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Luo M, Mei Z, Tang S, Huang J, Yuan K, Jiang L, Tang Z, Li K, Su M, Su C, Shi Y, Zhang Z, Chen J, Zheng Y, Bin P, Yuan Z, Xu G, Xiao Z. The impact of sarcopenia on the incidence of postoperative outcomes following spine surgery: Systematic review and meta-analysis. PLoS One 2024; 19:e0302291. [PMID: 39186727 PMCID: PMC11346935 DOI: 10.1371/journal.pone.0302291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 04/01/2024] [Indexed: 08/28/2024] Open
Abstract
PURPOSE Sarcopenia is considered to be an important predictor of adverse outcomes following spinal surgery, but the specific relationship between the two is not clear. The purpose of this meta-analysis is to systematically review all relevant studies to evaluate the impact of sarcopenia on spinal surgery outcomes. METHODS We systematically searched PubMed, Embase and the Cochrane Library for relevant articles published on or before January 9, 2023. The pooled odds ratio (OR) with 95% confidence intervals (CIs) was calculated in a random effects meta-analysis. The main outcome was the risk of adverse outcomes after spinal surgery, including adverse events and mortality. This systematic review and meta-analysis was conducted following the PRISMA guidelines to evaluate the impact of sarcopenia on spinal surgery outcomes. In addition, we also conducted a subgroup analysis and leave-one-out sensitivity analyses to explore the main sources of heterogeneity and the stability of the results. RESULTS Twenty-four cohort studies, with a total of 243,453 participants, met the inclusion criteria. The meta-analysis showed that sarcopenia was significantly associated with adverse events (OR 1.63, 95% CI 1.17-2.27, P < 0.001) but was no significantly associated with mortality (OR 1.17, 95% CI 0.93-1.46, P = 0.180), infection (OR 2.24, 95% CI 0.95-5.26, P < 0.001), 30-day reoperation (OR 1.47, 95% CI 0.92-2.36, P = 0.413), deep vein thrombosis (OR 1.78, 95% CI 0.69-4.61, P = 0.234), postoperative home discharge (OR 0.60, 95% CI 0.26-1.37, P = 0.002) and blood transfusion (OR 3.28, 95% CI 0.74-14.64, P = 0.015). CONCLUSION The current meta-analysis showed that patients with sarcopenia have an increased risk of adverse events and mortality after spinal surgery. However, these results must be carefully interpreted because the number of studies included is small and the studies are significantly different. These findings may help to increase the clinicians' awareness of the risks concerning patients with sarcopenia to improve their prognosis.
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Affiliation(s)
- Mingjiang Luo
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Zubing Mei
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
- Department of Anorectal Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Anorectal Disease Institute of Shuguang Hospital, Shanghai, China
| | - Siliang Tang
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Jinshan Huang
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Kun Yuan
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Lingling Jiang
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Zhifeng Tang
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Keni Li
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Mingxuan Su
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Can Su
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Yuxin Shi
- Department of Pediatric Dentistry, First Affiliated Hospital (Affiliated Stomatological Hospital) of Xinjiang Medical University, Urumqi, China
| | - Zihan Zhang
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Jiang Chen
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Yuan Zheng
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Peng Bin
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Zhengbing Yuan
- Department of Orthopaedics, Dongguan Qiaotou Hospital, Dongguan, Guangdong, China
| | - Guosong Xu
- Department of Orthopaedics, The First Hospital of Putian City, The School of Clinical Medicine, Fujian Medical University, Putian, Fujian, China
| | - Zhihong Xiao
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
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Evans AR, Smith L, Bakhsheshian J, Anderson DB, Elliott JM, Shakir HJ, Smith ZA. Sarcopenia and the management of spinal disease in the elderly. GeroScience 2024:10.1007/s11357-024-01300-2. [PMID: 39138794 DOI: 10.1007/s11357-024-01300-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 07/22/2024] [Indexed: 08/15/2024] Open
Abstract
Sarcopenia, generally defined by the loss of skeletal mass and function, may disproportionately affect elderly individuals and heavily influence spinal disease. Muscle atrophy is associated with myriad clinical problems, including thoracic kyphosis, increased sagittal vertical axis (SVA), spinal implant failures, and postoperative complications. As such, the aim of this narrative review is to synthesize pertinent literature detailing the intersection between sarcopenia and the impact of sarcopenia on the management of spine disease. Specifically, we focus on the domains of etiology, diagnosis and assessment, impact on the cervical and lumbar spine, spinal augmentation procedures, neoplastic disease, whiplash injury, and recovery/prevention. A narrative review was conducted by searching the PubMed and Google Scholar databases from inception to July 12, 2024, for any cohort studies, systematic reviews, or randomized controlled trials. Case studies and conference abstracts were excluded. Diagnosis of sarcopenia relies on the assessment of muscle strength and quantity/quality. Strength may be assessed using clinical tools such as gait speed, timed up and go (TUG) test, or hand grip strength, whereas muscle quantity/quality may be assessed via computed tomography (CT scan), magnetic resonance imaging (MRI), and dual-energy X-ray absorptiometry (DXA scan). Sarcopenia has a generally negative impact on the clinical course of those undergoing cervical and lumbar surgery, and may be predictive of mortality in those with neoplastic spinal disease. In addition, severe acceleration-deceleration (whiplash) injuries may result in cervical extensor muscle atrophy. Intervention and recovery measures include nutrition or exercise therapy, although the evidence for nutritional intervention is lacking. Sarcopenia is a widely prevalent pathology in the advanced-age population, in which the diagnostic criteria, impact on spinal pathology, and recovery/prevention measures remain understudied. However, further understanding of this therapeutically challenging pathology is paramount, as surgical outcome may be heavily influenced by sarcopenia status.
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Affiliation(s)
- Alexander R Evans
- Department of Neurosurgery, University of Oklahoma, 1000 N Lincoln Blvd, #4000, Oklahoma City, OK, 73104, USA
| | | | | | - David B Anderson
- Sydney School of Health Sciences, The University of Sydney, Camperdown, Australia
| | - James M Elliott
- Sydney School of Health Sciences, The University of Sydney, Camperdown, Australia
| | - Hakeem J Shakir
- Department of Neurosurgery, University of Oklahoma, 1000 N Lincoln Blvd, #4000, Oklahoma City, OK, 73104, USA
| | - Zachary A Smith
- Department of Neurosurgery, University of Oklahoma, 1000 N Lincoln Blvd, #4000, Oklahoma City, OK, 73104, USA.
