoo C, Park SY, Khang S, Jeong H, Lee J. Impact of Baseline Muscle Mass and Myosteatosis on the Development of Early Toxicity During First-Line Chemotherapy in Patients With Initially Metastatic Pancreatic Cancer. Front Oncol 2022; 12:878472. [PMID: 35669437 PMCID: PMC9163383 DOI: 10.3389/fonc.2022.878472] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/25/2022] [Indexed: 12/15/2022] Open
Abstract
ObjectivesAlthough chemotherapy is the only treatment option for metastatic pancreatic cancer (PDAC), patients frequently encounter adverse events during chemotherapy leading deterioration of patients’ quality of life and treatment interruption. We evaluated the role of baseline CT-assessed body composition in predicting early toxicity during first cycle of the first-line chemotherapy in patients with metastatic PDAC.MethodsThis retrospective study included 636 patients with initially metastatic PDAC who underwent first-line chemotherapy from January 2009 to December 2019. Chemotherapy regimen, baseline laboratory data, and body composition parameters acquired from baseline CT were obtained. The skeletal muscle index (SMI) was used to identify patients with a low muscle mass (SMI < 41 cm2/m2 for women, and < 43 cm2/m2 [body mass index < 25 cm/kg2] or < 53 cm2/m2 [body mass index ≥ 25 cm/kg2] for men), and myosteatosis was defined as low-attenuated muscle area divided by skeletal muscle area (LAMA/SMA index) ≥ 20%. Univariate and multivariable binary logistic regression analyses were performed using bootstrapping with 500 interactions to identify predictors of grade 3–4 toxicity and any treatment-modifying toxicity which led to a dose reduction, delayed administration, drug skip or discontinuation.ResultsDuring the first cycle of the first-line chemotherapy, grade 3–4 toxicity and treatment-modifying toxicity occurred in 160 patients (25.2%) and in 247 patients (38.8%), respectively. The presence of both low muscle mass and myosteatosis was significantly associated with the occurrence of both grade 3-4 toxicity (odd ratio [OR], 1.73; 95% confidence interval [CI], 1.14–2.63) and treatment-modifying toxicity (OR, 1.83; 95% CI, 1.26–2.66) whereas low muscle mass alone did not.ConclusionsThe presence of both low muscle mass and myosteatosis assessed on baseline CT may be used to predict early chemotherapy-related toxicity in patients with metastatic PDAC.
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Affiliation(s)
- Sun Hong
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kyung Won Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyo Jung Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- *Correspondence: Hyo Jung Park,
| | - Yousun Ko
- Biomedical Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, South Korea
| | - Changhoon Yoo
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seo Young Park
- Department of Statistics and Data Science, Korea National Open University, Seoul, South Korea
| | - Seungwoo Khang
- School of Computer Science and Engineering, Soongsil University, Seoul, South Korea
| | - Heeryeol Jeong
- School of Computer Science and Engineering, Soongsil University, Seoul, South Korea
| | - Jeongjin Lee
- School of Computer Science and Engineering, Soongsil University, Seoul, South Korea
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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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Sugimura K, Miyata H, Kanemura T, Takeoka T, Shinnno N, Yamamoto K, Omori T, Motoori M, Ohue M, Yano M. Impact of preoperative skeletal muscle mass and physical performance on short‐term and long‐term postoperative outcomes in patients with esophageal cancer after esophagectomy. Ann Gastroenterol Surg 2022; 6:623-632. [PMID: 36091312 PMCID: PMC9444856 DOI: 10.1002/ags3.12560] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/28/2022] [Accepted: 02/07/2022] [Indexed: 01/11/2023] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Keijiro Sugimura
- Department of Digestive Surgery Osaka International Cancer Institute Osaka Japan
- Department of Surgery Kansai Rosai Hospital Hyogo Japan
| | - Hiroshi Miyata
- Department of Digestive Surgery Osaka International Cancer Institute Osaka Japan
| | - Takashi Kanemura
- Department of Digestive Surgery Osaka International Cancer Institute Osaka Japan
| | - Tomohira Takeoka
- Department of Digestive Surgery Osaka International Cancer Institute Osaka Japan
| | - Naoki Shinnno
- Department of Digestive Surgery Osaka International Cancer Institute Osaka Japan
| | - Kazuyoshi Yamamoto
- Department of Digestive Surgery Osaka International Cancer Institute Osaka Japan
| | - Takeshi Omori
- Department of Digestive Surgery Osaka International Cancer Institute Osaka Japan
| | - Masaaki Motoori
- Department of Surgery Osaka General Medical Center Osaka Japan
| | - Masayuki Ohue
- Department of Digestive Surgery Osaka International Cancer Institute Osaka Japan
| | - Masahiko Yano
- Department of Digestive Surgery Osaka International Cancer Institute Osaka Japan
- Department of Surgery Osaka Suita Municipal Hospital Osaka Japan
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Martin L, Tom M, Basualdo-Hammond C, Baracos V, Gramlich L. Piloting a training program in computed tomography (CT) skeletal muscle assessment for Registered Dietitians. JPEN J Parenter Enteral Nutr 2022; 46:1317-1325. [PMID: 35147237 DOI: 10.1002/jpen.2348] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/25/2022] [Accepted: 02/04/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Consensus definitions for disease-associated malnutrition and sarcopenia include reduced skeletal muscle mass as a diagnostic criterion. There is a need to develop and validate techniques to assess skeletal muscle in clinical practice. Skeletal muscle mass can be precisely quantified from computed tomography (CT) images. This pilot study aimed to train Registered Dietitians (RD) to complete precise skeletal muscle measurements using CT. METHODS Purposive sampling identified RDs employed in clinical areas where CT scans are routinely performed. CT training included: 1) a 3-day training session focused on manual segmentation of skeletal muscle cross-sectional areas (cm2 ) from abdominal CT images at the third lumber (L3) vertebra, using SliceOmatic® software, and 2) a precision assessment to quantify the intra- and inter-observer precision error of repeated skeletal muscle measurements (30 images in duplicate). Precision error is reported as the root mean standard deviation (cm2 ) and % coefficient of variation (%CV), our primary performance indicator was defined as a precision error <2%. RESULTS Five RDs completed CT training. RDs were from three clinical areas (cancer care (N=1), surgery (N=2), and critical care (N=1). RDs precision error