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Timsina SR, Tanomkiat W, Geater SL, Ina N. Exploring previously used thresholds for computed tomography-defined low skeletal muscle mass in predicting functional limitations among lung cancer patients. Thorac Cancer 2024; 15:1287-1295. [PMID: 38666456 PMCID: PMC11147667 DOI: 10.1111/1759-7714.15313] [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: 03/17/2024] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Various cutoffs have been used to diagnose computed tomography (CT)-defined low skeletal muscle mass; however, the impact of this variability on predicting physical functional limitations (PFL) remains unclear. In the present study we aimed to evaluate the diagnostic test metrics for predicting PFLs using a fixed cutoff value from previous reports and sought to create a prediction score that incorporated the skeletal muscle index (SMI) and other clinical factors. METHODS In this cross-sectional study including 237 patients with lung cancer, the SMI was assessed using CT-determined skeletal muscle area at the third lumbar vertebra. Physical function was assessed using the short physical performance battery (SPPB) test, with PFL defined as an SPPB score ≤9. We analyzed the diagnostic metrics of the five previous cutoffs for CT-defined low skeletal muscle mass in predicting PFL. RESULTS The mean age of participants was 66.0 ± 10.4 years. Out of 237 patients, 158 (66.7%) had PFLs. A significant difference was observed in SMI between individuals with and without PFLs (35.7 cm2/m2 ± 7.8 vs. 39.5 cm2/m2 ± 8.4, p < 0.001). Diagnostic metrics of previous cutoffs in predicting PFL showed suboptimal sensitivity (63.29%-91.77%), specificity (11.39%-50.63%), and area under the receiver operating characteristic curve (AUC) values (0.516-0.592). Age and the SMI were significant predictors of PFL; therefore, a score for predicting PFL (age - SMI + 21) was constructed, which achieved an AUC value of 0.748. CONCLUSION Fixed cutoffs for CT-defined low skeletal muscle mass may inadequately predict PFLs, potentially overlooking declining physical functions in patients with lung cancer.
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Affiliation(s)
- Shiva Raj Timsina
- Department of Radiology, Faculty of MedicinePrince of Songkla UniversitySongklaThailand
| | - Wiwatana Tanomkiat
- Department of Radiology, Faculty of MedicinePrince of Songkla UniversitySongklaThailand
| | - Sarayut L. Geater
- Unit of Respiratory and Respiratory Critical Care Medicine, Department of Medicine, Faculty of MedicinePrince of Songkla UniversitySongklaThailand
| | - Natee Ina
- Department of Radiology, Faculty of MedicinePrince of Songkla UniversitySongklaThailand
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Knoedler S, Schliermann R, Knoedler L, Wu M, Hansen FJ, Matar DY, Obed D, Vervoort D, Haug V, Hundeshagen G, Paik A, Kauke-Navarro M, Kneser U, Pomahac B, Orgill DP, Panayi AC. Impact of sarcopenia on outcomes in surgical patients: a systematic review and meta-analysis. Int J Surg 2023; 109:4238-4262. [PMID: 37696253 PMCID: PMC10720826 DOI: 10.1097/js9.0000000000000688] [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: 04/15/2023] [Accepted: 08/04/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Surgeons have historically used age as a preoperative predictor of postoperative outcomes. Sarcopenia, the loss of skeletal muscle mass due to disease or biological age, has been proposed as a more accurate risk predictor. The prognostic value of sarcopenia assessment in surgical patients remains poorly understood. Therefore, the authors aimed to synthesize the available literature and investigate the impact of sarcopenia on perioperative and postoperative outcomes across all surgical specialties. METHODS The authors systematically assessed the prognostic value of sarcopenia on postoperative outcomes by conducting a systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching the PubMed/MEDLINE and EMBASE databases from inception to 1st October 2022. Their primary outcomes were complication occurrence, mortality, length of operation and hospital stay, discharge to home, and postdischarge survival rate at 1, 3, and 5 years. Subgroup analysis was performed by stratifying complications according to the Clavien-Dindo classification system. Sensitivity analysis was performed by focusing on studies with an oncological, cardiovascular, emergency, or transplant surgery population and on those of higher quality or prospective study design. RESULTS A total of 294 studies comprising 97 643 patients, of which 33 070 had sarcopenia, were included in our analysis. Sarcopenia was associated with significantly poorer postoperative outcomes, including greater mortality, complication occurrence, length of hospital stay, and lower rates of discharge to home (all P <0.00001). A significantly lower survival rate in patients with sarcopenia was noted at 1, 3, and 5 years (all P <0.00001) after surgery. Subgroup analysis confirmed higher rates of complications and mortality in oncological (both P <0.00001), cardiovascular (both P <0.00001), and emergency ( P =0.03 and P =0.04, respectively) patients with sarcopenia. In the transplant surgery cohort, mortality was significantly higher in patients with sarcopenia ( P <0.00001). Among all patients undergoing surgery for inflammatory bowel disease, the frequency of complications was significantly increased among sarcopenic patients ( P =0.007). Sensitivity analysis based on higher quality studies and prospective studies showed that sarcopenia remained a significant predictor of mortality and complication occurrence (all P <0.00001). CONCLUSION Sarcopenia is a significant predictor of poorer outcomes in surgical patients. Preoperative assessment of sarcopenia can help surgeons identify patients at risk, critically balance eligibility, and refine perioperative management. Large-scale studies are required to further validate the importance of sarcopenia as a prognostic indicator of perioperative risk, especially in surgical subspecialties.
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Affiliation(s)
- Samuel Knoedler
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, USA
| | - Rainer Schliermann
- Faculty of Social and Health Care Sciences, University of Applied Sciences Regensburg, Regensburg
| | - Leonard Knoedler
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, USA
| | - Mengfan Wu
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong, People’s Republic of China
| | - Frederik J. Hansen
- Department of General and Visceral Surgery, Friedrich-Alexander University Erlangen, Erlangen
| | - Dany Y. Matar
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston
| | - Doha Obed
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston
| | - Dominique Vervoort
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Valentin Haug
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston
| | - Gabriel Hundeshagen
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Angie Paik
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, USA
| | - Martin Kauke-Navarro
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, USA
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Bohdan Pomahac
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, USA
| | - Dennis P. Orgill
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston
| | - Adriana C. Panayi
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston
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Jogiat U, Jimoh Z, Turner SR, Baracos V, Eurich D, Bédard ELR. Sarcopenia in Lung Cancer: A Narrative Review. Nutr Cancer 2023:1-14. [PMID: 37177914 DOI: 10.1080/01635581.2023.2212425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
It has been over 10 years since the relationship between sarcopenia and lung cancer was first explored. Since then, sarcopenia research has progressed substantially, and the prognostic value of this condition is becoming increasingly apparent. Prior systematic reviews and meta-analyses have established sarcopenia to be negatively associated with disease-free and overall-survival, as well as a major risk factor for post-operative complications. The bulk of the literature has explored sarcopenia in the resectable setting, with less emphasis placed on studies evaluating this condition in advanced disease. In this up-to-date review, an examination of the literature exploring the association between sarcopenia and long-term outcomes in advanced lung cancer is provided. We further explore the association between adverse events of medical therapy and the role of sarcopenia as a predictor of tumor response. Finally, the interventions on sarcopenia and cancer cachexia are reviewed, with an emphasis placed on prospective studies.
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Affiliation(s)
- Uzair Jogiat
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | | | - Simon R Turner
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | - Vickie Baracos
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Canada
| | - Dean Eurich
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Eric L R Bédard
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
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Chen WM, Chang CH, Ko JY, Chen MC, Shia BC, Wu SY. Comparison of medical resource consumption between oral cavity squamous cell carcinoma with and without sarcopenia: A nationwide population-based cohort study. Head Neck 2023. [PMID: 37141406 DOI: 10.1002/hed.27383] [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: 09/30/2022] [Revised: 01/17/2023] [Accepted: 04/18/2023] [Indexed: 05/06/2023] Open
Abstract
PURPOSE No study has compared long-term medical resource consumption between patients with oral cavity squamous cell carcinoma (OCSCC) with and without sarcopenia receiving curative surgery. PATIENTS AND METHODS Generalized linear mixed and logistic regression models were employed to evaluate the number of postoperative visits and medical reimbursement for head and neck cancer or complications and the number of hospitalizations for treatment-related complications over 5 years after curative surgery, respectively. RESULTS The mean difference (95% CI) in total medical claims amounts between the nonsarcopenia and sarcopenia groups were new Taiwan dollars (NTD) 47 820 (35 864-59 776, p < 0.0001), 11 902 (4897-18 908, p = 0.0009), 17 282 (10 666-23 898, p < 0.0001), 17 364 (9644-25 084, p < 0.0001), and 8236 (111-16 362, p = 0.0470) for the first, second, third, fourth, and fifth years, respectively. CONCLUSION The long-term medical resource consumption was higher in the sarcopenia group than in the nonsarcopenia group.
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Affiliation(s)
- Wan-Ming Chen
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan
| | - Chia-Hao Chang
- Department of Otolaryngology, Lotung Pohai Hospital, Yilan, Taiwan
| | - Jenq-Yuh Ko
- Department of Otolaryngology, Lotung Pohai Hospital, Yilan, Taiwan
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ming-Chih Chen
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan
| | - Ben-Chang Shia
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan
| | - Szu-Yuan Wu
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
- Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
- Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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Sun M, Chen WM, Wu SY, Zhang J. Sarcopenia is associated with an increase in long-term use of analgesics after elective surgery under general anesthesia. Reg Anesth Pain Med 2023; 48:205-210. [PMID: 36631231 DOI: 10.1136/rapm-2022-104144] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/29/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE To elucidate the association of presurgical sarcopenia and long-term non-opioid analgesic and opioid use after elective surgery under general anesthesia. METHODS We conducted this population-based propensity score matched to investigate the effects of sarcopenia and long-term non-opioid analgesic and opioid use after elective surgery under general anesthesia between 1 October 2016 and 31 December 2019 from Taiwan's National Health Insurance Research Database. Sarcopenia is a disease and coded as M62.84 in the International Classification of Diseases, 10th Revision, Clinical Modification. The primary outcome was the combined rate of the long-term use of all non-opioid analgesics or opioids over 3 and 6 months after elective surgery. By performing a logistic regression analysis, we calculated the adjusted ORs (aORs) with 95% CIs to identify the independent predictors for long-term non-opioid analgesic and opioid use after surgery. RESULTS In total, 2860 patients underwent elective surgery. The 3-month non-opioid analgesic and opioid use rates were respectively 49.7% and 1.8% in the sarcopenia group and 37.9% and 0.9% in the non-sarcopenia group; by contrast, 6-month non-opioid analgesic and opioid use rates were respectively 31.6% and 1.2% in the sarcopenia group and 17.2% and 0.3% in the non-sarcopenia group. Moreover, presurgical sarcopenia increased the risk of long-term non-opioid analgesic and opioid use after elective surgery under general anesthesia (aORs for non-opioid analgesic use over 3 and 6 months after surgery: 1.17 (95% CI 1.05 to 2.23) and 1.26 (95% CI 1.04 to 1.45), respectively; aORs for opioid use over 3 and 6 months after surgery: 1.17 (95% CI 1.07 to 2.21) and 1.23 (95% CI 1.10 to 3.64), respectively). CONCLUSION Sarcopenia is associated with higher rates of long-term non-opioid analgesic and opioid use after elective surgery under general anesthesia. SUMMARY The aim of this study was to compare the long-term use of non-opioid analgesics and opioids after elective surgery under general anesthesia between patients with and without sarcopenia. Results suggest that patients with sarcopenia are more likely to have increased use of non-opioid analgesics and opioids after surgery. Further research is needed to determine if sarcopenia can be modified prior to surgery and if this impacts the need for long-term pain management with these medications.
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Affiliation(s)
- Mingyang Sun
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Wan-Ming Chen
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan
| | - Szu-Yuan Wu
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
- Division of Radiation Oncology, Lo-Hsu Medical Foundation, LotungPoh-Ai Hospital, Yilan, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
- Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Management, College of Management, Fo Guang University, Yilan, Taiwan
| | - Jiaqiang Zhang
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Usefulness of 18 F-FDG PET/computed tomography metabolic parameters in predicting sarcopenia and prognosis of treatment-naive patients with non-small cell lung cancer. Nucl Med Commun 2023; 44:309-317. [PMID: 36756769 DOI: 10.1097/mnm.0000000000001669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
PURPOSE Sarcopenia tremendously impacts the quality of life but remains debatable in prognostication in treatment-naive patients with non-small cell lung cancer (NSCLC). Hence, this study aimed to find a clinically feasible approach using 18 F-FDG PET/computed tomography (CT) imaging parameters and clinical characteristics to predict sarcopenia and determine independent prognostic factors. METHODS Clinical characteristics and 18 F-FDG PET/CT metabolic parameters, including maximum standard uptake value, metabolic tumor volume, and total lesion glycolysis of primary tumor (SUVmax_P, MTV_P, and TLG_P) and combination of whole-body lesions (MTV_C and TLG_C) were collected in 344 treatment-naive patients with NSCLC. Skeletal muscle index at the third lumbar vertebra was calculated to determine sarcopenia. SUVmax of the psoas major muscle (SUVmax_M) was measured at the third lumbar vertebra as well. The diagnostic endpoint is the probability of sarcopenia, and the survival endpoints include progression-free survival (PFS) and overall survival (OS). RESULTS Among 344 patients with NSCLC there were 271 patients with adenocarcinoma and 73 with squamous cell carcinoma (SCC). One hundred forty-seven patients (42.7%) were diagnosed with sarcopenia. Higher age, male, lower BMI, SCC, and lower SUVmax_M were correlated with a higher incidence of sarcopenia ( P < 0.05), while age, sex and SUVmax_M were independently predictive of sarcopenia. Multivariate Cox-regression analysis revealed that BMI, advanced stage and TLG_C were independent predictors of PFS and OS, while sex was independently predictive of OS. CONCLUSIONS The incidence of sarcopenia increased with declining SUVmax of muscle. BMI, tumor stage, and TLG_C, but not sarcopenia, were found independently predictive of both PFS and OS.
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Yuan H, Tan X, Sun X, He L, Li D, Jiang L. Role of 18F-FDG PET/CT and sarcopenia in untreated non-small cell lung cancer with advanced stage. Jpn J Radiol 2022; 41:521-530. [PMID: 36480105 DOI: 10.1007/s11604-022-01369-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Sarcopenia is essential in managing advanced stage (III-IV) non-small cell lung cancer (NSCLC) but is laborious to diagnose using currently available method. This study aimed to establish a simple approach to predict sarcopenia using 18F-FDG PET/CT parameters and clinical characteristics and determine their roles in prognostication in advanced stage NSCLC. METHODS Untreated 202 NSCLC patients with stage III-IV were retrospectively reviewed. Sarcopenia was defined using the skeletal muscle index (SMI) measured at the third lumbar vertebra (L3). 18F-FDG PET/CT metabolic parameters of maximum standard uptake value, metabolic tumor volume, and total lesion glycolysis of the primary tumor (SUVmax_T, MTV_T, and TLG_T) and of whole-body lesions (MTV_WB and TLG_WB) were measured. Besides, SUVmax of the psoas major muscle (SUVmax_Muscle) was measured at the L3 level. The diagnostic endpoint was the probability of sarcopenia, and the survival endpoints included progression-free survival (PFS) and overall survival (OS). RESULTS Among the enrolled 202 patients, 82 (40.6%) were diagnosed with sarcopenia. Higher age, male, lower BMI, and lower SUVmax_Muscle were correlated with a higher incidence of sarcopenia (P < 0.05), while age, sex, BMI, and SUVmax_Muscle were independently predictive of sarcopenia, and thus were utilized to construct a nomogram model. Multivariate Cox regression analysis revealed that sarcopenia score derived from the nomogram model, sarcopenia, stage, and TLG_WB were independently predictive of both PFS and OS. CONCLUSION The incidence of sarcopenia increased with declining SUVmax_Muscle in advanced stage NSCLC. Our model using age, sex, BMI, and SUVmax_Muscle might be substituted for the complicated measurement of SMI. After adjustment by stage and TLG_WB, both sarcopenia score and sarcopenia were found to be independently predictive of PFS and OS.
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Lin TY, Chen YF, Wu WT, Han DS, Tsai IC, Chang KV, Özçakar L. Impact of sarcopenia on the prognosis and treatment of lung cancer: an umbrella review. Discov Oncol 2022; 13:115. [PMID: 36307591 PMCID: PMC9616989 DOI: 10.1007/s12672-022-00576-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/17/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Lung cancer is the leading cause of cancer-related mortality worldwide. Sarcopenia, defined as the loss of muscle mass and function, is known to cause adverse health outcomes. The purpose of this umbrella review was to integrate published systematic reviews and meta-analyses exploring sarcopenia and lung cancer to provide comprehensive knowledge on their relationship. METHODS Eligible studies were searched from scientific databases until June 28, 2022. Critical appraisal was performed using A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2. The impact of sarcopenia on the pathophysiology, prevalence, and prognosis of lung cancer is summarized at the level of systematic reviews or meta-analyses. RESULTS Fourteen reviews and meta-analyses were conducted. The methodological quality was high for one review, low for nine, and critically low for four. The most common standard for diagnosing sarcopenia in the lung cancer population is computed tomography (CT) to measure the skeletal muscle index at the third lumbar vertebra (L3). Sarcopenia was highly prevalent among patients with lung cancer, with a pooled prevalence ranging from 42.8% to 45.0%. The association between sarcopenia and increased postoperative complications and decreased disease control rates with immune checkpoint inhibitors has been demonstrated. Mortality was significantly higher in sarcopenic patients than in non-sarcopenic patients with lung cancer, regardless of the stage of disease or type of treatment. CONCLUSIONS Sarcopenia is a poor prognostic factor for lung cancer. Future studies are necessary to clarify the pathophysiology of sarcopenia and develop effective interventions for sarcopenia in patients with lung cancer.
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Affiliation(s)
- Ting-Yu Lin
- Department of Physical Medicine and Rehabilitation, Lo-Hsu Medical Foundation, Inc., Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Yen-Fu Chen
- Department of Internal Medicine, National Taiwan University Hospital, Yunlin Branch, Douliu, Yunlin, Taiwan
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
| | - Der-Sheng Han
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
| | - I-Chen Tsai
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Congenital Heart Disease Study Group, Asian Society of Cardiovascular Imaging, Seoul, Korea
- InnovaRad Inc., Taichung, Taiwan
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan.
- Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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Shared and Divergent Epigenetic Mechanisms in Cachexia and Sarcopenia. Cells 2022; 11:cells11152293. [PMID: 35892590 PMCID: PMC9332174 DOI: 10.3390/cells11152293] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 01/27/2023] Open
Abstract
Significant loss of muscle mass may occur in cachexia and sarcopenia, which are major causes of mortality and disability. Cachexia represents a complex multi-organ syndrome associated with cancer and chronic diseases. It is often characterized by body weight loss, inflammation, and muscle and adipose wasting. Progressive muscle loss is also a hallmark of healthy aging, which is emerging worldwide as a main demographic trend. A great challenge for the health care systems is the age-related decline in functionality which threatens the independence and quality of life of elderly people. This biological decline can also be associated with functional muscle loss, known as sarcopenia. Previous studies have shown that microRNAs (miRNAs) play pivotal roles in the development and progression of muscle wasting in both cachexia and sarcopenia. These small non-coding RNAs, often carried in extracellular vesicles, inhibit translation by targeting messenger RNAs, therefore representing potent epigenetic modulators. The molecular mechanisms behind cachexia and sarcopenia, including the expression of specific miRNAs, share common and distinctive trends. The aim of the present review is to compile recent evidence about shared and divergent epigenetic mechanisms, particularly focusing on miRNAs, between cachexia and sarcopenia to understand a facet in the underlying muscle wasting associated with these morbidities and disclose potential therapeutic interventions.
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Detopoulou P, Voulgaridou G, Papadopoulou S. Cancer, Phase Angle and Sarcopenia: The Role of Diet in Connection with Lung Cancer Prognosis. Lung 2022; 200:347-379. [PMID: 35616720 DOI: 10.1007/s00408-022-00536-z] [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: 02/28/2022] [Accepted: 04/07/2022] [Indexed: 12/12/2022]
Abstract
Lung cancer is the most common cause of cancer death and is associated with malnutrition and sarcopenia. The detection of sarcopenia and conduction of simple body composition measurements, such as the phase angle (PhA) deriving from bioelectrical impedance analysis (BIA), can help to early identify, monitor, prevent and treat malnutrition. The present review aims to clarify the relationship between PhA and sarcopenia with the pathophysiology, clinical outcomes, and therapeutic aspects of lung cancer. PhA and sarcopenia are connected to lung cancer prognosis through various mechanisms including inflammation and oxidative stress, although more research is needed to identify the critical thresholds for increased mortality risk. Moreover, emphasis is given on the role of dietary interventions (oral nutritional supplementation, and dietary counseling) to manage sarcopenia and related variables in patients with lung cancer. Oral nutritional supplements and/or those containing n - 3 polyunsaturated fatty acids may have a positive effect on physical strength measures and muscle mass if administered at the beginning of chemotherapy. Data on sole dietary counseling or multimodal interventions are less promising so far. In the future, sophisticated body composition phenotypes deriving from the described methods along with artificial intelligence techniques could be used to design personalized nutrition interventions and timely treat these patients.
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Affiliation(s)
- Paraskevi Detopoulou
- Department of Clinical Nutrition, General Hospital Korgialenio Benakio, Athens, Greece.,Department of Nutritional Science and Dietetics, University of the Peloponnese, Kalamata, Greece
| | - Gavriela Voulgaridou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Sindos, Thessaloniki, Greece
| | - Sousana Papadopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Sindos, Thessaloniki, Greece.
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de Mattos JN, Santiago Escovar CE, Zereu M, Rubin AS, Camargo SM, Mohammed TL, Dos Santos RS, Verma N, Penha Pereira D, Guedes Pinto E, Machuca T, Medeiros TM, Hochhegger B. Computed tomography on lung cancer screening is useful for adjuvant comorbidity diagnosis in developing countries. ERJ Open Res 2022; 8:00061-2022. [PMID: 35747230 PMCID: PMC9209849 DOI: 10.1183/23120541.00061-2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/26/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose The aim of this study was to analyse and quantify the prevalence of six comorbidities from lung cancer screening (LCS) on computed tomography (CT) scans of patients from developing countries. Methods For this retrospective study, low-dose CT scans (n=775) were examined from patients who underwent LCS in a tertiary hospital between 2016 and 2020. An age- and sex-matched control group was obtained for comparison (n=370). Using the software, coronary artery calcification (CAC), the skeletal muscle area, interstitial lung abnormalities, emphysema, osteoporosis and hepatic steatosis were accessed. Clinical characteristics of each participant were identified. A t-test and Chi-squared test were used to examine differences between these values. Interclass correlation coefficients (ICCs) and interobserver agreement (assessed by calculating kappa coefficients) were calculated to assess the correlation of measures interpreted by two observers. p-values <0.05 were considered significant. Results One or more comorbidities were identified in 86.6% of the patients and in 40% of the controls. The most prevalent comorbidity was osteoporosis, present in 44.2% of patients and in 24.8% of controls. New diagnoses of cardiovascular disease, emphysema and osteoporosis were made in 25%, 7% and 46% of cases, respectively. The kappa coefficient for CAC was 0.906 (p<0.001). ICCs for measures of liver, spleen and bone density were 0.88, 0.93 and 0.96, respectively (p<0.001). Conclusions CT data acquired during LCS led to the identification of previously undiagnosed comorbidities. The LCS is useful to facilitate comorbidity diagnosis in developing countries, providing opportunities for its prevention and treatment. Lung cancer screening is useful to facilitate comorbidity diagnosis in developing countries, providing opportunities for its prevention and treatmenthttps://bit.ly/3KEdGuW
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Affiliation(s)
- Juliane Nascimento de Mattos
- Graduate Program in Pathology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil.,Medical Imaging Research Lab, LABIMED, Dept of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | | | - Manuela Zereu
- Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | | | | | - Tan-Lucien Mohammed
- Dept of Radiology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Ricardo Sales Dos Santos
- Dept of Radiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Israelita Albert Einstein Hospital, São Paulo, Brazil
| | - Nupur Verma
- Dept of Radiology, College of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Erique Guedes Pinto
- Dept of Radiology, Lincoln County Hospital, United Lincolnshire Hospitals NHS Trust, Lincoln, UK
| | - Tiago Machuca
- Dept of Radiology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Tássia Machado Medeiros
- Postgraduate Program in Medicine and Health Sciences, Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Bruno Hochhegger
- Graduate Program in Pathology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil.,Medical Imaging Research Lab, LABIMED, Dept of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil.,Dept of Radiology, College of Medicine, University of Florida, Gainesville, FL, USA.,Dept of Radiology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
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Impact of preoperative computed tomography-determined quantity and quality of skeletal muscle on survival after resected non-small cell lung carcinoma. Eur J Surg Oncol 2022; 48:1937-1946. [DOI: 10.1016/j.ejso.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/17/2022] [Accepted: 03/10/2022] [Indexed: 11/23/2022] Open
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Voorn M, Beukers K, Trepels C, Bootsma G, Bongers B, Janssen-Heijnen M. Associations between pretreatment nutritional assessments and treatment complications in patients with stage I-III non-small cell lung cancer: A systematic review. Clin Nutr ESPEN 2022; 47:152-162. [DOI: 10.1016/j.clnesp.2021.12.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 12/18/2022]
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14
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Pennathur A, Brunelli A, Criner GJ, Keshavarz H, Mazzone P, Walsh G, Luketich J, Liptay M, Wafford QE, Murthy S, Marshall MB, Tong B, Lanuti M, Wolf A, Pettiford B, Loo BW, Merritt RE, Rocco G, Schuchert M, Varghese TK, Swanson SJ. Definition and assessment of high risk in patients considered for lobectomy for stage I non-small cell lung cancer: The American Association for Thoracic Surgery expert panel consensus document. J Thorac Cardiovasc Surg 2021; 162:1605-1618.e6. [PMID: 34716030 DOI: 10.1016/j.jtcvs.2021.07.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/08/2021] [Accepted: 07/09/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Lobectomy is a standard treatment for stage I non-small cell lung cancer, but a significant proportion of patients are considered at high risk for complications, including mortality, after lobectomy and might not be candidates. Identifying who is at risk is important and in evolution. The objective of The American Association for Thoracic Surgery Clinical Practice Standards Committee expert panel was to review important considerations and factors in assessing who is at high risk among patients considered for lobectomy. METHODS The American Association for Thoracic Surgery Clinical Practice Standards Committee assembled an expert panel that developed an expert consensus document after systematic review of the literature. The expert panel generated a priori a list of important risk factors in the determination of high risk for lobectomy. A survey was administered, and the expert panel was asked to grade the relative importance of each risk factor. Recommendations were developed using discussion and a modified Delphi method. RESULTS The expert panel survey identified the most important factors in the determination of high risk, which included the need for supplemental oxygen because of severe underlying lung disease, low diffusion capacity, the presence of frailty, and the overall assessment of daily activity and functional status. The panel determined that factors, such as age (as a sole factor), were less important in risk assessment. CONCLUSIONS Defining who is at high risk for lobectomy for stage I non-small cell lung cancer is challenging, but remains critical. There was impressive strong consensus on identification of important factors and their hierarchical ranking of perceived risk. The panel identified several key factors that can be incorporated in risk assessment. The factors are evolving and as the population ages, factors such as neurocognitive function and frailty become more important. A minimally invasive approach becomes even more critical in this older population to mitigate risk. The determination of risk is a clinical decision and judgement, which should also take into consideration patient perspectives, values, preferences, and quality of life.
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Affiliation(s)
- Arjun Pennathur
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, and UPMC Hillman Cancer Center, Pittsburgh, Pa.
| | - Alessandro Brunelli
- Department of Thoracic Surgery, St. James University Hospital, Leeds, United Kingdom
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pa
| | - Homa Keshavarz
- The American Association for Thoracic Surgery, Beverly, Mass
| | - Peter Mazzone
- Department of Pulmonology, Cleveland Clinic, Cleveland, Ohio
| | - Garrett Walsh
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass
| | - James Luketich
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, and UPMC Hillman Cancer Center, Pittsburgh, Pa
| | - Michael Liptay
- Department of Thoracic Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Tex
| | | | - Sudish Murthy
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, Ill
| | - M Blair Marshall
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Betty Tong
- Department of Thoracic Surgery, Duke University Hospital, Durham, NC
| | - Michael Lanuti
- Department of Thoracic Surgery, Massachusetts General Hospital, Boston, Mass
| | - Andrea Wolf
- The Icahn School of Medicine at Mount Sinai and Mount Sinai Hospital, New York, NY
| | - Brian Pettiford
- Section of Cardiothoracic Surgery, Ochsner Health System, New Orleans, La
| | - Billy W Loo
- Department of Radiation Oncology & Stanford Cancer Institute, Stanford University School of Medicine, Stanford, Calif
| | - Robert E Merritt
- Division of Thoracic Surgery, The Ohio State University-Wexner Medical Center, Columbus, Ohio
| | - Gaetano Rocco
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Matthew Schuchert
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, and UPMC Hillman Cancer Center, Pittsburgh, Pa
| | - Thomas K Varghese
- Division of Thoracic Surgery, University of Utah, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Scott J Swanson
- Division of Thoracic Surgery, Harvard Medical School and Brigham and Women's Hospital, Boston, Mass.
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Sarcopenia predicts adverse outcomes in an elderly population with coronary artery disease: a systematic review and meta-analysis. BMC Geriatr 2021; 21:493. [PMID: 34521369 PMCID: PMC8439080 DOI: 10.1186/s12877-021-02438-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 08/26/2021] [Indexed: 01/07/2023] Open
Abstract
Background The development of sarcopenia is attributed to normal aging and factors like type 2 diabetes, obesity, inactivity, reduced testosterone levels, and malnutrition, which are factors of poor prognosis in patients with coronary artery disease (CAD). This study aimed to perform a meta-analysis to assess whether preoperative sarcopenia can be used to predict the outcomes after cardiac surgery in elderly patients with CAD. Methods PubMed, Embase, the Cochrane library, and Web of Science were searched for available papers published up to December 2020. The primary outcome was major adverse cardiovascular outcomes (MACE). The secondary outcomes were mortality and heart failure (HF)-related hospitalization. The random-effects model was used. Hazard ratios (HRs) with 95% confidence intervals (95%CIs) were estimated. Results Ten studies were included, with 3707 patients followed for 6 months to 4.5 ± 2.3 years. The sarcopenia population had a higher rate of MACE compared to the non-sarcopenia population (HR = 2.27, 95%CI: 1.58–3.27, P < 0.001; I2 = 60.0%, Pheterogeneity = 0.02). The association between sarcopenia and MACE was significant when using the psoas muscle area index (PMI) to define sarcopenia (HR = 2.86, 95%CI: 1.84–4.46, P < 0.001; I2 = 0%, Pheterogeneity = 0.604). Sarcopenia was not associated with higher late mortality (HR = 2.15, 95%CI: 0.89–5.22, P = 0.090; I2 = 91.0%, Pheterogeneity < 0.001), all-cause mortality (HR = 1.35, 95%CI: 0.14–12.84, P = 0.792; I2 = 90.5%, Pheterogeneity = 0.001), and death, HF-related hospitalization (HR = 1.37, 95%CI: 0.59–3.16, P = 0.459; I2 = 62.0%, Pheterogeneity = 0.105). The sensitivity analysis revealed no outlying study in the analysis of the association between sarcopenia and MACE after coronary intervention. Conclusion Sarcopenia is associated with poor MACE outcomes in patients with CAD. The results could help determine subpopulations of patients needing special monitoring after CAD surgery. The present study included several kinds of participants; although non-heterogeneity was found, interpretation should be cautious. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02438-w.
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Humphry NA, Wilson T, Cox MC, Carter B, Arkesteijn M, Reeves NL, Brakenridge S, McCarthy K, Bunni J, Draper J, Hewitt J. Association of Postoperative Clinical Outcomes With Sarcopenia, Frailty, and Nutritional Status in Older Patients With Colorectal Cancer: Protocol for a Prospective Cohort Study. JMIR Res Protoc 2021; 10:e16846. [PMID: 34402798 PMCID: PMC8408756 DOI: 10.2196/16846] [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: 10/30/2019] [Revised: 01/13/2021] [Accepted: 03/24/2021] [Indexed: 01/05/2023] Open
Abstract
Background Older patients account for a significant proportion of patients undergoing colorectal cancer surgery and are vulnerable to a number of preoperative risk factors that are not often present in younger patients. Further, three preoperative risk factors that are more prevalent in older adults include frailty, sarcopenia, and malnutrition. Although each of these has been studied in isolation, there is little information on the interplay between them in older surgical patients. A particular area of increasing interest is the use of urine metabolomics for the objective evaluation of dietary profiles and malnutrition. Objective Herein, we describe the design, cohort, and standard operating procedures of a planned prospective study of older surgical patients undergoing colorectal cancer resection across multiple institutions in the United Kingdom. The objectives are to determine the association between clinical outcomes and frailty, nutritional status, and sarcopenia. Methods The procedures will include serial frailty evaluations (Clinical Frailty Scale and Groningen Frailty Indicator), functional assessments (hand grip strength and 4-meter walk test), muscle mass evaluations via computerized tomography morphometric analysis, and the evaluation of nutritional status via the analysis of urinary dietary biomarkers. The primary feasibility outcome is the estimation of the incidence rate of postoperative complications, and the primary clinical outcome is the association between the presence of postoperative complications and frailty, sarcopenia, and nutritional status. The secondary outcome measures are the length of hospital stay, 30-day hospital readmission rate, and mortality rate at days 30 and 90. Results Our study was approved by the National Health Service Research Ethics Committee (reference number: 19/WA/0190) via the Integrated Research Application System (project ID: 231694) prior to subject recruitment. Cardiff University is acting as the study sponsor. Our study is financially supported through an external, peer-reviewed grant from the British Geriatrics Society and internal funding resources from Cardiff University. The results will be disseminated through peer-review publications, social media, and conference proceedings. Conclusions As frailty, sarcopenia, and malnutrition are all areas of common derangement in the older surgical population, prospectively studying these risk factors in concert will allow for the analysis of their interplay as well as the development of predictive models for those at risk of commonly tracked surgical complications and outcomes. International Registered Report Identifier (IRRID) PRR1-10.2196/16846
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Affiliation(s)
| | - Thomas Wilson
- Institute of Biological, Environmental & Rural Sciences, Aberystwyth University, Aberystwyth, United Kingdom
| | - Michael Christian Cox
- Department of Surgery, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Ben Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom
| | - Marco Arkesteijn
- Institute of Biological, Environmental & Rural Sciences, Aberystwyth University, Aberystwyth, United Kingdom
| | - Nicola Laura Reeves
- Department of Surgery, Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - Scott Brakenridge
- Department of Surgery, Harborview Medical Center, University of Washington, Seattle, WA, United States
| | - Kathryn McCarthy
- North Bristol National Health Service Trust, Bristol, United Kingdom
| | - John Bunni
- Royal United Hospitals Bath National Health Service Foundation Trust, Bath, United Kingdom
| | - John Draper
- Institute of Biological, Environmental & Rural Sciences, Aberystwyth University, Aberystwyth, United Kingdom
| | - Jonathan Hewitt
- Division of Population Medicine, Cardiff University, Cardiff, United Kingdom
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Avancini A, Cavallo A, Trestini I, Tregnago D, Belluomini L, Crisafulli E, Micheletto C, Milella M, Pilotto S, Lanza M, Infante MV. Exercise prehabilitation in lung cancer: Getting stronger to recover faster. Eur J Surg Oncol 2021; 47:1847-1855. [PMID: 33757650 DOI: 10.1016/j.ejso.2021.03.231] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/10/2021] [Accepted: 03/05/2021] [Indexed: 02/07/2023] Open
Abstract
Despite several recent advances, lung cancer surgery is still associated with potentially severe postoperative complications. It has been suggested that preoperative exercise training could render patients with borderline functional parameters eligible for surgery, improve perioperative outcomes and that these benefits might reduce healthcare costs. Nevertheless, given the substantial heterogeneity of the available studies, no specific guidelines for preoperative exercise training have been released so far. This narrative review aims to provide an overview of the potential benefits of exercise training in the preoperative period as a central intervention for lung cancer patients. In detail, the effects of exercise (with different regimens) were evaluated in terms of physical functions, patients' eligibility for curative surgery, postoperative complications and length of stay, with an exploratory focus on healthcare costs and long-term outcomes. Furthermore, a feasible approach for every-day clinical practice is proposed in order to increase the expected benefit deriving from a more extensive and methodical application of prehabilitation exercise, ideally in the context of a comprehensive approach to lung cancer patients, including nutritional and psychological support.
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Affiliation(s)
- Alice Avancini
- Biomedical, Clinical and Experimental Sciences, Department of Medicine, University of Verona, Verona, Italy.
| | - Alessandro Cavallo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Ilaria Trestini
- Section of Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
| | - Daniela Tregnago
- Section of Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
| | - Lorenzo Belluomini
- Section of Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
| | - Ernesto Crisafulli
- Respiratory Medicine Unit, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
| | - Claudio Micheletto
- Department of Cardiovascular and Thoracic, Pneumology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
| | - Michele Milella
- Section of Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
| | - Sara Pilotto
- Section of Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
| | - Massimo Lanza
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Maurizio Valentino Infante
- Thoracic Surgery Department, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
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Kim KW, Baek MO, Yoon MS, Son KH. Deterioration of mitochondrial function in the human intercostal muscles differs among individuals with sarcopenia, obesity, and sarcopenic obesity. Clin Nutr 2021; 40:2697-2706. [PMID: 33933735 DOI: 10.1016/j.clnu.2021.03.009] [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: 09/07/2020] [Revised: 02/19/2021] [Accepted: 03/05/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND & AIMS Sarcopenic obesity (SO) increases the risk of mortality more than sarcopenia or obesity alone. Sarcopenia weakens the peripheral and respiratory muscles, leading to respiratory complications. It also induces mitochondrial dysfunction in the peripheral muscle; however, whether mitochondrial dysfunction in respiratory muscles differs among individuals with obesity, sarcopenia, and SO remains unknown. We evaluated the deterioration of respiratory muscle strength and mitochondrial function among normal, sarcopenia, obesity, and SO subjects. METHODS Twenty-five patients who underwent lung resections were enrolled between April 2017 and January 2021, and their intercostal muscles were harvested. Based on their L3 muscle index and visceral fat area, the patients were divided into four groups (normal, obesity, sarcopenia, and SO). The clinical data, mRNA expression, and protein expressions associated with mitochondrial biogenesis/fusion/fission in the intercostal muscles were compared among the four groups. RESULTS The respiratory muscle strength was evaluated using peak expiratory flow rate (PEFR). The PEFR values of the four groups were not significantly different. The levels of pAkt/Akt and mTOR (a marker of protein synthesis) were not significantly different among the four groups; however, those in the SO group were substantially lower than those in the sarcopenia or obesity groups. The levels of Atrogen-1 and MuRF1 (a marker of protein degradation) were not significantly different among the four groups; however, those in the SO group were substantially higher than those in the sarcopenia or obesity groups. Expression of PGC1-α (a marker of mitochondrial biogenesis) in the SO group was significantly lower than that in the normal group. MFN1 and MFN2 (marker of mitochondrial fusion) levels were significantly lower in the SO group than those in the normal group. DRP1 (a marker of mitochondrial fission) level in the SO group was substantially lower than that in the normal group. The expression of TNF-α (a pro-inflammatory cytokine) in the SO group was substantially lower than that in the normal group. CONCLUSION Our results suggest that the deterioration of protein synthesis and degradation of mitochondrial function in the respiratory muscles was most prominent in the SO before the weakening of the respiratory muscles. The deterioration mechanism may differentially regulate obesity, sarcopenia, and SO.
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Affiliation(s)
- Kun Woo Kim
- Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Center, College of Medicine, Gachon University, Incheon 21565, South Korea
| | - Mi-Ock Baek
- Department of Molecular Medicine, School of Medicine, Gachon University, Incheon 21999, South Korea; Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon 21999, South Korea; Department of Health Sciences and Technology, GAIHST, Gachon University, Incheon 21999, South Korea
| | - Mee-Sup Yoon
- Department of Molecular Medicine, School of Medicine, Gachon University, Incheon 21999, South Korea; Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon 21999, South Korea; Department of Health Sciences and Technology, GAIHST, Gachon University, Incheon 21999, South Korea.
| | - Kuk Hui Son
- Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Center, College of Medicine, Gachon University, Incheon 21565, South Korea.
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Balki HBSc I, de Perrot M, