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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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Jayaprakash K, Wells JCK, Rajwal S, Mushtaq T, Kyrana E. Preservation of fat mass at the expense of lean mass in children with end-stage chronic liver disease. Pediatr Transplant 2024; 28:e14767. [PMID: 38895795 DOI: 10.1111/petr.14767] [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: 10/16/2023] [Revised: 04/02/2024] [Accepted: 04/09/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Sarcopenia predicts morbidity and mortality in end-stage chronic liver disease (ESCLD). Here, we describe changes in body composition in children with ESCLD before and after liver transplantation (LT). METHODS Retrospective analysis of whole body DXA scans performed before and after LT over 4 years. Appendicular and whole-body fat mass and lean mass were expressed as fat mass (FMI) and lean mass (LMI) index z-scores. Sarcopenia was defined as leg LMI z-score <-1.96. RESULTS Eighty-three DXA scans of children before or after LT were studied. Sarcopenia had a positive correlation with weight (0.8, p < .01), height (0.48, p < .05), and BMI z-score (0.77, p < .01), as well as arm, trunk, and total mean mass indices. It correlated negatively with indices of hypersplenism: PLTs (-0.57, p < .01), Neu (-0.50, p < .05), WCC (-0.44, p < .05), and days to discharge (-0.46, p < .05). At baseline: 13/25 (52%) children were sarcopenic and stayed in the hospital after LT for longer. Eight were stunted with a higher WCC and Ne/Ly ratio. All had normal FM indices. One year after LT, 12/26 children remained sarcopenic. Seven were stunted. Two years after LT, 5/15 were sarcopenic, and 5 were stunted. Three years after LT, 1/10 was sarcopenic, and 2 were stunted. By 4 years after LT, 1/7 was sarcopenic, and the same one was stunted. FM indices remained normal. CONCLUSIONS Sarcopenic patients stayed longer in the hospital after LT. Lean mass indices were mostly within the normal range by 4 years after LT. 32% of children were stunted, and markers of inflammation were correlated with stunting. Fat mass was preserved at the cost of lean mass.
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Affiliation(s)
| | - Jonathan C K Wells
- Childhood Nutrition Research Centre, University College London, London, UK
| | - Sanjay Rajwal
- Children's Liver Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Talat Mushtaq
- Children's Endocrinology Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Eirini Kyrana
- Institute of Liver Studies, King's College London, London, UK
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Hu M, Yingyu Z, Zhang M, Wang Q, Cheng W, Hou L, Yuan J, Yu Z, Li L, Zhang X, Zhang W. Functionalizing tetrahedral framework nucleic acids-based nanostructures for tumor in situ imaging and treatment. Colloids Surf B Biointerfaces 2024; 240:113982. [PMID: 38788473 DOI: 10.1016/j.colsurfb.2024.113982] [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: 03/18/2024] [Revised: 05/13/2024] [Accepted: 05/20/2024] [Indexed: 05/26/2024]
Abstract
Timely in situ imaging and effective treatment are efficient strategies in improving the therapeutic effect and survival rate of tumor patients. In recent years, there has been rapid progress in the development of DNA nanomaterials for tumor in situ imaging and treatment, due to their unsurpassed structural stability, excellent material editability, excellent biocompatibility and individual endocytic pathway. Tetrahedral framework nucleic acids (tFNAs), are a typical example of DNA nanostructures demonstrating superior stability, biocompatibility, cell-entry performance, and flexible drug-loading ability. tFNAs have been shown to be effective in achieving timely tumor in situ imaging and precise treatment. Therefore, the progress in the fabrication, characterization, modification and cellular internalization pathway of tFNAs-based functional systems and their potential in tumor in situ imaging and treatment applications were systematically reviewed in this article. In addition, challenges and future prospects of tFNAs in tumor in situ imaging and treatment as well as potential clinical applications were discussed.
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Affiliation(s)
- Minghui Hu
- Health Commission of Henan Province Key Laboratory for Precision Diagnosis and Treatment of Pediatric Tumor, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou 450018, China
| | - Zhang Yingyu
- Henan Key Laboratory of Rare Diseases, Endocrinology and Metabolism Center, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang 471003, China
| | - Mengxin Zhang
- Health Commission of Henan Province Key Laboratory for Precision Diagnosis and Treatment of Pediatric Tumor, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou 450018, China
| | - Qionglin Wang
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou 450018, China
| | - Weyland Cheng
- Henan International Joint Laboratory for Prevention and Treatment of Pediatric Disease, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou 450018, China
| | - Ligong Hou
- Henan International Joint Laboratory for Prevention and Treatment of Pediatric Disease, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou 450018, China
| | - Jingya Yuan
- Henan Key Laboratory of Rare Diseases, Endocrinology and Metabolism Center, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang 471003, China
| | - Zhidan Yu
- Henan International Joint Laboratory for Prevention and Treatment of Pediatric Disease, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou 450018, China
| | - Lifeng Li
- Henan International Joint Laboratory for Prevention and Treatment of Pediatric Disease, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou 450018, China
| | - Xianwei Zhang
- Health Commission of Henan Province Key Laboratory for Precision Diagnosis and Treatment of Pediatric Tumor, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou 450018, China.
| | - Wancun Zhang
- Health Commission of Henan Province Key Laboratory for Precision Diagnosis and Treatment of Pediatric Tumor, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou 450018, China; Henan International Joint Laboratory for Prevention and Treatment of Pediatric Disease, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou 450018, China; Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou 450018, China.
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Matsuoka W, Mizuguchi S, Kaku N, Higashi K, Tetsuhara K, Akahoshi T, Ohga S. Skeletal Muscle Mass Assessment in Pediatric Patients: Development of a Normative Equation and Assessment of Factors Associated With a Low Skeletal Muscle Mass in PICU Patients. Pediatr Crit Care Med 2024; 25:621-628. [PMID: 38629921 DOI: 10.1097/pcc.0000000000003511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
OBJECTIVES To develop an equation for defining a low skeletal muscle mass (SMM) in children and to investigate risk factors and outcomes associated with low SMM in critically ill pediatric patients. DESIGN Single-center retrospective pediatric cohorts, 2011-2018. SETTING Tertiary Emergency and Critical Care Center of Kyushu University Hospital in Japan. PATIENTS We studied two cohorts of pediatric patients 1-15 years old who underwent abdominal CT at the level of the third lumbar vertebra (L3). First a cohort of trauma patients presented to the emergency department in whom we developed an SMM regression equation. Second, a cohort of patients who had undergone abdominal CT within 3 days of PICU admission. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The equation for estimating normal SMM used sex, age, and weight. Low SMM was defined as less than 80% of normal. In the 112 patients in the PICU cohort, median (range) age was 68 (13-191) months, and 83 (74.1%) had underlying disease. There was low SMM in 54 patients (48.2%). Regarding associations, using odds ratio (OR) and 95% CI, we found that low dietary intake (OR 4.33 [95% CI, 1.37-13.70]; p = 0.013) and the presence of underlying disease (OR 7.44 [95% CI, 2.10-26.30]; p = 0.002) were independently associated with greater odds of low SMM. Low SMM, compared with normal SMM, was also associated with longer hospital stays (42.5 d vs. 20.5 d; p = 0.007; β, 1.59; 95% CI, 1.09-2.33; p = 0.016). CONCLUSIONS In this retrospective PICU cohort from a single center in Japan, we found that low SMM at PICU admission was present in almost half the cases. Low SMM, as defined by being less than 80% of the normal, was associated with greater odds of low dietary intake and underlying chronic disease. Furthermore, low SMM was associated with longer hospital stays.
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Affiliation(s)
- Wakato Matsuoka
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan
| | - Soichi Mizuguchi
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan
| | - Noriyuki Kaku
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan
| | - Kanako Higashi
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan
| | - Kenichi Tetsuhara
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan
| | - Tomohiko Akahoshi
- Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Rodriguez C, Mota JD, Palmer TB, Heymsfield SB, Tinsley GM. Skeletal muscle estimation: A review of techniques and their applications. Clin Physiol Funct Imaging 2024; 44:261-284. [PMID: 38426639 DOI: 10.1111/cpf.12874] [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: 01/13/2024] [Accepted: 02/14/2024] [Indexed: 03/02/2024]
Abstract
Quantifying skeletal muscle size is necessary to identify those at risk for conditions that increase frailty, morbidity, and mortality, as well as decrease quality of life. Although muscle strength, muscle quality, and physical performance have been suggested as important assessments in the screening, prevention, and management of sarcopenic and cachexic individuals, skeletal muscle size is still a critical objective marker. Several techniques exist for estimating skeletal muscle size; however, each technique presents with unique characteristics regarding simplicity/complexity, cost, radiation dose, accessibility, and portability that are important factors for assessors to consider before applying these modalities in practice. This narrative review presents a discussion centred on the theory and applications of current non-invasive techniques for estimating skeletal muscle size in diverse populations. Common instruments for skeletal muscle assessment include imaging techniques such as computed tomography, magnetic resonance imaging, peripheral quantitative computed tomography, dual-energy X-ray absorptiometry, and Brightness-mode ultrasound, and non-imaging techniques like bioelectrical impedance analysis and anthropometry. Skeletal muscle size can be acquired from these methods using whole-body and/or regional assessments, as well as prediction equations. Notable concerns when conducting assessments include the absence of standardised image acquisition/processing protocols and the variation in cut-off thresholds used to define low skeletal muscle size by clinicians and researchers, which could affect the accuracy and prevalence of diagnoses. Given the importance of evaluating skeletal muscle size, it is imperative practitioners are informed of each technique and their respective strengths and weaknesses.
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Affiliation(s)
- Christian Rodriguez
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas, USA
| | - Jacob D Mota
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas, USA
| | - Ty B Palmer
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas, USA
| | - Steven B Heymsfield
- Metabolism and Body Composition Laboratory, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana, USA
| | - Grant M Tinsley
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas, USA
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Sun Y, Deng M, Gevaert O, Aberle M, Olde Damink SW, van Dijk D, Rensen SS. Tumor metabolic activity is associated with subcutaneous adipose tissue radiodensity and survival in non-small cell lung cancer. Clin Nutr 2024; 43:1809-1815. [PMID: 38870661 DOI: 10.1016/j.clnu.2024.05.040] [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: 03/14/2024] [Revised: 05/23/2024] [Accepted: 05/23/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Cachexia-associated body composition alterations and tumor metabolic activity are both associated with survival of cancer patients. Recently, subcutaneous adipose tissue properties have emerged as particularly prognostic body composition features. We hypothesized that tumors with higher metabolic activity instigate cachexia related peripheral metabolic alterations, and investigated whether tumor metabolic activity is associated with body composition and survival in patients with non-small-cell lung cancer (NSCLC), focusing on subcutaneous adipose tissue. METHODS A retrospective analysis was performed on a cohort of 173 patients with NSCLC. 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) scans obtained before treatment were used to analyze tumor metabolic activity (standardized uptake value (SUV) and SUV normalized by lean body mass (SUL)) as well as body composition variables (subcutaneous and visceral adipose tissue radiodensity (SAT/VAT radiodensity) and area; skeletal muscle radiodensity (SM radiodensity) and area). Subjects were divided into groups with high or low SAT radiodensity based on Youden Index of Receiver Operator Characteristics (ROC). Associations between tumor metabolic activity, body composition variables, and survival were analyzed by Mann-Whitney tests, Cox regression, and Kaplan-Meier analysis. RESULTS The overall prevalence of high SAT radiodensity was 50.9% (88/173). Patients with high SAT radiodensity had shorter survival compared with patients with low SAT radiodensity (mean: 45.3 vs. 50.5 months, p = 0.026). High SAT radiodensity was independently associated with shorter overall survival (multivariate Cox regression HR = 1.061, 95% CI: 1.022-1.101, p = 0.002). SAT radiodensity also correlated with tumor metabolic activity (SULpeak rs = 0.421, p = 0.029; SUVpeak rs = 0.370, p = 0.048). In contrast, the cross-sectional areas of SM, SAT, and VAT were not associated with tumor metabolic activity or survival. CONCLUSION Higher SAT radiodensity is associated with higher tumor metabolic activity and shorter survival in patients with NSCLC. This may suggest that tumors with higher metabolic activity induce subcutaneous adipose tissue alterations such as decreased lipid density, increased fibrosis, or browning.
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Affiliation(s)
- Yan Sun
- Department of Surgery and NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Min Deng
- Department of Surgery and NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Olivier Gevaert
- Stanford Center for Biomedical Informatics Research, Department of Medicine, Stanford University, USA; Stanford Center for Biomedical Informatics Research, Department of Biomedical Data Science, Stanford University, USA
| | - Merel Aberle
- Department of Surgery and NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Steven W Olde Damink
- Department of Surgery and NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands; Department of General, Visceral- and Transplantation Surgery, University Hospital Essen, Duisberg-Essen University, Germany
| | - David van Dijk
- Department of Surgery and NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Sander S Rensen
- Department of Surgery and NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.
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Surov A, Wienke A, Gutzmer R, Borggrefe J. Prognostic role of the skeletal musculature in oncology: significance, coherences and clinical implications. ROFO-FORTSCHR RONTG 2024; 196:699-706. [PMID: 38134902 DOI: 10.1055/a-2213-2320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Affiliation(s)
- Alexey Surov
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling Medical Center, Ruhr University Bochum, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin Luther University Halle Wittenberg, Halle, Germany
| | - Ralf Gutzmer
- Department of Dermatology, Johannes Wesling Medical Center, Ruhr University Bochum, Germany
| | - Jan Borggrefe
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling Medical Center, Ruhr University Bochum, Germany
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Shachar E, Raphael A, Katz U, Kessner R, Shachar SS. Body composition measures as a determinant of Alpelisib related toxicity. Breast Cancer Res Treat 2024; 206:369-376. [PMID: 38584192 PMCID: PMC11182811 DOI: 10.1007/s10549-024-07315-9] [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: 01/15/2024] [Accepted: 03/22/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Body composition has emerged as an important prognostic factor in patients treated with cancer. Severe depletion of skeletal muscle, sarcopenia, has been associated with poor performance status and worse oncological outcomes. We studied patients with metastatic breast cancer receiving alpelisib, to determine if sarcopenia and additional body composition measures accounting for muscle and adiposity are associated with toxicity. METHODS A retrospective observational analysis was conducted, including 38 women with metastatic breast cancer and a PIK3CA mutation, treated with alpelisib as advanced line of therapy. Sarcopenia was determined by measuring skeletal muscle cross-sectional area at the third lumbar vertebra using computerized tomography. Various body composition metrics were assessed along with drug toxicity, dose reductions, treatment discontinuation, hospitalizations, time to treatment failure and overall survival. RESULTS Sarcopenia was observed in half of the patients (n = 19, 50%), spanning normal weight, overweight, and obese individuals. Among the body composition measures, lower skeletal muscle density (SMD) was associated with an increased risk of treatment-related hyperglycaemia (P = 0.03). Additionally, lower visceral adipose tissue (VAT) was associated with alpelisib-induced rash (P = 0.04) and hospitalizations (P = 0.04). Notably, alpelisib treatment discontinuation was not impacted by alpelisib toxicity. CONCLUSION Body composition measures, specifically SMD and VAT may provide an opportunity to identify patients at higher risk for severe alpelisib related hyperglycemia, and cutaneous toxicity. These findings suggest the potential use of body composition assessment to caution toxicity risk, allowing for personalized therapeutic observation and intervention.
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Affiliation(s)
- Eliya Shachar
- Oncology Department, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ari Raphael
- Oncology Department, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uriel Katz
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rivka Kessner
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Radiology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shlomit Strulov Shachar
- Oncology Department, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, Israel.
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Ding P, Wu H, Li T, Wu J, Yang L, Yang J, Guo H, Tian Y, Yang P, Meng L, Zhao Q. Impact of preoperative sarcopenia on postoperative complications and prognosis in patients undergoing robotic gastric cancer surgery: A propensity score matching study. Nutrition 2024; 123:112408. [PMID: 38513525 DOI: 10.1016/j.nut.2024.112408] [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: 12/19/2023] [Revised: 02/09/2024] [Accepted: 02/17/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Sarcopenia, defined as decreased muscle mass and function, correlates with postoperative morbidity and mortality in cancer surgery. However, sarcopenia's impact specifically following robotic gastrectomy for gastric cancer has not been clearly defined. This study aimed to determine the influence of sarcopenia on short- and long-term clinical outcomes after robotic gastrectomy for gastric cancer. METHODS This retrospective study analyzed 381 gastric cancer patients undergoing robotic gastrectomy. Sarcopenia was diagnosed by preoperative computed tomography (CT) body composition analysis. Propensity score matching created 147 pairs of sarcopenia and nonsarcopenia patients for comparison. Outcomes included postoperative complications, survival, inflammatory markers, length of stay, intensive care unit (ICU) transfer, and readmissions. RESULTS Sarcopenia patients exhibited significantly higher rates of overall (53.7% versus 21.1%, P < 0.001), serious (12.9% versus 4.1%, P = 0.007), and grade III-IV complications compared to nonsarcopenia pairs after matching. Sarcopenia independently predicted reduced 3-years overall (HR = 2.53, 95% CI: 1.19-5.40, P = 0.016) and disease-free survival (HR = 1.99, 95% CI: 1.09-3.66, P = 0.026). Sarcopenia patients also showed heightened postoperative leukocyte, neutrophil, platelet, platelet to lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and monocyte to lymphocyte ratio (MLR) levels alongside suppressed lymphocytes, monocytes, and neutrophil to lymphocyte ratio (NLR). CONCLUSION Preoperative sarcopenia is correlated with increased postoperative complications and poorer long-term survival in gastric cancer patients undergoing robotic gastrectomy. Sarcopenia assessment can optimize preoperative risk stratification and perioperative management in this population.
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Affiliation(s)
- Ping'an Ding
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China; Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, China; Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer Hebei Provincial Engineering Research Center, Shijiazhuang, China
| | - Haotian Wu
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China; Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, China; Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer Hebei Provincial Engineering Research Center, Shijiazhuang, China
| | - Tongkun Li
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China; Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, China; Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer Hebei Provincial Engineering Research Center, Shijiazhuang, China
| | - Jiaxiang Wu
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China; Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, China; Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer Hebei Provincial Engineering Research Center, Shijiazhuang, China
| | - Li Yang
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, China; Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer Hebei Provincial Engineering Research Center, Shijiazhuang, China; The Department of CT/MRI, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jiaxuan Yang
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China; Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, China; Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer Hebei Provincial Engineering Research Center, Shijiazhuang, China
| | - Honghai Guo
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China; Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, China; Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer Hebei Provincial Engineering Research Center, Shijiazhuang, China
| | - Yuan Tian
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China; Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, China; Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer Hebei Provincial Engineering Research Center, Shijiazhuang, China
| | - Peigang Yang
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China; Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, China; Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer Hebei Provincial Engineering Research Center, Shijiazhuang, China
| | - Lingjiao Meng
- Research Center and Tumor Research Institute of the Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
| | - Qun Zhao
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China; Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, China; Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer Hebei Provincial Engineering Research Center, Shijiazhuang, China.
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10
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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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11
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Siwakoti K, Nabell L, McDonald AM, Williams GR. Association of malnutrition with geriatric assessment impairments and health-related quality of life among older adults with head and neck cancers. J Geriatr Oncol 2024:101818. [PMID: 38942691 DOI: 10.1016/j.jgo.2024.101818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 05/07/2024] [Accepted: 06/21/2024] [Indexed: 06/30/2024]
Affiliation(s)
- Krishmita Siwakoti
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Lisle Nabell
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andrew M McDonald
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Grant R Williams
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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12
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Rai J, Pring ET, Knight K, Tilney H, Gudgeon J, Gudgeon M, Taylor F, Gould LE, Wong J, Andreani S, Mai DVC, Drami I, Lung P, Athanasiou T, Roxburgh C, Jenkins JT. Sarcopenia is independently associated with poor preoperative physical fitness in patients undergoing colorectal cancer surgery. J Cachexia Sarcopenia Muscle 2024. [PMID: 38925534 DOI: 10.1002/jcsm.13536] [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: 11/20/2023] [Revised: 04/05/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Accurate preoperative risk assessment for major colorectal cancer (CRC) surgery remains challenging. Body composition (BC) and cardiopulmonary exercise testing (CPET) can be used to evaluate risk. The relationship between BC and CPET in patients undergoing curative CRC surgery is unclear. METHODS Consecutive patients undergoing CPET prior to CRC surgery between 2010 and 2020 were identified between two different UK hospitals. Body composition phenotypes such as sarcopenia, myosteatosis, and visceral obesity were defined using widely accepted thresholds using preoperative single axial slice CT image at L3 vertebrae. Relationships between clinicopathological, BC, and CPET variables were investigated using linear regression analysis. RESULTS Two hundred eighteen patients with stage I-III CRC were included. The prevalence of sarcopenia, myosteatosis, and visceral obesity was 62%, 33%, and 64%, respectively. The median oxygen uptake at anaerobic threshold (VO2 at AT) was 12.2 mL/kg/min (IQR 10.6-14.2), and oxygen uptake at peak exercise (VO2 peak) was 18.8 mL/kg/min (IQR 15.4-23). On univariate linear regression analysis, male sex (P < 0.001) was positively associated with VO2 at AT. While ASA grade (P < 0.001) and BMI (P = 0.007) were negatively associated with VO2 at AT, on multivariate linear regression analysis, these variables remained significant (P < 0.05). On univariate linear regression analysis, male sex (P < 0.001) was positively associated with VO2 peak, whereas age (P < 0.001), ASA grade (P < 0.001), BMI (P = 0.003), sarcopenia (P = 0.015), and myosteatosis (P < 0.001) were negatively associated with VO2 peak. On multivariate linear regression analysis age (P < 0.001), ASA grade (P < 0.001), BMI (P < 0.001), and sarcopenia (P = 0.006) were independently and negatively associated with VO2 peak. CONCLUSIONS The novel finding that sarcopenia is independently associated with reduced VO2 peak performance in CPET supports the supposition that reduced muscle mass relates to poor physical function in CRC patients. Further work should be undertaken to assess whether sarcopenia diagnosed on CT can act as suitable surrogate for CPET to further enhance personalized risk stratification.
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Affiliation(s)
- Jason Rai
- BiCyCLE Research Group, St Mark's the National Bowel Hospital, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Edward T Pring
- BiCyCLE Research Group, St Mark's the National Bowel Hospital, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Katrina Knight
- Department of Surgery, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
| | - Henry Tilney
- Department of Surgery and Cancer, Imperial College London, London, UK
- Frimley Park Hospital, Frimley Health NHS Foundation Trust, Frimley, UK
| | - Judy Gudgeon
- Frimley Park Hospital, Frimley Health NHS Foundation Trust, Frimley, UK
| | - Mark Gudgeon
- Frimley Park Hospital, Frimley Health NHS Foundation Trust, Frimley, UK
| | - Fiona Taylor
- Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | - Laura E Gould
- BiCyCLE Research Group, St Mark's the National Bowel Hospital, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Joel Wong
- Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | - Stefano Andreani
- Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | - Dinh V C Mai
- BiCyCLE Research Group, St Mark's the National Bowel Hospital, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ioanna Drami
- BiCyCLE Research Group, St Mark's the National Bowel Hospital, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Phillip Lung
- BiCyCLE Research Group, St Mark's the National Bowel Hospital, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Thanos Athanasiou
- BiCyCLE Research Group, St Mark's the National Bowel Hospital, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Campbell Roxburgh
- Department of Surgery, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
| | - John T Jenkins
- BiCyCLE Research Group, St Mark's the National Bowel Hospital, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
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13
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Brath MSG, Kristensen SV, Sahakyan M, Mark EB, Rasmussen HH, Østergaard LR, Frøkjær JB, Weinreich UM. Influence of weight-adjusted contrast enhancement on CT-derived skeletal muscle measures: A retrospective proof-of concept comparative study between Danish females and males. Am J Clin Nutr 2024:S0002-9165(24)00578-1. [PMID: 38936776 DOI: 10.1016/j.ajcnut.2024.06.009] [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: 09/15/2023] [Revised: 05/31/2024] [Accepted: 06/21/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Computed Tomography (CT) has an underutilized potential for evaluating body composition in clinical settings. Often conducted with intravenous contrast (IVC), CT scans yield unused body composition data due to unclear effects on skeletal muscle area (SMA), skeletal muscle index (SMI), and muscle density (SMD). OBJECTIVE This study investigates whether weight-adjusted IVC influences SMA, SMI, and SMD differently in female and male compared to non-contrast abdominal CT. Additionally, the study explores associations between contrast and non-contrast assessed SMA, SMI, SMD, and demographic factors. METHODS A comparative observational retrospective study was conducted on Danish patients who underwent consecutive four-phased contrast-enhanced abdominal CT scans (non-contrast, arterial, venous, and late venous phases). Muscle measures were evaluated using validated semi-automated threshold-based software by three independent raters. RESULTS The study included 72 patients (51 male, 21 female) with a mean age of 59 (55, 62) years. Weight-adjusted IVC increased SMA by up to 3.28 cm2 (CI: 2.58, 3.98) corresponding to 2.4% (1.8, 2.9) in late venous phase compared to non-contrast CT. Analysis between sexes showed no difference in the effects of IVC on SMA and SMI between female and male. However, females exhibited a higher increase in SMD during the venous by a mean of 1.7 HU 0.9; 2.5) and late venous phases with a mean HU of 1.80 (1.0; 2.6) compared to males. Multivariate regression analysis indicated an association between the differences in SMD and sex during venous (-1.38 , 95%CI: - 2.48, -0.48) and late venous phases (-1.23, 95% CI: -2.27, -0.19) CONCLUSION: Weight-adjusted IVC leads to increased SMA, SMI, and SMD. While SMA and SMI differences were consistent across the sexes, females exhibited a significantly higher SMD increase than male in the venous and late venous phases. Further investigations are necessary to determine the applicability of SMD as a muscle quality proxy in IVC CT scans.
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Affiliation(s)
- Mia Solholt Godthaab Brath
- Dept. of Respiratory Medicine, Aalborg University Hospital, Aalborg, Denmark; Research unit of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark; Dept. of Clinical Medicine; Aalborg University, Aalborg, Denmark.
| | - Sebastian Villesen Kristensen
- Institute of Regional Health Research, Southern Danish University; Dept. of Radiology, Kolding, Lillebaelt Hospital, University Hospitals of Southern Denmark, Denmark
| | - Marina Sahakyan
- Dept. of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | - Esben Bolvig Mark
- Dept. of Clinical Medicine; Aalborg University, Aalborg, Denmark; Mech-Sense, Dept. of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Henrik Højgaard Rasmussen
- Dept. of Clinical Medicine; Aalborg University, Aalborg, Denmark; Danish Nutrition Science Center, Dept. of Gastroenterology & Hepatology, Aalborg University Hospital; Center for Nutrition and Intestinal Failure, Dept. of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark; The Dietitians and Nutritional Research Unit, EATEN, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Lasse Riis Østergaard
- Dept. of Clinical Medicine; Aalborg University, Aalborg, Denmark; Medical Informatics group, Dept. of Health Science and Technology, Aalborg University
| | - Jens Brøndum Frøkjær
- Dept. of Clinical Medicine; Aalborg University, Aalborg, Denmark; Dept. of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | - Ulla Møller Weinreich
- Dept. of Respiratory Medicine, Aalborg University Hospital, Aalborg, Denmark; Research unit of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark; Dept. of Clinical Medicine; Aalborg University, Aalborg, Denmark
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14
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Song M, Liu Z, Wu F, Nie T, Heng Y, Xu J, Huang N, Wu X, Cao Y, Hu G. Serum tumor marker and CT body composition scoring system predicts outcomes in colorectal cancer surgical patients. Eur Radiol 2024:10.1007/s00330-024-10849-7. [PMID: 38913246 DOI: 10.1007/s00330-024-10849-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 04/29/2024] [Accepted: 06/03/2024] [Indexed: 06/25/2024]
Abstract
OBJECTIVE To investigate the prognostic value of preoperative body composition and serum tumor markers (STM) in patients undergoing surgical treatment for colorectal cancer (CRC) and to establish the prognostic score for patients with CRC. METHODS This study enrolled 365 patients (training set 245, validation set 120) with CRC who underwent surgical resection. The predictive value of various body composition features and STM for determining CRC prognosis were compared. A novel index score based on the independent risk factors from Cox regression for CRC patients was established and evaluated for its usefulness. RESULTS Multivariate Cox regression showed that low skeletal muscle radiodensity (SMD) (p = 0.020), low subcutaneous fat area (SFA) (p = 0.029), high carcinoembryonic antigen (CEA) (p = 0.008), and high alpha-fetoprotein (AFP) (p = 0.039) were all independent prognostic factors for poor overall survival (OS). The multifactorial analysis indicated that high intermuscular fat area (IMFA) (p = 0.033) and high CEA (p = 0.009) were independent prognostic factors for poor disease-free survival (DFS). Based on these findings, two scoring systems for OS and DFS were established in the training datasets. CRC patients who scored higher on the new scoring systems had lower OS and DFS (both p < 0.001) as shown in the Kaplan-Meier survival curves in the training and validation datasets. CONCLUSION In predicting the prognosis of CRC patients, SFA and SMD are superior to other body composition measurements. A scoring system based on body composition and STM can have prognostic value and clinical applicability. CLINICAL RELEVANCE STATEMENT This scoring system, combining body composition and serum tumor markers, may help predict postoperative survival of CRC patients and help clinicians make well-informed decisions regarding the treatment of patients. KEY POINTS Colorectal cancer prognosis can be related to body composition. High intermuscular fat area and CEA were independent prognostic factors for poor disease-free survival. This scoring system, based on body composition and tumor markers, can prognosticate for colorectal cancer patients.
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Affiliation(s)
- Mingming Song
- Department of General Surgery, The Second People's Hospital of Hefei Affiliated to Bengbu Medical University, Hefei, 230011, China
- Department of General Surgery, The Second People's Hospital of Hefei, Hefei, 230011, China
| | - Zhihao Liu
- China Medical University, Shenyang, 110122, China
| | - Feihong Wu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Tong Nie
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Yixin Heng
- Department of General Surgery, The First Affiliated Hospital of Shihezi University, Shihezi, 832000, P.R. China
| | - Jiaxin Xu
- Department of General Surgery, The First Affiliated Hospital of Shihezi University, Shihezi, 832000, P.R. China
| | - Ning Huang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xiaoyu Wu
- Department of General Surgery, The First Affiliated Hospital of Shihezi University, Shihezi, 832000, P.R. China
| | - Yinghao Cao
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- National Local Joint Laboratory for Advanced Textile Processing and Clean Production, Wuhan Textile University, Wuhan, 430073, China.
| | - Gang Hu
- Department of General Surgery, The Second People's Hospital of Hefei Affiliated to Bengbu Medical University, Hefei, 230011, China.
- Department of General Surgery, The Second People's Hospital of Hefei, Hefei, 230011, China.
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15
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Hidaka Y, Tanoue S, Ayukawa T, Takumi K, Noguchi H, Higashi M, Idichi T, Kawasaki Y, Kurahara H, Mataki Y, Ohtsuka T, Koriyama C. Impact of pancreatic ductal occlusion on postoperative outcomes in pancreatic head cancer patients undergoing neoadjuvant therapy. J Gastroenterol 2024:10.1007/s00535-024-02125-8. [PMID: 38900299 DOI: 10.1007/s00535-024-02125-8] [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: 02/22/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Pancreatic ductal occlusion can accompany pancreatic head cancer, leading to pancreatic exocrine insufficiency (PEI) and adverse effects on nutritional status and postoperative outcomes. We investigated its impact on nutritional status, body composition, and postoperative outcomes in patients with pancreatic head cancer undergoing neoadjuvant therapy (NAT). METHODS We analyzed 136 patients with pancreatic head cancer who underwent NAT prior to intended pancreaticoduodenectomy (PD) between 2015 and 2022. Nutritional and anthropometric indices (body mass index [BMI], albumin, prognostic nutritional index [PNI], Glasgow prognostic score, psoas muscle index, subcutaneous adipose tissue index [SATI], and visceral adipose tissue index) and postoperative outcomes were compared between the occlusion (n = 78) and non-occlusion (n = 58) groups, in which 61 and 44 patients, respectively, ultimately underwent PD. RESULTS The occlusion group showed significantly lower post-NAT BMI, PNI, and SATI (p = 0.011, 0.005, and 0.015, respectively) in the PD cohort. The occlusion group showed significantly larger main pancreatic duct, smaller pancreatic parenchyma, and greater duct-parenchymal ratio (p < 0.001), and these morphological parameters significantly correlating with post-NAT nutritional and anthropometric indices. Postoperative 3-year survival and recurrence-free survival (RFS) rates were significantly poorer (p = 0.004 and 0.013) with pancreatic ductal occlusion, also identified as an independent postoperative risk factor for overall survival (hazard ratio [HR]: 2.31, 95% confidence interval [CI] 1.08-4.94, p = 0.030) and RFS (HR: 2.03, 95% CI 1.10-3.72, p = 0.023), in multivariate analysis. CONCLUSIONS Pancreatic ductal occlusion may be linked to poorer postoperative outcomes due to PEI-related malnutrition.
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Affiliation(s)
- Yoshifumi Hidaka
- Department of Epidemiology and Preventive Medicine, Graduate School of Medical and Dental Science, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
- Department of Digestive Surgery, Graduate School of Medical and Dental Science, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Shiroh Tanoue
- Department of Epidemiology and Preventive Medicine, Graduate School of Medical and Dental Science, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan.
| | - Takuro Ayukawa
- Department of Radiology, Graduate School of Medical and Dental Science, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Koji Takumi
- Department of Radiology, Graduate School of Medical and Dental Science, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Hirotsugu Noguchi
- Department of Pathology, Graduate School of Medical and Dental Science, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Michiyo Higashi
- Department of Pathology, Graduate School of Medical and Dental Science, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Tetsuya Idichi
- Department of Digestive Surgery, Graduate School of Medical and Dental Science, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Yota Kawasaki
- Department of Digestive Surgery, Graduate School of Medical and Dental Science, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Hiroshi Kurahara
- Department of Digestive Surgery, Graduate School of Medical and Dental Science, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Yuko Mataki
- Department of Digestive Surgery, Graduate School of Medical and Dental Science, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Takao Ohtsuka
- Department of Digestive Surgery, Graduate School of Medical and Dental Science, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Chihaya Koriyama
- Department of Epidemiology and Preventive Medicine, Graduate School of Medical and Dental Science, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
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16
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Buxton C, Schmeusser BN, Holt SK, Patil D, Phuong A, Chahine S, Marquardt JP, O'Malley R, Laidlaw G, Schade GR, Lin DW, Schweizer MT, Yezefski T, Yu EY, Montgomery B, Fintelmann FJ, Master VA, Psutka SP. A Multicenter Evaluation of Treatment-Associated Changes in Body Composition in Men with Germ Cell Tumors (GCT) of the Testis: Implications for Adverse Events and Complications. Urology 2024:S0090-4295(24)00473-4. [PMID: 38906271 DOI: 10.1016/j.urology.2024.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 05/15/2024] [Accepted: 06/11/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVES To characterize changes in body composition following cytotoxic chemotherapy for germ cell carcinoma of the testis (GCT) and quantify associations between body composition metrics and chemotherapy-associated adverse events (AEs) and post-retroperitoneal lymph node dissection (RPLND) complications. MATERIALS AND METHODS This retrospective multi-center study included 216 men with GCT treated with cytotoxic chemotherapy and/or RPLND (2005-2020). We measured body composition including skeletal muscle (SMI), visceral adipose (VAI,), subcutaneous adipose (SAI), and fat mass (FMI) indices on computed tomography. We quantified chemotherapy-associated changes in body composition and evaluated associations between body composition and incidence of grade 3+ AEs and post-RPLND complications on multivariable logistic regression analyses. RESULTS 182 men received a median of 3 cycles of cisplatin-based chemotherapy. Following chemotherapy, median change in SMI was -6% (p=<0.0001), while VAI, SAI, and FMI increased by +13% (p=<0.0001), +11% (p=<0.0001), and +6% (p=<0.0001), respectively. 79 patients (43%) experienced at least one grade 3+ AE. A decrease in SMI following chemotherapy was associated with increased risk of grade 3+ AEs (p=0.047). 103 men with a median age of 28.5 years (IQR 23-35.5) underwent RPLND of whom 22 (21.3%) experienced at least one grade 3+ post-RPLND complication. No baseline body composition metrics were associated with post-RPLND complications. CONCLUSIONS In men with GCT of the testis, chemotherapy was associated with 6% loss of lean muscle mass and gains in adiposity. Lower skeletal muscle was associated with a higher incidence of chemotherapy-associated AEs. Body composition was not associated with the incidence of post-RPLND complications.
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Affiliation(s)
- Claire Buxton
- University of Washington School of Medicine, Seattle WA
| | - Benjamin N Schmeusser
- Department of Urology, Emory University, Atlanta GA; Department of Urology, Indiana University, Indianapolis, IN
| | - Sarah K Holt
- Department of Urology, University of Washington, Seattle WA
| | | | - Anthea Phuong
- University of Washington School of Medicine, Seattle WA
| | | | - J Peter Marquardt
- Department of Radiology, Massachusetts General Hospital, Boston MA; Department of Neurology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Ryan O'Malley
- Department of Radiology, University of Washington, Seattle WA
| | - Grace Laidlaw
- Department of Radiology, University of Washington, Seattle WA
| | - George R Schade
- Department of Urology, University of Washington, Seattle WA; Clinical Research Division, Fred Hutchinson Cancer Center
| | - Daniel W Lin
- Department of Urology, University of Washington, Seattle WA; Clinical Research Division, Fred Hutchinson Cancer Center
| | - Michael T Schweizer
- Division of Hematology and Oncology, Dept. of Medicine, University of Washington, Seattle WA; Clinical Research Division, Fred Hutchinson Cancer Center
| | - Todd Yezefski
- Division of Hematology and Oncology, Dept. of Medicine, University of Washington, Seattle WA; Clinical Research Division, Fred Hutchinson Cancer Center
| | - Evan Y Yu
- Division of Hematology and Oncology, Dept. of Medicine, University of Washington, Seattle WA; Clinical Research Division, Fred Hutchinson Cancer Center
| | - Bruce Montgomery
- Division of Hematology and Oncology, Dept. of Medicine, University of Washington, Seattle WA; Clinical Research Division, Fred Hutchinson Cancer Center
| | | | | | - Sarah P Psutka
- Department of Urology, University of Washington, Seattle WA; Clinical Research Division, Fred Hutchinson Cancer Center.
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17
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van Erck D, Moeskops P, Schoufour JD, Weijs PJM, Scholte Op Reimer WJM, van Mourik MS, Planken RN, Vis MM, Baan J, Išgum I, Henriques JP, de Vos BD, Delewi R. Low muscle quality on a procedural computed tomography scan assessed with deep learning as a practical useful predictor of mortality in patients with severe aortic valve stenosis. Clin Nutr ESPEN 2024; 63:142-147. [PMID: 38944828 DOI: 10.1016/j.clnesp.2024.06.013] [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: 01/24/2023] [Revised: 05/18/2024] [Accepted: 06/11/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND & AIMS Accurate diagnosis of sarcopenia requires evaluation of muscle quality, which refers to the amount of fat infiltration in muscle tissue. In this study, we aim to investigate whether we can independently predict mortality risk in transcatheter aortic valve implantation (TAVI) patients, using automatic deep learning algorithms to assess muscle quality on procedural computed tomography (CT) scans. METHODS This study included 1199 patients with severe aortic stenosis who underwent transcatheter aortic valve implantation (TAVI) between January 2010 and January 2020. A procedural CT scan was performed as part of the preprocedural-TAVI evaluation, and the scans were analyzed using deep-learning-based software to automatically determine skeletal muscle density (SMD) and intermuscular adipose tissue (IMAT). The association of SMD and IMAT with all-cause mortality was analyzed using a Cox regression model, adjusted for other known mortality predictors, including muscle mass. RESULTS The mean age of the participants was 80 ± 7 years, 53% were female. The median observation time was 1084 days, and the overall mortality rate was 39%. We found that the lowest tertile of muscle quality, as determined by SMD, was associated with an increased risk of mortality (HR 1.40 [95%CI: 1.15-1.70], p < 0.01). Similarly, low muscle quality as defined by high IMAT in the lowest tertile was also associated with increased mortality risk (HR 1.24 [95%CI: 1.01-1.52], p = 0.04). CONCLUSIONS Our findings suggest that deep learning-assessed low muscle quality, as indicated by fat infiltration in muscle tissue, is a practical, useful and independent predictor of mortality after TAVI.
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Affiliation(s)
- Dennis van Erck
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Pim Moeskops
- Quantib - AI Radiology Software, Westblaak 106, 3012 KM, Rotterdam, The Netherlands
| | - Josje D Schoufour
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Science, Tafelbergweg 51, 1105 BD, Amsterdam, The Netherlands; Center of Expertise Urban Vitality, Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Dokter Meurerlaan 8, 1067 SM, Amsterdam, The Netherlands
| | - Peter J M Weijs
- Center of Expertise Urban Vitality, Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Dokter Meurerlaan 8, 1067 SM, Amsterdam, The Netherlands
| | - Wilma J M Scholte Op Reimer
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands; Research Group Chronic Diseases, HU University of Applied Sciences, Heidelberglaan 15, 3584 CS, Utrecht, The Netherlands
| | - Martijn S van Mourik
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - R Nils Planken
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Marije M Vis
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Jan Baan
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Ivana Išgum
- Quantib - AI Radiology Software, Westblaak 106, 3012 KM, Rotterdam, The Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - José P Henriques
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Bob D de Vos
- Quantib - AI Radiology Software, Westblaak 106, 3012 KM, Rotterdam, The Netherlands; Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Ronak Delewi
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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18
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Camilleri GM, Delrieu L, Bouleuc C, Pierga JY, Cottu P, Berger F, Raynard B, Cyrille S, Marchal T. Prevalence and survival implications of malnutrition and sarcopenia in metastatic breast cancer: A longitudinal analysis. Clin Nutr 2024; 43:1710-1718. [PMID: 38908032 DOI: 10.1016/j.clnu.2024.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/28/2024] [Accepted: 06/08/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND Malnutrition and sarcopenia are challenges for patients with metastatic breast cancer and have been proposed as independent prognostic factors. Very few studies have addressed the temporal evolution of these parameters and, notably, the separate and combined analysis of sarcopenia and malnutrition. This study aimed to i) determine the prevalence of malnutrition and sarcopenia, individually and combined, and their evolution over time, ii) identify risk factors for each condition, and iii) explore their impact on overall survival (OS). METHODS This retrospective study was conducted on 111 patients treated for at least a third-line metastatic breast cancer at the Institut Curie between January 1st and March 31st, 2018. Solitary malnutrition was defined from weight loss and body mass index values while solitary sarcopenia was defined solely based on low muscle mass. We analyzed solitary malnutrition, solitary sarcopenia, and then malnutrition with or without sarcopenia, at three key stages (T1: diagnosis of metastasis, T2: initiation of third-line treatment, and T3: 3-month re-evaluation). Univariate and multivariate logistic regression analyses were conducted to investigate the risk factors. We performed Cox proportional hazards analyses for each variable. RESULTS At T1, the prevalence of solitary malnutrition, solitary sarcopenia and malnutrition with or without sarcopenia was 18.6%, 36.1% and 48.9% respectively, increasing to 27.7%, 45.5% and 56.6% at T2. At T2, in multivariate logistic regression analyses, patients aged over 60 years were at an elevated risk of experiencing solitary malnutrition as well as malnutrition with or without sarcopenia, but not solitary sarcopenia. In multivariate analyses, solitary malnutrition was significantly associated with poorer OS (HR 2.2 [95% CI 1.1-4.1], p = 0.02), while solitary sarcopenia and malnutrition with or without sarcopenia showed no association. CONCLUSION Solitary malnutrition and sarcopenia were highly prevalent in patients with metastatic breast cancer, affecting around a quarter and half of patients respectively at third-line treatment initiation. Notably, solitary malnutrition emerged as a prognostic factor for overall survival, whereas no significant association was observed for solitary sarcopenia or malnutrition with or without sarcopenia. This highlights the critical need for early identification of patients at risk of malnutrition and the importance of timely intervention.
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Affiliation(s)
| | - Lidia Delrieu
- Residual Tumour & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Institut Curie, Paris University, 75005 Paris, France; Institute for Biomedical and Epidemiological Research in Sport, EA7329, Paris, France University, Paris, France; INSEP, Institut National du Sport de l'Expertise et de la Performance, Paris, France
| | - Carole Bouleuc
- Department of Supportive Care, Institut Curie, 75005 Paris, France
| | - Jean-Yves Pierga
- Department of Medical Oncology, Institut Curie, 26 Rue d'Ulm, 75005, Paris, France; Circulating Tumor Biomarkers laboratory, Inserm CIC-BT 1428, Institut Curie, Paris France; Université Paris Cité, France
| | - Paul Cottu
- Department of Medical Oncology, Institut Curie, 26 Rue d'Ulm, 75005, Paris, France
| | - Frédérique Berger
- Institut Curie, PSL Research University, DREH, Department of Biometrics, Saint-Cloud, France
| | - Bruno Raynard
- Department of Supportive Care, Unit of Nutrition, Gustave Roussy, 24 Rue Albert Thuret, 94550 Chevilly-Larue, France
| | - Stacy Cyrille
- Institut Curie, PSL Research University, DREH, Department of Biometrics, Saint-Cloud, France
| | - Timothée Marchal
- Department of Supportive Care, Institut Curie, 75005 Paris, France.
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19
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Pecchi A, Valoriani F, Cuoghi Costantini R, Squecco D, Spallanzani A, D’Amico R, Dominici M, Di Benedetto F, Torricelli P, Menozzi R. Role of Body Composition in Patients with Resectable Pancreatic Cancer. Nutrients 2024; 16:1834. [PMID: 38931189 PMCID: PMC11206463 DOI: 10.3390/nu16121834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 05/28/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
This study investigates the role of body composition parameters in patients with pancreatic cancer undergoing surgical treatment. The research involved 88 patients diagnosed with pancreatic cancer who underwent surgery at the Modena Cancer Center between June 2015 and October 2023. Body composition parameters were obtained from CT scans performed before and after surgery. The percentage of sarcopenic patients at the time of diagnosis of pancreatic cancer is 56.82%. Of the patients who died between the first and second CT evaluated, 58% were sarcopenic, thus confirming the role of sarcopenia on outcome. The study found that all body composition parameters (TAMA, SMI, VFI, and SFI) demonstrated a trend towards reduction between two examinations, indicating an overall depletion in muscle and adipose tissue. We then evaluated the relationships between fat-related parameters (VFI, SFI and VSR) and survival outcomes: overall survival and progression-free survival. Cox univariate regression model show significant parameter related to outcomes was adipose tissue, specifically VFI. The study found that higher VFI levels were associated with greater survival rates. This research holds promise for advancing our understanding of the link between body composition and the prognosis of pancreatic cancer patients.
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Affiliation(s)
- Annarita Pecchi
- Radiology Department, Modena University Hospital, University of Modena and Reggio Emilia, 41124 Modena, Italy; (D.S.); (P.T.)
| | - Filippo Valoriani
- Division of Metabolic Diseases and Clinical Nutrition, Department of Specialistic Medicines, Modena University Hospital, 41124 Modena, Italy; (F.V.); (R.M.)
| | | | - Denise Squecco
- Radiology Department, Modena University Hospital, University of Modena and Reggio Emilia, 41124 Modena, Italy; (D.S.); (P.T.)
| | - Andrea Spallanzani
- Oncology Department, Modena University Hospital, University of Modena and Reggio Emilia, 41124 Modena, Italy; (A.S.); (M.D.)
| | - Roberto D’Amico
- Unit of Clinical Statistics, University Hospital of Modena, 41124 Modena, Italy; (R.C.C.); (R.D.)
| | - Massimo Dominici
- Oncology Department, Modena University Hospital, University of Modena and Reggio Emilia, 41124 Modena, Italy; (A.S.); (M.D.)
| | - Fabrizio Di Benedetto
- Hepato-Bilio-Pancreatic Surgery and Liver Transplantation Unit, Modena University Hospital, University of Modena and Reggio Emilia, 41124 Modena, Italy;
| | - Pietro Torricelli
- Radiology Department, Modena University Hospital, University of Modena and Reggio Emilia, 41124 Modena, Italy; (D.S.); (P.T.)
| | - Renata Menozzi
- Division of Metabolic Diseases and Clinical Nutrition, Department of Specialistic Medicines, Modena University Hospital, 41124 Modena, Italy; (F.V.); (R.M.)
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20
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Mueller TC, Henselmann M, Reischl S, Jaeger C, Trefzer C, Demir IE, Friess H, Martignoni ME. Associations of body composition parameters with postoperative outcome and perineural tumour invasion after oncological pancreatic resection. BMC Surg 2024; 24:175. [PMID: 38835067 DOI: 10.1186/s12893-024-02457-5] [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: 02/01/2024] [Accepted: 05/17/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Pancreatic cancer is often accompanied by wasting conditions. While surgery is the primary curative approach, it poses a substantial risk of postoperative complications, hindering subsequent treatments. Therefore, identifying patients at high risk for complications and optimizing their perioperative general condition is crucial. Sarcopenia and other body composition abnormalities have shown to adversely affect surgical and oncological outcomes in various cancer patients. As most pancreatic tumours are located close to the neuronal control centre for the digestive tract, it is possible that neural infiltration in this area deranges bowel functions and contributes to malabsorption and malnutrition and ultimately worsen sarcopenia and weight loss. METHODS A retrospective analysis of CT scans was performed for pancreatic cancer patients who underwent surgical tumour resection at a single high-volume centre from 2007 to 2023. Sarcopenia prevalence was assessed by skeletal muscle index (SMI), and visceral obesity was determined by the visceral adipose tissue area (VAT). Obesity and malnutrition were determined by the GLIM criteria. Sarcopenic obesity was defined as simultaneous sarcopenia and obesity. Postoperative complications, mortality and perineural tumour invasion, were compared among patients with body composition abnormalities. RESULTS Of 437 patients studied, 46% were female, the median age was 69 (61;74) years. CT analysis revealed 54.9% of patients with sarcopenia, 23.7% with sarcopenic obesity and 45.9% with visceral obesity. Sarcopenia and sarcopenic obesity were more prevalent in elderly and male patients. Postoperative surgical complications occurred in 67.7% of patients, most of which were mild (41.6%). Severe complications occurred in 22.7% of cases and the mortality rate was 3.4%. Severe postoperative complications were significantly more common in patients with sarcopenia or sarcopenic obesity. Visceral obesity or malnutrition based on BMI alone, did not significantly impact complications. Perineural invasion was found in 80.1% of patients and was unrelated to malnutrition or body composition parameters. CONCLUSIONS This is the first and largest study evaluating the associations of CT-based body mass analysis with surgical outcome and histopathological perineural tumour invasion in pancreatic cancer patients. The results suggest that elderly and male patients are at high risk for sarcopenia and should be routinely evaluated by CT before undergoing pancreatic surgery, irrespective of their BMI. Confirmation of the results in prospective studies is needed to assess if pancreatic cancer patients with radiographic sarcopenia benefit from preoperative amelioration of muscle mass and function by exercise and nutritional interventions.
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Affiliation(s)
- Tara C Mueller
- Department of Surgery, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany.
| | - Martin Henselmann
- Department of Surgery, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Stefan Reischl
- Institute of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Carsten Jaeger
- Department of Surgery, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Charlotte Trefzer
- Department of Surgery, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Ihsan Ekin Demir
- Department of Surgery, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Marc E Martignoni
- Department of Surgery, Klinikum rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
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21
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Anabtawi NM, Pasala MS, Grimshaw AA, Kharel P, Bal S, Godby K, Siwakoti A, Buford TW, Bhatia S, Costa LJ, Williams GR, Giri S. Low skeletal muscle mass and treatment outcomes among adults with haematologic malignancies: A systematic review and meta-analysis. J Cachexia Sarcopenia Muscle 2024; 15:1084-1093. [PMID: 38558541 PMCID: PMC11154774 DOI: 10.1002/jcsm.13446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 11/21/2023] [Accepted: 02/08/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Low skeletal muscle mass (LSMM) and/or, function associated with an increased risk of treatment-related toxicities and inferior overall survival (OS) among adults with solid malignancies. However, the association between LSMM and treatment-related toxicities among adults with haematologic malignancies remains unclear. METHODS Using a pre-published protocol (CRD42020197814), we searched seven bibliographic databases from inception to 08/2021 for studies reporting the impact of LSMM among adults ≥18 years with a known haematologic malignancy. The primary outcome of interest was OS, and secondary outcomes included progression free survival (PFS) and non-relapse mortality (NRM). These effect sizes were quantified in terms of hazards ratio (HR) along with 95% confidence interval (CI) and pooled across studies using a DerSimonian-Laird random-effects model. Heterogeneity was assessed using the Cochran's Q and the I2 statistic. All hypothesis testing was two-sided with an alpha of 0.05. RESULTS Of 3791 studies screened, we identified 20 studies involving 3468 patients with a mean age of 60 years; 44% were female and the most common malignancy was diffuse large B-cell lymphoma (42%). Most studies measured muscle mass using single slice computed tomography imaging at the L3 level. The presence of LSMM was associated with worse OS (pooled HR = 1.81, 95% CI = 1.48-2.22, P < 0.001) with moderate heterogeneity (Cochran's Q, I2 = 60.4%), PFS (pooled HR = 1.61, 95% CI = 1.28-2.02, P < 0.001) with moderate heterogeneity (Cochran's Q, I2 = 66.0%). Similarly, LSMM was associated with worse NRM (HR = 1.72, 95% CI = 1.34-2.22, P < 0.001) with little evidence of heterogeneity (Cochran's Q, I2 = 0.0%). CONCLUSIONS LSMM is associated with worse survival outcomes among adults with haematologic malignancies. Further research into understanding the underlying mechanism of this association and mitigating the negative effects of LSMM among adults with haematologic malignancies is needed.
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Affiliation(s)
- Nadia M. Anabtawi
- School of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
| | - Monica Sai Pasala
- School of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
| | - Alyssa A. Grimshaw
- Harvey Cushing/John Hay Whitney Medical LibraryYale UniversityNew HavenCTUSA
| | - Prakash Kharel
- Department of Hospital MedicineGeisinger Health System, GeisingerDanvillePAUSA
| | - Susan Bal
- Department of Medicine, Division of Hematology and OncologyUniversity of Alabama at BirminghamBirminghamALUSA
| | - Kelly Godby
- Department of Medicine, Division of Hematology and OncologyUniversity of Alabama at BirminghamBirminghamALUSA
| | | | - Thomas W. Buford
- Department of Medicine, Division of Gerontology, Geriatrics & Palliative CareUniversity of Alabama at BirminghamBirminghamALUSA
- Birmingham/Atlanta VA GRECCBirmingham VA Medical CenterBirminghamALUSA
| | - Smita Bhatia
- Institute for Cancer Outcomes and SurvivorshipUniversity of Alabama at BirminghamBirminghamALUSA
| | - Luciano J. Costa
- Department of Medicine, Division of Hematology and OncologyUniversity of Alabama at BirminghamBirminghamALUSA
| | - Grant R. Williams
- Department of Medicine, Division of Hematology and OncologyUniversity of Alabama at BirminghamBirminghamALUSA
- Institute for Cancer Outcomes and SurvivorshipUniversity of Alabama at BirminghamBirminghamALUSA
| | - Smith Giri
- Department of Medicine, Division of Hematology and OncologyUniversity of Alabama at BirminghamBirminghamALUSA
- Institute for Cancer Outcomes and SurvivorshipUniversity of Alabama at BirminghamBirminghamALUSA
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22
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Kinkopf P, Choo HJ, Roy I, Strauss J, Sun Z, Donnelly E. Impact of cachexia on disease recurrence and survival outcomes in endometrial cancer patients. Gynecol Oncol Rep 2024; 53:101401. [PMID: 38707863 PMCID: PMC11067329 DOI: 10.1016/j.gore.2024.101401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 05/07/2024] Open
Abstract
Objective Cancer cachexia is progressive weight loss due to muscle/adipose tissue wasting and inadequate intake that occurs in response to malignancy. It is an independent predictor of disease recurrence and reduced survival in several cancers. However, cachexia's relationship with gynecologic malignancy outcomes has only been examined in small studies with limited follow-up and inconsistent definitions of cachexia. This study investigated the impact of cachexia on disease recurrence and overall survival in high-risk endometrial carcinoma patients. Methods This retrospective cohort study examined data from patients with high-risk non-metastatic primary endometrial carcinoma treated at a single institution from 2015 to 2020. Treatment for all subjects included total hysterectomy, surgical staging, pelvic external beam radiotherapy with or without adjuvant chemotherapy. Radiation planning CT datasets were used to measure skeletal musculature at the L3 vertebral level. Skeletal muscle index (SMI) was defined as total L3 skeletal muscle cross sectional area (cm2)/height2 (m2), and cachexia was defined based on SMI. Results 55 patients were eligible for analysis. Several SMI thresholds were used to define cachexia, and analysis was performed for each definition. Kaplan-Meier and Cox-proportional hazards regression analysis yielded no significant reduction in overall survival (OS) or progression-free survival (PFS) in patients with cachexia, regardless of threshold chosen. However, 4 of 13 definitions of cachexia showed significantly improved OS in patients without cachexia, relative to those with cachexia. There were no significant differences in disease recurrence. Conclusions Cachexia as defined in this study was not associated with poor outcomes in endometrial carcinoma patients based on OS, PFS, or disease recurrence.
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Affiliation(s)
- Paul Kinkopf
- Department of Radiation Oncology, Northwestern Medicine, Chicago, IL 60611, USA
| | | | - Ishan Roy
- Department of Radiation Oncology, Northwestern Medicine, Chicago, IL 60611, USA
- Shirley Ryan Ability Lab, Chicago, IL 60611, USA
| | - Jonathan Strauss
- Department of Radiation Oncology, Northwestern Medicine, Chicago, IL 60611, USA
- Robert H. Lurie Comprehensive Cancer Care Center of Northwestern University, Chicago, IL 60611, USA
| | - Zequn Sun
- Robert H. Lurie Comprehensive Cancer Care Center of Northwestern University, Chicago, IL 60611, USA
- Department of Preventive Medicine, Northwestern Medicine, Chicago, IL 60611, USA
| | - Eric Donnelly
- Department of Radiation Oncology, Northwestern Medicine, Chicago, IL 60611, USA
- Robert H. Lurie Comprehensive Cancer Care Center of Northwestern University, Chicago, IL 60611, USA
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23
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Rentz LE, Malone BM, Vettiyil B, Sillaste EA, Mizener AD, Clayton SA, Pistilli EE. New Perspectives for Estimating Body Composition From Computed Tomography: Clothing Associated Artifacts. Acad Radiol 2024; 31:2620-2626. [PMID: 38355363 PMCID: PMC11214598 DOI: 10.1016/j.acra.2024.01.013] [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: 09/08/2023] [Revised: 01/03/2024] [Accepted: 01/06/2024] [Indexed: 02/16/2024]
Abstract
As the value of clinical imaging is expanded through retrospective analyses, it is imperative that all efforts are made to optimize validity. Such considerations for retrospective designs should prioritize factors like naturalistic conditions for observations and measurement replicability, while avoiding sample biases and reliance on strict clinical timelines. Valid methodological approaches are immanent for successful translation from retrospective observational designs into prospective pragmatic research with actionable potential. In particular, thousands of studies have sought to associate clinical outcomes to measures of body composition across diverse patient groups. Post-hoc use of computed tomography (CT) to quantify adiposity and lean tissue characteristics has most frequently involved just a single slice at the level of the third lumbar vertebrae (L3). Abundant in statistical significance and inconsistencies alike, such methods have yet to be implemented or deemed valuable for making real-world clinical decisions. We present herein a concerning perspective, for both magnitude and prevalence, of a widely overlooked source of data variability for this methodology: the hinderance of pants and other tightly fit clothing.
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Affiliation(s)
- Lauren E Rentz
- Division of Exercise Physiology, Department of Human Performance, West Virginia University School of Medicine, Morgantown, West Virginia 26505, USA; Cancer Institute, West Virginia University School of Medicine, Morgantown, West Virginia 26506, USA
| | - Briauna M Malone
- Division of Exercise Physiology, Department of Human Performance, West Virginia University School of Medicine, Morgantown, West Virginia 26505, USA
| | - Beth Vettiyil
- Section of Musculoskeletal Radiology, Department of Radiology, West Virginia University, Morgantown, West Virginia 26506, USA
| | - Erik A Sillaste
- Cancer Institute, West Virginia University School of Medicine, Morgantown, West Virginia 26506, USA; College of Health and Human Sciences, Purdue University, West Lafayette, Indiana 47907, USA
| | - Alan D Mizener
- Cancer Institute, West Virginia University School of Medicine, Morgantown, West Virginia 26506, USA
| | - Stuart A Clayton
- Division of Exercise Physiology, Department of Human Performance, West Virginia University School of Medicine, Morgantown, West Virginia 26505, USA; Cancer Institute, West Virginia University School of Medicine, Morgantown, West Virginia 26506, USA
| | - Emidio E Pistilli
- Division of Exercise Physiology, Department of Human Performance, West Virginia University School of Medicine, Morgantown, West Virginia 26505, USA; Cancer Institute, West Virginia University School of Medicine, Morgantown, West Virginia 26506, USA.
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24
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Chen D, Yuan Z, Guo Y, Liu W, Cheng Z, Ye L, Mo W, Wei X. The evolution and impact of sarcopenia in severe aplastic anaemia survivors following allogeneic haematopoietic cell transplantation. J Cachexia Sarcopenia Muscle 2024; 15:1094-1107. [PMID: 38526005 PMCID: PMC11154763 DOI: 10.1002/jcsm.13449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/18/2024] [Accepted: 02/08/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Sarcopenia is a potential risk factor for adverse outcomes in haematopoietic cell transplantation (HSCT) recipients. We aimed to explore longitudinal body changes in muscle and adipose mass and their prognostic value in allogeneic HSCT-treated severe aplastic anaemia (SAA) patients. METHODS We retrospectively analysed consecutive SAA patients who underwent allogeneic HSCT between January 2017 and March 2022. Measurements of pectoral muscle and corresponding subcutaneous fat mass were obtained via chest computed tomography at baseline and at 1 month, 3 months, 6 months, and 12 months following HSCT. Sarcopenia was defined as pectoral muscle index (PMI) lower than the sex-specific median at baseline. Changes in body composition over time were evaluated by generalized estimating equations. Cox regression models were used to investigate prognostic factors affecting overall survival (OS) and failure-free survival (FFS). A nomogram was constructed from the Cox regression model for OS. RESULTS We included 298 adult SAA patients (including 129 females and 169 males) with a median age of 31 years [interquartile range (IQR), 24-39 years] at baseline. Sarcopenia was present in 148 (148/298, 50%) patients at baseline, 218 (218/285, 76%) patients post-1 month, 209 (209/262, 80%) patients post-3 month, 169 (169/218, 78%) patients post-6 month, and 129 (129/181, 71%) patients post-12 month. A significant decrease in pectoral muscle mass was observed in SAA patients from the time of transplant to 1 year after HSCT, and the greatest reduction occurred in post 1-3 months (P < 0.001). The sarcopenia group exhibited significantly lower 5-year OS (90.6% vs. 100%, log-rank P = 0.039) and 5-year FFS (89.2% vs. 100%, log-rank P = 0.021) than the nonsarcopenia group at baseline. Sarcopenia at baseline (hazard ratio, HR, 6.344; 95% confidence interval, CI: 1.570-25.538; P = 0.01; and HR, 3.275; 95% CI: 1.159-9.252; P = 0.025, respectively) and the delta value of the PMI at 6 months post-transplantation (ΔPMI6) (HR, 0.531; 95% CI: 0.374-0.756; P < 0.001; and HR, 0.666; 95% CI: 0.505-0.879; P = 0.004, respectively) were demonstrated to be independent prognostic factors for OS and FFS in SAA patients undergoing HSCT, and were used to construct the nomogram. The C-index of the nomogram was 0.75, and the calibration plot showed good agreement between the predictions made by the nomogram and actual observations. CONCLUSIONS Sarcopenia persists in SAA patients from the time of transplant to the 1-year follow-up after HSCT. Both sarcopenia at baseline and at 6 months following HSCT are associated with poor clinical outcomes, especially in patients with persistent muscle mass loss up to 6 months after transplantation.
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Affiliation(s)
- Dandan Chen
- Department of Radiology, Guangzhou First People's Hospital, School of MedicineSouth China University of TechnologyGuangzhouChina
| | - Zhaohu Yuan
- Department of Blood Transfusion, Guangzhou First People's Hospital, School of MedicineSouth China University of TechnologyGuangzhouChina
| | - Yuan Guo
- Department of Radiology, Guangzhou First People's Hospital, School of MedicineSouth China University of TechnologyGuangzhouChina
| | - Weifeng Liu
- Guangzhou First People's Hospital, School of MedicineSouth China University of TechnologyGuangzhouChina
| | - Zixuan Cheng
- Department of Radiology, Guangzhou First People's Hospital, School of MedicineSouth China University of TechnologyGuangzhouChina
| | - Lihua Ye
- Department of Radiology, Guangzhou First People's Hospital, School of MedicineSouth China University of TechnologyGuangzhouChina
| | - Wenjian Mo
- Department of Hematology, Guangzhou First People's Hospital, School of MedicineSouth China University of TechnologyGuangzhouChina
| | - Xinhua Wei
- Department of Radiology, Guangzhou First People's Hospital, School of MedicineSouth China University of TechnologyGuangzhouChina
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Brown LR, Sousa MS, Yule MS, Baracos VE, McMillan DC, Arends J, Balstad TR, Bye A, Dajani O, Dolan RD, Fallon MT, Greil C, Hjermstad MJ, Jakobsen G, Maddocks M, McDonald J, Ottestad IO, Phillips I, Sayers J, Simpson MR, Vagnildhaug OM, Solheim TS, Laird BJ, Skipworth RJ. Body weight and composition endpoints in cancer cachexia clinical trials: Systematic Review 4 of the cachexia endpoints series. J Cachexia Sarcopenia Muscle 2024; 15:816-852. [PMID: 38738581 PMCID: PMC11154800 DOI: 10.1002/jcsm.13478] [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: 09/29/2023] [Revised: 02/12/2024] [Accepted: 03/16/2024] [Indexed: 05/14/2024] Open
Abstract
Significant variation exists in the outcomes used in cancer cachexia trials, including measures of body composition, which are often selected as primary or secondary endpoints. To date, there has been no review of the most commonly selected measures or their potential sensitivity to detect changes resulting from the interventions being examined. The aim of this systematic review is to assess the frequency and diversity of body composition measures that have been used in cancer cachexia trials. MEDLINE, Embase and Cochrane Library databases were systematically searched between January 1990 and June 2021. Eligible trials examined adults (≥18 years) who had received an intervention aiming to treat or attenuate the effects of cancer cachexia for >14 days. Trials were also of a prospective controlled design and included body weight or at least one anthropometric, bioelectrical or radiological endpoint pertaining to body composition, irrespective of the modality of intervention (e.g., pharmacological, nutritional, physical exercise and behavioural) or comparator. Trials with a sample size of <40 patients were excluded. Data extraction used Covidence software, and reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. This review was prospectively registered (PROSPERO: CRD42022276710). A total of 84 clinical trials, comprising 13 016 patients, were eligible for inclusion. Non-small-cell lung cancer and pancreatic cancer were studied most frequently. The majority of trial interventions were pharmacological (52%) or nutritional (34%) in nature. The most frequently reported endpoints were assessments of body weight (68 trials, n = 11 561) followed by bioimpedance analysis (BIA)-based estimates (23 trials, n = 3140). Sixteen trials (n = 3052) included dual-energy X-ray absorptiometry (DEXA)-based endpoints, and computed tomography (CT) body composition was included in eight trials (n = 841). Discrepancies were evident when comparing the efficacy of interventions using BIA-based estimates of lean tissue mass against radiological assessment modalities. Body weight, BIA and DEXA-based endpoints have been most frequently used in cancer cachexia trials. Although the optimal endpoints cannot be determined from this review, body weight, alongside measurements from radiological body composition analysis, would seem appropriate. The choice of radiological modality is likely to be dependent on the trial setting, population and intervention in question. CT and magnetic resonance imaging, which have the ability to accurately discriminate tissue types, are likely to be more sensitive and provide greater detail. Endpoints are of particular importance when aligned with the intervention's mechanism of action and/or intended patient benefit.
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Affiliation(s)
- Leo R. Brown
- Clinical SurgeryThe University of Edinburgh, Royal Infirmary of EdinburghEdinburghUK
| | - Mariana S. Sousa
- Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation (IMPACCT)University of Technology SydneySydneyAustralia
| | - Michael S. Yule
- Clinical SurgeryThe University of Edinburgh, Royal Infirmary of EdinburghEdinburghUK
- Institute of Genetics and CancerThe University of Edinburgh, Western General HospitalEdinburghUK
- St Columba's Hospice CareEdinburghUK
| | | | - Donald C. McMillan
- Academic Unit of SurgeryUniversity of Glasgow, Glasgow Royal InfirmaryGlasgowUK
| | - Jann Arends
- Department of Medicine I, Medical Centre—University of Freiburg Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Trude R. Balstad
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
- Department of Clinical Medicine, Clinical Nutrition Research GroupUiT The Arctic University of NorwayTromsøNorway
| | - Asta Bye
- Department of OncologyOslo University HospitalOsloNorway
- Department of Nursing and Health Promotion, Faculty of Health SciencesOslo Metropolitan UniversityOsloNorway
| | - Olav Dajani
- Department of OncologyOslo University HospitalOsloNorway
| | - Ross D. Dolan
- Academic Unit of SurgeryUniversity of Glasgow, Glasgow Royal InfirmaryGlasgowUK
| | - Marie T. Fallon
- Institute of Genetics and CancerThe University of Edinburgh, Western General HospitalEdinburghUK
- St Columba's Hospice CareEdinburghUK
| | - Christine Greil
- Department of Medicine I, Medical Centre—University of Freiburg Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | | | - Gunnhild Jakobsen
- Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
- Cancer ClinicSt. Olav's Hospital, Trondheim University HospitalTrondheimNorway
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and RehabilitationKing's College LondonLondonUK
| | - James McDonald
- Institute of Genetics and CancerThe University of Edinburgh, Western General HospitalEdinburghUK
- St Columba's Hospice CareEdinburghUK
| | - Inger O. Ottestad
- Department of Nutrition, Institute of Basic Medical SciencesUniversity of OsloOsloNorway
- The Clinical Nutrition Outpatient Clinic, Section of Clinical Nutrition, Department of Clinical Service, Division of Cancer MedicineOslo University HospitalOsloNorway
| | - Iain Phillips
- Edinburgh Cancer CentreWestern General HospitalEdinburghUK
| | - Judith Sayers
- Clinical SurgeryThe University of Edinburgh, Royal Infirmary of EdinburghEdinburghUK
- Institute of Genetics and CancerThe University of Edinburgh, Western General HospitalEdinburghUK
- St Columba's Hospice CareEdinburghUK
| | - Melanie R. Simpson
- Department of Nursing and Health Promotion, Faculty of Health SciencesOslo Metropolitan UniversityOsloNorway
| | - Ola M. Vagnildhaug
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
- Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
| | - Tora S. Solheim
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
- Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
| | - Barry J.A. Laird
- Institute of Genetics and CancerThe University of Edinburgh, Western General HospitalEdinburghUK
- St Columba's Hospice CareEdinburghUK
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Xiao X, Fang PH, Zhou JF, Li XK, Shang QX, Yang YS, Luan SY, Chen LQ, Yuan Y. Impact of Skeletal Muscle Loss and Sarcopenia on Outcomes of Locally Advanced Esophageal Cancer during Neoadjuvant Chemoradiation. Ann Surg Oncol 2024; 31:3819-3829. [PMID: 38245646 DOI: 10.1245/s10434-024-14936-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 01/02/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND The impact of changes in skeletal muscle and sarcopenia on outcomes during neoadjuvant chemoradiotherapy (NACR) for patients with esophageal cancer remains controversial. PATIENTS AND METHODS We retrospectively analyzed the data of patients with locally advanced esophageal squamous cell cancer who received NACR followed by esophagectomy between June 2013 and December 2021. The images at third lumbar vertebra were analyzed to measure the cross-sectional area and calculate skeletal muscle index (SMI) before and after NACR. SMI less than 52.4 cm2/m2 for men and less than 38.5 cm2/m2 for women were defined as sarcopenia. The nonlinearity of the effect of percent changes in SMI (ΔSMI%) to survival outcomes was assessed by restricted cubic splines. RESULTS Overall, data of 367 patients were analyzed. The survival outcomes between sarcopenia and non-sarcopenia groups had no significant differences before NACR. However, patients in post-NACR sarcopenia group showed poor overall survival (OS) benefit (P = 0.016) and poor disease-free survival (DFS) (P = 0.043). Severe postoperative complication rates were 11.9% in post-NACR sarcopenia group and 5.0% in post-NACR non-sarcopenia group (P = 0.019). There was a significant non-linear relationship between ΔSMI% and survival outcomes (P < 0.05 for non-linear). On the multivariable analysis of OS, ΔSMI% > 12% was the independent prognostic factor (HR 1.76, 95% CI 1.03-2.99, P = 0.039) and significant difference was also found on DFS analysis (P = 0.025). CONCLUSIONS Patients with post-neoadjuvant chemoradiotherapy sarcopenia have worse survival and adverse short-term outcomes. Moreover, greater loss in SMI is associated with increased risks of death and disease progression during neoadjuvant chemoradiotherapy, with maximum impact noted with SMI loss greater than 12%.
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Affiliation(s)
- Xin Xiao
- Department of Thoracic Surgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, China
| | - Pin-Hao Fang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, China
| | - Jian-Feng Zhou
- Department of Thoracic Surgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, China
| | - Xiao-Kun Li
- Department of Thoracic Surgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, China
| | - Qi-Xin Shang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, China
| | - Yu-Shang Yang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, China
| | - Si-Yuan Luan
- Department of Thoracic Surgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, China
| | - Long-Qi Chen
- Department of Thoracic Surgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, China
| | - Yong Yuan
- Department of Thoracic Surgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, China.
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Gagnon B, Murphy J, Simonyan D, Penafuerte CA, Sirois J, Chasen M, Tremblay ML. Cancer anorexia-cachexia syndrome is characterized by more than one inflammatory pathway. J Cachexia Sarcopenia Muscle 2024; 15:1041-1053. [PMID: 38481033 PMCID: PMC11154782 DOI: 10.1002/jcsm.13430] [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: 07/12/2022] [Revised: 12/03/2023] [Accepted: 12/18/2023] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND The interdependence of cytokines and appetite-modifying hormones implicated in cancer anorexia-cachexia syndrome (CACS) remains unclear. This study aimed to regroup these cytokines and hormones into distinct inflammatory (or non-inflammatory) pathways and determine whether these pathways can classify patients with CACS phenotypes. METHODS Clinical characteristics of 133 patients [61.7% male; mean age = 63.4 (SD: 13.1) years] with advanced cancer prior to oncology treatments were documented, including weight loss history. Patients completed the Functional Assessment of Anorexia-Cachexia Therapy (FAACT) questionnaire and Timed Up and Go test and had their sex-standardized skeletal muscle index (z-SMI) and fat mass index (z-FMI) derived using computed tomography scans. Their plasma levels of cytokines and appetite-modifying hormones were also determined. Date of death was recorded. Exploratory factor analysis (EFA) was used to regroup 15 cytokines and hormone into distinct inflammatory pathways (factors). For each patient, regression factor scores (RFS), which tell how strongly the patient associates with each factor, were derived. Two-step cluster analysis on the RFS was used to classify patients into groups. CACS phenotypes were correlated with RFS and compared between groups. Groups' survival was estimated using Kaplan-Meier analysis. RESULTS Patients had low z-SMI (mean = -3.78 cm2/m2; SD: 8.88) and z-FMI (mean = 0.08 kg2/m2; SD: 56.25), and 62 (46.6%) had cachexia. EFA identified three factors: (F-1) IFN-γ, IL-1β, Il-4, IL-6, IL-10, IL-12, TGFβ1 (positive contribution), and IL-18 (negative); (F-2) IL-8, IL-18, MCP-1, TGFβ1, TNF-α (positive), and ghrelin (negative); and (F-3) TRAIL and leptin (positive), and TGFβ1 and adiponectin (negative). RFS-1 was associated with cachexia (P = 0.002); RFS-2, with higher CRP (P < 0.0001) and decreased physical function (P = 0.01); and RFS-3 with better appetite (P = 0.04), lower CRP (P = 0.002), higher z-SMI (P = 0.04) and z-FMI (P < 0.0001), and less cachexia characteristics (all P < 0.001). Four patient groups were identified with specific RFS clusters aligning with the CACS continuum from no cachexia to pre-cachexia, cachexia, and terminal cachexia. Compared to the other two groups, groups 1 and 2 had higher plasma levels of IL-18 and TRAIL. Group 1 also had lower inflammatory cytokines, adiponectin, and CRP compared to the other three groups. Group 3 had inflammatory cytokine levels similar to group 2, except for TNF-α and leptin which were lower. Group 4 had very high inflammatory cytokines, adiponectin, and CRP compared to the other 3 groups (all P < 0.0001). Groups 3 and 4 had worse cachexia characteristics (P < 0.05) and shorter survival (log rank: P = 0.0009) than the other two groups. CONCLUSIONS This exploratory study identified three distinct pathways of inflammation, or lack thereof, characterizing different CACS phenotypes.
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Affiliation(s)
- Bruno Gagnon
- Département de médecine familiale et de médecine d'urgence, Centre de recherche sur le cancerUniversité Laval, Centre de recherche du CHU de QuébecQuébecCanada
- Division of Clinical EpidemiologyMcGill University Health CentreMontrealCanada
| | - Jessica Murphy
- Division of Clinical EpidemiologyMcGill University Health CentreMontrealCanada
- Department of Health, Kinesiology, and Applied PhysiologyConcordia UniversityMontrealCanada
| | - David Simonyan
- Clinical and Evaluative Research PlatformUniversité Laval, Centre de recherche du CHU de QuébecQuébecCanada
| | - Claudia A. Penafuerte
- Cura TherapeuticsNEOMED InstituteSaint‐LaurentCanada
- Rosalind and Morris Goodman Cancer InstituteMcGill UniversityMontrealCanada
| | - Jacinthe Sirois
- Rosalind and Morris Goodman Cancer InstituteMcGill UniversityMontrealCanada
| | - Martin Chasen
- Departments of Medicine and Family and Community MedicineUniversity of TorontoTorontoCanada
- Department of Family MedicineMcMaster UniversityHamiltonCanada
| | - Michel L. Tremblay
- Rosalind and Morris Goodman Cancer InstituteMcGill UniversityMontrealCanada
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Byrne CA, Fantuzzi G, Stephan JT, Kim S, Oddo VM, Koh TJ, Gomez SL. Sarcopenia Identification Using Alternative Vertebral Landmarks in Individuals with Lung Cancer. MUSCLES (BASEL, SWITZERLAND) 2024; 3:121-132. [PMID: 38846908 PMCID: PMC11155469 DOI: 10.3390/muscles3020012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
Background (1)Sarcopenia, or low skeletal mass index (SMI), contributes to higher lung cancer mortality. The SMI at third lumbar vertebrae (L3) is the reference standard for body composition analysis. However, there is a need to explore the validity of alternative landmarks in this population. We compared the agreement of sarcopenia identification at the first lumbar (L1) and second lumbar (L2) to L3 in non-Hispanic Black (NHB) and White (NHW) individuals with lung cancer. Methods (2)This retrospective, cross-sectional study included 214 NHB and NHW adults with lung cancer. CT scans were analyzed to calculate the SMI at L1, L2, and L3. T-tests, chi-square, Pearson's correlation, Cohen's kappa, sensitivity, and specificity analysis were used. Results (3)Subjects presented with a mean age of 68.4 ± 9.9 years and BMI of 26.3 ± 6.0 kg/m2. Sarcopenia prevalence varied from 19.6% at L1 to 39.7% at L3. Cohen's kappa coefficient was 0.46 for L1 and 0.64 for L2, indicating weak and moderate agreement for the identification of sarcopenia compared to L3. Conclusions (4)Sarcopenia prevalence varied greatly depending on the vertebral landmark used for assessment. Using L2 or L1 alone resulted in a 16.8% and 23.8% misclassification of sarcopenia in this cohort of individuals with lung cancer.
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Affiliation(s)
- Cecily A. Byrne
- Cancer Health Equity and Career Development Program, University of Illinois Chicago, 1747 W. Roosevelt Rd., Chicago, IL 60608, USA
| | - Giamila Fantuzzi
- Department of Kinesiology and Nutrition, University of Illinois Chicago, 1919 W. Taylor St., Chicago, IL 60612, USA
| | - Jeremy T. Stephan
- Department of Radiology, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL 60612, USA
| | - Sage Kim
- School of Public Health, University of Illinois Chicago, 1603 W. Taylor St., Chicago, IL 60612, USA
| | - Vanessa M. Oddo
- Department of Kinesiology and Nutrition, University of Illinois Chicago, 1919 W. Taylor St., Chicago, IL 60612, USA
| | - Timothy J. Koh
- Department of Kinesiology and Nutrition, University of Illinois Chicago, 1919 W. Taylor St., Chicago, IL 60612, USA
| | - Sandra L. Gomez
- Department of Clinical Nutrition, Rush University, 600 S. Paulina St., Chicago, IL 60612, USA
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Chen H, Hu Z, Xu Q, He C, Yang X, Shen W, Lin Z, Li H, Zhuang L, Cai J, Lerut J, Zheng S, Lu D, Xu X. The adverse impact of perioperative body composition abnormalities on outcomes after split liver transplantation: a multicenter retrospective cohort study. Int J Surg 2024; 110:3543-3553. [PMID: 38489552 PMCID: PMC11175784 DOI: 10.1097/js9.0000000000001303] [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: 01/24/2024] [Accepted: 02/23/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Split liver transplantation (SLT) increases graft availability, but it's safe and effective utilization is insufficiently documented. This study aimed to investigate the association between perioperative body composition abnormalities and outcomes in adult SLT. MATERIALS AND METHODS Two hundred forty recipients who underwent SLT in three centers were enrolled in this retrospective cohort study. Body composition abnormalities including sarcopenia, myosteatosis, visceral obesity, and sarcopenic obesity were evaluated at baseline and 1 month after surgery using computed tomography. Their impact on outcomes including early allograft dysfunction, early complications, ICU stay, graft regeneration rate, and survival was analyzed. RESULTS Recipients with sarcopenia or myosteatosis had a higher risk of early allograft dysfunction, higher early complication rate, and longer length of ICU stay (all P <0.05), while there was no difference in graft regeneration rate. Recipient and graft survival were significantly worse for recipients with body composition abnormalities (all P <0.05). In multivariable Cox-regression analysis, sarcopenia [hazard ratio (HR)=1.765, P =0.015], myosteatosis (HR=2.066, P =0.002), and visceral obesity (HR=1.863, P =0.008) were independently associated with shorter overall survival. Piling up of the three factors increased the mortality risk stepwise ( P <0.001). Recipients experienced skeletal muscle loss and muscle fat infiltration 1 month after surgery. Postoperative worsening sarcopenia (HR=2.359, P =0.009) and myosteatosis (HR=1.878, P =0.026) were also identified as independent risk factors for mortality. CONCLUSION Sarcopenia, myosteatosis, and their progression negatively affect outcomes including early allograft dysfunction, early complications, ICU stay and survival after SLT. Systemic evaluation and dynamic monitoring of body composition are valuable.
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Affiliation(s)
- Hao Chen
- Zhejiang University, School of Medicine
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
| | - Zhihang Hu
- Zhejiang University, School of Medicine
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
| | - Qingguo Xu
- Organ Transplantation Center, Affiliated Hospital of Qingdao University, Qingdao, People’s Republic of China
| | - Chiyu He
- Zhejiang University, School of Medicine
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
| | - Xinyu Yang
- Zhejiang University, School of Medicine
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
| | - Wei Shen
- Zhejiang University, School of Medicine
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
| | - Zuyuan Lin
- Zhejiang University, School of Medicine
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
| | - Huigang Li
- Zhejiang University, School of Medicine
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
| | - Li Zhuang
- Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital
| | - Jinzhen Cai
- Organ Transplantation Center, Affiliated Hospital of Qingdao University, Qingdao, People’s Republic of China
| | - Jan Lerut
- Starzl Unit of Abdominal Transplantation, University Hospitals Saint Luc, Université catholique Louvain, Brussels, Belgium
| | - Shusen Zheng
- Zhejiang University, School of Medicine
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
- National Center for Healthcare Quality Management in Liver Transplant
- Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, People’s Republic of China
| | - Di Lu
- Zhejiang University, School of Medicine
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
- National Center for Healthcare Quality Management in Liver Transplant
| | - Xiao Xu
- Zhejiang University, School of Medicine
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health
- National Center for Healthcare Quality Management in Liver Transplant
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30
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Davis EW, Attwood K, Prunier J, Paragh G, Joseph JM, Klein A, Roche C, Barone N, Etter JL, Ray AD, Trabert B, Schabath MB, Peres LC, Cannioto R. The association of body composition phenotypes before chemotherapy with epithelial ovarian cancer mortality. J Natl Cancer Inst 2024:djae112. [PMID: 38802116 DOI: 10.1093/jnci/djae112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/17/2024] [Accepted: 05/11/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND The association of body composition with epithelial ovarian carcinoma (EOC) mortality is poorly understood. To date, evidence suggests high adiposity associates with decreased mortality (an obesity paradox), but the impact of muscle on this association has not been investigated. Herein, we define associations of muscle and adiposity joint-exposure body composition phenotypes with EOC mortality. METHODS Body composition from 500 women in The Body Composition and Epithelial Ovarian Cancer Survival Study was dichotomized as normal/low skeletal muscle index (SMI), a proxy for sarcopenia and high/low adiposity. Four phenotypes were classified as fit/reference (normal SMI/low adiposity; 16.2%), overweight/obese (normal SMI/high adiposity; 51.2%), sarcopenia/overweight-obese (low SMI/high adiposity; 15.6%), and sarcopenia/cachexia (low SMI/low adiposity; 17%). We used multivariable Cox models to estimate associations of each phenotype with mortality for EOC overall and high-grade serous ovarian carcinoma (HGSOC). RESULTS Overweight/obesity was associated with up to 51% and 104% increased mortality in EOC and HGSOC (HR = 1.51, 95% CI: 1.05-2.19 and HR = 2.04, 95% CI: 1.29-3.21). Sarcopenia/overweight-obesity was associated with up to 66% and 67% increased mortality in EOC and HGSOC (HR = 1.66, 95% CI: 1.13-2.45 and HR = 1.67, 95% CI: 1.05-2.68). Sarcopenia/cachexia was associated with up to 73% and 109% increased mortality in EOC and HGSOC (HR = 1.73, 95% CI: 1.14-2.63 and HR = 2.09, 95% CI: 1.25-3.50). CONCLUSIONS Overweight/obesity, sarcopenia/overweight-obesity and sarcopenia/cachexia phenotypes were each associated with increased mortality in EOC and HGSOC. Exercise and dietary interventions could be leveraged as ancillary treatment strategies for improving outcomes in the most fatal gynecological malignancy with no previously established modifiable prognostic factors.
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Affiliation(s)
- Evan W Davis
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, 14263, NY, USA
| | - Kristopher Attwood
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, 14263, NY, USA
| | - Joseph Prunier
- Lake Erie College of Osteopathic Medicine, Elmira, 14901, NY, USA
| | - Gyorgy Paragh
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, 14263, NY, USA
| | - Janine M Joseph
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, 14263, NY, USA
| | - André Klein
- Department of Research Information Technology, Roswell Park Comprehensive Cancer Center, Buffalo, 14263, NY, USA
| | - Charles Roche
- Department of Diagnostic Radiology, Roswell Park Comprehensive Cancer Center, Buffalo, 14263, NY, USA
| | - Nancy Barone
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, 14263, NY, USA
| | - John Lewis Etter
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, 14623, NY, USA
| | - Andrew D Ray
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, 14263, NY, USA
- Department of Rehabilitation, Roswell Park Comprehensive Cancer Center, Buffalo, 14263, NY, USA
| | - Britton Trabert
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, 84112, UT, USA
- Huntsman Cancer Institute at the University of Utah, Cancer Control and Population Sciences, Salt Lake City, 84112, UT, USA
| | - Matthew B Schabath
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, 33612, FL, USA
| | - Lauren C Peres
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, 33612, FL, USA
| | - Rikki Cannioto
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, 14263, NY, USA
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31
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Kitano M, Yasumatsu R. The impact of sarcopenia in the treatment for patients with head and neck cancer. Auris Nasus Larynx 2024; 51:717-723. [PMID: 38805807 DOI: 10.1016/j.anl.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/30/2024]
Abstract
Sarcopenia is a disease in which a decline in muscle mass with age is associated with a decline in physical performance. In the field of otorhinolaryngology, head and neck surgery, sarcopenia is gaining attention as a cause of swallowing disorders and as a problem in the treatment of head and neck cancer. Head and neck cancer occurs in anatomical sites related to swallowing, so patients with head and neck cancer are prone to swallowing disorders and "nutrition-related sarcopenia." Since it is a cancer, it also becomes a "disease-related sarcopenia," making it easy for patients to develop secondary sarcopenia. Medical intervention against sarcopenia is important in order to decrease the number of adverse events related to treatments for cases with sarcopenia, with reports stating that proactive exercise and nutritional therapy prior to treatment for cases with sarcopenia contributes to a decrease in serious complications as well as improving the survival rate. It is the same for head and neck cancer patients with sarcopenia, so intervention prior to treatment of head and neck cancer is an area that is expected to see reports in the future. However, if the disease is malignant, it is highly likely that sarcopenia cannot be sufficiently improved due to the short period of time from diagnosis to the beginning of treatment. In this case, choosing a treatment that takes sarcopenia into consideration is another way to handle it. Assessing sarcopenia prior to treatment may help avoid post-treatment pneumonia related to sarcopenia, postoperative complications including fistula, radiation-induced toxicity including swallowing disorders, and chemotherapy-related toxicity, and it is believed to greatly contribute to the prognosis of the overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS).
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Affiliation(s)
- Mutsukazu Kitano
- Department of Otolaryngology-Head and neck surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan.
| | - Ryuji Yasumatsu
- Department of Otolaryngology-Head and neck surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan
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Cho Y, Kim EN, You JS, Han M, Park YS. Association between Muscle Mass Index and Neurological Outcomes of Patients with Out-of-Hospital Cardiac Arrest. Life (Basel) 2024; 14:680. [PMID: 38929664 PMCID: PMC11204909 DOI: 10.3390/life14060680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/13/2024] [Accepted: 05/24/2024] [Indexed: 06/28/2024] Open
Abstract
Muscle mass depletion is associated with unfavorable outcomes in many diseases. However, its relationship with cardiac arrest outcomes has not been explored. This retrospective single-center study determined the relationship between muscle mass depletion and the neurological outcomes of patients with out-of-hospital cardiac arrest (OHCA) by measuring muscle mass at various locations. Adult patients with OHCA, who were treated with target temperature management, and who underwent abdominal or chest computed tomography (CT) within 3 months of the cardiac arrest were included. Skeletal muscle index (SMI) was measured at the third lumbar vertebra (L3) level, psoas muscle, fourth thoracic vertebra (T4) level, and pectoralis muscle. The Youden index was used to determine a low SMI based on sex-specific cutoff values. The outcome variables were "good neurological outcome" and "survival" at hospital discharge. Multivariable analyses revealed that patients with low T4 SMI level were significantly associated with good neurological outcomes at hospital discharge (odds ratio = 0.26, 95% confidence interval: 0.07-0.88, p = 0.036). However, no significant differences were observed between good neurological outcomes and low SMI at the L3 level and psoas and pectoralis muscles; SMIs were not associated with survival at hospital discharge. T4 level SMI depletion was inversely associated with good neurological outcomes in patients with OHCA. Thoracic muscle depletion may be crucial for predicting the neurological outcomes in patients with OHCA and further investigation in larger prospective study is warranted.
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Affiliation(s)
- Yongtak Cho
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Department of Emergency Medicine, Hanyang University Hospital, Seoul 04763, Republic of Korea
| | - Eung Nam Kim
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Je Sung You
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Minkyung Han
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Yoo Seok Park
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
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Cazeneuve N, Bouché O, Leger J, Borg C, Labbe-Devilliers C, Lucidarme O, Tasu JP, Manfredi S, Aubé C, Trillaud H, Manzoni P, Marcus C, Terrebonne E, Douillard JY, Chautard R, Lobet S, Scotto B, Bleuzen A, Lecomte T. Visceral fat and clinical outcome in patients receiving first-line chemotherapy with bevacizumab for metastatic colorectal cancer. Clin Res Hepatol Gastroenterol 2024; 48:102380. [PMID: 38788975 DOI: 10.1016/j.clinre.2024.102380] [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: 12/30/2022] [Revised: 04/19/2024] [Accepted: 05/22/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Visceral fat produces angiogenic factors such as vascular endothelial growth factor that promote tumoral growth. However, its influence on outcome for patients with advanced cancer treated with anti-angiogenic agents is controversial. AIMS The aim of this study was to determine whether visceral fat volume, visceral fat area and body mass index are associated with outcome in patients receiving first-line bevacizumab-based treatment for metastatic colorectal cancer. METHODS This multicenter prospective study included 103 patients with metastatic colorectal cancer who received first-line bevacizumab-based chemotherapy. Computed tomography was used to measure visceral fat volume and visceral fat area. Endpoints were tumoral response at 2 months, progression free survival and overall survival. RESULTS Visceral fat volume and visceral fat area, but not body mass index, were significantly associated with better outcome. Using sex-specific median values progression free survival was significantly longer in patients with high visceral fat volume (13.2 versus 9.4 months; p = 0.0043). In the same way, high visceral fat volume and visceral fat area were associated with a significantly better overall survival: 31.3 versus 20.5 months (p = 0.0072) and 29.3 versus 20.5 months (p = 0.0078), respectively. By multivariate analysis, visceral fat volume was associated with longer progression free survival and overall survival. CONCLUSION This study demonstrates that a high visceral fat volume is associated with better outcome in patients receiving first-line bevacizumab-based chemotherapy for metastatic colorectal cancer.
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Affiliation(s)
- Nicolas Cazeneuve
- Department of Radiology, Hôpital Trousseau, CHRU de Tours, 37044 Tours Cedex 09, France
| | - Olivier Bouché
- Department of Hepatogastroenterology, Hôpital Robert Debré, CHU de Reims, avenue Général Koenig, 51092 Reims Cedex, France
| | - Julie Leger
- INSERM CIC 1415, CHRU de Tours, CHRU de Tours, 37044 Tours Cedex 09, France
| | - Christophe Borg
- Department of Medical Oncology, Hôpital Jean Minjoz, CHRU de Besançon, 3 Boulevard Alexandre Fleming, 25000 Besançon, France
| | | | - Olivier Lucidarme
- Department of Radiology, Hôpital Pitié-Salpétrière, APHP, 47, Boulevard de l'Hôpital, 75013 Paris, France
| | - Jean-Pierre Tasu
- Department of Radiology, CHU de Poitiers, 2 rue Milétrie, 86021 Poitiers Cedex, France
| | - Sylvain Manfredi
- Department of Hepatogastroenterology and Digestive Oncology, CHU de Rennes, Hôpital Pontchaillou, 2 rue Henri Le Guilloux, 35033 Rennes Cedex 9, France
| | - Christophe Aubé
- Department of Radiology, CHU d'Angers, 4 rue Larrey 49100 Angers, France
| | - Hervé Trillaud
- Department of Diagnostic and Interventional Imaging, Hôpital Saint-André, CHU de Bordeaux, 1 rue Jean Burguet, 33000 Bordeaux, France
| | - Philippe Manzoni
- Department of Radiology, Hôpital Jean Minjoz, CHRU de Besançon, Hôpital Jean Minjoz, CHRU de Besançon, 3 Boulevard Alexandre Fleming, 25000 Besançon, France
| | - Claude Marcus
- Department of Radiology, Hôpital Robert Debré, CHU de Reims, avenue Général Koenig, 51092 Reims Cedex, France
| | - Eric Terrebonne
- Department of Hepatogastroenterology and Digestive Oncology, Hôpital du Haut Lêvèque, CHU de Bordeaux, avenue Magellan, 33604 Pessac Cedex, France
| | - Jean-Yves Douillard
- Department of Medical Oncology, ICO René Gauducheau, 44805 Saint-Herblain, France
| | - Romain Chautard
- Department of Hepatogastroenterology and Digestive Oncology, Hôpital Trousseau, CHRU de Tours, 37044 Tours Cedex 09, France; UMR INSERM U 1069, Université de Tours, 10 Boulevard Tonnellé, 37000 Tours, France
| | - Sarah Lobet
- UMR INSERM U 1069, Université de Tours, 10 Boulevard Tonnellé, 37000 Tours, France
| | - Béatrice Scotto
- Department of Radiology, Hôpital Trousseau, CHRU de Tours, 37044 Tours Cedex 09, France
| | - Aurore Bleuzen
- Department of Radiology, Hôpital Bretonneau, CHRU de Tours, CHRU de Tours, 37044 Tours Cedex 09, France
| | - Thierry Lecomte
- Department of Hepatogastroenterology and Digestive Oncology, Hôpital Trousseau, CHRU de Tours, 37044 Tours Cedex 09, France; UMR INSERM U 1069, Université de Tours, 10 Boulevard Tonnellé, 37000 Tours, France.
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da Silva Nascimento ML, Alves Bennemann N, de Sousa IM, de Oliveira Bezerra MR, Villaça Chaves G, Moreira Lima Verde SM, Fernandes Maurício S, Barreto Campello Carvalheira J, Santos Mendes MC, Miranda AL, da Costa Pereira JP, Gonzalez MC, Prado CM, Fayh APT. Examining variations in body composition among patients with colorectal cancer according to site and disease stage. Sci Rep 2024; 14:10829. [PMID: 38734789 PMCID: PMC11088614 DOI: 10.1038/s41598-024-61790-0] [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: 01/10/2024] [Accepted: 05/09/2024] [Indexed: 05/13/2024] Open
Abstract
Patients with colorectal cancer (CRC) often exhibit changes in body composition (BC) which are associated with poorer clinical outcomes. Many studies group colon and rectal cancers together, irrespective of staging, potentially affecting assessment and treatment strategies. Our study aimed to compare BC in patients with CRC focusing on tumor location and metastasis presence. A total of 635 individuals were evaluated, with a mean age of 61.8 ± 12.4 years and 50.2% female. The majority had rectal cancer as the primary cancer site (51.0%), and 23.6% had metastatic disease. The first regression model showed tumor site and metastasis as independent factors influencing skeletal muscle (SM), skeletal muscle index (SMI), and visceral adipose tissue variability (all p values < 0.05). The second model, adjusted for BMI, indicated tumor site as the primary factor affecting SMI variations (adjusted R2 = 0.50 p < 0.001), with colon tumors inversely associated with SM (standardized β - 2.15(- 3.3; - 0.9) p < 0.001). A third model, considering all the confounders from the directed acyclic graphs, was constructed and the found association remained independent. Our findings highlight significant BC variations in patients with CRC, influenced by tumor location and metastases presence, underscoring the need for location-specific assessment in CRC management.
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Affiliation(s)
- Mayra Laryssa da Silva Nascimento
- PesqClin Lab, Onofre Lopes University Hospital, Brazilian Company of Hospital Services (EBSERH), Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Nithaela Alves Bennemann
- PesqClin Lab, Onofre Lopes University Hospital, Brazilian Company of Hospital Services (EBSERH), Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Iasmin Matias de Sousa
- Health Sciences Center, Federal University of Rio Grande do Norte, Avenida Senador Salgado Filho, No 3000, Natal, RN, 59078-970, Brazil
| | - Mara Rubia de Oliveira Bezerra
- Health Sciences Center, Federal University of Rio Grande do Norte, Avenida Senador Salgado Filho, No 3000, Natal, RN, 59078-970, Brazil
| | | | | | | | - José Barreto Campello Carvalheira
- Division of Oncology, Department of Anesthesiology, Oncology and Radiology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Maria Carolina Santos Mendes
- Division of Oncology, Department of Anesthesiology, Oncology and Radiology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Ana Lucia Miranda
- Health Sciences Center, Federal University of Rio Grande do Norte, Avenida Senador Salgado Filho, No 3000, Natal, RN, 59078-970, Brazil
- Liga Norteriograndense Contra o Câncer, Natal, Rio Grande do Norte, Brazil
| | | | | | - Carla M Prado
- Human Nutrition Research Unit, Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Ana Paula Trussardi Fayh
- PesqClin Lab, Onofre Lopes University Hospital, Brazilian Company of Hospital Services (EBSERH), Federal University of Rio Grande do Norte, Natal, RN, Brazil.
- Health Sciences Center, Federal University of Rio Grande do Norte, Avenida Senador Salgado Filho, No 3000, Natal, RN, 59078-970, Brazil.
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Di Fiore R, Drago-Ferrante R, Suleiman S, Veronese N, Pegreffi F, Calleja-Agius J. Sarcopenia in gynaecological cancers. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024:108403. [PMID: 38760237 DOI: 10.1016/j.ejso.2024.108403] [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: 01/08/2024] [Revised: 04/26/2024] [Accepted: 05/07/2024] [Indexed: 05/19/2024]
Abstract
Gynaecological cancers (GCs) comprise a group of cancers that originate in the female reproductive organs. Each GC is unique, with different signs and symptoms, risk factors and therapeutic strategies. Worldwide, the majority of GCs are still associated with high mortality rates, especially ovarian, due to difficulty in early detection. Despite numerous studies on the underlying pathophysiology, research in the field of GCs poses unique scientific and technological challenges. These challenges require a concerted multi- and inter-disciplinary effort by the clinical, scientific and research communities to accelerate the advancement of prognostic, diagnostic, and therapeutic approaches. Sarcopenia is a multifactorial disease which leads to the systemic loss of skeletal muscle mass and function. It can be caused by malignancies, as well as due to malnutrition, physical inactivity, ageing and neuromuscular, inflammatory, and/or endocrine diseases. Anorexia and systemic inflammation can shift the metabolic balance of patients with cancer cachexia towards catabolism of skeletal muscle, and hence sarcopenia. Therefore, sarcopenia is considered as an indicator of poor general health status, as well as the possible indicator of advanced cancer. There is a growing body of evidence showing the prognostic significance of sarcopenia in various cancers, including GCs. This review will outline the clinical importance of sarcopenia in patients with GCs.
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Affiliation(s)
- Riccardo Di Fiore
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, MSD 2080, Msida, Malta; Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, PA, 19122, USA.
| | - Rosa Drago-Ferrante
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, MSD 2080, Msida, Malta; BioDNA Laboratories, Malta Life Sciences Park, SGN 3000, San Gwann, Malta.
| | - Sherif Suleiman
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, MSD 2080, Msida, Malta.
| | - Nicola Veronese
- Department of Internal Medicine, Geriatrics Section, University of Palermo, 90128, Palermo, Italy.
| | - Francesco Pegreffi
- Department of Medicine and Surgery, Kore University of Enna, 94100, Enna, Italy.
| | - Jean Calleja-Agius
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, MSD 2080, Msida, Malta.
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Bozzetti F. Evolving concepts on perioperative nutrition of sarcopenic cancer patients. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:106748. [PMID: 36376142 DOI: 10.1016/j.ejso.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 11/13/2022]
Abstract
The recent recognition of the association of sarcopenia with an increased risk of complications after a surgical procedure calls for rethinking the proper approach of the perioperative care in cancer patients. Sarcopenia is broadly considered in literature according to three different definitions: loss of muscle mass, loss of muscle mass plus reduced muscle function and myosteatosis. The aim of this short review on this issue is to define the excess of risk by type of primary and of surgical procedure, depending on the definition of sarcopenia, to speculate on this association (casual versus causal) and to examine the current therapeutical approaches. The analysis of the data shows that sarcopenia, defined as loss of muscle mass plus reduced muscle function, has the higher predictive power for the occurrence of postoperative complications than the two other definitions, and any definition of sarcopenia works better than the usual indexes or scores of surgical risk. Our analysis supports the concept that: a) sarcopenia is frequently associated with inflammation, but inflammation cannot be considered the only or the absolute cause for sarcopenia, b) sarcopenia is not a simple marker of risk but can have a direct role in the increase of risk. Data on perioperative care of sarcopenic cancer patients are scanty but a correct approach cannot rely on nutritional support alone but on a combined approach of optimized nutrition and exercise, hopefully associated with an anti-inflammatory treatment. This strategy should be applied proactively in keeping with the recent recommendations of the American Society of Clinical Oncology for the medical treatment of advanced cancer patients even if a clear demonstration of effectiveness is still lacking.
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Affiliation(s)
- Federico Bozzetti
- University of Milan, Faculty of Medicine, via Festa del Perdono, 20100, Milano, Italy.
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Fulbert M, El Amrani M, Baillet C, Lecolle K, Ernst O, Louvet A, Pruvot FR, Huglo D, Truant S. Sarcopenia does not affect liver regeneration and postoperative course after a major hepatectomy. A prospective study on 125 patients using CT volumetry and HIDA scintigraphy. Clin Res Hepatol Gastroenterol 2024; 48:102332. [PMID: 38574887 DOI: 10.1016/j.clinre.2024.102332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND & OBJECTIVES Sarcopenia is a morbi-mortality risk factor in digestive surgery, though its impact after major hepatectomy (MH) remains unknown. This prospective pilot study investigated whether volume and function of a regenerating liver is influenced by body composition. METHODS From 2011 to 2016, 125 consecutive patients had computed tomography and 99mTc-labelled-mebrofenin SPECT-scintigraphy before and after MH at day 7 and 1 month for measurements of liver volumes and functions. L3 vertebra muscle mass identified sarcopenia. Primary endpoint was the impact of sarcopenia on regeneration capacities (i.e. volume/function changes and post-hepatectomy liver failure (PHLF) rate). Secondary endpoint was 3-month morbi-mortality. RESULTS Sarcopenic patients (SP; N = 69) were significantly older than non-sarcopenic (NSP), with lower BMI and more malignancies, but with comparable liver function/volume at baseline. Postoperatively, SP showed higher rates of ISGLS_PHLF (24.6 % vs 10.9 %; p = 0.05) but with comparable rates of severe morbidity (23.2 % vs 16.4 %; p = 0.35), overall (8.7 % vs 3.6 %; p = 0.3) and PHLF-related mortality (8,7 % vs 1.8 %; p = 0.075). After matching on the extent of resection or using propensity score, regeneration and PHLF rates were similar. CONCLUSION This prospective study using first sequential SPECT-scintigraphy showed that sarcopenia by itself does not affect liver regeneration capacities and short-term postoperative course after MH.
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Affiliation(s)
- Maxence Fulbert
- Department of Digestive Surgery and Transplantation, CHU Lille, University Lille, Lille F-59000, France
| | - Mehdi El Amrani
- Department of Digestive Surgery and Transplantation, CHU Lille, University Lille, Lille F-59000, France; CANTHER laboratory "Cancer Heterogeneity, Plasticity and Resistance to Therapies" UMR-S1277, Team "Mucins, Cancer and Drug Resistance", Lille F-59000, France
| | - Clio Baillet
- Department of Nuclear Medicine, CHU Lille, University Lille, Lille F-59000, France
| | - Katia Lecolle
- Department of Digestive Surgery and Transplantation, CHU Lille, University Lille, Lille F-59000, France
| | - Olivier Ernst
- Department of Digestive Radiology, CHU Lille, University Lille, Lille F-59000, France
| | - Alexandre Louvet
- Department of Hepatogastroenterology, CHU Lille, University Lille, Lille F-59000, France
| | - François-René Pruvot
- Department of Digestive Surgery and Transplantation, CHU Lille, University Lille, Lille F-59000, France
| | - Damien Huglo
- Department of Nuclear Medicine, CHU Lille, University Lille, Lille F-59000, France
| | - Stéphanie Truant
- Department of Digestive Surgery and Transplantation, CHU Lille, University Lille, Lille F-59000, France; CANTHER laboratory "Cancer Heterogeneity, Plasticity and Resistance to Therapies" UMR-S1277, Team "Mucins, Cancer and Drug Resistance", Lille F-59000, France.
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Freckelton J, Rajagopalan A, Moore GT, Croagh D. Handgrip Strength Predicts Survival in Patients With Pancreatic Cancer. Pancreas 2024; 53:e405-e409. [PMID: 38517481 DOI: 10.1097/mpa.0000000000002319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
OBJECTIVES Pancreatic ductal adenocarcinoma (PDAC) is a common cancer with a poor prognosis and is associated with a high prevalence of cachexia, a metabolic syndrome of muscle wasting due to complex mechanisms. In addition to loss of muscle mass, cancer patients also experience functional deterioration. The aim of this study is to determine whether there is an association between muscle mass and function and clinical outcomes, particularly survival. METHODS We performed a prospective cohort study including all patients with PDAC at Monash Health from March 2016 to December 2017. We conducted body composition analysis for myopenia and handgrip strength testing. We constructed Kaplan-Meier curves to estimate whether myopenia and low hand grip strength were associated with poorer survival. RESULTS Myopenia was not associated with a significant difference in PDAC-specific survival (log-rank P = 0.60). However, low handgrip strength was associated with significantly worse PDAC-specific survival compared with other patients (log-rank hazard ratio, 1.88; 95% confidence interval, 1.15-3.09; P = 0.004). CONCLUSIONS The relationship between survival in PDAC and handgrip strength, but not anatomical muscle mass, suggests that functional testing of strength may be important in prognostication of patients with PDAC, alongside existing tools such as the Eastern Cooperative Oncology Group performance status.
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Zhong Q, Huang JB, Lu J, Xue LW, Lin GT, Xie JW, Lin JX, Zheng CH, Huang CM, Li P. Predictive Value of a New Muscle Parameter in Patients with Resectable Gastric Cancer: A Pooled Analysis of Three Prospective Trials. Ann Surg Oncol 2024; 31:3005-3016. [PMID: 38270825 PMCID: PMC10997550 DOI: 10.1245/s10434-024-14913-w] [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: 10/16/2023] [Accepted: 12/29/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Sarcopenia is closely associated with gastric cancer (GC) prognosis. However, its exact definition remains controversial. METHODS This study included computed tomography images and clinical data of patients from three prospective studies. The skeletal muscle index (SMI) and skeletal muscle radiation attenuation (SMRA) were analyzed, and a new muscle parameter, skeletal muscle gauge (SMG), was obtained by multiplying the two parameters. The values of the three indices for predicting the prognosis of patients with GC were compared. RESULTS The study included 717 patients. The findings showed median values of 42 cm2/m2 (range, 36.8-48.2 cm2/m2) for SMI, 45 HU (range, 41-49 HU) for SMRA, and 1842 (range, 1454-2260) for SMG. Postoperatively, 111 patients (15.5%) experienced complications. The 3-year overall survival (OS), disease-free survival (DFS), and recurrence-free survival (RFS) were 74.3%, 68.2%, and 70%, respectively. Univariate logistic analysis showed that postoperative complications were associated with SMI (odds ratio [OR] 0.94; 95% confidence interval [CI] 0.92-0.96), SMRA (OR, 0.87; 95% CI 0.84-0.90), and SMG (OR 0.99; 95% CI 0.98-0.99). After a two-step multivariate analysis, only SMG (OR 0.98, 95% CI 0.97-0.99) was an independent protective factor of postoperative complications. Multivariate analysis showed that SMG also was an independent protective factor of OS, DFS, and RFS. The patients were divided into low-SMG (L-SMG) group and high-SMG (H-SMG) groups. Chemotherapy benefit analysis of the patients with stage II low SMG showed that the OS, DFS, and RFS of the chemotherapy group were significantly better than those of the non-chemotherapy group (p < 0.05). CONCLUSION The prospective large sample data showed that the new muscle parameter, SMG, can effectively predict the short-term outcome and long-term prognosis of patients with resectable gastric cancer. As a new muscle parameter index, SMG is worthy of further study.
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Affiliation(s)
- Qing Zhong
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Jiao-Bao Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Li-Wei Xue
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Guang-Tan Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
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Faiella E, Vergantino E, Vaccarino F, Bruno A, Perillo G, Grasso RF, Zobel BB, Santucci D. A Review of the Paradigmatic Role of Adipose Tissue in Renal Cancer: Fat Measurement and Tumor Behavior Features. Cancers (Basel) 2024; 16:1697. [PMID: 38730649 PMCID: PMC11083503 DOI: 10.3390/cancers16091697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/25/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
(1) Background: Renal-cell carcinoma (RCC) incidence has been steadily rising, with obesity identified as a potential risk factor. However, the relationship between obesity and RCC prognosis remains unclear. This systematic review aims to investigate the impact of different adipose tissue measurements on RCC behavior and prognosis. (2) Methods: A search of MEDLINE databases identified 20 eligible studies focusing on various fat measurements, including visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), perirenal adipose tissue (PRAT), and the Mayo adhesive probability (MAP) score. (3) Results: The review revealed conflicting findings regarding the association between adipose tissue measurements and RCC outcomes. While some studies suggested a protective role of certain fat deposits, particularly VAT, against disease progression and mortality, others reported contradictory results across different adipose metrics and RCC subtypes. (4) Conclusions: Methodological variations and limitations, such as retrospective designs and sample size constraints, pose challenges to standardization and generalizability. Further research is needed to understand these associations better and establish standardized approaches for adiposity assessment in RCC patients, which could inform clinical practice and therapeutic decision-making.
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Affiliation(s)
- Eliodoro Faiella
- Operative Reasearch Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128 Rome, Italy; (E.F.); (F.V.); (A.B.); (G.P.); (R.F.G.); (B.B.Z.); (D.S.)
- Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Elva Vergantino
- Operative Reasearch Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128 Rome, Italy; (E.F.); (F.V.); (A.B.); (G.P.); (R.F.G.); (B.B.Z.); (D.S.)
- Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Federica Vaccarino
- Operative Reasearch Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128 Rome, Italy; (E.F.); (F.V.); (A.B.); (G.P.); (R.F.G.); (B.B.Z.); (D.S.)
- Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Amalia Bruno
- Operative Reasearch Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128 Rome, Italy; (E.F.); (F.V.); (A.B.); (G.P.); (R.F.G.); (B.B.Z.); (D.S.)
- Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Gloria Perillo
- Operative Reasearch Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128 Rome, Italy; (E.F.); (F.V.); (A.B.); (G.P.); (R.F.G.); (B.B.Z.); (D.S.)
- Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Rosario Francesco Grasso
- Operative Reasearch Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128 Rome, Italy; (E.F.); (F.V.); (A.B.); (G.P.); (R.F.G.); (B.B.Z.); (D.S.)
- Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Bruno Beomonte Zobel
- Operative Reasearch Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128 Rome, Italy; (E.F.); (F.V.); (A.B.); (G.P.); (R.F.G.); (B.B.Z.); (D.S.)
- Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Domiziana Santucci
- Operative Reasearch Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128 Rome, Italy; (E.F.); (F.V.); (A.B.); (G.P.); (R.F.G.); (B.B.Z.); (D.S.)
- Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
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Phillips ME, Robertson MD, Bennett-Eastley K, Rowe L, Frampton AE, Hart KH. Standard Nutritional Assessment Tools Are Unable to Predict Loss of Muscle Mass in Patients Due to Undergo Pancreatico-Duodenectomy: Highlighting the Need for Detailed Nutritional Assessment. Nutrients 2024; 16:1269. [PMID: 38732516 PMCID: PMC11085118 DOI: 10.3390/nu16091269] [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: 03/30/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND AND METHODS Pancreatico-duodenectomy (PD) carries significant morbidity and mortality, with very few modifiable risk factors. Radiological evidence of sarcopenia is associated with poor outcomes. This retrospective study aimed to analyse the relationship between easy-to-use bedside nutritional assessment techniques and radiological markers of muscle loss to identify those patients most likely to benefit from prehabilitation. RESULTS Data were available in 184 consecutive patients undergoing PD. Malnutrition was present in 33-71%, and 48% had a high visceral fat-to-skeletal muscle ratio, suggestive of sarcopenic obesity (SO). Surgical risk was higher in patients with obesity (OR 1.07, 95%CI 1.01-1.14, p = 0.031), and length of stay was 5 days longer in those with SO (p = 0.006). There was no correlation between skeletal muscle and malnutrition using percentage weight loss or the malnutrition universal screening tool (MUST), but a weak correlation between the highest hand grip strength (HGS; 0.468, p < 0.001) and the Global Leadership in Malnutrition (GLIM) criteria (-0.379, p < 0.001). CONCLUSIONS Nutritional assessment tools give widely variable results. Further research is needed to identify patients at significant nutritional risk prior to PD. In the meantime, those with malnutrition (according to the GLIM criteria), obesity or low HGS should be referred to prehabilitation.
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Affiliation(s)
- Mary E. Phillips
- Department of Nutrition and Dietetics, Royal Surrey NHS Foundation Trust, Guildford GU2 7XX, UK
- Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - M. Denise Robertson
- Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Kate Bennett-Eastley
- Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Lily Rowe
- Department of Nutrition and Dietetics, Royal Surrey NHS Foundation Trust, Guildford GU2 7XX, UK
| | - Adam E. Frampton
- Department of Nutrition and Dietetics, Royal Surrey NHS Foundation Trust, Guildford GU2 7XX, UK
- HPB Surgical Unit, Royal Surrey NHS Foundation Trust, Guildford GU2 7XX, UK
- Section of Oncology, Department of Clinical and Experimental Medicine, FHMS, University of Surrey, Guildford GU2 7XH, UK
| | - Kathryn H. Hart
- Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
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Pekař M, Jiravský O, Novák J, Branny P, Balušík J, Daniš D, Hečko J, Kantor M, Prosecky R, Blaha L, Neuwirth R. Sarcopenia and adipose tissue evaluation by artificial intelligence predicts the overall survival after TAVI. Sci Rep 2024; 14:8842. [PMID: 38632317 PMCID: PMC11024085 DOI: 10.1038/s41598-024-59134-z] [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: 01/16/2024] [Accepted: 04/08/2024] [Indexed: 04/19/2024] Open
Abstract
Sarcopenia is a serious systemic disease that reduces overall survival. TAVI is selectively performed in patients with severe aortic stenosis who are not indicated for open cardiac surgery due to severe polymorbidity. Artificial intelligence-assisted body composition assessment from available CT scans appears to be a simple tool to stratify these patients into low and high risk based on future estimates of all-cause mortality. Within our study, the segmentation of preprocedural CT scans at the level of the lumbar third vertebra in patients undergoing TAVI was performed using a neural network (AutoMATiCA). The obtained parameters (area and density of skeletal muscles and intramuscular, visceral, and subcutaneous adipose tissue) were analyzed using Cox univariate and multivariable models for continuous and categorical variables to assess the relation of selected variables with all-cause mortality. 866 patients were included (median(interquartile range)): age 79.7 (74.9-83.3) years; BMI 28.9 (25.9-32.6) kg/m2. Survival analysis was performed on all automatically obtained parameters of muscle and fat density and area. Skeletal muscle index (SMI in cm2/m2), visceral (VAT in HU) and subcutaneous adipose tissue (SAT in HU) density predicted the all-cause mortality in patients after TAVI expressed as hazard ratio (HR) with 95% confidence interval (CI): SMI HR 0.986, 95% CI (0.975-0.996); VAT 1.015 (1.002-1.028) and SAT 1.014 (1.004-1.023), all p < 0.05. Automatic body composition assessment can estimate higher all-cause mortality risk in patients after TAVI, which may be useful in preoperative clinical reasoning and stratification of patients.
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Affiliation(s)
- Matej Pekař
- Hospital AGEL Třinec-Podlesí, Konská 453, 739 61, Třinec, Czech Republic
- Department of Physiology, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic
| | - Otakar Jiravský
- Hospital AGEL Třinec-Podlesí, Konská 453, 739 61, Třinec, Czech Republic
| | - Jan Novák
- Department of Physiology, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic.
- 2nd Department of Internal Medicine, St. Anne's University Hospital in Brno, Pekařská 53, 656 91, Brno, Czech Republic.
- Faculty of Medicine, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic.
| | - Piotr Branny
- Hospital AGEL Třinec-Podlesí, Konská 453, 739 61, Třinec, Czech Republic
- Faculty of Medicine, Palacky University, Krizkovskeho 511/8, 779 00, Olomouc, Czech Republic
| | - Jakub Balušík
- Hospital AGEL Třinec-Podlesí, Konská 453, 739 61, Třinec, Czech Republic
| | - Daniel Daniš
- The Jackson Laboratory for Genomic Medicine, 10 Discovery Drive, Farmington, CT, 06032, USA
| | - Jan Hečko
- Hospital AGEL Třinec-Podlesí, Konská 453, 739 61, Třinec, Czech Republic
- Faculty of Electrical Engineering and Computer Science, VSB - Technical University of Ostrava, 17. Listopadu Street 2172/15, 708 00, Ostrava, Czech Republic
| | - Marek Kantor
- Hospital AGEL Třinec-Podlesí, Konská 453, 739 61, Třinec, Czech Republic
| | - Robert Prosecky
- 2nd Department of Internal Medicine, St. Anne's University Hospital in Brno, Pekařská 53, 656 91, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic
| | - Lubomir Blaha
- Hospital AGEL Třinec-Podlesí, Konská 453, 739 61, Třinec, Czech Republic
| | - Radek Neuwirth
- Hospital AGEL Třinec-Podlesí, Konská 453, 739 61, Třinec, Czech Republic
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Zambrano Chaves JM, Lenchik L, Gallegos IO, Blankemeier L, Rubin DL, Willis MH, Chaudhari AS, Boutin RD. Abdominal CT metrics in 17,646 patients reveal associations between myopenia, myosteatosis, and medical phenotypes: a phenome-wide association study. EBioMedicine 2024; 103:105116. [PMID: 38636199 PMCID: PMC11031722 DOI: 10.1016/j.ebiom.2024.105116] [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: 11/21/2023] [Revised: 03/29/2024] [Accepted: 03/30/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Deep learning facilitates large-scale automated imaging evaluation of body composition. However, associations of body composition biomarkers with medical phenotypes have been underexplored. Phenome-wide association study (PheWAS) techniques search for medical phenotypes associated with biomarkers. A PheWAS integrating large-scale analysis of imaging biomarkers and electronic health record (EHR) data could discover previously unreported associations and validate expected associations. Here we use PheWAS methodology to determine the association of abdominal CT-based skeletal muscle metrics with medical phenotypes in a large North American cohort. METHODS An automated deep learning pipeline was used to measure skeletal muscle index (SMI; biomarker of myopenia) and skeletal muscle density (SMD; biomarker of myosteatosis) from abdominal CT scans of adults between 2012 and 2018. A PheWAS was performed with logistic regression using patient sex and age as covariates to assess for associations between CT-derived muscle metrics and 611 common EHR-derived medical phenotypes. PheWAS P values were considered significant at a Bonferroni corrected threshold (α = 0.05/1222). FINDINGS 17,646 adults (mean age, 56 years ± 19 [SD]; 57.5% women) were included. CT-derived SMI was significantly associated with 268 medical phenotypes; SMD with 340 medical phenotypes. Previously unreported associations with the highest magnitude of significance included higher SMI with decreased cardiac dysrhythmias (OR [95% CI], 0.59 [0.55-0.64]; P < 0.0001), decreased epilepsy (OR, 0.59 [0.50-0.70]; P < 0.0001), and increased elevated prostate-specific antigen (OR, 1.84 [1.47-2.31]; P < 0.0001), and higher SMD with decreased decubitus ulcers (OR, 0.36 [0.31-0.42]; P < 0.0001), sleep disorders (OR, 0.39 [0.32-0.47]; P < 0.0001), and osteomyelitis (OR, 0.43 [0.36-0.52]; P < 0.0001). INTERPRETATION PheWAS methodology reveals previously unreported associations between CT-derived biomarkers of myopenia and myosteatosis and EHR medical phenotypes. The high-throughput PheWAS technique applied on a population scale can generate research hypotheses related to myopenia and myosteatosis and can be adapted to research possible associations of other imaging biomarkers with hundreds of EHR medical phenotypes. FUNDING National Institutes of Health, Stanford AIMI-HAI pilot grant, Stanford Precision Health and Integrated Diagnostics, Stanford Cardiovascular Institute, Stanford Center for Digital Health, and Stanford Knight-Hennessy Scholars.
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Affiliation(s)
- Juan M Zambrano Chaves
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA; Department of Radiology, Stanford University, Stanford, CA, USA
| | - Leon Lenchik
- Department of Diagnostic Radiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Isabel O Gallegos
- Department of Computer Science, (IOG), Stanford University, Stanford, CA, USA
| | - Louis Blankemeier
- Department of Electrical Engineering, Stanford University, Stanford, CA, USA
| | - Daniel L Rubin
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA; Department of Radiology, Stanford University, Stanford, CA, USA
| | - Marc H Willis
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Akshay S Chaudhari
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA; Department of Radiology, Stanford University, Stanford, CA, USA
| | - Robert D Boutin
- Department of Radiology, Stanford University, Stanford, CA, USA.
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Suthakaran R, Cao K, Arafat Y, Yeung J, Chan S, Master M, Faragher IG, Baird PN, Yeung JMC. Body composition assessment by artificial intelligence can be a predictive tool for short-term postoperative complications in Hartmann's reversals. BMC Surg 2024; 24:111. [PMID: 38622633 PMCID: PMC11017666 DOI: 10.1186/s12893-024-02408-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 04/09/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Hartmann's reversal, a complex elective surgery, reverses and closes the colostomy in individuals who previously underwent a Hartmann's procedure due to colonic pathology like cancer or diverticulitis. It demands careful planning and patient optimisation to help reduce postoperative complications. Preoperative evaluation of body composition has been useful in identifying patients at high risk of short-term postoperative outcomes following colorectal cancer surgery. We sought to explore the use of our in-house derived Artificial Intelligence (AI) algorithm to measure body composition within patients undergoing Hartmann's reversal procedure in the prediction of short-term postoperative complications. METHODS A retrospective study of all patients who underwent Hartmann's reversal within a single tertiary referral centre (Western) in Melbourne, Australia and who had a preoperative Computerised Tomography (CT) scan performed. Body composition was measured using our previously validated AI algorithm for body segmentation developed by the Department of Surgery, Western Precinct, University of Melbourne. Sarcopenia in our study was defined as a skeletal muscle index (SMI), calculated as Skeletal Muscle Area (SMA) /height2 < 38.5 cm2/m2 in women and < 52.4 cm2/m2 in men. RESULTS Between 2010 and 2020, 47 patients (mean age 63.1 ± 12.3 years; male, n = 28 (59.6%) underwent body composition analysis. Twenty-one patients (44.7%) were sarcopenic, and 12 (25.5%) had evidence of sarcopenic obesity. The most common postoperative complication was surgical site infection (SSI) (n = 8, 17%). Sarcopenia (n = 7, 87.5%, p = 0.02) and sarcopenic obesity (n = 5, 62.5%, p = 0.02) were significantly associated with SSIs. The risks of developing an SSI were 8.7 times greater when sarcopenia was present. CONCLUSION Sarcopenia and sarcopenic obesity were related to postoperative complications following Hartmann's reversal. Body composition measured by a validated AI algorithm may be a beneficial tool for predicting short-term surgical outcomes for these patients.
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Affiliation(s)
- Reshi Suthakaran
- Department of Colorectal Surgery, Western Health, Footscray, Melbourne, VIC, 3011, Australia.
- Department of Surgery, Western Precinct, University of Melbourne, Level 3, WCHRE, Sunshine Hospital, St Albans, Melbourne, VIC, 3021, Australia.
| | - Ke Cao
- Department of Surgery, Western Precinct, University of Melbourne, Level 3, WCHRE, Sunshine Hospital, St Albans, Melbourne, VIC, 3021, Australia
| | - Yasser Arafat
- Department of Colorectal Surgery, Western Health, Footscray, Melbourne, VIC, 3011, Australia
- Department of Surgery, Western Precinct, University of Melbourne, Level 3, WCHRE, Sunshine Hospital, St Albans, Melbourne, VIC, 3021, Australia
| | - Josephine Yeung
- Department of Surgery, Western Precinct, University of Melbourne, Level 3, WCHRE, Sunshine Hospital, St Albans, Melbourne, VIC, 3021, Australia
| | - Steven Chan
- Department of Surgery, Western Precinct, University of Melbourne, Level 3, WCHRE, Sunshine Hospital, St Albans, Melbourne, VIC, 3021, Australia
| | - Mobin Master
- Department of Radiology, Western Health, Melbourne, Australia
| | - Ian G Faragher
- Department of Colorectal Surgery, Western Health, Footscray, Melbourne, VIC, 3011, Australia
| | - Paul N Baird
- Department of Surgery, Western Precinct, University of Melbourne, Level 3, WCHRE, Sunshine Hospital, St Albans, Melbourne, VIC, 3021, Australia
| | - Justin M C Yeung
- Department of Colorectal Surgery, Western Health, Footscray, Melbourne, VIC, 3011, Australia.
- Department of Surgery, Western Precinct, University of Melbourne, Level 3, WCHRE, Sunshine Hospital, St Albans, Melbourne, VIC, 3021, Australia.
- Western Health Chronic Disease Alliance, Western Health, Footscray Hospital, Melbourne, VIC, 3011, Australia.
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Keenan RA, Nic An Riogh AU, Brennan D, Morrin M, Lee MJ, Davis NF, Ferede AA, Little DM. Lean body mass in living kidney donors impacts postoperative renal function. World J Urol 2024; 42:214. [PMID: 38581460 PMCID: PMC10998768 DOI: 10.1007/s00345-024-04908-3] [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: 01/08/2024] [Accepted: 02/26/2024] [Indexed: 04/08/2024] Open
Abstract
PURPOSE A living donor kidney transplant is the optimal treatment for chronic renal impairment. Our objective is to assess if lean skeletal muscle mass and donor factors such as body mass index, hypertension, and age impact on renal function following donor nephrectomy. METHODS Potential donors undergo CT angiography as part of their work-up in our institution. Using dedicated software (Horos®), standardized skeletal muscle area measured at the L3 vertebrae was calculated. When corrected for height, skeletal muscle index can be derived. Skeletal muscle mass index below predefined levels was classified as sarcopenic. The correlation of CT-derived skeletal muscle index and postoperative renal function at 12 months was assessed. Co-variables including donor gender, age, body mass index (BMI), and presence of pre-op hypertension were also assessed for their impact on postoperative renal function. RESULTS 275 patients who underwent living donor nephrectomy over 10 years were included. Baseline pre-donation glomerular filtration rate (GFR) and renal function at one year post-op were similar between genders. 29% (n = 82) of patients met the criteria for CT-derived sarcopenia. Sarcopenic patients were more likely to have a higher GFR at one year post-op (69.3 vs 63.9 mL/min/1.73 m2, p < 0.001). The main factors impacting better renal function at one year were the presence of sarcopenia and younger age at donation. CONCLUSION When selecting donors, this study highlights that patients with low skeletal mass are unlikely to underperform in terms of recovery of their renal function postoperatively at one year when compared to patients with normal muscle mass and should not be a barrier to kidney donation.
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Affiliation(s)
- Robert A Keenan
- Department of Surgical Affairs, Royal College of Surgeons, Dublin, Ireland.
- National Kidney Transplant Service, Beaumont Hospital, Dublin, Ireland.
| | - Aisling U Nic An Riogh
- Department of Surgical Affairs, Royal College of Surgeons, Dublin, Ireland
- National Kidney Transplant Service, Beaumont Hospital, Dublin, Ireland
| | - David Brennan
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - Martina Morrin
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - Michael J Lee
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - Niall F Davis
- Department of Surgical Affairs, Royal College of Surgeons, Dublin, Ireland
- National Kidney Transplant Service, Beaumont Hospital, Dublin, Ireland
| | - Atakelet A Ferede
- National Kidney Transplant Service, Beaumont Hospital, Dublin, Ireland
| | - Dilly M Little
- National Kidney Transplant Service, Beaumont Hospital, Dublin, Ireland
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Lee S, Yoon Y, Suh J, You D, Hong B, Hong JH, Ahn H, Jeong IG, Lim B. Association of preoperative sarcopenia with the long-term prognosis of patients with bladder cancer undergoing radical cystectomy. J Cancer Res Clin Oncol 2024; 150:173. [PMID: 38568255 PMCID: PMC10991012 DOI: 10.1007/s00432-024-05705-6] [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: 02/16/2024] [Accepted: 03/15/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE This retrospective study aimed to assess the correlation between preoperative sarcopenia and long-term oncologic outcomes in patients undergoing radical cystectomy for bladder cancer. METHODS We included 528 patients who underwent radical cystectomy for bladder cancer between 2000 and 2010 at Asan Medical Center, Seoul, Korea. Preoperative skeletal muscle mass was quantified by analyzing computed tomography images at the third lumbar vertebra. Sarcopenia was defined based on the skeletal muscle index. We evaluated various clinical and pathological factors to analyze the association between sarcopenia and long-term oncologic outcomes. RESULTS The median follow-up time was 104 months. Sarcopenia was identified in 37.9% of the patients. Although no significant differences were observed in traditional pathological factors between the sarcopenic and non-sarcopenic groups, sarcopenia was significantly associated with worse oncologic outcomes. Compared to the non-sarcopenic groups, the sarcopenic group had lower overall survival rates (52.0% vs. 67.1% at 5 years, 35.5% vs. 52.7% at 10 years) and higher cancer-specific mortality (63.3% vs. 74.3% at 5 years, 50.7% vs. 67.4% at 10 years). Multivariable Cox regression analysis demonstrated that sarcopenia was an independent predictor of cancer-specific survival (hazard ratio: 1.49, 95% confidence interval: 1.11-2.01, p = 0.008), alongside body mass index, tumor stage, lymph node metastasis, and lymphovascular invasion. CONCLUSION Sarcopenia was significantly associated with poor cancer-specific survival in patients undergoing radical cystectomy for bladder cancer. Detecting sarcopenia may assist in preoperative risk stratification and long-term management after radical cystectomy.
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Affiliation(s)
- Sangmin Lee
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Youngjoon Yoon
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Jungyo Suh
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Dalsan You
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Bumsik Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Bumjin Lim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
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Tokashiki T, Igarashi T, Shiraishi M, Kano R, Ojiri H. Evaluation of the association between osteoporotic vertebral compression fractures and psoas major/paraspinal muscle mass and ADC measured on MRI. Skeletal Radiol 2024; 53:675-682. [PMID: 37831148 DOI: 10.1007/s00256-023-04461-x] [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: 03/23/2023] [Revised: 09/21/2023] [Accepted: 09/24/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE Evaluate magnetic resonance imaging factors associated with osteoporotic vertebral compression fractures. MATERIALS AND METHODS We retrospectively reviewed 457 patients' records. Age, sex, and body mass index were recorded. Two blinded readers measured psoas major and paraspinal muscle areas at the L3 vertebral body level on transverse T2-weighted magnetic resonance images and the mean apparent diffusion coefficient values of the non-fractured vertebrae from Th12 to L5. Inter-reader reliability for continuous variables was assessed by intraclass correlation coefficients. RESULTS We evaluated 210 patients (103 [49.0%] men). The osteoporotic vertebral compression fractures group was older and had lower BMI and smaller psoas major and paraspinal muscle areas than the group without vertebral compression fractures (p < 0.001). The mean apparent diffusion coefficient was weakly correlated with paraspinal muscle area in the osteoporotic vertebral compression fractures group. The intraclass correlation coefficient value was 0.83, and the intraclass correlation coefficients of the psoas major and paraspinal muscles were 0.94 and 0.97, respectively. Multivariate analysis revealed that decreased psoas major and paraspinal muscle areas and increased mean apparent diffusion coefficient values were significantly associated with the presence of osteoporotic vertebral compression fractures (all p < 0.05). Psoas major and paraspinal muscle areas showed relatively high predictive accuracy (57%, 61%). CONCLUSION Psoas major and paraspinal muscle areas at the L3 level and the mean apparent diffusion coefficient value of non-fractured vertebrae from the Th12 to L5 level were associated with osteoporotic vertebral compression fractures. This may contribute to detecting the potential risk of healthy individuals developing osteoporotic vertebral compression fractures.
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Affiliation(s)
- Tadashi Tokashiki
- Department of Radiology, Jikei University School of Medicine, Nishi-Shimbashi, Minato-Ku, Tokyo, Japan.
| | - Takao Igarashi
- Department of Radiology, Jikei University School of Medicine, Nishi-Shimbashi, Minato-Ku, Tokyo, Japan
| | - Megumi Shiraishi
- Department of Radiology, Jikei University School of Medicine, Nishi-Shimbashi, Minato-Ku, Tokyo, Japan
| | - Rui Kano
- Department of Radiology, Jikei University School of Medicine, Nishi-Shimbashi, Minato-Ku, Tokyo, Japan
| | - Hiroya Ojiri
- Department of Radiology, Jikei University School of Medicine, Nishi-Shimbashi, Minato-Ku, Tokyo, Japan
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Berg HB, Alavi DT, Beichmann B, Pesonen M, Henriksen C, Paur I, Bøhn SK, Lauritzen PM, Blomhoff R, Henriksen HB. The choice of diagnostic modality influences the proportion of low muscle strength, low muscle mass, and sarcopenia in colorectal cancer patients. Clin Nutr ESPEN 2024; 60:17-23. [PMID: 38479906 DOI: 10.1016/j.clnesp.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/28/2023] [Accepted: 01/09/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND AND AIMS Low muscle strength, low muscle mass, and sarcopenia have a negative impact on health outcomes in colorectal cancer (CRC) patients. Different diagnostic modalities are used to identify these conditions but it is unknown how well the modalities agree. The aim of this study was to compare different diagnostic modalities by means of calculating the proportion of low muscle strength, low muscle mass, and sarcopenia in CRC patients, and to investigate the agreement for sarcopenia between the various modalities. METHODS Men and women participating in the Norwegian Dietary Guidelines and colorectal cancer Survival (CRC-NORDIET) study were included in the analyses. Cut-off values for low muscle strength, low muscle mass, and sarcopenia were defined according to the second consensus set by the European Working Group on Sarcopenia in Older People (EWGSOP2). The diagnostic modalities used to assess muscle strength were handgrip strength and the sit-to-stand test. For muscle mass, computed tomography, dual-energy X-ray absorptiometry (DXA), multi-frequency bioelectrical impedance analysis (MF-BIA), and single-frequency BIA (SF-BIA) were applied. Cohen's kappa was calculated to determine the agreement for low muscle strength and confirmed sarcopenia between diagnostic modalities. RESULTS Five hundred and three men and women (54 % men, mean age of 66 (range 50-80) years old) were included in the analysis. As much as 99 % (n = 70) of the population was identified with low muscle mass by MF-BIA, while the other modalities identified 9-49 % as having low muscle mass. Handgrip strength identified a lower proportion of low muscle strength as compared with the sit-to-stand test (4 % vs. 8 %). When applying various combinations of diagnostic modalities for low muscle strength and low muscle mass, the proportion of sarcopenia was found to be between 0.3 and 11.4 %. There was relatively poor agreement between the different diagnostic modalities with Cohen's Kappa ranging from 0.0 to 0.55, except for the agreement between SF-BIASergi and MF-BIASergi, which was 1. CONCLUSION The proportion of low muscle strength, low muscle mass, and sarcopenia in CRC patients varied considerably depending on the diagnostic modalities used. Further studies are needed to provide modality-specific cut-off values, adjusted to sex, age and body size.
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Affiliation(s)
- Hedda Beate Berg
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, P.O. Box 1046 Blindern 0317 Oslo, Norway.
| | - Dena Treider Alavi
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, P.O. Box 1046 Blindern 0317 Oslo, Norway.
| | - Benedicte Beichmann
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, P.O. Box 1046 Blindern 0317 Oslo, Norway.
| | - Maiju Pesonen
- Oslo Centre for Biostatistics & Epidemiology (OCBE), Oslo University Hospital, P.O. Box 4950 Nydalen, 0424 Oslo, Norway.
| | - Christine Henriksen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, P.O. Box 1046 Blindern 0317 Oslo, Norway.
| | - Ingvild Paur
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, P.O. Box 4950 Nydalen, 0424 Oslo, Norway; Norwegian Advisory Unit on Disease-related Undernutrition, P.O. Box 4950 Nydalen, 0424 Oslo, Norway; Department of Clinical Service, Division of Cancer Medicine, Oslo University Hospital, P.O. Box 4950 Nydalen, 0424 Oslo, Norway.
| | - Siv Kjølsrud Bøhn
- Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, P.O. Box 5003 NO-1432 Ås, Norway.
| | - Peter Mæhre Lauritzen
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo and Department of Life Sciences and Health, Oslo Metropolitan University, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway.
| | - Rune Blomhoff
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, P.O. Box 1046 Blindern 0317 Oslo, Norway; Department of Clinical Service, Division of Cancer Medicine, Oslo University Hospital, P.O. Box 1046 Blindern 0317 Oslo, Norway.
| | - Hege Berg Henriksen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, P.O. Box 1046 Blindern 0317 Oslo, Norway.
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Sachsamanis G, Stahl J, Pfister K, Schierling W, Betz T, Jage S. The Impact of Sarcopenia in the Long-Term Survival of Patients following Complex Endovascular Aortic Surgery for Thoracoabdominal Aortic Aneurysms. Diagnostics (Basel) 2024; 14:751. [PMID: 38611664 PMCID: PMC11011763 DOI: 10.3390/diagnostics14070751] [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: 02/09/2024] [Revised: 03/25/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
OBJECTIVES Image-based sarcopenia has been the subject of recent studies, hypothesized as a prognostic factor for patients with thoracoabdominal aortic aneurysms. METHODS AND MATERIALS We conducted a single-center retrospective analysis of patients who underwent complex endovascular repair for thoracoabdominal aortic aneurysms between 2008 and 2016. CT image assessment was performed and patients were classified as sarcopenic and non-sarcopenic using two stratification methods: skeletal mass index (SMI) and total psoas muscle index (TPMI). According to sex, each patient was defined as sarcopenic if their SMI or TPMI was in the lowest third of the study group. The primary endpoint was impact of sarcopenia on perioperative mortality and long-term survival. Secondary endpoints were perioperative complications. RESULTS From a total of 155 patients, 135 were eligible for study. Overall, in-hospital mortality was 5.9% (8/135). The 30-day, 1-year, 3-year and 5-year mortality was 10.4% (14/135), 20% (27/135), 28.1% (38/135) and 31.1% (42/135), respectively. There was no difference in the long-term mortality rates between sarcopenic and non-sarcopenic patients regardless of the stratification method used (p = 0.4 for SMI and p = 0.2 for TPMI). According to SMI, 30-day mortality of sarcopenic patients was significantly lower in comparison to non-sarcopenic patients (1/45, 2.2% vs. 13/90, 14.4%, p = 0.028). Based on the total psoas muscle index, sarcopenic patients were at higher risk for development of pulmonary complications in comparison to non-sarcopenic patients postoperatively (p = 0.03). CONCLUSION Using SMI and TPMI, sarcopenia was not associated with reduced long-term survival in patients undergoing complex endovascular repair for thoracoabdominal aortic aneurysms.
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Affiliation(s)
- Georgios Sachsamanis
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany; (J.S.); (K.P.); (W.S.); (T.B.)
| | - Judith Stahl
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany; (J.S.); (K.P.); (W.S.); (T.B.)
| | - Karin Pfister
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany; (J.S.); (K.P.); (W.S.); (T.B.)
| | - Wilma Schierling
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany; (J.S.); (K.P.); (W.S.); (T.B.)
| | - Thomas Betz
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany; (J.S.); (K.P.); (W.S.); (T.B.)
| | - Simon Jage
- Department of Radiology, University Medical Center Regensburg, 93053 Regensburg, Germany;
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50
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Suwannaying K, Ong AA, Dhaduk R, Pei D, Iijima M, Merkle E, Zhuang TZ, Goodenough CG, Brown J, Browne EK, Wolcott B, Cheng C, Wilson CL, Pui CH, Ness KK, Kaste SC, Inaba H. Quantitative computed tomography analysis of body composition changes in paediatric patients with acute lymphoblastic leukaemia. Br J Haematol 2024; 204:1335-1343. [PMID: 38291722 PMCID: PMC11006578 DOI: 10.1111/bjh.19310] [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: 10/31/2023] [Revised: 01/04/2024] [Accepted: 01/10/2024] [Indexed: 02/01/2024]
Abstract
Children with acute lymphoblastic leukaemia (ALL) are at risk for obesity and cardiometabolic diseases. To gain insight into body composition changes among children with ALL, we assessed quantitative computed tomography (QCT) data for specific body compartments (subcutaneous adipose tissue [SAT], visceral adipose tissue [VAT], total adipose tissue [TAT], lean tissue [LT], LT/TAT and VAT/SAT at lumbar vertebrae L1 and L2) at diagnosis and at off-therapy for 189 children with ALL and evaluated associations between body mass index (BMI) Z-score and clinical characteristics. BMI Z-score correlated positively with SAT, VAT and TAT and negatively with LT/TAT and VAT/SAT. At off-therapy, BMI Z-score, SAT, VAT and TAT values were higher than at diagnosis, but LT, LT/TAT and VAT/SAT were lower. Patients aged ≥10 years at diagnosis had higher SAT, VAT and TAT and lower LT and LT/TAT than patients aged 2.0-9.9 years. Female patients had lower LT and LT/TAT than male patients. Black patients had less VAT than White patients. QCT analysis showed increases in adipose tissue and decreases in LT during ALL therapy when BMI Z-scores increased. Early dietary and physical therapy interventions should be considered, particularly for patients at risk for obesity.
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Affiliation(s)
- Kunanya Suwannaying
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Pediatrics, Khon Kaen university, Khon Kaen, Thailand
| | - Adrian A. Ong
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Rikeenkumar Dhaduk
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Deqing Pei
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Mayuko Iijima
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Eric Merkle
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Tony Z. Zhuang
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Chelsea G. Goodenough
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | | | - Emily K. Browne
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Bruce Wolcott
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Cheng Cheng
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Carmen L. Wilson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Kirsten K. Ness
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Sue C. Kaste
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Radiology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Hiroto Inaba
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
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