was low and below the minimal acceptable error of <2%; intra-observer error was ≤1.8 cm2 (range 0.8 - 1.8 cm2 ) or ≤1.5% (range 0.8 - 1.5%) and inter-observer error was 1.2 cm2 or 1.1%. CONCLUSION RDs can be trained to perform precise CT skeletal muscle measurements. Increasing capacity to assess skeletal muscle is a first step toward developing this technique for use in clinical practice. CLINICAL RELEVANCE STATEMENT There is significant interest from both researchers and clinicians to undertake the measurement of skeletal muscle. Reduced skeletal muscle mass places individuals at risk of experiencing adverse outcomes and is a diagnostic criterion for disease-associated malnutrition and sarcopenia. In this study we piloted a training program in computed tomography (CT)-skeletal muscle assessments for RDs, and demonstrated after completion of the program RDs were able to perform CT skeletal muscle measurements with high precision. The addition of new tools to the comprehensive nutrition assessment tool box may benefit clinical practice in multiple ways including improved identification of patients with reduced skeletal muscle mass, individualization of interventions, and monitoring effectiveness of interventions over time. Other clinicians may also benefit from knowing about their patients' skeletal muscle mass to help identify risk and make treatment decisions. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Lisa Martin
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mei Tom
- Alberta Health Services, Edmonton, Alberta, Canada
| | | | - Vickie Baracos
- Department of Oncology, University of Alberta. Edmonton, Alberta, Canada
| | - Leah Gramlich
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Application of Prognostic Models Based on Psoas Muscle Index, Stage, Pathological Grade, and Preoperative Carcinoembryonic Antigen Level in Stage II-III Colorectal Cancer Patients Undergoing Adjuvant Chemotherapy. JOURNAL OF ONCOLOGY 2022; 2022:6851900. [PMID: 35154320 PMCID: PMC8828329 DOI: 10.1155/2022/6851900] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/03/2022] [Indexed: 12/22/2022]
Abstract
Objective To investigate the effect of sarcopenia on the prognosis of stage II-III colorectal cancer patients undergoing adjuvant chemotherapy. Methods A total of 196 stage II-III colorectal cancer patients who received 8 cycles of postoperative chemotherapy were retrospectively analyzed. An abdominal CT acquired at 3-4 weeks after surgery was used to calculate the psoas muscle index. Subsequently, once gender-specific receiver operating characteristic curves were plotted and cut-off values of psoas muscle index were defined, the clinicopathological characteristics and the prognosis of patients with high and low values were compared. Lastly, prognostic models were established based on the independent prognostic factors of relapse-free survival and overall survival identified by COX analysis. Results Based on the psoas muscle index, the prevalence of sarcopenia was 37.5% among 196 patients. This prevalence has significant correlation with patients' age and gender. However, it was not related to the AJCC stage, T stage, lymph node metastasis, pathological grade, grade III-IV myelosuppression, or preoperative carcinoembryonic antigen level. In addition, both the relapse-free and the overall survival of patients with low and high psoas muscle indexes were significantly different. COX analysis indicated that the psoas muscle index was an independent prognostic factor. Both the overall survival prognostic model based on patients' psoas muscle index, stage, pathological grade, and preoperative carcinoembryonic antigen level and the relapse-free survival prognostic model based on patients' psoas muscle index, pathological grade, and preoperative carcinoembryonic antigen level could accurately predict the prognosis of patients. Conclusion For stage II-III colorectal cancer patients, the presence of sarcopenia before adjuvant chemotherapy would adversely affect their recurrence-free and overall survival. Prognostic models based on psoas muscle index, stage, pathological grade, and preoperative carcinoembryonic antigen level could accurately predict the prognosis in these patients.
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Bennett S, Murphy CF, Fanning M, Reynolds JV, Doyle SL, Donohoe CL. The impact of Nutrition and Gastrointestinal Symptoms on Health-related Quality of Life in Survivorship after Oesophageal Cancer Surgery. CLINICAL NUTRITION OPEN SCIENCE 2022. [DOI: 10.1016/j.nutos.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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de Jong MC, Patel N, Hassan-Smith Z, Mihai R, Khan S. Sarcopenia is Associated with Reduced Survival following Surgery for Adrenocortical Carcinoma. Endocr Res 2022; 47:8-17. [PMID: 34340645 DOI: 10.1080/07435800.2021.1954942] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM Adrenocortical cancer (ACC) is an aggressive malignancy and robust prognostic factors remain unclear. The presence of sarcopenia has been shown to negatively impact survival for other malignancies, but has not been extensively analyzed in ACC. METHODS Patients who underwent resection of their ACC between 2010 and 2020 were identified; therapeutic, operative, and outcome data were analyzed. Sarcopenia was assessed by calculation of the skeletal muscle index (SMI) and was defined as an SMI <52.4cm2/m2 for males and <38.5cm2/m2 for females. RESULTS Data on 35 patients (18 F: 17 M; median age 54 [range: 18-86]) who had primary surgical treatment were analyzed. Median tumor size was 10 cm [range:3-15]. In eleven patients (31%), the tumor was hormonally active (cortisol = 8;23%). Seventeen patients (49%) were classified as having sarcopenia on their pre-operative CT scan. The Intraclass Correlation Coefficient (ICC) for intra- and inter-observer variability showed very good agreement (0.99 and 0.98). There was no difference in incidence of sarcopenia stratifying for sex, BMI, or tumor-size, but incidence was higher with increasing age (p < .05). Overall median survival was 36 months, with 1- and 3-year survival rates of 77% and 52%. The presence of sarcopenia was strongly associated with a shorter overall survival (HR = 3.21; [95%CI: 1.06-9.69];p = .03) on unadjusted analyses. Moreover, age, higher T-stage, and presence of capsular invasion were also associated with poorer survival on univariable analyses. CONCLUSION The presence of sarcopenia in patients undergoing surgery for ACC could be a predictor of reduced overall survival, although replications of these analyses should be performed in similar, larger cohorts. Specifically, the influence of a patient's hormonal status on the manifestation of sarcopenia should be further defined.
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Affiliation(s)
- Mechteld C de Jong
- Department of Endocrine Surgery - Churchill Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Neel Patel
- Department of Radiology - Churchill Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Zaki Hassan-Smith
- Centre for Endocrinology, Diabetes & Metabolism, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Radu Mihai
- Department of Endocrine Surgery - Churchill Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Shahab Khan
- Department of Endocrine Surgery - Churchill Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Takagi A, Hawke P, Tokuda S, Toda T, Higashizono K, Nagai E, Watanabe M, Nakatani E, Kanemoto H, Oba N. Serum carnitine as a biomarker of sarcopenia and nutritional status in preoperative gastrointestinal cancer patients. J Cachexia Sarcopenia Muscle 2022; 13:287-295. [PMID: 34939358 PMCID: PMC8818668 DOI: 10.1002/jcsm.12906] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 09/05/2021] [Accepted: 11/29/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Sarcopenia is an important factor in the postoperative outcome of gastrointestinal cancer patients. However, little research has been carried out on potential biomarkers of sarcopenia. Carnitine is an amino acid derivative that is stored in skeletal muscle and is essential for muscle energy metabolism. The primary purpose of this study was to investigate whether serum carnitine level is a biomarker of sarcopenia in preoperative patients with gastrointestinal cancer. The secondary purposes were (i) to examine the associations between carnitine, nutritional status, and albumin level, and (ii) to determine whether carnitine is a prognostic factor for postoperative complications. METHODS One hundred fourteen patients scheduled to undergo gastroenterological surgery between August 2016 and January 2017 were enrolled. Their mean age was 68.4 ± 10.5, and 64.9% were male. Serum carnitine fractions [total carnitine (TC), free l-carnitine (FC), and acylcarnitine (AC)] were measured prior to surgery. The correlation between carnitine level and a variety of clinical features was analysed, including skeletal muscle index (SMI), sarcopenia, prognostic nutritional index (PNI), and postoperative complications. RESULTS Tumour locations included the oesophagus (n = 17), stomach (n = 16), pancreas (n = 20), bile duct (n = 9), liver [n = 33; primary liver cancer (n = 18), liver metastasis (n = 15)], and colorectal region (n = 19). TC and FC levels varied significantly by tumour location. TC and FC showed significant positive correlations with SMI [TC (r = 0.295, P = 0.0014), FC (r = 0.286, P = 0.0020)] and PNI [TC (P = 0.0178, r = 0.222), FC (P = 0.0067, r = 0.2526)]. These levels were significantly lower in the sarcopenia group (TC, P = 0.0124; FC, P = 0.0243). In addition, TC and FC showed significant positive correlations with ALB level [TC (P = 0.038 r = 0.19), FC (P = 0.016 r = 0.23)]. When patients were divided into high ALB (≥3.5 g/dL, 96 patients) and low ALB (<3.5 g/dL, 18 patients) groups, these correlations were no longer significant, but in the low ALB group there was a tendency towards a negative relationship between ALB level and both TC and FC. No significant relationship was found between postoperative complications and carnitine level. CONCLUSIONS This study suggests that carnitine level is a biomarker of sarcopenia and nutritional status. However, it did not find an association between carnitine level and postoperative complications.
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Affiliation(s)
- Akihiko Takagi
- Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Philip Hawke
- School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Satoshi Tokuda
- Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Takeo Toda
- Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Kazuya Higashizono
- Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Erina Nagai
- Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Masaya Watanabe
- Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Eiji Nakatani
- Division of Statistical Analysis, Research Support Center, Shizuoka General Hospital, Shizuoka, Japan
| | - Hideyuki Kanemoto
- Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Noriyuki Oba
- Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, Japan
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Brown LR, Laird BJA, Wigmore SJ, Skipworth RJE. Understanding Cancer Cachexia and Its Implications in Upper Gastrointestinal Cancers. Curr Treat Options Oncol 2022; 23:1732-1747. [PMID: 36269458 PMCID: PMC9768000 DOI: 10.1007/s11864-022-01028-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2022] [Indexed: 01/30/2023]
Abstract
OPINION STATEMENT Considerable advances in the investigation and management of oesophagogastric cancer have occurred over the last few decades. While the historically dismal prognosis associated with these diseases has improved, outcomes remain very poor. Cancer cachexia is an often neglected, yet critical, factor for this patient group. There is a persuasive argument that a lack of assessment and treatment of cachexia has limited progress in oesophagogastric cancer care. In the curative setting, the stage of the host (based on factors such as body composition, function, and inflammatory status), alongside tumour stage, has the potential to influence treatment efficacy. Phenotypical features of cachexia may decrease the survival benefit of (peri-operative) chemoradiotherapy, immunotherapy, or surgical resection in patients with potentially curative malignancy. Most patients with oesophagogastric cancer unfortunately present with disease which is not amenable, or is unlikely to respond, to these treatments. In the palliative setting, host factors can similarly impair results from systemic anti-cancer therapies, cause adverse symptoms, and reduce quality of life. To optimise treatment pathways and enhance patient outcomes, we must utilise this information during clinical decision-making. As our understanding of the genesis of cancer cachexia improves and more therapeutic options, ranging from basic (e.g. exercise and nutrition) to targeted (e.g. anti-IL1 α and anti-GDF-15), become available, there can be grounds for optimism. Cachexia can change from a hitherto neglected condition to an integral part of the oesophagogastric cancer treatment pathway.
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Affiliation(s)
- Leo R. Brown
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, Scotland EH16 4SA UK
| | - Barry J. A. Laird
- Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital, Edinburgh, Scotland EH4 2XU UK ,St Columba’s Hospice, Edinburgh, Scotland EH5 3RW UK
| | - Stephen J. Wigmore
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, Scotland EH16 4SA UK
| | - Richard J. E. Skipworth
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, Scotland EH16 4SA UK
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Zouhry Y, Taibi A, Durand-Fontanier S, Darbas T, Forestier G, Monteil J, Lebrun-Ly V, Fayemendy P, Leobon S, Jesus P, Deluche E. Degradation of skeletal mass in locally advanced oesophageal cancer between initial diagnosis and recurrence. BMC Cancer 2021; 21:1313. [PMID: 34876055 PMCID: PMC8653570 DOI: 10.1186/s12885-021-09037-3] [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: 09/29/2021] [Accepted: 11/19/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The prognostic value of a low skeletal mass index (SMI) has been investigated in locally advanced oesophageal (LAE) cancer at diagnosis. However, nothing is known about its evolution and clinical impact between initial diagnosis and recurrence. METHODS A total of 89 patients treated for LAE cancer between January 2009 and December 2019 were included in this study. Computed tomography (CT) scans before treatment and at recurrence were evaluated. SMI and other body composition parameters were analysed by the L3 scan method. RESULTS Participants were aged 66.0 (36.0-86) years. The incidence of low SMI increased by 12.3% between diagnosis and recurrence (70.7% vs. 83.0%, respectively) over a median follow-up of 16.9 (1.7-101.6) months. Patients with high SMI at diagnosis showed loss of muscle mass (58.0 vs. 55.2 cm2/m2, respectively; P < 0.001) and decreased body mass index (BMI) (27.9 vs. 26.3 kg/m2, respectively; P = 0.05), but fat mass was increased (68.9 vs. 72.0 cm2/m2, respectively; P = 0.01). Patients with low SMI at diagnosis showed no significant changes in body composition parameters and no improvement of SMI, even with nutritional support. Low SMI (hazard ratio [HR]: 1.8; 95% confidence interval [CI]: 1.02-3.16) was an independent predictor (P = 0.041) of high nutritional risk index (HR: 1.79; 95% CI: 1.03-3.11; P = 0.039) at diagnosis. CONCLUSIONS The percentage of patients with a low SMI increased during follow-up. Our data suggest that an assessment of skeletal muscle parameters and nutrition support may be more useful in patients with a high SMI.
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Affiliation(s)
- Yacine Zouhry
- Medical Oncology Department, Limoges University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France
| | - Abdelkader Taibi
- Digestive Surgery Department, Limoges University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France
| | - Sylvaine Durand-Fontanier
- Digestive Surgery Department, Limoges University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France
| | - Tiffany Darbas
- Medical Oncology Department, Limoges University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France
| | - Geraud Forestier
- Neuroradiology Department, Limoges University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France
| | - Jacques Monteil
- Nuclear Medicine Department, Limoges University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France
| | - Valérie Lebrun-Ly
- Medical Oncology Department, Limoges University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France
| | - Philippe Fayemendy
- Nutrition Unit, Limoges University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France.,Tropical Neuroepidemiology Institute GEIST, INSERM, U1094, 33 rue François Mitterrand, 87032, Limoges, France
| | - Sophie Leobon
- Medical Oncology Department, Limoges University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France
| | - Pierre Jesus
- Medical Oncology Department, Limoges University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France
| | - Elise Deluche
- Medical Oncology Department, Limoges University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France.
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Preoperative Muscle Strength Is a Predictor of Outcomes After Esophagectomy. J Gastrointest Surg 2021; 25:3040-3048. [PMID: 34729696 DOI: 10.1007/s11605-021-05183-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/04/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Sarcopenia, loss of muscle mass and strength, has been associated with more frequent complications after esophagectomy. This study compared hand-grip strength, muscle mass, and intramuscular adipose tissue as predictors of postoperative outcomes and mortality after esophagectomy. METHODS Minimally invasive esophagectomy was performed on 175 patients with esophageal cancer. Skeletal muscle index and skeletal muscle density were derived from preoperative CTs. Hand-grip strength was measured using dynamometer. Univariate and multivariable analyses were performed. RESULTS Preoperative hand-grip strength was normal in 91 (52%), intermediate in 43 (25%), and weak in 41 (23%) patients. Hand-grip strength was significantly correlated with both skeletal muscle index and skeletal muscle density. Postoperative pneumonia occurred in 8/41 (20%) patients with weak strength compared to 4/91 (4%) with normal strength (p = 0.006; Cochran-Armitage Test). Prolonged postoperative ventilation occurred in 11/41 (27%) patients with weak strength compared to 11/91 (12%) with normal strength (p = 0.036). Median length of stay was 9 days in patients with weak strength compared to 7 days for those with normal strength (p = 0.005; Kruskal-Wallis Test). Discharge to non-home location occurred in 15/41 (37%) with weak strength compared to 8/91 (9%) with normal strength (p < 0.001). Postoperative mortality at 90 days was 4/41 (10%) with weak strength compared with no mortalities (0/91) in the normal strength group (p = 0.004). Mortality at 1 year was 18/39 (46%) in patients with weak strength compared to 6/81 (7%) with normal strength, among 158 patients with 1-year follow-up (p < 0.001). CONCLUSIONS Preoperative hand-grip strength was found to be a powerful predictor of postoperative pneumonia, length of stay, discharge to non-home location, and mortality after esophagectomy.
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Findlay M, White K, Brown C, Bauer JD. Nutritional status and skeletal muscle status in patients with head and neck cancer: Impact on outcomes. J Cachexia Sarcopenia Muscle 2021; 12:2187-2198. [PMID: 34676673 PMCID: PMC8718020 DOI: 10.1002/jcsm.12829] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 09/05/2021] [Accepted: 09/11/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Computed tomography (CT)-defined skeletal muscle depletion and malnutrition are demonstrated as poor prognostic factors in patients with head and neck cancer (HNC), however to date, have only been explored in isolation. We aimed to describe body composition profile and examine the impact of nutritional status as well as independently and concurrently occurring body composition features on overall survival, treatment completion, unplanned admissions and length of stay (LOS) in patients undergoing radiotherapy (RT) or chemoradiotherapy (CRT) of curative intent for HNC. METHODS This work is a retrospective, observational study of patients who had completed treatment of curative intent for HNC. Scored Patient-Generated Subjective Global Assessment (PG-SGA) was used to determine nutritional status. Tissue-density data were derived at the third lumbar vertebra (L3) with sarcopenia and myosteatosis defined by published, sex-specific threshold values stratified by body mass index for skeletal muscle index (cm2 /m2 ) and skeletal muscle radiodensity (SMR, Hounsfield Unit). RESULTS Pre-treatment data (n = 277: 78% male, mean (SD) age 60 (13) years) revealed the prevalence of malnutrition (24.9%), sarcopenia (52.3%), myosteatosis (82.3%), and concurrently occurring sarcopenia and myosteatosis (39.7%). Malnutrition was independently associated with reduced OS for patients with moderate [hazard ratio (HR) 2.57; 95% confidence interval (CI) 1.45-4.55, P = 0.001] and severe (HR 3.19; 95% CI 1.44-7.07, P = 0.004) malnutrition on multivariable analysis but not sarcopenia (HR 1.09; 95% CI 0.70-1.71), P = 0.700 or myosteatosis (HR 1.28; 95% CI 0.57-2.84), P = 0.500). Malnutrition was associated with treatment discontinuation (P < 0.001), not completing RT as planned (P < 0.001), unplanned hospital admission (P = 0.021), and greater LOS (P < 0.001). Skeletal muscle status features were associated with unplanned hospital admissions for those with no features (32%), with sarcopenia only (50%), myosteatosis only (25%), and concurrent sarcopenia and myosteatosis (50%), P < 0.001. Similarly, a clinically relevant greater median (Q1, Q3) LOS was observed for those with sarcopenia only [5 (3, 32)], myosteatosis only [10 (5, 30)], concurrent sarcopenia, and myosteatosis [14 (4, 33)] days vs. those with no features [3 (2, 11)] days, P = 0.2. CONCLUSIONS Malnutrition was a more powerful prognostic indicator than CT-defined skeletal muscle depletion and was independently associated with reduced OS in patients undergoing RT or CRT of curative intent for HNC. CT-defined skeletal muscle depletion studies should recognize the multifaceted nature of human body composition and also measure nutritional status using validated methods in order to move towards developing a typology of high risk criteria for this complex patient group.
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Affiliation(s)
- Merran Findlay
- Cancer ServicesRoyal Prince Alfred HospitalCamperdownNSWAustralia
- Chris O'Brien Lifehouse, New South WalesCamperdownNSWAustralia
- Cancer Nursing Research Unit, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and HealthUniversity of SydneyCamperdownNSWAustralia
- The Daffodil CentreThe University of Sydney, a joint venture with Cancer CouncilNSWAustralia
| | - Kathryn White
- Cancer ServicesRoyal Prince Alfred HospitalCamperdownNSWAustralia
- Cancer Nursing Research Unit, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and HealthUniversity of SydneyCamperdownNSWAustralia
- The Daffodil CentreThe University of Sydney, a joint venture with Cancer CouncilNSWAustralia
| | - Chris Brown
- National Health and Medical Research Council Clinical Trials CentreThe University of SydneyCamperdownNSWAustralia
| | - Judith D. Bauer
- School of Human Movement and Nutrition SciencesUniversity of QueenslandSt LuciaQLDAustralia
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Surgical Therapy of Esophageal Adenocarcinoma-Current Standards and Future Perspectives. Cancers (Basel) 2021; 13:cancers13225834. [PMID: 34830988 PMCID: PMC8616112 DOI: 10.3390/cancers13225834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/15/2021] [Accepted: 11/18/2021] [Indexed: 12/18/2022] Open
Abstract
Simple Summary Subtotal resection of the esophagus with resection of local lymph nodes is the oncological procedure of choice for advanced esophageal cancer. Reconstruction of the intestinal tract is predominantly performed with a gastric tube. Even in specialized centers, this surgical procedure is associated with a high complication but low mortality rate. Therefore, clinical research aims to develop peri- and intra-operative strategies to improve the patient related outcome. Abstract Transthoracic esophagectomy is currently the predominant curative treatment option for resectable esophageal adenocarcinoma. The majority of carcinomas present as locally advanced tumors requiring multimodal strategies with either neoadjuvant chemoradiotherapy or perioperative chemotherapy alone. Minimally invasive, including robotic, techniques are increasingly applied with a broad spectrum of technical variations existing for the oncological resection as well as gastric reconstruction. At the present, intrathoracic esophagogastrostomy is the preferred technique of reconstruction (Ivor Lewis esophagectomy). With standardized surgical procedures, a complete resection of the primary tumor can be achieved in almost 95% of patients. Even in expert centers, postoperative morbidity remains high, with an overall complication rate of 50–60%, whereas 30- and 90-day mortality are reported to be <2% and <6%, respectively. Due to the complexity of transthoracic esophagetomy and its associated morbidity, esophageal surgery is recommended to be performed in specialized centers with an appropriate caseload yet to be defined. In order to reduce postoperative morbidity, the selection of patients, preoperative rehabilitation and postoperative fast-track concepts are feasible strategies of perioperative management. Future directives aim to further centralize esophageal services, to individualize surgical treatment for high-risk patients and to implement intraoperative imaging modalities modifying the oncological extent of resection and facilitating surgical reconstruction.
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Uemura S, Shichinohe T, Kurashima Y, Ebihara Y, Murakami S, Hirano S. Effects of preoperative psoas muscle index and body mass index on postoperative outcomes after video-assisted esophagectomy for esophageal cancer. Asian J Endosc Surg 2021; 14:739-747. [PMID: 33759373 DOI: 10.1111/ases.12933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/10/2021] [Accepted: 03/05/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Preoperative psoas muscle index (PMI) and body mass index (BMI) are relevant to postoperative outcomes. We investigated the associations of PMI, BMI, and preoperative nutritional and muscular score with postoperative outcomes in patients with esophageal cancer who underwent video-assisted surgery. METHODS We examined 150 patients (124 men, 26 women) who underwent video-assisted esophagectomy from February 2002 to March 2016. We used the Clavien-Dindo (CD) classification to analyze postoperative complications. Because skeletal muscle volume differs significantly between male and female patients, all analyses were performed separately. In male patients, we used the following cut-off values to categorize patients into three groups: PMI = 600 mm2 /m2 , BMI = 18.5 kg/m2 , and preoperative nutritional and muscular (PNM) scores 0 to 2. RESULTS Two patients were converted to open thoracotomy. Among male patients, PMI and PNM scores were significant risk factors for complications. Among male patients, in the high PMI group, the number of CD ≥ IIIa complications was significantly lower. In the PNM score 0 group (both PMI and BMI values exceeded the cut-off values), the number of complications was significantly lower. In both genders, PMI and BMI were not significantly associated with survival. CONCLUSIONS PMI and PNM scores can be useful for predicting postoperative outcomes in male patients with esophageal cancer having undergone video-assisted surgery.
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Affiliation(s)
- Shion Uemura
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Toshiaki Shichinohe
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Yo Kurashima
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Yuma Ebihara
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Soichi Murakami
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Japan
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Trussardi Fayh AP, de Sousa IM. Comparison of revised EWGSOP2 criteria of sarcopenia in patients with cancer using different parameters of muscle mass. PLoS One 2021; 16:e0257446. [PMID: 34520502 PMCID: PMC8439478 DOI: 10.1371/journal.pone.0257446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 09/01/2021] [Indexed: 01/06/2023] Open
Abstract
Calf circumference (CC) has been established as a marker of muscle mass (MM) with good performance for predicting survival in individuals with cancer. The study aims to determine the prevalence of sarcopenia according to the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria and to evaluate the accuracy of sarcopenia using low CC relative to MM assessment by computed tomography (CT) at third lumbar vertebra level (L3) as a reference. Cross-sectional study with cancer patients aged ≥ 60 years. Data included socio-demographic, clinical and anthropometric variables. MM was assessed by CC and by CT images at the L3. Sarcopenia was diagnosed according to the EWGSOP2 criteria: a) low handgrip strength (HGS) + reduced MM evaluated by CT; and b) low HGS + low CC. Pearson's correlation, accuracy, sensitivity, specificity, positive predictive and negative predictive value were analyzed. A total of 108 patients were evaluated, age of 70.6 ± 7.4 years (mean ± standard deviation). The prevalence of sarcopenia was of 24.1% (low MM) and 25.9% (low CC). The Kappa test showed a substantial agreement (K = 0.704), 81% sensitivity, and 92% specificity. Although the EWGSOP2 advises that we should use CC measures in the algorithm for sarcopenia when no other MM diagnostic methods are available, the findings allow the use of CC instead of MM by CT in cancer patients.