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Diallo TD, Blessing AIL, Ihorst G, Möller MD, Jungmann PM, Bamberg F, Herget G, Wäsch R, Engelhardt M, Neubauer J. Myosteatosis in multiple myeloma: a key determinant of survival beyond sarcopenia. Skeletal Radiol 2024:10.1007/s00256-024-04735-y. [PMID: 38940940 DOI: 10.1007/s00256-024-04735-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE Fatty infiltration of skeletal muscle (Myosteatosis) is associated with increased frailty, decreased muscle and mobility function, which seems fairly prevalent in multiple myeloma (MM) patients. This study aimed to determine the prognostic value of myosteatosis assessed by CT for progression-free survival (PFS) and overall survival (OS). MATERIALS AND METHODS This IRB-approved cohort study included patients with newly diagnosed MM who were treated at a single university hospital and received CT at baseline. Geriatric assessment was performed via International Myeloma Working Group frailty score and Revised Myeloma Comorbidity Index. Myosteatosis was determined through measurement of paravertebral muscle radiodensity. Statistical analyses included uni- and multivariable Cox proportional hazard models and the Kaplan-Meier-method. RESULTS A total of 226 newly diagnosed MM patients (median age: 65 years [range: 29-89], 63% males, mean BMI: 25 [14-42]) were analyzed. The prevalence of myosteatosis was 51%. Muscle radiodensity was significantly decreased in individuals with International Staging System stage III vs. I (p < 0.001), indicating higher fatty muscle infiltration in patients with advanced disease. Both PFS and OS were significantly decreased in patients with myosteatosis (PFS: median 32.0 months (95% CI 20.5.5-42.2) vs. 66.4 months without myosteatosis (95% CI 42.5-not reached), p < .001); OS: median 58.6 (95% CI 51.3-90.2) vs. not reached, p < .001). Myosteatosis remained an independent predictor of OS in multivariable analyses (HR: 1.98; 95%-CI: 1.20-3.27). CONCLUSION Myosteatosis seems fairly prevalent in patients with newly diagnosed MM and associated with impaired overall survival. Prospective clinical trials are required to better understand the role of myosteatosis in MM patients.
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Affiliation(s)
- Thierno D Diallo
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
| | - Ariane Irma Luise Blessing
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Gabriele Ihorst
- Clinical Trials Unit, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Mandy Deborah Möller
- Department of Medicine I Hematology and Oncology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Comprehensive Cancer Center Freiburg (CCCF), University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Pia M Jungmann
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Georg Herget
- Department of Orthopaedics and Trauma Surgery, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Ralph Wäsch
- Department of Medicine I Hematology and Oncology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Comprehensive Cancer Center Freiburg (CCCF), University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Monika Engelhardt
- Department of Medicine I Hematology and Oncology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Comprehensive Cancer Center Freiburg (CCCF), University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jakob Neubauer
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
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Chao B, Jiao J, Yang L, Wang Y, Yu T, Liu H, Zhang H, Li M, Wang W, Cui X, Du S, Wang Z, Wu M. Comprehensive evaluation and advanced modification of polymethylmethacrylate cement in bone tumor treatment. J Mater Chem B 2023; 11:9369-9385. [PMID: 37712890 DOI: 10.1039/d3tb01494k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Bone tumors are invasive diseases with a tendency toward recurrence, disability, and high mortality rates due to their grievous complications. As a commercial polymeric biomaterial, polymethylmethacrylate (PMMA) cement possesses remarkable mechanical properties, injectability, and plasticity and is, therefore, frequently applied in bone tissue engineering. Numerous positive effects in bone tumor treatment have been demonstrated, including biomechanical stabilization, analgesic effects, and tumor recurrence prevention. However, to our knowledge, a comprehensive evaluation of the application of the PMMA cement in bone tumor treatment has not yet been reported. This review comprehensively evaluates the efficiency and complications of the PMMA cement in bone tumor treatment, for the first time, and introduces advanced modification strategies, providing an objective and reliable reference for the application of the PMMA cement in treating bone tumors. We have also summarized the current research on modifications to enhance the anti-tumor efficacy of the PMMA cement, such as drug carriers and magnetic hyperthermia.
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Affiliation(s)
- Bo Chao
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Jianhang Jiao
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Lili Yang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Yang Wang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Tong Yu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - He Liu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Han Zhang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Mufeng Li
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Wenjie Wang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Xiangran Cui
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Shangyu Du
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Zhonghan Wang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Minfei Wu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
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5
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Laufer M, Perelman M, Sarfaty M, Itelman E, Segal G. Low Alanine Aminotransferase, as a Marker of Sarcopenia and Frailty, Is Associated with Shorter Survival Among Prostate Cancer Patients and Survivors. A Retrospective Cohort Analysis of 4064 Patients. EUR UROL SUPPL 2023; 55:38-44. [PMID: 37693730 PMCID: PMC10485784 DOI: 10.1016/j.euros.2023.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 09/12/2023] Open
Abstract
Background Sarcopenia is characterized by loss of muscle mass and function and is associated with frailty, a syndrome with higher likelihood of falls, fractures, physical disability, and mortality. Both frailty and sarcopenia are known markers of shorter survival in various cancer patient populations. Low alanine aminotransferase (ALT), reflecting loss of muscle mass (sarcopenia), may be associated with greater frailty and shorter survival in multiple cancers. Objective To assess the potential association between low ALT and shorter survival among prostate cancer (PCa) patients and survivors. Design setting and participants This was a retrospective analysis of a historical cohort of PCa patients and survivors. Patients were defined as those still actively receiving PCa treatment, while those no longer receiving such treatment were classified as PCa survivors. Outcome measurements and statistical analysis ALT data were obtained from results for basic biochemical blood testing carried out for patients on their first hospital admission. Patients were divided into two groups: those with ALT ≥17 IU/l and those with ALT <17 IU/l. Univariate and multivariable analyses were conducted for between-group survival comparisons. Results and limitations We identified 9489 PCa records. The final study cohort with ALT data available included 4064 patients with ALT <40 IU/l. Of this cohort, 536 patients were actively receiving medical anticancer therapy for PCa. The mean age for the entire cohort was 74.6 yr (standard deviation 9.6) and the median ALT level was 19.28 IU/l; 1676 patients (41%) had low ALT (<17 IU/l). On univariate analysis, low ALT was associated with a 78% increase in mortality risk (95% confidence interval [CI] 1.62-1.97; p < 0.001). A sensitivity analysis of the 536 patients actively receiving medical anticancer treatment revealed that low ALT was associated with a 48% increase in mortality risk (95% CI 1.19-1.85; p = 0.001). In a multivariable model controlled for age, kidney disease, history of cerebrovascular event/transient ischemic attack, and baseline prostate-specific antigen, low ALT was still associated with a 35% increase in mortality risk (95% CI 1.12-1.63; p = 0.001). Limitations include the single-center, retrospective design. Conclusions Low ALT, which is indicative of sarcopenia and frailty, is associated with shorter survival among PCa patients and survivors and could potentially be used for treatment personalization. Patient summary We compared survival for prostate cancer patients and survivors according to their blood level of the protein alanine aminotransferase (ALT). Low ALT levels in the general population are associated with loss of muscle mass. We found that in our group of prostate cancer patients and survivors, the risk of death from any cause was higher for those with low ALT levels.
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Affiliation(s)
- Menachem Laufer
- Department of Urology, Chaim Sheba Medical Center, Ramat Gan, Israel§
| | - Maxim Perelman
- Department of Internal Medicine T, Chaim Sheba Medical Center, Ramat Gan, Israel§
| | - Michal Sarfaty
- Institute of Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel§
| | - Edward Itelman
- Department of Internal Medicine E, Rabin Medical Center, Beilenson Campus, Peta-Tiqva, Israel§
- Cardiology Division, Rabin Medical Center, Beilenson Campus, Peta-Tiqva, Israel§
| | - Gad Segal
- Sheba Education Authority, Chaim Sheba Medical Center, Ramat Gan, Israel§
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Matsunaga T, Furuya T, Deto T, Masuda H, Nakanishi K. Two Older Hematological Malignancy Patients for Whom Nutrition Rehabilitation Was Effective Against Global Leadership Initiative on Malnutrition-Defined Malnutrition and Sarcopenia. Cureus 2023; 15:e43069. [PMID: 37554378 PMCID: PMC10405756 DOI: 10.7759/cureus.43069] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 08/10/2023] Open
Abstract
The long-term survival rate of hematological malignancy patients with Global Leadership Initiative on Malnutrition (GLIM)-defined malnutrition and sarcopenia is poor, but nutritional rehabilitation effects in such patients are unknown. Here, two cases of older hematological malignancy patients in whom nutritional rehabilitation was effective against GLIM-defined malnutrition and sarcopenia are reported. By undergoing nutritional rehabilitation, the myeloma patient increased her six-meter walking speed and her maintained body mass index (BMI), appendicular skeletal muscle mass (ASM), and hand grip strength, whereas the Hodgkin lymphoma patient regained his hand grip strength and maintained his BMI, ASM, and six-meter walking speed.
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Affiliation(s)
- Takuya Matsunaga
- Department of Hematology, Japan Community Health Care Organization (JCHO) Sapporo Hokushin Hospital, Sapporo, JPN
| | - Tatsunori Furuya
- Department of Rehabilitation, Japan Community Health Care Organization (JCHO) Sapporo Hokushin Hospital, Sapporo, JPN
| | - Tomoko Deto
- Department of Nutrition Management, Japan Community Health Care Organization (JCHO) Sapporo Hokushin Hospital, Sapporo, JPN
| | - Hajime Masuda
- Department of Diabetes, Japan Community Health Care Organization (JCHO) Sapporo Hokushin Hospital, Sapporo, JPN
| | - Katsuya Nakanishi
- Department of Pathology, Japan Community Health Care Organization (JCHO) Sapporo Hokushin Hospital, Sapporo, JPN
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Moskven E, Lasry O, Singh S, Flexman AM, Street JT, Dea N, Fisher CG, Ailon T, Dvorak MF, Kwon BK, Paquette SJ, Charest-Morin R. The Role of Frailty and Sarcopenia in Predicting Major Adverse Events, Length of Stay and Reoperation Following En Bloc Resection of Primary Tumours of the Spine. Global Spine J 2023:21925682231173360. [PMID: 37118871 DOI: 10.1177/21925682231173360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
STUDY DESIGN Retrospective observational cohort study. OBJECTIVE En bloc resection for primary tumours of the spine is associated with a high rate of adverse events (AEs). The objective was to explore the relationship between frailty/sarcopenia and major perioperative AEs, length of stay (LOS), and unplanned reoperation following en bloc resection of primary spinal tumours. METHODS This is a unicentre study consisting of adult patients undergoing en bloc resection for a primary spine tumor. Frailty was calculated with the modified frailty index (mFI) and spine tumour frailty index (STFI). Sarcopenia was quantified with the total psoas area/vertebral body area ratio (TPA/VB) at L3 and L4. Univariable regression analysis was used to quantify the association between frailty/sarcopenia and major perioperative AEs, LOS and unplanned reoperation. RESULTS 95 patients met the inclusion criteria. The mFI and STFI identified a frailty prevalence of 3% and 18%. Mean CT TPA/VB ratios were 1.47 (SD ± .05) and 1.83 (SD ± .06) at L3 and L4. Inter-observer reliability was .93 and .99 for CT and MRI L3 and L4 TPA/VB ratios. Unadjusted analysis demonstrated sarcopenia and mFI did not predict perioperative AEs, LOS or unplanned reoperation. Frailty defined by an STFI score ≥2 predicted unplanned reoperation for surgical site infection (SSI) (P < .05). CONCLUSIONS The STFI was only associated with unplanned reoperation for SSI on unadjusted analysis, while the mFI and sarcopenia were not predictive of any outcome. Further studies are needed to investigate the relationship between frailty, sarcopenia and perioperative outcomes following en bloc resection of primary spinal tumors.
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Affiliation(s)
- Eryck Moskven
- Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Oliver Lasry
- Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic Surgery, University of British Columbia, Vancouver, BC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Supriya Singh
- Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Alana M Flexman
- Department of Anaesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
- Department of Anaesthesiology and Perioperative Care, St Paul's Hospital, Vancouver, BC, Canada
| | - John T Street
- Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Nicolas Dea
- Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Charles G Fisher
- Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Tamir Ailon
- Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Marcel F Dvorak
- Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Brian K Kwon
- Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Scott J Paquette
- Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Raphaële Charest-Morin
- Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic Surgery, University of British Columbia, Vancouver, BC, Canada
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8
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Mafla-España MA, Torregrosa MD, Beamud-Cortés M, Bermell-Marco L, Rubio-Briones J, Cauli O. Comparison of Frailty Criteria, Cognitive Function, Depressive and Insomnia Symptoms in Men with Localized and Advanced Prostate Cancer under Androgen Deprivation Therapy. Healthcare (Basel) 2023; 11:healthcare11091266. [PMID: 37174808 PMCID: PMC10178148 DOI: 10.3390/healthcare11091266] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Prostate cancer (PCa) is considered one of the most important medical problems in the male population, with a very high incidence after the age of 65. Frailty represents one of the most critical issues facing healthcare due to its inherent relationship with poor healthcare outcomes. The physical phenotype of frailty syndrome based on Fried criteria has been associated with poor outcomes, morbidity, and premature mortality. To date, there are few studies that have analyzed frailty syndrome in patients with localized and advanced (mPCa) disease under androgen-deprivation therapy. OBJECTIVE Our goal was to assess whether there are differences in frailty criteria between mPCa and localized PCa. We also evaluated the role of other geriatric variables such as depressive and insomnia symptoms, which are frequently reported in cancer patients. METHODS In this cross-sectional study, frailty syndrome was evaluated in both groups, as well as its possible relationship with cognitive functions, depressive and insomnia symptoms, and other clinical variables related to PCa and its treatment. Frailty was defined on Fried's criteria: low lean mass, weakness, self-reported exhaustion, low activity level, and slow walking speed; prefrailty was defined as having one or two of those criteria and frailty as having three or more, depressive symptoms were defined by the Yesavage scale, cognitive functions with the Mini-Mental examination test, and insomnia symptoms by the Athens scale and self-reported health status. RESULTS The prevalence of prefrailty/frailty was slightly higher in mPCa compared to localized PCa (81.5% versus 72.3%, respectively), however by analyzing each of the frailty criteria, two of them were significantly reduced in mPCa compared to localized PCa patients, e.g., gait speed (p = 0.001) and muscle strength (p = 0.04). The reduced gait speed and muscle strength in mPCa were not due to the increased age in mPCa group, or to an increase in comorbidities or shorter time under androgen-deprivation therapy. The symptoms of insomnia were significantly higher in mPCa patients compared to those with localized PCa (p < 0.05) whereas cognitive functions or depressive symptoms were not significantly different between the two groups. CONCLUSION Patients with mPCa under androgen-deprivation therapy display higher alterations in gait speed and muscular strength and insomnia symptoms, thus interventions should be aimed to reduce these alterations in order to limit adverse outcomes related to them and to improve quality of life in these patients.
