1
|
Is central sarcopenia a predictor of prognosis for patients with pathological fracture? Surgeon 2023; 21:108-118. [PMID: 35430110 DOI: 10.1016/j.surge.2022.03.005] [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: 11/15/2021] [Revised: 02/20/2022] [Accepted: 03/03/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION We aimed to investigate the relationship between central sarcopenia and survival in patients with pathological fracture. METHODS We reviewed records of patients who were treated for pathological fracture of axial and appendicular skeleton in our clinic between 2011 and 2020. We used the psoas: lumbar vertebral index (PLVI) on axial computer tomographic evaluation to assess for central sarcopenia. A multivariate Cox algorithm was applied to recognize these factors independently associated with one month, six months, one year, and overall survival. RESULTS A total of 147 patients [61 (41.4%) male and 86 (58.6%) female] were included, with an average age of 62.4 years. During the study, 108 (73.4%) patients died, and 39 (26.6%) were alive. The survival rates at 1 month, 6 months, and 1 year after surgery were 94.6%, 68.7%, and 53.1%, respectively. PLVI values ranged from 0.21 to 1.20 with a mean of 0.536 and a median of 0.520. According to the median value of PLVI, 68 patients with sarcopenia had low PLVI and 79 patients without sarcopenia had high PLVI. For the first month, only the preoperative albumin level was identified as a prognostic factor. Eastern Cooperative Oncology Group Performance Status (ECOG), American Society of Anesthesia (ASA) scores and primary malignancy (rapid grade) were strong predictor of poor survival. The PLVI was independent significant predictor of first month (HR, 0.083 [95% CI, 0.011-0.649], p = 0.018) and overall survival (HR, 0.129 [95% CI, 0.034-0.492], p = 0.003). CONCLUSION The PLVI was a strong predictor of first year, and overall survival in patients with pathological fracture.
Collapse
|
2
|
Telli TA, Bugdayci O, Alan O, Sariyar N, Isik S, Arikan R, Yasar A, Majidova N, Celebi A, Erol B, Ozgen Z, Kostek O, Bayoglu IV, Ercelep O, Dane F, Yumuk PF. Impact of Skeletal Muscle Measurements by Chest Computed Tomography on Survival and Postoperative Complications in Patients with Soft Tissue Sarcoma. Nutr Cancer 2022; 74:2499-2507. [PMID: 35416100 DOI: 10.1080/01635581.2022.2063349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study aims to evaluate whether sarcopenia, measured by chest computed tomography (CT), affects survival outcomes and postoperative complications in soft tissue sarcoma (STS) patients undergoing surgery. In this retrospective study, CT scans of 79 patients were reviewed to measure pectoralis and T12 vertebra muscle area. Both were then adjusted for height (cm2/m2) as pectoralis muscle index (PMI) and T12 vertebra muscle index (TMI). Analyses were performed by dichotomizing muscle indices at gender-specific 50th percentile; PMI and TMI < 50th percentile were defined as low, and ≥50th percentile as high. Overall postsurgical complication rate (PCR) was 16%. Median length of hospital stay (LOHS) was 10 days (3-90). PMI and TMI were significantly lower in women (p = 0.02, p = 0.04). Median body mass index was significantly higher in high PMI and TMI groups (p = 0.01 for both). PCR and LOHS were similar between low and high PMI and TMI groups. Median follow-up was 29 months, 37 patients had recurrence and 23 died. No significant difference was noted between low and high PMI and TMI groups, in terms of disease-free or overall survival. PMI and TMI as measured by chest CT had no impact on survival outcomes or postoperative complications in localized STS.
Collapse
Affiliation(s)
- Tugba Akin Telli
- Division of Medical Oncology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Onur Bugdayci
- Department of Radiology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Ozkan Alan
- Division of Medical Oncology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Nisanur Sariyar
- Department of Internal Medicine, School of Medicine, Marmara University, Istanbul, Turkey
| | - Selver Isik
- Division of Medical Oncology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Rukiye Arikan
- Division of Medical Oncology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Alper Yasar
- Division of Medical Oncology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Nargiz Majidova
- Division of Medical Oncology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Abdussamet Celebi
- Division of Medical Oncology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Bulent Erol
- Department of Orthopaedic Surgery and Traumatology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Zerrin Ozgen
- Department of Radiation Oncology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Osman Kostek
- Division of Medical Oncology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Ibrahim Vedat Bayoglu
- Division of Medical Oncology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Ozlem Ercelep
- Division of Medical Oncology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Faysal Dane
- Division of Medical Oncology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Perran Fulden Yumuk
- Division of Medical Oncology, School of Medicine, Marmara University, Istanbul, Turkey.,Division of Medical Oncology, School of Medicine, Koç University, Istanbul, Turkey
| |
Collapse
|
3
|
Yoon JK, Yoon JH, Park VY, Lee M, Kwak JY. Sarcopenia increases the risk of major organ or vessel invasion in patients with papillary thyroid cancer. Sci Rep 2022; 12:4233. [PMID: 35273343 PMCID: PMC8913816 DOI: 10.1038/s41598-022-08224-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 02/23/2022] [Indexed: 12/04/2022] Open
Abstract
While sarcopenia is associated with poor overall survival and cancer-specific survival in solid cancer patients, the impact of sarcopenia on clinicopathologic features that can influence conventional papillary thyroid cancer (PTC) prognosis remains unclear. To investigate the impact of sarcopenia on aggressive clinicopathologic features in PTC patients, prospectively collected data on 305 patients who underwent surgery for PTC with preoperative staging ultrasonography and bioelectrical impedance analysis were retrospectively analyzed. Nine sarcopenia patients with preoperative sarcopenia showed more patients aged 55 or older (p = 0.022), higher male proportion (p < 0.001), lower body-mass index (p = 0.015), higher incidence of major organ or vessel invasion (p = 0.001), higher T stage (p = 0.002), higher TNM stage (p = 0.007), and more tumor recurrence (p = 0.023) compared to the non-sarcopenia patients. Unadjusted and adjusted logistic regression analyses showed that sarcopenia (odds ratio (OR) 9.936, 95% confidence interval (CI) 2.052–48.111, p = 0.004), tumor size (OR 1.048, 95% CI 1.005–1.093, p = 0.027), and tumor multiplicity (OR 3.323, 95% CI 1.048–10.534, p = 0.041) significantly increased the risk of T4 cancer. Sarcopenia patients showed significantly lower disease-free survival probability compared to non-sarcopenia patients. Therefore, preoperative sarcopenia in PTC patients should raise clinical suspicion for a more locally advanced disease and direct appropriate management and careful follow-up.