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Affiliation(s)
- Ana Paula Trussardi Fayh
- Postgraduate Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
- Postgraduate Program in Nutrition, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
- Postgraduate Program in Physical Education, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
- * E-mail:
| | - Iasmin Matias de Sousa
- Postgraduate Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
- Postgraduate Program in Nutrition, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
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Hiatt JS, Young A, Brown TE, Banks M, Bauer J. Patient and carer experience of nutrition care throughout and beyond treatment for head and neck cancer: a qualitative longitudinal study. Support Care Cancer 2021; 30:813-824. [PMID: 34390400 DOI: 10.1007/s00520-021-06484-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/31/2021] [Indexed: 11/29/2022]
Abstract
Nutrition care plays a critical role in optimising outcomes for patients receiving treatment for head and neck cancer (HNC), with carers playing an important role in supporting patients to maintain nutrition intake. This study explores patient and carer experience of nutrition care from diagnosis of HNC to 1 year post treatment completion to identify areas for improvement of service delivery. A longitudinal qualitative study design was used with a heterogeneous sample of 20 patients and 15 carers of patients undergoing curative intent treatment for HNC. Interviews conducted at four time points provided a total of 117 interview datasets that were analysed using reflexive thematic analysis based on Gadamerian hermeneutic inquiry. Patient and carer experiences were reflected in two primary themes: (1) the battle to maintain control and (2) navigating the road ahead. This research identifies the need to co-design strategies to improve nutrition care that is inclusive of patients and carers.
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Affiliation(s)
- Joanne S Hiatt
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Australia. .,Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Level 2, Dr James Mayne Building, Butterfield Street, Herston, QLD, 4029, Australia.
| | - Adrienne Young
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Australia.,Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Level 2, Dr James Mayne Building, Butterfield Street, Herston, QLD, 4029, Australia
| | - Teresa E Brown
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Australia.,Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Level 2, Dr James Mayne Building, Butterfield Street, Herston, QLD, 4029, Australia
| | - Merrilyn Banks
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Australia.,Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Level 2, Dr James Mayne Building, Butterfield Street, Herston, QLD, 4029, Australia
| | - Judith Bauer
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Australia
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Xu YY, Zhou XL, Yu CH, Wang WW, Ji FZ, He DC, Zhu WG, Tong YS. Association of Sarcopenia With Toxicity and Survival in Postoperative Recurrent Esophageal Squamous Cell Carcinoma Patients Receiving Chemoradiotherapy. Front Oncol 2021; 11:655071. [PMID: 34307131 PMCID: PMC8297440 DOI: 10.3389/fonc.2021.655071] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/24/2021] [Indexed: 12/11/2022] Open
Abstract
Background Sarcopenia has been associated with treatment-related toxicities and poor survival in cancer patients. Our aim was to investigate the prevalence of sarcopenia in postoperative recurrent esophageal squamous cell carcinoma (ESCC) patients receiving chemoradiotherapy (CRT) and evaluate associations with treatment-related toxicity and prognosis. Methods One hundred and eighty-four patients with postoperative locoregional recurrent ESCC receiving CRT between January 2014 and December 2016 were included. The skeletal muscle area (SMA) was measured at the third lumbar vertebra level. Sarcopenia was defined as skeletal muscle index (SMI = SMA/height2) less than 47.24/cm2/m2 for men and 36.92/cm2/m2 for women. Association of sarcopenia with overall survival (OS) was analyzed using univariate and multivariate cox regression models. Results Sarcopenia was observed in 94 of 184 (51.1%) patients. Sarcopenic patients had significantly higher rates of grade 3-4 toxicities compared to those without sarcopenia (36.2% vs 21.1%, p = 0.034). The survival rate at 12 and 24 months was 36.2% and 3.2% in the sarcopenic patients and 57.8% and 17.8% in the non-sarcopenic patients (p < 0.001). Multivariate cox regression analysis showed that sarcopenia was significantly associated with decreased OS (HR = 1.729, 95% CI 1.231-2.428, p = 0.002). Conclusions Sarcopenia is an independent indicator of poor survival in postoperative locoregional recurrent ESCC patients treated with CRT. Early nutritional interventions before treatment may improve the prognosis.
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Affiliation(s)
- Ying-Ying Xu
- Department of Radiation Oncology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, China
| | - Xi-Lei Zhou
- Department of Radiation Oncology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, China
| | - Chang-Hua Yu
- Department of Radiation Oncology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, China
| | - Wan-Wei Wang
- Department of Radiation Oncology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, China
| | - Fu-Zhi Ji
- Department of Radiation Oncology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, China
| | - Dong-Cheng He
- Department of Radiation Oncology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, China
| | - Wei-Guo Zhu
- Department of Radiation Oncology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, China
| | - Yu-Suo Tong
- Department of Radiation Oncology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, China
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Fujisawa K. ASO Author Reflections: Longitudinal Nutritional Outcomes of Thoracic Duct Resection for Radical Esophagectomy. Ann Surg Oncol 2021; 28:8426-8427. [PMID: 34120265 DOI: 10.1245/s10434-021-10280-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 05/27/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Kentoku Fujisawa
- Department of Gastroenterological Surgery, Toranomon Hospital, Okinaka Memorial Institute for Medical Research, Tokyo, Japan.
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Bossi P, Delrio P, Mascheroni A, Zanetti M. The Spectrum of Malnutrition/Cachexia/Sarcopenia in Oncology According to Different Cancer Types and Settings: A Narrative Review. Nutrients 2021; 13:1980. [PMID: 34207529 PMCID: PMC8226689 DOI: 10.3390/nu13061980] [Citation(s) in RCA: 131] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/26/2021] [Accepted: 06/02/2021] [Indexed: 12/15/2022] Open
Abstract
Nutritional status in oncological patients may differ according to several modifiable and non-modifiable factors. Knowledge of the epidemiology of malnutrition/cachexia/sarcopenia may help to manage these complications early in the course of treatment, potentially impacting patient quality of life, treatment intensity, and disease outcome. Therefore, this narrative review aimed to critically evaluate the current evidence on the combined impact of tumor- and treatment-related factors on nutritional status and to draw some practical conclusions to support the multidisciplinary management of malnutrition in cancer patients. A comprehensive literature search was performed from January 2010 to December 2020 using different combinations of pertinent keywords and a critical evaluation of retrieved literature papers was conducted. The results show that the prevalence of weight loss and associated symptoms is quite heterogeneous and needs to be assessed with recognized criteria, thus allowing a clear classification and standardization of therapeutic interventions. There is a large range of variability influenced by age and social factors, comorbidities, and setting of cures (community-dwelling versus hospitalized patients). Tumor subsite is one of the major determinants of malnutrition, with pancreatic, esophageal, and other gastroenteric cancers, head and neck, and lung cancers having the highest prevalence. The advanced stage is also linked to a higher risk of developing malnutrition, as an expression of the relationship between tumor burden, inflammatory status, reduced caloric intake, and malabsorption. Finally, treatment type influences the risk of nutritional issues, both for locoregional approaches (surgery and radiotherapy) and for systemic treatment. Interestingly, personalized approaches based on the selection of the most predictive malnutrition definitions for postoperative complications according to cancer type and knowledge of specific nutritional problems associated with some new agents may positively impact disease course. Sharing common knowledge between oncologists and nutritionists may help to better address and treat malnutrition in this population.
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Affiliation(s)
- Paolo Bossi
- Medical Oncology Unit, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, 25123 Brescia, Italy
| | - Paolo Delrio
- Colorectal Surgical Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione Giovanni Pascale IRCCS-Italia, 80131 Naples, Italy;
| | - Annalisa Mascheroni
- Clinical Nutrition and Dietetics Unit, ASST Melegnano-Martesana, 20077 Melegnano, Italy;
| | - Michela Zanetti
- Department of Medical Sciences, University of Trieste, 34100 Trieste, Italy;
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Fujisawa K, Ohkura Y, Ueno M, Yago A, Shimoyama H, Udagawa H. Nutritional Outcomes of Thoracic Duct Resection for Radical Esophagectomy by Assessing Body Composition Changes in One Year: A Single-Center Retrospective Study. Ann Surg Oncol 2021; 28:8414-8425. [PMID: 34085142 DOI: 10.1245/s10434-021-10222-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 05/12/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Thoracic duct (TD) resection is performed when the tumor or a metastatic lymph node directly invades the TD, and is sometimes indicated for radical lymphadenectomy during esophagectomy in esophageal cancer patients. However, the effect of TD resection on nutritional status has not been established. PATIENTS AND METHODS In total, 174 consecutive patients from October 2015 to March 2019 who underwent radical esophagectomy for esophageal cancer in Toranomon Hospital were classified into thoracic duct preserved group (n = 51) and TD-resected (TD-R) group (n = 123). We compared laboratory data, body composition data from bioelectrical impedance analysis measured preoperatively and at 1 and 12 months after surgery, and postoperative complications between the two groups. RESULTS Clinical stage was significantly more advanced in the TD-R group. Total body weight, body mass index, and fat mass continuously decreased in the two groups over 12 months after surgery, and the decreases were statistically greater in the TD-R group at 12 months after surgery. Skeletal muscle mass and fat-free mass decreased over 1 month after surgery and stayed in a reduced state until 12 months after surgery without statistically significant differences between the two groups. TD resection did not increase incidence of postoperative complications (Clavien-Dindo classification ≥ grade III), but TD resection increased incidence of chylothorax. CONCLUSIONS Our results suggest that loss of body fat mass, which was a main contributor to body weight loss, was accelerated in the TD-R group, but TD resection does not deteriorate loss of muscle mass at 12 months after surgery.
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Affiliation(s)
- Kentoku Fujisawa
- Department of Gastroenterological Surgery, Toranomon Hospital, Okinaka Memorial Institute for Medical Research, Tokyo, Japan.
| | - Yu Ohkura
- Department of Gastroenterological Surgery, Toranomon Hospital, Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Masaki Ueno
- Department of Gastroenterological Surgery, Toranomon Hospital, Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Akikazu Yago
- Department of Gastroenterological Surgery, Toranomon Hospital, Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Hayato Shimoyama
- Department of Gastroenterological Surgery, Toranomon Hospital, Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Harushi Udagawa
- Department of Gastroenterological Surgery, Toranomon Hospital, Okinaka Memorial Institute for Medical Research, Tokyo, Japan
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Influence of Postoperative Changes in Sarcopenia on Long-Term Survival in Non-Metastatic Colorectal Cancer Patients. Cancers (Basel) 2021; 13:cancers13102410. [PMID: 34067568 PMCID: PMC8156120 DOI: 10.3390/cancers13102410] [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: 04/09/2021] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary The number of colorectal cancer survivors is increasing due to improvements in oncologic outcomes. Therefore, the risks of metachronous cancer and second cancer are also increased, as well as recurrences. The influence of muscle mass measured as sarcopenia on long-term survival has been studied recently in colorectal cancer patients. Sarcopenia is a factor controllable by lifestyle modification and has gained interest more recently. This study showed an influence of changes in sarcopenia on long-term oncologic outcomes in colorectal cancer and suggests a basis for further investigation of body composition factors, including sarcopenia. Abstract The effect of perioperative sarcopenic changes on prognosis remains unclear. We conducted a retrospective cohort study with 2333 non-metastatic colorectal cancer patients treated between January 2009 and December 2012 at the Asan Medical Center. The body composition at diagnosis was measured via abdominopelvic computed tomography (CT) using Asan-J software. Patients underwent CT scans preoperatively, as well as at 6 months–1 year and 2–3 years postoperatively. The primary outcome was the association between perioperative sarcopenic changes and survival. According to sarcopenic criteria, 1155 (49.5%), 890 (38.2%), and 893 (38.3%) patients had sarcopenia preoperatively, 6 months–1 year, and 2–3 years postoperatively, respectively. The 5-year overall survival (OS) (95.8% vs. 92.1%, hazard ratio (HR) = 2.234, p < 0.001) and 5-year recurrence-free survival (RFS) (93.2% vs. 86.2%, HR = 2.251, p < 0.001) rates were significantly lower in patients with preoperative sarcopenia. Both OS and RFS were lower in patients with persistent sarcopenia 2–3 years postoperatively than in those who recovered (OS: 96.2% vs. 90.2%, p = 0.001; RFS: 91.1% vs. 83.9%, p = 0.002). In multivariate analysis, postoperative sarcopenia was confirmed as an independent factor associated with decreased OS and RFS. Pre- and postoperative sarcopenia and changes in the condition during surveillance were associated with oncological outcomes.
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Ancellin R, Cottet V, Dossus L, Fassier P, Gaillot de Saintignon J, Ginhac J, Romieu I, Salas S, Schneider S, Srour B, Touillaud M, Touvier M, Latino-Martel P. [Impact of nutritional factors during and after cancer]. Bull Cancer 2021; 108:455-464. [PMID: 33836862 DOI: 10.1016/j.bulcan.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/07/2021] [Indexed: 02/07/2023]
Abstract
Nutritional factors (diet, weight, alcohol, physical activity) are identified as factors having an impact on the onset of several cancer sites. Less abundant scientific data also underline their impact on the tumor progression. A review of the scientific literature was carried out by a group of experts established by the French National Cancer Institute (INCa) to better document the influence of nutritional factors during and after cancer on outcomes such as overall mortality, cancer specific mortality, recurrence, second primary cancers and quality of life. This analysis of the literature completes messages of reduction of alcohol consumption, prevention of undernutrition or excess weight and adherence to dietary recommendations, avoiding the use of dietary supplements, fasting or restrictive diets and strengthens messages promoting the practice of physical activity and the fight against sedentary lifestyle.
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Affiliation(s)
- Raphaëlle Ancellin
- Institut national du cancer, 52, avenue André-Morizet, 92100 Boulogne-Billancourt, France.
| | - Vanessa Cottet
- CHU de Dijon, université de Bourgogne-Franche-Comté, Inserm UMR1231 & CIC1432, 7, boulevard Jeanne-d'Arc, 21079 Dijon, France
| | - Laure Dossus
- Centre international de recherche sur le cancer (CIRC), 150, cours Albert-Thomas, 69008 Lyon, France
| | | | | | - Julie Ginhac
- Cellule de coordination, domaine de Vilvert, réseau national alimentation cancer recherche (Réseau NACRe), 78350 Jouy-en-Josas, France
| | - Isabelle Romieu
- Center for Research on Population Health, National Institute of Public Health, Mexico, Mexique; Emory University, Hubert Department of Global Health, Atlanta, Georgia, États-Unis
| | - Sébastien Salas
- CHU de Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Stéphane Schneider
- Université Côte d'Azur, CHU de Nice, Hôpital de l'Archet, 151, route de Saint-Antoine, 06200 Nice, France
| | - Bernard Srour
- Cellule de coordination, domaine de Vilvert, réseau national alimentation cancer recherche (Réseau NACRe), 78350 Jouy-en-Josas, France; Université Sorbonne Paris Nord, université de Paris (CRESS), Inrae U1125, Cnam, équipe de recherche en épidémiologie nutritionnelle (EREN), centre de recherche en épidémiologie et statistiques, Inserm U1153, 74, rue Marcel-Cachin, 93017 Bobigny, France
| | - Marina Touillaud
- Centre Léon-Bérard, Inserm UA8 « Radiations : défense, santé et environnement », 28, rue Laennec, 69008 Lyon, France
| | - Mathilde Touvier
- Université Sorbonne Paris Nord, université de Paris (CRESS), Inrae U1125, Cnam, équipe de recherche en épidémiologie nutritionnelle (EREN), centre de recherche en épidémiologie et statistiques, Inserm U1153, 74, rue Marcel-Cachin, 93017 Bobigny, France
| | - Paule Latino-Martel
- Cellule de coordination, domaine de Vilvert, réseau national alimentation cancer recherche (Réseau NACRe), 78350 Jouy-en-Josas, France
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Boshier PR, Klevebro F, Jenq W, Puccetti F, Muthuswamy K, Hanna GB, Low DE. Long-term variation in skeletal muscle and adiposity in patients undergoing esophagectomy. Dis Esophagus 2021; 34:6209412. [PMID: 33822916 PMCID: PMC8597909 DOI: 10.1093/dote/doab016] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/05/2021] [Accepted: 03/05/2021] [Indexed: 12/11/2022]
Abstract
This study seeks to define long-term variation in body composition in patients undergoing esophagectomy for cancer and to associate those changes with survival. Assessment of skeletal muscle, visceral (VAT) and subcutaneous adipose tissue (SAT) was performed using computed tomography (CT) images routinely acquired: at diagnosis; after neoadjuvant therapy, and; >6 months after esophagectomy. In cases where multiple CT scans were performed >6 months after surgery, all available images were assessed. Ninty-seven patients met inclusion criteria with a median of 2 (range 1-10) postoperative CT images acquired between 0.5 and 9.7 years after surgery. Following surgical treatment of esophageal cancer, patients lost on average 13.3% of their skeletal muscle, 64.5% of their VAT and 44.2% of their SAT. Sarcopenia at diagnosis was not associated with worse overall survival (66.3% vs. 68.5%; P = 0.331). Sarcopenia 1 year after esophagectomy was however associated with lower 5-year overall survival (53.8% vs. 87.5%; P = 0.019). Survival was lower in those patients who had >10% decrease in skeletal muscle index (SMI; 33.3% vs. 72.1%; P = 0.003) and >40% decrease in SAT 1 year after surgery (40.4% vs. 67.4%; P = 0.015). On multivariate analysis, a decline in SMI 1 year after surgery was predictive of worse survival (HR 0.38, 95%CI 0.20-0.73; P = 0.004). This study provides new insight relating to long-term variation in body composition in patients undergoing esophagectomy for cancer. Findings provide further evidence of the importance of body composition, in particular depletion of skeletal muscle, in predicting survival following esophagectomy.
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Affiliation(s)
- Piers R Boshier
- Address correspondence to: Mr Piers Boshier, Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Wing, St Mary’s Hospital, London W2 1NY, UK.
| | - Fredrik Klevebro
- Department of Thoracic Surgery and Thoracic Oncology, Virginia Mason Medical Center, Seattle, WA, USA
| | - Wesley Jenq
- Department of Thoracic Surgery and Thoracic Oncology, Virginia Mason Medical Center, Seattle, WA, USA
| | - Francesco Puccetti
- Department of Thoracic Surgery and Thoracic Oncology, Virginia Mason Medical Center, Seattle, WA, USA
| | | | - George B Hanna
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Donald E Low
- Department of Thoracic Surgery and Thoracic Oncology, Virginia Mason Medical Center, Seattle, WA, USA
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Elliott JA, Reynolds JV. Visceral Obesity, Metabolic Syndrome, and Esophageal Adenocarcinoma. Front Oncol 2021; 11:627270. [PMID: 33777773 PMCID: PMC7994523 DOI: 10.3389/fonc.2021.627270] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 02/19/2021] [Indexed: 12/16/2022] Open
Abstract
Esophageal adenocarcinoma (EAC) represents an exemplar of obesity-associated carcinogenesis, with a progressive increase in EAC risk with increased body mass index. In this context, there is increased focus on visceral adipose tissue and associated metabolic dysfunction, including hypertension, diabetes mellitus and hyperlipidemia, or combinations of these in the metabolic syndrome. Visceral obesity (VO) may promote EAC via both directly impacting on gastro-esophageal reflux disease and Barrett's esophagus, as well as via reflux-independent effects, involving adipokines, growth factors, insulin resistance, and the microbiome. In this review these pathways are explored, including the impact of VO on the tumor microenvironment, and on cancer outcomes. The current evidence-based literature regarding the role of dietary, lifestyle, pharmacologic and surgical interventions to modulate the risk of EAC is explored.
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Affiliation(s)
- Jessie A Elliott
- Trinity St. James's Cancer Institute, Trinity College Dublin and St. James's Hospital, Dublin, Ireland
| | - John V Reynolds
- Trinity St. James's Cancer Institute, Trinity College Dublin and St. James's Hospital, Dublin, Ireland
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