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Affiliation(s)
- Mayra Alejandra Mafla-España
- Nursing Department, University of Valencia, 46010 Valencia, Spain
- Frailty Research Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
| | | | | | | | | | - Omar Cauli
- Nursing Department, University of Valencia, 46010 Valencia, Spain
- Frailty Research Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
- Chair of Healthy, Active and Participative Ageing, University of Valencia, 46010 Valencia, Spain
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9
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Analysis of Frailty Syndrome in Men with Metastatic Prostate Cancer: A Scoping Review. J Pers Med 2023; 13:jpm13020319. [PMID: 36836553 PMCID: PMC9964735 DOI: 10.3390/jpm13020319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 02/01/2023] [Accepted: 02/11/2023] [Indexed: 02/15/2023] Open
Abstract
Most patients with metastatic prostate cancer (mPCa) are older. In addition, current geriatric oncology guidelines suggest that all cancer patients aged over 70 years should undergo a comprehensive geriatric assessment (CGA), with the identification of frailty syndrome being crucial for clinical decisions. Frailty can be associated with lower quality of life (QoL) and interfere with the feasibility or side effects of oncology treatments. METHODS We performed a systematic literature search to evaluate frailty syndrome and associated alterations related to CGA impairment by searching in different academic databases (PubMed, Embase, and Scopus). The identified articles were reviewed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Of the 165 articles consulted, 7 met our inclusion criteria. Analysis of data related to frailty syndrome in patients with mPCa showed a prevalence between 30-70% depending on the tool used. Additionally, frailty was associated with other CGA assessments and QoL evaluation outcomes. In general terms, CGA scores for patients with mPCa were lower than those for patients without metastasis. Furthermore, functional QoL appeared to be worse for patients with metastasis, and global QoL (burden) was more strongly associated with frailty. CONCLUSION Frailty syndrome was related to a poorer QoL in patients with mPCa and its evaluation should be considered in clinical decision-making and when choosing the most appropriate active treatment, if any, to increase survival.
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Massaad E, Bridge CP, Kiapour A, Fourman MS, Duvall JB, Connolly ID, Hadzipasic M, Shankar GM, Andriole KP, Rosenthal M, Schoenfeld AJ, Bilsky MH, Shin JH. Evaluating frailty, mortality, and complications associated with metastatic spine tumor surgery using machine learning-derived body composition analysis. J Neurosurg Spine 2022; 37:263-273. [PMID: 35213829 DOI: 10.3171/2022.1.spine211284] [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: 10/04/2021] [Accepted: 01/05/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Cancer patients with spinal metastases may undergo surgery without clear assessments of prognosis, thereby impacting the optimal palliative strategy. Because the morbidity of surgery may adversely impact recovery and initiation of adjuvant therapies, evaluation of risk factors associated with mortality risk and complications is critical. Evaluation of body composition of cancer patients as a surrogate for frailty is an emerging area of study for improving preoperative risk stratification. METHODS To examine the associations of muscle characteristics and adiposity with postoperative complications, length of stay, and mortality in patients with spinal metastases, the authors designed an observational study of 484 cancer patients who received surgical treatment for spinal metastases between 2010 and 2019. Sarcopenia, muscle radiodensity, visceral adiposity, and subcutaneous adiposity were assessed on routinely available 3-month preoperative CT images by using a validated deep learning methodology. The authors used k-means clustering analysis to identify patients with similar body composition characteristics. Regression models were used to examine the associations of sarcopenia, frailty, and clusters with the outcomes of interest. RESULTS Of 484 patients enrolled, 303 had evaluable CT data on muscle and adiposity (mean age 62.00 ± 11.91 years; 57.8% male). The authors identified 2 clusters with significantly different body composition characteristics and mortality risks after spine metastases surgery. Patients in cluster 2 (high-risk cluster) had lower muscle mass index (mean ± SD 41.16 ± 7.99 vs 50.13 ± 10.45 cm2/m2), lower subcutaneous fat area (147.62 ± 57.80 vs 289.83 ± 109.31 cm2), lower visceral fat area (82.28 ± 48.96 vs 239.26 ± 98.40 cm2), higher muscle radiodensity (35.67 ± 9.94 vs 31.13 ± 9.07 Hounsfield units [HU]), and significantly higher risk of 1-year mortality (adjusted HR 1.45, 95% CI 1.05-2.01, p = 0.02) than individuals in cluster 1 (low-risk cluster). Decreased muscle mass, muscle radiodensity, and adiposity were not associated with a higher rate of complications after surgery. Prolonged length of stay (> 7 days) was associated with low muscle radiodensity (mean 30.87 vs 35.23 HU, 95% CI 1.98-6.73, p < 0.001). CONCLUSIONS Body composition analysis shows promise for better risk stratification of patients with spinal metastases under consideration for surgery. Those with lower muscle mass and subcutaneous and visceral adiposity are at greater risk for inferior outcomes.
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Affiliation(s)
- Elie Massaad
- 1Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Christopher P Bridge
- 2Massachusetts General Hospital and Brigham and Women's Hospital Center for Clinical Data Science, Harvard Medical School, Boston
- 4Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Ali Kiapour
- 1Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Mitchell S Fourman
- 3Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Julia B Duvall
- 1Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Ian D Connolly
- 1Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Muhamed Hadzipasic
- 1Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Ganesh M Shankar
- 1Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Katherine P Andriole
- 2Massachusetts General Hospital and Brigham and Women's Hospital Center for Clinical Data Science, Harvard Medical School, Boston
- 4Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Michael Rosenthal
- 4Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston
- 5Department of Radiology, Dana Farber Cancer Institute, Boston
| | - Andrew J Schoenfeld
- 6Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - Mark H Bilsky
- 7Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - John H Shin
- 1Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston
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11
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Park HY, Park YH, Lee JY, Lee JI. Bioimpedance phase angle and sarcopenia in older patients with prostate cancer. Geriatr Gerontol Int 2022; 22:623-627. [PMID: 35831243 DOI: 10.1111/ggi.14427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022]
Abstract
AIM The purpose of this study was to evaluate the factors associated with the bioimpedance phase angle (PhA) in older patients with prostate cancer, and to determine the optimal cutoff for the PhA in patients with sarcopenia and prostate cancer. METHODS This retrospective cross-sectional analysis enrolled patients with prostate cancer aged ≥60 years. Appendicular skeletal muscle mass and PhA estimated by bioimpedance analysis, grip strength, the five-time chair stand test, gait speed, the Short Physical Performance Battery, the 2-min walk test and the International Physical Activity Questionnaire Short Form were obtained at enrollment. The diagnosis of sarcopenia was based on the 2019 consensus of the Asian Working Group for Sarcopenia. RESULTS In total, 119 male participants (mean age = 70.7 ± 6.1 years) were available for analysis. A multivariable linear regression model revealed that age, body mass index and the maximal grip strength value were associated with the PhA. The area under the receiver operating characteristic curve value of the PhA for sarcopenia diagnosis was 0.77 (95% confidence interval 0.64-0.90, P < 0.001), with a PhA cutoff value of 4.87°. CONCLUSIONS PhA estimated by bioimpedance analysis may be utilized as useful clinical biomarker for reflecting muscle strength and sarcopenia in older patients with prostate cancer. Geriatr Gerontol Int 2022; ••: ••-••.
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Affiliation(s)
- Hae-Yeon Park
- Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong Hyun Park
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Youl Lee
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong In Lee
- Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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12
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Tan H, Gao X, Li X, Huang Y, Cao Q, Wan T. Sarcopenia in Patients With Spinal Metastasis: A Systematic Review and Meta-Analysis of Retrospective Cohort Studies. Front Oncol 2022; 12:864501. [PMID: 35480101 PMCID: PMC9037148 DOI: 10.3389/fonc.2022.864501] [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: 01/28/2022] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background As a metastasis cancer that happens up to 70% of the cancer patients, spinal metastasis is drawing attention for its significant impairment to health. There exist several predictive models designed to estimate mortality in spinal metastasis patients but they are reported with limited accuracy. In recent years, some retrospective cohort studies have been carried out to associate sarcopenia with mortality in spinal metastasis. Introduction As a risk factor leading to adverse events in many diseases, sarcopenia was considered to significantly impact on patients with spinal metastasis in mortality by some scientists. We aimed to look through the current evidence and use statistic measures to value the role of sarcopenia in spinal metastasis. In this study, we are going to perform a systematic review and meta-analysis of available retrospective cohort studies where sarcopenia is assessed for outcomes in spinal metastasis patients. Methods On October 7, 2021, we performed a search in PubMed, Embase, and the Cochrane Library. We set no restrictions on language, date or areas. Results were expressed as hazard ratio (HR) or odds ratio (OR) with 95% CI by random effects model. Sensitivity analyses were performed to explore sources of heterogeneity and stability of results. Results Of the 4,196 papers screened, 10 retrospective cohort studies were included, with a total of 1,674 patients. Results showed that sarcopenia was associated with higher overall mortality (OR, 1.60; 95% CI 1.35–1.90) and lower overall survival (HR, 2.08; 95% CI 1.55–2.80). The sensitivity analysis proved the stability of results in terms of publication years, region, time of diagnosis, sample size, female rate, measurement and follow up period. Conclusions Sarcopenia is a robust indicator of mortality in spinal metastasis patients and it might be applied to decision-making tools to assess survival probability and adjust the extent of treatment, while a lack of higher level of evidence is existing. Systematic Review Registration PROSPERO CRD42021283348.
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Affiliation(s)
- Haifeng Tan
- Hengyang Medical College, University of South China, Hengyang, China
| | - Xiaoyu Gao
- Hengyang Medical College, University of South China, Hengyang, China
| | - Xiaoyu Li
- Hengyang Medical College, University of South China, Hengyang, China
| | - Yunling Huang
- Hengyang Medical College, University of South China, Hengyang, China
| | - Qi Cao
- Department of Spine Surgery, The Second Affiliated Hospital, University of South China, Hengyang, China
| | - Teng Wan
- Hengyang Medical College, University of South China, Hengyang, China
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13
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Tagliafico AS, Rossi F, Bignotti B, Torri L, Bonsignore A, Belgioia L, Domineitto A. CT-derived relationship between low relative muscle mass and bone damage in patients with multiple myeloma undergoing stem cells transplantation. Br J Radiol 2022; 95:20210923. [PMID: 34918544 PMCID: PMC9153728 DOI: 10.1259/bjr.20210923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Sarcopenia or low muscle mass is related to worse prognosis in cancer patients. We investigated whether muscle mass is related to bone damage on CT in patients with multiple myeloma (MM). METHODS Approval from the institutional review board was obtained. N = 74 consecutive patients (mean age, 60.8 years ± 9.24 [standard deviation]; range, 36-89 years) for MM who underwent transplant were included. Sarcopenia cut-off points defined as skeletal muscle index (SMI) used were<41 cm2/m2. To assess bone damage in MM the MSBDS (myeloma spine and bone damage score) was used. One-way analysis of variance and the X2 test were used. Kaplan-Meier analysis was performed to generate progression and survival curves according to SMI and MSBDS. The testing level was set at 0.05. RESULTS The median SMI was 47.1 ± 14.2 and according to SMI 18/74 (24%) had sarcopenia which was more prevalent in females (p.001). A strong and significant association between patients with low muscle mass and elevated bone damage (24/74, 32.4%) and patients with normal/non-low muscle mass low bone damage (30/74, 40.5%) was present. Multiple Logistic regression did not show any significant relationship or confounding influence among SMI and MSBDS regarding sex (p.127), cytogenetic status (p.457), staging (p.756) and relapse (.126). Neither SMI nor MSBDS resulted significantly related to overall survival as shown in Kaplan-Meier analysis. CONCLUSION Sarcopenia and bone damage affected MM patients undergoing stem cell transplantation and are significantly associated. ADVANCES IN KNOWLEDGE Quantitative measurement of sarcopenia and bone damage on CT resulted present in MM patients undergoing stem cell transplantation and are significantly associated.
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Affiliation(s)
| | | | | | - Lorenzo Torri
- Vascular
Surgery Unit, Azienda Ospedaliero Universitaria Pisana,
Pisa, Italy
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14
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Hu MH, Yen HK, Chen IH, Wu CH, Chen CW, Yang JJ, Wang ZY, Yen MH, Yang SH, Lin WH. Decreased psoas muscle area is a prognosticator for 90-day and 1-year survival in patients undergoing surgical treatment for spinal metastasis. Clin Nutr 2022; 41:620-629. [PMID: 35124469 DOI: 10.1016/j.clnu.2022.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 01/06/2022] [Accepted: 01/12/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND AIMS Survival estimation for patients with spinal metastasis is crucial to treatment decisions. Psoas muscle area (PMA), a surrogate for total muscle mass, has been proposed as a useful survival prognosticator. However, few studies have validated the predictive value of decreased PMA in an Asian cohort or its predictive value after controlling for existing preoperative scoring systems (PSSs). In this study, we aim to answer: (1) Is PMA associated with survival in Han Chinese patients with spinal metastasis? (2) Is PMA a good prognosticator according to concordance index (c-index) and decision curve analysis (DCA) after controlling for six existing and commonly used PSSs? METHODS This study included 180 adult (≥18 years old) Taiwanese patients with a mean age of 58.3 years (range: 22-85) undergoing surgical treatment for spinal metastasis. A patient's PMA was classified into decreased, medium, and large if it fell into the lower (0-33%), middle (33-67%), and upper (67-100%) 1/3 in the study cohort, respectively. We used logistic and cox proportional-hazard regressions to assess whether PMA was associated with 90-day, 1-year, and overall survival. The model performance before and after addition of PMA to six commonly used PSSs, including Tomita score, original Tokuhashi score, revised Tokuhashi score, modified Bauer score, New England Spinal Metastasis Score, and Skeletal Oncology Research Group machine learning algorithms (SORG-MLAs), was compared by c-index and DCA to determine if PMA was a useful survival prognosticator. RESULTS Patients with a larger PMA is associated with better 90-day, but not 1-year, survival. The model performance of 90-day survival prediction improved after PMA was incorporated into all PSSs except SORG-MLAs. PMA barely improved the discriminatory ability (c-index, 0.74; 95% confidence interval [CI], 0.67-0.82 vs. c-index, 0.74; 95% CI, 0.66-0.81) and provided little gain of clinical net benefit on DCA for SORG-MLAs' 90-day survival prediction. CONCLUSIONS PMA is a prognosticator for 90-day survival and improves the discriminatory ability of earlier-proposed PSSs in our Asian cohort. However, incorporating PMA into more modern PSSs such as SORG-MLAs did not significantly improve its prediction performance.
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Affiliation(s)
- Ming-Hsiao Hu
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Hung-Kuan Yen
- Department of Education, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - I-Hsin Chen
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Horng Wu
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Wei Chen
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Jiun-Jen Yang
- School of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Zhong-Yu Wang
- School of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Mao-Hsu Yen
- Department Computer Science and Engineering, National Taiwan Ocean University, Taiwan
| | - Shu-Hua Yang
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Hsin Lin
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan.
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15
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Dakis K, Nana P, Brodis A, Kouvelos G, Behrendt CA, Giannoukas A, Kölbel T, Spanos K. Sarcopenia is a prognostic biomarker for long-term survival after endovascular aortic aneurysm repair: A systematic review and meta-analysis. Ann Vasc Surg 2022; 83:358-368. [DOI: 10.1016/j.avsg.2022.02.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/19/2022] [Accepted: 02/25/2022] [Indexed: 12/11/2022]
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Associations of fat and muscle mass with overall survival in men with prostate cancer: a systematic review with meta-analysis. Prostate Cancer Prostatic Dis 2022; 25:615-626. [PMID: 34420038 PMCID: PMC9705235 DOI: 10.1038/s41391-021-00442-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND To systematically review and analyse the associations between fat and muscle mass measures with overall survival in men with prostate cancer. METHODS A systematic search was conducted in CINAHL, Cochrane Library, EMBASE, PubMed, and Web of Science databases from inception to December 2020, while abstracts from the American Society of Clinical Oncology (ASCO), Clinical Oncology Society of Australia (COSA), and the American College of Sports Medicine (ACSM) conferences were searched from 2014 to 2020. Eligible articles examined the association of body composition measures, such as fat mass (e.g., fat mass, visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and VAT/SAT) and muscle mass measures, with overall survival in prostate cancer patients at any treatment stage. The primary endpoint was overall survival. Random-effect meta-analysis was conducted for studies reporting multivariable or univariable analysis assessing the associations of fat mass measures (i.e., fat mass, VAT, SAT, VAT/SAT) and muscle mass measures with overall survival. RESULTS Sixteen cohort studies that comprised 4807 men with prostate cancer were included. Total adiposity (hazard ratio (HR) 0.98, 95% CI: 0.75-1.28, p = 0.888) and VAT (HR 1.03, 95% CI: 0.74-1.43, p = 0.873) were not significantly associated with overall survival, while higher subcutaneous adipose tissue levels were associated with higher survival (HR 0.68, 95% CI: 0.54-0.84, p = 0.001). Greater mortality risk was found in patients with localised (HR 1.91, 95% CI: 1.40-2.62, p < 0.001) and advanced disease (HR 1.43, 95% CI: 1.07-1.92, p = 0.020) presenting with low levels of muscle mass compared to those presenting with high levels. DISCUSSION These results indicate that although overall adiposity should be cautiously interpreted in regards to survival, high muscle mass and SAT, and low VAT/SAT ratio values are associated with overall survival in men with prostate cancer.
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Prognostic Impact of Sarcopenia in Patients with Metastatic Hormone-Sensitive Prostate Cancer. Cancers (Basel) 2021; 13:cancers13246345. [PMID: 34944964 PMCID: PMC8699789 DOI: 10.3390/cancers13246345] [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: 10/29/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 12/24/2022] Open
Abstract
The clinical value of sarcopenia has not been determined yet in metastatic hormone-sensitive prostate cancer (mHSPC). We retrospectively evaluated data of 70 consecutive patients with mHSPC receiving treatment with either early docetaxel (n = 42) or abiraterone acetate (n = 28) between July 2018 and April 2021. Skeletal muscle index was calculated from cross-sectional areas of skeletal muscle on baseline computed tomography (CT), defining sarcopenia as a skeletal muscle index of ≤52.4 cm2/m2. Failure-free survival (FFS), radiographic progression-free survival, and time to prostate-specific antigen (PSA) progression were estimated using the Kaplan-Meier method, and differences in survival probability were compared using the log-rank test. Cox proportional hazards regression analysis was conducted to identify the predictors of clinical outcomes. Patients with sarcopenia (n = 47) had shorter FFS than those without sarcopenia (n = 23) (median, 20.1 months vs. not reached; log-rank p < 0.001). Sarcopenia was independently associated with shorter FFS (hazard ratio (HR), 6.69; 95% confidence interval (CI), 1.57-28.49; p = 0.010) and time to PSA progression (HR, 12.91; 95% CI, 1.08-153.85; p = 0.043). In conclusion, sarcopenia is an independent prognostic factor for poor FFS and time to PSA progression in patients with mHSPC who receive early docetaxel or abiraterone acetate treatment.
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Mrowczynski OD, Yang AL, Liao J, Rizk E. The Potential of Glioblastoma Patient Symptoms to Diagnose and Predict Survival. Cureus 2021; 13:e16675. [PMID: 34462698 PMCID: PMC8389861 DOI: 10.7759/cureus.16675] [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: 05/26/2021] [Accepted: 07/15/2021] [Indexed: 12/25/2022] Open
Abstract
Glioblastoma is a devastating malignancy with a dismal survival rate and median survival time of 14 months. Currently, the biomarkers for glioblastoma are mostly molecular and include EGFRvIII, ATRX, PTEN, IDH1, MGMT, and others. These prognostic tumor biomarkers are obtained through a surgical biopsy and thus are not easily attainable. Clinicians would benefit from a robust, non-invasive, and readily available indicator for early diagnosis and accurate prognostication for glioblastoma patients. In this study, we assessed whether specific patient symptoms could provide an early diagnosis of glioblastoma. Further, we also assessed if any patient symptomatology could provide clinicians with the ability to prognosticate patient survival more accurately. We retrospectively reviewed the clinical data for 218 patients. We determined whether symptoms including headache, weakness, seizure, memory loss/confusion, visual changes, speech changes, and loss of consciousness led to a patient being diagnosed earlier and if any of these symptoms predicted diminished patient survival. Our study determined that weakness and memory loss/confusion were the symptoms that predicted diminished survival, and weakness alone was the symptom that predicted an earlier diagnosis. This study further elucidates the complexities of glioblastoma and provides clinicians with more data for their patients when discussing prognostication after diagnosis of glioblastoma.
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Affiliation(s)
| | - Ae L Yang
- Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Jiangang Liao
- Public Health Sciences, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Elias Rizk
- Neurological Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
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Trestini I, Sperduti I, Sposito M, Kadrija D, Drudi A, Avancini A, Tregnago D, Carbognin L, Bovo C, Santo A, Lanza M, D'Onofrio M, Tortora G, Bria E, Milella M, Pilotto S. Evaluation of nutritional status in non-small-cell lung cancer: screening, assessment and correlation with treatment outcome. ESMO Open 2021; 5:e000689. [PMID: 32424067 PMCID: PMC7239526 DOI: 10.1136/esmoopen-2020-000689] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/28/2020] [Accepted: 03/06/2020] [Indexed: 12/21/2022] Open
Abstract
Background Nutritional derangements are common hallmarks of non-small-cell lung cancer (NSCLC). Nevertheless, their early detection is overlooked in clinical routine. This study aimed to evaluate nutritional status and its correlation with outcome in NSCLC patients. Methods Data regarding NSCLC patients undergoing nutritional evaluation were prospectively collected (May 2016–October 2018). Nutritional risk was assessed by Nutritional Risk Screening 2002 (NRS-2002). Bilateral psoas major muscles were measured at L3 vertebrae level with routine staging-computed tomography and changes were evaluated using Wilcoxon signed-rank test. Clinico-pathological and nutritional data were correlated to progression-free/overall survival (PFS/OS) and response rate (ORR) using a Cox and logistic regression model. Kaplan–Meier curves were compared with log-rank test. Results Thirty-eight patients were included. The majority (65.8%) of them were at nutritional risk (NRS-2002 ≥3). At multivariate analysis for patients with advanced disease, age (HR 2.44, p=0.05), performance status (HR 2.48, p=0.043) and NRS-2002 (HR 1.74, p=0.001) were significant independent predictors for PFS and weight loss (HR 1.07, p=0.008) for OS. Patients with baseline NRS-2002 <3 had significantly longer 1-year PFS (85.7% vs 19.4%, p=0.02) and higher ORR (66.7% vs 21.4%) than those with NRS-2002 ≥3. An explorative evaluation demonstrated that NRS-2002 score significantly decreased after nutritional intervention (p=0.001) for 3 months. Conclusion Baseline nutritional risk represents a prognostic factor in NSCLC. Nutritional counselling should be applied as a fundamental tool to improve nutritional risk in a short period, ameliorating patients’ outcome.
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Affiliation(s)
- Ilaria Trestini
- Section of Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Isabella Sperduti
- Biostatistics Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Marco Sposito
- Section of Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Dzenete Kadrija
- Section of Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Alessandro Drudi
- Department of Radiology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Alice Avancini
- Biomedical Sciences, Department of Medicine, University of Verona, Verona, Italy
| | - Daniela Tregnago
- Section of Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Luisa Carbognin
- Division of Gynecologic Oncology, Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, I.R.C.C.S., Università Cattolica del Sacro Cuore, Roma, Italy; Department of Medicine, University of Verona, Verona, Italy
| | - Chiara Bovo
- Healthcare Department, Azienda Ospedaliera Universitaria Integrata (AOUI) Verona, Verona, Italy
| | - Antonio Santo
- Section of Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Massimo Lanza
- Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Mirko D'Onofrio
- Department of Radiology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Giampaolo Tortora
- Medical Oncology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario 'A.Gemelli' I.R.C.C.S, Roma, Italy
| | - Emilio Bria
- Medical Oncology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario 'A.Gemelli' I.R.C.C.S, Roma, Italy
| | - Michele Milella
- Section of Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Sara Pilotto
- Section of Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy.
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Jahrreiss V, Laukhtina E, D'Andrea D, Shariat SF. The prognostic value of sarcopenia in patients with prostate cancer: a systematic review. Curr Opin Urol 2021; 31:315-323. [PMID: 33965982 DOI: 10.1097/mou.0000000000000885] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Sarcopenia is known to affect perioperative and oncologic outcomes in patients with different urological malignancies. Nevertheless, the use of pretreatment sarcopenia as a predictor of clinical outcomes in patients with prostate cancer is still poorly studied. Therefore, we aimed to conduct a systematic review summarizing the available evidence and identifying the prognostic value of sarcopenia in prostate cancer patients. RECENT FINDINGS Sarcopenia was not predictive of biochemical recurrence in patients treated with radical prostatectomy. However, it was associated with worse long-term survival outcomes as well as the likelihood of developing postoperative complications after radical prostatectomy. In the context of radiotherapy, sarcopenia was a predictive factor for overall survival. In patients with hormone-sensitive prostate cancer treated with androgen deprivation, sarcopenia was associated with overall and cancer-specific survival. In patients with castration-resistant prostate cancer, sarcopenia was associated with poorer tolerance to docetaxel-based chemotherapy. SUMMARY Most studies found sarcopenia to be a predictor for worse perioperative and oncologic outcomes in patients treated with radical surgery, radiotherapy, or systemic therapy for prostate cancer. However, there is significant heterogeneity across the studies in terms of sarcopenia definition. For a better understanding of the prognostic value of sarcopenia in patients with prostate cancer, large-scale prospective studies are needed.
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Affiliation(s)
- Victoria Jahrreiss
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - David D'Andrea
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Department of Urology, Weill Cornell Medical College, New York, New York
- Department of Urology, University of Texas Southwestern, Dallas, Texas, USA
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
- Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
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21
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Huq S, Khalafallah AM, Ruiz-Cardozo MA, Botros D, Oliveira LAP, Dux H, White T, Jimenez AE, Gujar SK, Sair HI, Pillai JJ, Mukherjee D. A novel radiographic marker of sarcopenia with prognostic value in glioblastoma. Clin Neurol Neurosurg 2021; 207:106782. [PMID: 34186275 DOI: 10.1016/j.clineuro.2021.106782] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Sarcopenia is an important prognostic consideration in surgical oncology that has received relatively little attention in brain tumor patients. Temporal muscle thickness (TMT) has recently been proposed as a novel radiographic marker of sarcopenia that can be efficiently obtained within existing workflows. We investigated the prognostic value of TMT in primary and progressive glioblastoma. METHODS TMT measurements were performed on magnetic resonance images of 384 patients undergoing 541 surgeries for glioblastoma. Relationships between TMT and clinical characteristics were examined on bivariate analysis. Optimal TMT cutpoints were established using maximally selected rank statistics. Predictive value of TMT upon postoperative survival (PS) was assessed using Cox proportional hazards regression adjusted for age, sex, Karnofsky performance status (KPS), Stupp protocol completion, extent of resection, and tumor molecular markers. RESULTS Average TMT for the primary and progressive glioblastoma cohorts was 9.55 mm and 9.40 mm, respectively. TMT was associated with age (r = -0.14, p = 0.0008), BMI (r = 0.29, p < 0.0001), albumin (r = 0.11, p = 0.0239), and KPS (r = 0.11, p = 0.0101). Optimal TMT cutpoints for the primary and progressive cohorts were ≤ 7.15 mm and ≤ 7.10 mm, respectively. High TMT was associated with increased Stupp protocol completion (p = 0.001). On Cox proportional hazards regression, high TMT predicted increased PS in progressive [HR 0.47 (95% confidence interval (CI)) 0.25-0.90), p = 0.023] but not primary [HR 0.99 (95% CI 0.64-1.51), p = 0.949] glioblastoma. CONCLUSIONS TMT correlates with important prognostic variables in glioblastoma and predicts PS in patients with progressive, but not primary, disease. TMT may represent a pragmatic neurosurgical biomarker in glioblastoma that could inform treatment planning and perioperative optimization.
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Affiliation(s)
- Sakibul Huq
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Adham M Khalafallah
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Miguel A Ruiz-Cardozo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287, USA
| | - David Botros
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Leonardo A P Oliveira
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Hayden Dux
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Taija White
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Adrian E Jimenez
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Sachin K Gujar
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Haris I Sair
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Jay J Pillai
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287, USA; The Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287, USA.
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22
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Sheldon BL, DiMarzio M, Chung SH, Tram J, Khazen O, Staudt MD, Bondoc M, Pilitsis JG. Association of Outcomes of Spinal Cord Stimulation for Chronic Low Back Pain and Psoas Measurements Based on Size of Iliopsoas Muscles. Neuromodulation 2021; 25:121-127. [PMID: 33616289 DOI: 10.1111/ner.13375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/02/2021] [Accepted: 02/02/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Patients experience variable long-term improvement in chronic back pain despite successful spinal cord stimulation (SCS) trials. Iliopsoas (IP) size has been shown to differ between patients with low back pain and healthy controls. In this study, we examine whether IP muscle cross-sectional area (CSA) is associated with SCS outcomes. MATERIALS AND METHODS We examined patients for whom we had lumbar MRIs 6.3 years prior to SCS and had baseline and one-year outcome data. Percent change from baseline to one year was calculated for Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), Beck Depression Inventory (BDI), Pain Catastrophizing Scale (PCS), and McGill Pain Questionnaire (MPQ). Correlations between IP muscle CSA, ratio of iliopsoas muscle size to the vertebral body area (P/VBA), and the ratio of iliopsoas muscle size to BMI (P/BMI) were examined. Sex differences were considered. RESULTS A total of 73 subjects were included in this study including 30 females and 43 males. Males had significantly larger IP (males 15.70 ± 0.58, females 9.72 ± 0.43; p < 0.001), P/VBA (males 1.00 ± 0.04, females 0.76 ± 0.03, p < 0.001) and P/BMI ratio (males 0.51 ± 0.02, females 0.32 ± 0.01; p < 0.001) than females. In females, P/VBA predicted NRS worst pain scores (β = 0.82, p = 0.004, r2 = 0.55) and BDI (β = 0.59, p = 0.02, r2 = 0.24). In males, P/BMI was a significant predictor of BDI outcomes scores (β = 0.45, p = 0.03, r2 = 0.16). Males who had more muscle mass measured by iliopsoas size had more depression as measured using BDI (p = 0.03, r = 0.61). Females with less muscle mass measured by P/VBA also experienced more depression (p = 0.02, r = 0.74). CONCLUSIONS Our study showed that psoas measurements correlated with various pain outcomes specifically. P/VBA was most predictive in females and P/BMI in males. Depression correlated with P/BMI, reinforcing the complex relationship between depression and constant chronic pain. Tertile analyses further showed a relationship between iliopsoas CSA and depression in males and females. We provide preliminary data of sex-specific psoas measurements as a risk factor for worse SCS outcomes.
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Affiliation(s)
- Breanna L Sheldon
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Marisa DiMarzio
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Sung Hwan Chung
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Justin Tram
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Olga Khazen
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Michael D Staudt
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Melanie Bondoc
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Julie G Pilitsis
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA.,Department of Neurosurgery, Albany Medical College, Albany, NY, USA
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Rijken J, Crowe S, Trapp J, Kairn T. A review of stereotactic body radiotherapy for the spine. Phys Eng Sci Med 2020; 43:799-824. [DOI: 10.1007/s13246-020-00889-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 06/11/2020] [Indexed: 12/11/2022]
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Defining the vulnerable patient with myeloma-a frailty position paper of the European Myeloma Network. Leukemia 2020; 34:2285-2294. [PMID: 32555295 DOI: 10.1038/s41375-020-0918-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 12/20/2022]
Abstract
As the treatment landscape continues to evolve towards the application of precision medicine in multiple myeloma (MM), there is a clear need to identify those patients who are at risk of not achieving the maximum benefit whilst exposed to the highest level of toxicity. This group of patients, defined as frail, is an unmet clinical need. However, how we define such a vulnerable group of patients with MM remains to be clarified. An integral aspect of this is to define the physiological age and capacity of patients with MM to deal with the burden of their disease and it's treatment. Such assessments may include not only functional and clinical assessments but also laboratory-based biomarkers of frailty, aging and senescent cellular burden. A need to develop, test and validate clinical screening scores before their adoption into clinical practice is mandated. This position paper from the European Myeloma Network aims to review what is known about defining frailty in MM, and how we can advance this knowledge for the design of clinical trials and ultimately how we deliver treatment in the clinic.
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