Collapse
Affiliation(s)
- Ja Kyung Yoon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Jung Hyun Yoon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Vivian Youngjean Park
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Minah Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Jin Young Kwak
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
| |
Collapse
|
4
|
Ban Y, Manabu H, Oebisu N, Shimatani A, Takada N, Nakamura H. Outcomes of Sarcopenia Treatment for Malignant Bone and Soft Tissue Tumors in Elderly Patients. CANCER DIAGNOSIS & PROGNOSIS 2022; 2:194-200. [PMID: 35399184 PMCID: PMC8962811 DOI: 10.21873/cdp.10094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/14/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND/AIM We determined the impact of sarcopenia on the treatment outcomes of malignant bone and soft tissue tumors in elderly patients. PATIENTS AND METHODS We retrospectively reviewed 76 patients (age ≥65 years) who were treated for malignant bone and soft tissue tumors. Sarcopenia was assessed by measuring the cross-sectional area of the psoas muscles at the L3 vertebra from preoperative computed tomography images and categorized using the total psoas area/m 2 (TPA/m 2 ) ≤5.0 cm 2 /m 2 . The patients' clinical data were then evaluated. RESULTS The operation time, length of hospital stay, and median overall survival were not different between the sarcopenia (n=41) and no-sarcopenia (n=35) groups. The local recurrence rate (p=0.01) and incidence of postoperative complications (p=0.02) significantly differed between both groups. The TPA/m 2 of both groups significantly decreased at the final follow-up. CONCLUSION Sarcopenia negatively influenced wound healing and local recurrence, and was significantly exacerbated postoperatively in all elderly patients.
Collapse
Affiliation(s)
- Yoshitaka Ban
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hoshi Manabu
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Naoto Oebisu
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Akiyoshi Shimatani
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Naoki Takada
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
5
|
Casirati A, Baia M, Vandoni G, Della Valle S, Greco G, Morosi C, Fiore M, Gronchi A, Gavazzi C. Risk of misclassification during diagnosis of malnutrition in retroperitoneal sarcoma patients. Clin Nutr ESPEN 2022; 49:459-465. [DOI: 10.1016/j.clnesp.2022.02.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/23/2022] [Accepted: 02/28/2022] [Indexed: 11/26/2022]
|
6
|
Xiao Y, Xiao-Yue Z, Yue W, Ruo-Tao L, Xiang-Jie L, Xing-Yuan W, Qian W, Xiao-Hua Q, Zhen-Yi J. Use of computed tomography for the diagnosis of surgical sarcopenia: Review of recent research advances. Nutr Clin Pract 2022; 37:583-593. [PMID: 35191086 DOI: 10.1002/ncp.10847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 12/14/2021] [Accepted: 01/22/2022] [Indexed: 11/12/2022] Open
Abstract
Sarcopenia, also known as muscle decay, is associated with high morbidity among surgical patients. It is highly correlated with adverse clinical outcomes, such as increased postoperative complications, prolonged hospital stay, and increased mortality. Computed tomography (CT) is one of the main methods for diagnosing sarcopenia, which has the advantages of intuitiveness, rapidity, and accuracy. Clinical studies have shown that CT-defined sarcopenia can help predict the clinical outcomes and prognosis of surgical patients and provide an important reference for the formulation of antitumor treatment protocols. In recent years, some scholars have tried to construct an intelligent CT-based diagnostic model, which is expected to improve the diagnostic efficiency and establish standardized diagnostic criteria for CT-defined sarcopenia. In this review, we summarize the recent progress in the understanding of the diagnosis of sarcopenia and its potential prognostic value in surgery.
Collapse
Affiliation(s)
- Yu Xiao
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhou Xiao-Yue
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wu Yue
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liu Ruo-Tao
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | | | - Wang Qian
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Qian Xiao-Hua
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jia Zhen-Yi
- Department of Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| |
Collapse
|
7
|
Brinkmann EJ, Wenger DE, Johnson JD, Karim SM, Blezek DJ, Rose PS, Houdek MT. Impact of preoperative sarcopenia in patients undergoing sacral tumor resection. J Surg Oncol 2021; 125:790-795. [PMID: 34932215 DOI: 10.1002/jso.26776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/21/2021] [Accepted: 12/12/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Sacral tumor resection is known for a high rate of complications. Sarcopenia has been found to be associated with wound complications; however, there is a paucity of data examining the impact of sarcopenia on the outcome of sacral tumor resection. METHODS Forty-eight patients (31 primary sarcomas, 17 locally recurrent carcinomas) undergoing sacrectomy were reviewed. Central sarcopenia was assessed by measuring the psoas:lumbar vertebra index (PLVI), with the 50th percentile (0.97) used to determine which patients were high (>0.97) versus low (<0.97). RESULTS Twenty-four (50%) patients had a high PLVI and 24 (50%) had a low PLVI (sarcopenic). There was no difference (p > 0.05) in the demographics of patients with or without sarcopenia. There was no difference in the incidence of postoperative wound complications (odds ratio [OR] = 1.0, p = 1.0) or deep infection (OR = 0.83, p = 1.0). Sarcopenia was not associated with death due to disease (hazard ratio [HR] = 2.04, p = 0.20) or metastatic disease (HR = 2.47, p = 0.17), but was associated with local recurrence (HR = 6.60, p = 0.01). CONCLUSIONS Central sarcopenia was not predictive of wound complications or infection following sacral tumor resection. Sarcopenia was, however, an independent risk factor for local tumor recurrence following sacrectomy and should be considered when counseling patients on the outcome of sacrectomy.
Collapse
Affiliation(s)
- Elyse J Brinkmann
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Doris E Wenger
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Joshua D Johnson
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Syed M Karim
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel J Blezek
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
8
|
Strassmann D, Hensen B, Grünwald V, Stange K, Eggers H, Länger F, Omar M, Zardo P, Christiansen H, Reuter CW, Wacker FK, Ganser A, Ivanyi P. Impact of sarcopenia in advanced and metastatic soft tissue sarcoma. Int J Clin Oncol 2021; 26:2151-2160. [PMID: 34318390 PMCID: PMC8520878 DOI: 10.1007/s10147-021-01997-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/18/2021] [Indexed: 12/27/2022]
Abstract
Introduction Advanced or metastatic soft tissue sarcoma (a/mSTS) is associated with a dismal prognosis. Patient counseling on treatment aggressiveness is pivotal to avoid over- or undertreatment. Recently, evaluation of body composition markers like the skeletal muscle index (SMI) became focus of interest in a variety of cancers. This study focuses on the prognostic impact of SMI in a/mSTS, retrospectively. Methods 181 a/mSTS patients were identified, 89 were eligible due to prespecified criteria for SMI assessment. Baseline CT-Scans were analyzed using an institutional software solution. Sarcopenia defining cut-off values for the SMI were established by optimal fitting method. Primary end point was overall survival (OS) and secondary endpoints were progression free survival (PFS), disease control rate (DCR), overall response rate (ORR). Descriptive statistics as well as Kaplan Meier- and Cox regression analyses were administered. Results 28/89 a/mSTS patients showed sarcopenia. Sarcopenic patients were significantly older, generally tended to receive less multimodal therapies (62 vs. 57 years, P = 0.025; respectively median 2.5 vs. 4, P = 0.132) and showed a significantly lower median OS (4 months [95%CI 1.9–6.0] vs. 16 months [95%CI 8.8–23.2], Log-rank P = 0.002). Sarcopenia was identified as independent prognostic parameter of impaired OS (HR 2.40 [95%-CI 1.4–4.0], P < 0.001). Moreover, DCR of first palliative medical treatment was superior in non-sarcopenic patients (49.2% vs. 25%, P = 0.032). Conclusion This study identifies sarcopenia as a prognostic parameter in a/mSTS. Further on, the data suggest that sarcopenia shows a trend of being associated with first line therapy response. SMI is a promising prognostic parameter, which needs further validation.
Collapse
Affiliation(s)
- Dennis Strassmann
- Klinik Für Hämatologie, Hämostaseologie, Onkologie Und Stammzelltransplantation, Medizinische Hochschule Hannover, OE 6860, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Bennet Hensen
- Department of Radiology, Hannover Medical School, Hannover, Germany
| | - Viktor Grünwald
- Clinic for Urology and Clinic for Medical Oncology, Interdisciplinary GU Oncology, University Hospital Essen, Essen, Germany
| | - Katharina Stange
- Klinik Für Hämatologie, Hämostaseologie, Onkologie Und Stammzelltransplantation, Medizinische Hochschule Hannover, OE 6860, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Hendrik Eggers
- Klinik Für Hämatologie, Hämostaseologie, Onkologie Und Stammzelltransplantation, Medizinische Hochschule Hannover, OE 6860, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Florian Länger
- Institute of Pathology, Hannover Medical School (MHH), Hannover, Germany
| | - Mohamed Omar
- Department of Orthopedics and Trauma, Hannover Medical School, Hannover, Germany
| | - Patrick Zardo
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Hans Christiansen
- Department of Radiotherapy, Hannover Medical School, Hannover, Germany
| | - Christoph W. Reuter
- Klinik Für Hämatologie, Hämostaseologie, Onkologie Und Stammzelltransplantation, Medizinische Hochschule Hannover, OE 6860, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Frank K. Wacker
- Department of Radiology, Hannover Medical School, Hannover, Germany
| | - Arnold Ganser
- Klinik Für Hämatologie, Hämostaseologie, Onkologie Und Stammzelltransplantation, Medizinische Hochschule Hannover, OE 6860, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Philipp Ivanyi
- Klinik Für Hämatologie, Hämostaseologie, Onkologie Und Stammzelltransplantation, Medizinische Hochschule Hannover, OE 6860, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| |
Collapse
|
9
|
Barnes ME, Elliott JA, McIntyre TV, Boyle EA, Gillis AE, Ridgway PF. Sarcopenia and obesity among patients with soft tissue sarcoma - Association with clinicopathologic characteristics, complications and oncologic outcome: A systematic review and meta-analysis. Eur J Surg Oncol 2021; 47:2237-2247. [PMID: 34023166 DOI: 10.1016/j.ejso.2021.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/31/2021] [Accepted: 04/16/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND AND AIMS Sarcopenia and obesity may be associated with negative outcomes in many cancers, but their prevalence and impact in modern regimens for soft-tissue sarcoma (STS) have not been systematically studied. This study summarises and critically evaluates the current evidence-based literature on body mass index (BMI) and body composition among patients with STS, with respect to clinical and pathologic characteristics, treatment-associated morbidity and oncologic outcome. METHODS A systematic literature search of the PubMed, Embase and Cochrane databases was performed. Meta-analysis of the relationship between BMI, body composition and pathologic characteristics, operative morbidity and oncologic outcome was undertaken using RevMan v.5.4 using fixed or random effects methods as appropriate. RESULTS 14 studies including 3598 patients met inclusion criteria. Ten studies reported on BMI, two on CT and two on PET-CT assessment of body composition. BMI ranged from 14.6 to 63.7 kg/m2, with obesity in 18%-39% of patients. Although some studies demonstrated larger tumours among patients with obesity, this was not significant on meta-analysis (P = 0.31, I2 = 99%). There was no significant difference in tumour grade or histologic type according to BMI. Postoperatively, obesity was associated with increased risk of overall morbidity (odds ratio (OR) 2.03 [95% CI 1.41-2.92], P = 0.0001, I2 = 22%), and wound morbidity (OR 1.32 [95% CI 1.02-1.71], P = 0.03, I2 = 0%). Similar effects were observed in studies of visceral adiposity. No differences in functional outcomes were observed. There was a trend towards reduced local recurrence among patients with obesity (HR 0.64 [95% CI 0.38-1.08], P = 0.10, I2 = 0%), but no difference in distant metastasis (HR 1.00 [95% CI 0.76-1.30], P = 0.98, I2 = 0%) or overall survival (HR 0.98 [95% CI 0.43-2.22], P = 0.95, I2 = 64%). Various measures of sarcopenia were associated with poorer survival outcomes. CONCLUSION While obesity is associated with increased postoperative morbidity, it had no significant association with long-term oncologic outcomes. Sarcopenia may be associated with a poorer long-term prognosis. A greater understanding of the impact of nutritional status on disease characteristics and treatment outcomes is essential to facilitate improvements in clinical care for patients with STS.
Collapse
Affiliation(s)
- Melissa E Barnes
- Department of Surgery, Tallaght University Hospital, Dublin, 24, Ireland.
| | - Jessie A Elliott
- Department of Surgery, Tallaght University Hospital, Dublin, 24, Ireland
| | - Tom V McIntyre
- Department of Surgery, Tallaght University Hospital, Dublin, 24, Ireland
| | - Ellen A Boyle
- Department of Surgery, Tallaght University Hospital, Dublin, 24, Ireland
| | - Amy E Gillis
- Department of Surgery, Tallaght University Hospital, Dublin, 24, Ireland
| | - Paul F Ridgway
- Department of Surgery, Tallaght University Hospital, Dublin, 24, Ireland
| |
Collapse
|
10
|
Hirai T, Kobayashi H, Okuma T, Ishibashi Y, Ikegami M, Ohki T, Shinoda Y, Okajima K, Zhang L, Akiyama T, Goto T, Tanaka S. Skeletal muscle measurements predict surgical wound complications but not overall survival in patients with soft tissue sarcoma. Jpn J Clin Oncol 2020; 50:1168-1174. [PMID: 32533175 DOI: 10.1093/jjco/hyaa100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/27/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND It is unknown whether sarcopenia influences treatment outcome in patients with soft tissue sarcoma. Herein, we aimed to elucidate the impact of sarcopenia on sarcoma treatment. METHODS A total of 163 soft tissue sarcoma patients were included. Skeletal muscle measures were calculated using computed tomography images. Skeletal muscle area (SMA) and density (SMD) at the L3 level were extracted, and SMA was normalized by height as skeletal muscle index (SMI). The skeletal muscle gauge (SMG) was calculated by multiplying SMD × SMI. The relationship of skeletal muscle measures and clinical factors to wound complications and prognosis was evaluated, and classification and regression tree (CART) analysis was used to develop classification models for risk groups of surgical wound complications. RESULTS Thirty-three patients developed wound complications. In univariate analysis, age (P = 0.0022), tumour location of adductor compartment of the thigh (P = 0.0019), operating time (P = 0.010), blood loss (P = 0.030), SMD (P = 0.0004) and SMG (P = 0.0001) were significantly correlated with complications. In multivariate analysis, lower SMG was an independent risk factor (P = 0.031, OR = 3.27). CART analysis classified three risk groups of surgical wound complications by SMG, age, tumour location and operating time, and area under the receiver operating characteristic curve (AUROCC) was 0.75. SMG was not associated with prognosis in univariate analysis (P = 0.15). CONCLUSIONS The SMG does not affect overall survival but predicts surgical wound complications.
Collapse
Affiliation(s)
- Toshihide Hirai
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Kobayashi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomotake Okuma
- Department of Musculoskeletal Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Yuki Ishibashi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masachika Ikegami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takahiro Ohki
- Department of Rehabilitation Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Yusuke Shinoda
- Department of Rehabilitation Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Koichi Okajima
- Department of Musculoskeletal Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Liuzhe Zhang
- Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Toru Akiyama
- Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Takahiro Goto
- Department of Musculoskeletal Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
11
|
Phan EN, Thorpe SW, Wong FS, Saiz AM, Taylor SL, Canter RJ, Lenchik L, Randall RL, Boutin R. Opportunistic muscle measurements on staging chest CT for extremity and truncal soft tissue sarcoma are associated with survival. J Surg Oncol 2020; 122:869-876. [PMID: 32613648 PMCID: PMC8254594 DOI: 10.1002/jso.26077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/10/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Computed tomography (CT) measurements of sarcopenia have been proposed as biomarkers associated with outcomes in various cancers and have typically been evaluated at the L3 vertebral level. However, staging imaging for patients with extremity and truncal soft tissue sarcoma (STS) often only includes chest CT imaging which precludes evaluation at L3. Therefore, we sought to evaluate muscle metrics at T12 on standard staging chest CT scans and evaluate for correlation with overall and event-free survival in patients with STS. METHODS CT chest imaging for 89 patients with intermediate and high-grade STS (53 male, 36 female; 58.5 ± 19.0 years old, follow-up 37.4 ± 27.1 months) was reviewed on PACS at T12 for skeletal muscle density (SMD) and skeletal muscle index (SMI). RESULTS Overall survival increased with increased SMD on univariate (hazard ratio [HR] = 0.61 [0.43, 0.86]) and age-adjusted analysis (HR = 0.65 [0.42, 0.89]. Event-free survival also increased with increased SMD in univariate analyses (HR = 0.68 [0.49, 0.95]) but did not maintain significance after adjusting for age (HR = 0.68 [0.43, 1.07]). SMI was not a predictor of overall or event-free survival. CONCLUSIONS Higher SMD measured on routinely obtained staging chest CTs in STS patients is associated with improved survival.
Collapse
Affiliation(s)
- Eileen N. Phan
- School of Medicine, University of California, Davis, Sacramento, California
| | - Steven W. Thorpe
- Sarcoma Services, Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California
| | - Felix S. Wong
- Department of Radiology, University of California, Davis, Sacramento, California
| | - Augustine M Saiz
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California
| | - Sandra L Taylor
- Department of Public Health Sciences, University of California, Davis, Sacramento, California
| | - Robert J. Canter
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, Sacramento, California
| | - Leon Lenchik
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - R Lor Randall
- Sarcoma Services, Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California
| | - Robert Boutin
- Department of Radiology, Stanford University, Stanford, California
| |
Collapse
|
12
|
Boutin RD, Katz JR, Chaudhari AJ, Yabes JG, Hirschbein JS, Nakache YP, Seibert JA, Lamba R, Fananapazir G, Canter RJ, Lenchik L. Association of adipose tissue and skeletal muscle metrics with overall survival and postoperative complications in soft tissue sarcoma patients: an opportunistic study using computed tomography. Quant Imaging Med Surg 2020; 10:1580-1589. [PMID: 32742953 DOI: 10.21037/qims.2020.02.09] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background To determine the relationship between adipose tissue and skeletal muscle measurements on computed tomography (CT) and overall survival and major postoperative complications in patients with soft-tissue sarcoma (STS). Methods The retrospective study included 137 STS patients (75 men, 62 women; mean age, 53 years, SD 17.7; mean BMI, 28.5, SD 6.6) who had abdominal CT exams. On a single CT image, at the L4 pedicle level, measurements of visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and skeletal muscle area and attenuation were obtained using clinical PACS and specialized segmentation software. Clinical information was recorded, including STS characteristics (size, depth, grade, stage, and site), overall survival, and postoperative complications. The relationships between CT metrics and survival were analyzed using Cox proportional hazard models and those between CT metrics and postoperative complications using logistic regression models. Results There were 33 deaths and 41 major postoperative complications. Measured on clinical PACS, the psoas area (P=0.003), psoas index (P=0.006), psoas attenuation (P=0.011), and total muscle attenuation (P=0.023) were associated with overall survival. Using specialized software, psoas attenuation was also associated with overall survival (P=0.018). Adipose tissue metrics were not associated with survival or postoperative complications. Conclusions In STS patients, CT-derived muscle size and attenuation are associated with overall survival. These prognostic biomarkers can be obtained using specialized segmentation software or routine clinical PACS.
Collapse
Affiliation(s)
- Robert D Boutin
- Department of Radiology, Stanford University Medical Center, Stanford, CA, USA
| | | | - Abhijit J Chaudhari
- Department of Radiology, University of California, Davis, School of Medicine, Sacramento, CA, USA
| | - Jonathan G Yabes
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Yves-Paul Nakache
- Department of Internal Medicine, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - J Anthony Seibert
- Department of Radiology, University of California, Davis, School of Medicine, Sacramento, CA, USA
| | - Ramit Lamba
- Department of Radiology, University of California, Davis, School of Medicine, Sacramento, CA, USA
| | - Ghaneh Fananapazir
- Department of Radiology, University of California, Davis, School of Medicine, Sacramento, CA, USA
| | - Robert J Canter
- Department of Surgery, University of California, Davis, School of Medicine, Sacramento, CA, USA
| | - Leon Lenchik
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
13
|
Broyles JM, Smith JM, Phillips BT, Mericli AF, Selber JC, Largo RD, Baumann DP, Liu J, Schaverien MV. The effect of sarcopenia on perioperative complications in abdominally based free-flap breast reconstruction. J Surg Oncol 2020; 122:1240-1246. [PMID: 32673425 DOI: 10.1002/jso.26120] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/27/2020] [Accepted: 07/06/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE The identification of patient-specific risk factors, which predict morbidity following abdominally based microvascular breast reconstruction is difficult. Sarcopenia is a proxy for patient frailty and is an independent predictor of complications in a myriad of surgical disciplines. We predict that sarcopenic patients will be at higher risk for surgical complications following abdominally based microvascular breast reconstruction. METHODS A retrospective study of all patients who underwent delayed abdominally based autologous breast reconstruction following postmastectomy radiation therapy from 2007 to 2013 at a single institution was conducted. Univariate and multiple logistic regression models were used to assess the effect of sarcopenia on postoperative outcomes. RESULTS Two hundred and eight patients met the inclusion criteria, of which 30 met criteria for sarcopenia (14.1%). There were no significant differences in demographics between groups. There were no significant differences in minor (36.7% vs 44.4%; P = .43) or major (16.7% vs 25.3%; P = .36) complications between groups as well as hospital length of stay. Multivariable logistic regression demonstrated that a staged reconstruction with the use of a tissue expander was the only consistent variable, which predicted major complications (OR, 2.24; 95% CI, 1.18-4.64; P = .015). CONCLUSIONS Sarcopenia does not predispose to minor or major surgical complications in patients who undergo abdominally based microsurgical breast reconstruction.
Collapse
Affiliation(s)
- Justin M Broyles
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jeffrey M Smith
- Division of Plastic and Reconstructive Surgery, The University of Texas Medical Branch, Galveston, Texas
| | - Brett T Phillips
- Division of Plastic and Reconstructive Surgery, Duke University Hospital, Durham, North Carolina
| | - Alex F Mericli
- Department of Plastic and Reconstructive Surgery, MD Anderson Cancer Center, The University of Texas, Houston, Texas
| | - Jesse C Selber
- Department of Plastic and Reconstructive Surgery, MD Anderson Cancer Center, The University of Texas, Houston, Texas
| | - Rene D Largo
- Department of Plastic and Reconstructive Surgery, MD Anderson Cancer Center, The University of Texas, Houston, Texas
| | - Donald P Baumann
- Department of Plastic and Reconstructive Surgery, MD Anderson Cancer Center, The University of Texas, Houston, Texas
| | - Jessie Liu
- Department of Plastic and Reconstructive Surgery, MD Anderson Cancer Center, The University of Texas, Houston, Texas
| | - Mark V Schaverien
- Department of Plastic and Reconstructive Surgery, MD Anderson Cancer Center, The University of Texas, Houston, Texas
| |
Collapse
|
14
|
Bayram S, Akgül T, Adıyaman AE, Karalar Ş, Dölen D, Aydoseli A. Effect of Sarcopenia on Mortality after Percutaneous Vertebral Augmentation Treatment for Osteoporotic Vertebral Compression Fractures in Elderly Patients: A Retrospective Cohort Study. World Neurosurg 2020; 138:e354-e360. [DOI: 10.1016/j.wneu.2020.02.121] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 11/30/2022]
|
15
|
Hendrickson NR, Mayo Z, Shamrock A, Kesler K, Glass N, Nau P, Miller BJ. Sarcopenia is associated with increased mortality but not complications following resection and reconstruction of sarcoma of the extremities. J Surg Oncol 2020; 121:1241-1248. [PMID: 32162343 DOI: 10.1002/jso.25898] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 02/08/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND OBJECTIVES Evidence regarding the impact of sarcopenia on operative outcomes in patients with sarcoma is lacking. We evaluated the relationship between sarcopenia and postoperative complications or mortality among patients undergoing tumor excision and reconstruction. METHODS: We retrospectively reviewed 145 patients treated with tumor excision and limb reconstruction for sarcoma of the extremities. Sarcopenia was defined as psoas index (PI) < 5.45 cm2 /m2 for men and <3.85 cm2 /m2 for women from preoperative axial CT. Regression analyses were used to assess the association between postoperative complications or mortality with PI, age, gender, race, body mass index, tumor histology, grade, depth, location, size, and neoadjuvant/adjuvant therapy. RESULTS There were 101 soft tissue tumors and 44 primary bone tumors. Sarcopenia was present in 38 patients (26%). Sarcopenic patients were older (median age: 72 vs 59 years, P = .0010) and had larger tumors (86.5%, >5 cm vs 77.7%, P = .023). Seventy-three patients experienced complications (51%) and 18 patients died within 1 year. Sarcopenia and metastatic disease were associated with increased 12-month mortality (hazard ratio [HR] = 6.68, P < .001; HR: 8.51, P < .001, respectively) but not complications (HR 1.45, P = .155, odds ratio, 1.32, P = .426, respectively). CONCLUSIONS Sarcopenia and metastatic disease were independently associated with postoperative mortality but no complications following surgery.
Collapse
Affiliation(s)
- Nathan R Hendrickson
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Zachary Mayo
- Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Alan Shamrock
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Kyle Kesler
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Natalie Glass
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Peter Nau
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Benjamin J Miller
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| |
Collapse
|
16
|
Brandt E, Tengberg LT, Bay-Nielsen M. Sarcopenia predicts 90-day mortality in elderly patients undergoing emergency abdominal surgery. Abdom Radiol (NY) 2019; 44:1155-1160. [PMID: 30600384 DOI: 10.1007/s00261-018-1870-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE Image-based measurement of sarcopenia is an established predictor of a decreased outcome for a large variety of surgical procedures. Sarcopenia in elderly patients undergoing emergency abdominal surgery has not been well studied. This study aims to investigate the association between the total psoas area (TPA) and postoperative mortality after 90 days in a group of elderly emergency laparotomy patients. METHODS We retrospectively reviewed the emergency CT-scans of 150 elderly patients from a consecutive cohort undergoing emergency abdominal surgery at our surgical center. TPA was measured manually at the level of L3 and indexed to patient height. Sarcopenia was defined as having a TPA index below the first quartile for gender in the cohort. Other collected variables were age, vital status/date of death, ASA-score, surgical procedure, and WHO performance score. RESULTS Overall 90-day mortality was 42.7%. Sarcopenic patients had a higher 90-day mortality (60.5%) than non-sarcopenic patients (36.6%), corresponding to an odds ratio of 2.66 (95% confidence interval 1.2-5.7, p = 0.01). Sarcopenic patients had an increased mortality compared with non-sarcopenic patients (p = 0.0009, Log-rank test), with a clear separation of the two groups within 30 days postoperatively. In a multivariate logistic regression model, with age, ASA-score, and WHO performance score as covariates, sarcopenia was independently associated with 90-day mortality. CONCLUSION Manual measurement of TPA on an abdominal CT-scan is a relevant risk factor for postoperative mortality in elderly patients undergoing high-risk emergency abdominal surgery. Incorporation of sarcopenia in postoperative risk-prediction models in emergency abdominal surgery should be considered.
Collapse
|
17
|
Abstract
OBJECTIVES To determine whether sarcopenia is an independent predictor of mortality in geriatric acetabular fractures. DESIGN Retrospective cohort. SETTING American College of Surgeons Level I trauma center. PATIENTS/PARTICIPANTS One hundred and forty-six patients over the age 60 with acetabular fractures treated at our institution over a 12-year period. MAIN OUTCOME MEASUREMENTS The primary outcome was 1-year mortality, collected using the Social Security Death Index. We used the psoas:lumbar vertebral index (PLVI), calculated using the cross-sectional area of the L4 vertebral body and the left and right psoas muscles, to assess for sarcopenia. RESULTS Using a multivariate logistic regression model, we found that low PLVI was associated with increased 1-year mortality (P = 0.046) when controlling for age, gender, Charlson Comorbidity Index, Injury Severity Score (ISS), smoking status, and associated pelvic ring injury. Increasing age and ISS also showed a relationship with 1-year mortality in this cohort (P < 0.001, P < 0.001, respectively). We defined sarcopenia as those patients in the lowest quartile of PLVI. The mortality rate of this cohort was 32.4%, compared with 11.0% in patients without sarcopenia (odds ratio 4.04; 95% confidence interval 1.62-10.1). Age >75 years, ISS >14, and sarcopenia had 1-year mortality rates of 37.1%, 30.9%, and 32.4%, respectively. In patients with all 3 factors, the mortality rate was 90%. CONCLUSION Sarcopenia is an independent risk factor for 1-year mortality in elderly patients with acetabular fractures. This study highlights the importance of objective measures to assess frailty in elderly patients who have sustained fractures about the hip and pelvis. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
|
18
|
Charest-Morin R, Street J, Zhang H, Roughead T, Ailon T, Boyd M, Dvorak M, Kwon B, Paquette S, Dea N, Fisher CG, Flexman AM. Frailty and sarcopenia do not predict adverse events in an elderly population undergoing non-complex primary elective surgery for degenerative conditions of the lumbar spine. Spine J 2018; 18:245-254. [PMID: 28709946 DOI: 10.1016/j.spinee.2017.07.003] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 05/31/2017] [Accepted: 07/06/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Sarcopenia measured by normalized total psoas area (NTPA) has been shown to predict mortality and adverse events (AEs) in numerous surgical populations. The relationship between sarcopenia and postoperative outcomes after surgery for degenerative spine disease (DSD) has not been investigated. PURPOSE This study aimed to determine the relationships between sarcopenia, frailty, and postoperative AEs in the elderly DSD population. Secondary objectives were to describe the distribution and predictors of NTPA and to determine the relationship between sarcopenia, frailty, and length of stay, discharge to a facility, and in-hospital mortality. STUDY DESIGN This is an ambispective study from a quaternary care academic center. PATIENT SAMPLE A total of 102 patients over 65 years old who underwent elective thoracolumbar surgery for DSD between 2009 and 2013 were included in this study. OUTCOME MEASURES The primary outcome was a composite of perioperative AEs; the secondary outcomes were length of stay, discharge disposition, and in-hospital mortality. METHODS Total psoas area (TPA) at mid-L3 level on preoperative computed tomography scan adjusted for height (NTPA) defined sarcopenia. The modified frailty index (mFI) of 11 clinical variables defined frailty. The distribution and predictors of sarcopenia (NTPA) were determined. The association of NTPA with AEs, length of stay, discharge disposition to care facility, and mortality was analyzed, including adjusting for known and suspected confounders using multivariate regression. RESULTS Median Spine Surgical Invasiveness Index was 8 (interquartile range 2-10), and mean NTPA was 674 mm2/m2 (293.21-1636.25). Using the mFI, 20.6% were pre-frail and 19.6% were frail. Inter- and intraobserver reliability for determining NTPA were near perfect with kappa 0.95-0.97 and 0.94-1.00, respectively. The NTPA was independently associated with patient gender and body mass index (BMI) but not frailty (mFI). Age, BMI, mFI, and American Anesthesiologists' Society score were not associated with incidence of postoperative AEs. The NTPA did not predict the occurrence of AE (odds ratio [OR] 1.06 per 100 mm2/m2, 95% confidence interval [CI] 0.91-1.23, p=.45). Similarly, NTPA was not predictive of length of stay (rho=-0.04, p=.67), discharge home (OR 0.95 (95% CI 0.76-1.20) per 100 mm2/m2, p=.70), or death (OR 1.12 (95% CI 0.83-1.53) per 100 mm2/m2, p=.47). In contrast, increasing mFI was associated with increased risk of mortality (OR 3.12 (95% CI 1.21-8.03) per 0.1 increase in frailty score, p=.006). CONCLUSIONS In contrast to other surgical groups, sarcopenia (NTPA) or frailty (mFI) did not predict acute care complications in a selected population of elderly patients undergoing simple lumbar spine surgery for DSD. Although NTPA can be reliably measured in this population, it may be an inappropriate surrogate for sarcopenia given its anatomical relationship to spinal function.
Collapse
Affiliation(s)
- Raphaële Charest-Morin
- Department of Orthopedic Surgery, Laval University, 1401 18e rue, Local B-2408, Québec, QC G1J 1Z4, Canada.
| | - John Street
- Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic Surgery, University of British Columbia, Blusson Spinal Cord Centre, 6th Floor, 818 West 10th Ave, Vancouver, BC V5Z 1M9, Canada
| | - Honglin Zhang
- Centre for Hip Health and Mobility, Department of Orthopedic Surgery, University of British Columbia, 466-2635 Laurel St, Vancouver, BC V5Z 1M9, Canada
| | - Taren Roughead
- Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada
| | - Tamir Ailon
- Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic Surgery, University of British Columbia, Blusson Spinal Cord Centre, 6th Floor, 818 West 10th Ave, Vancouver, BC V5Z 1M9, Canada
| | - Michael Boyd
- Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic Surgery, University of British Columbia, Blusson Spinal Cord Centre, 6th Floor, 818 West 10th Ave, Vancouver, BC V5Z 1M9, Canada
| | - Marcel Dvorak
- Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic Surgery, University of British Columbia, Blusson Spinal Cord Centre, 6th Floor, 818 West 10th Ave, Vancouver, BC V5Z 1M9, Canada
| | - Brian Kwon
- Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic Surgery, University of British Columbia, Blusson Spinal Cord Centre, 6th Floor, 818 West 10th Ave, Vancouver, BC V5Z 1M9, Canada
| | - Scott Paquette
- Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic Surgery, University of British Columbia, Blusson Spinal Cord Centre, 6th Floor, 818 West 10th Ave, Vancouver, BC V5Z 1M9, Canada
| | - Nicolas Dea
- Division of Neurosurgery, Department of Surgery, Centre Universitaire Hospitalier de Sherbrooke, 3001, 12th Ave North, Local 5110, Sherbrooke, QC J1H 5N4, Canada
| | - Charles G Fisher
- Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic Surgery, University of British Columbia, Blusson Spinal Cord Centre, 6th Floor, 818 West 10th Ave, Vancouver, BC V5Z 1M9, Canada
| | - Alana M Flexman
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver General Hospital, Room 2449 JPP 899 West 12th Ave, Vancouver, BC V5Z 1M9, Canada
| |
Collapse
|
19
|
Rutten IJG, Ubachs J, Kruitwagen RFPM, Beets-Tan RGH, Olde Damink SWM, Van Gorp T. Psoas muscle area is not representative of total skeletal muscle area in the assessment of sarcopenia in ovarian cancer. J Cachexia Sarcopenia Muscle 2017; 8:630-638. [PMID: 28513088 PMCID: PMC5566632 DOI: 10.1002/jcsm.12180] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 11/27/2016] [Accepted: 12/08/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Computed tomography measurements of total skeletal muscle area can detect changes and predict overall survival (OS) in patients with advanced ovarian cancer. This study investigates whether assessment of psoas muscle area reflects total muscle area and can be used to assess sarcopenia in ovarian cancer patients. METHODS Ovarian cancer patients (n = 150) treated with induction chemotherapy and interval debulking were enrolled retrospectively in this longitudinal study. Muscle was measured cross sectionally with computed tomography in three ways: (i) software quantification of total skeletal muscle area (SMA); (ii) software quantification of psoas muscle area (PA); and (iii) manual measurement of length and width of the psoas muscle to derive the psoas surface area (PLW). Pearson correlation between the different methods was studied. Patients were divided into two groups based on the extent of change in muscle area, and agreement was measured with kappa coefficients. Cox-regression was used to test predictors for OS. RESULTS Correlation between SMA and both psoas muscle area measurements was poor (r = 0.52 and 0.39 for PA and PLW, respectively). After categorizing patients into muscle loss or gain, kappa agreement was also poor for all comparisons (all κ < 0.40). In regression analysis, SMA loss was predictive of poor OS (hazard ratio 1.698 (95%CI 1.038-2.778), P = 0.035). No relationship with OS was seen for PA or PLW loss. CONCLUSIONS Change in psoas muscle area is not representative of total muscle area change and should not be used to substitute total skeletal muscle to predict survival in patients with ovarian cancer.
Collapse
Affiliation(s)
- Iris J G Rutten
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, PO Box 5800, Maastricht, 6202 AZ, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University, PO Box 616, Maastricht, 6200 MD, The Netherlands.,Department of Radiology, Maastricht University Medical Centre, PO Box 5800, Maastricht, 6202 AZ, The Netherlands
| | - Jorne Ubachs
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, PO Box 5800, Maastricht, 6202 AZ, The Netherlands
| | - Roy F P M Kruitwagen
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, PO Box 5800, Maastricht, 6202 AZ, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University, PO Box 616, Maastricht, 6200 MD, The Netherlands
| | - Regina G H Beets-Tan
- GROW School for Oncology and Developmental Biology, Maastricht University, PO Box 616, Maastricht, 6200 MD, The Netherlands.,Department of Radiology, Maastricht University Medical Centre, PO Box 5800, Maastricht, 6202 AZ, The Netherlands.,Department of Radiology, Netherlands Cancer Institute, PO Box 90203, Amsterdam, 1006 BE, The Netherlands
| | - Steven W M Olde Damink
- Department of General Surgery, Maastricht University Medical Centre, PO Box 5800, Maastricht, 6202 AZ, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, PO Box 616, Maastricht, 6200 MD, The Netherlands
| | - Toon Van Gorp
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, PO Box 5800, Maastricht, 6202 AZ, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University, PO Box 616, Maastricht, 6200 MD, The Netherlands
| |
Collapse
|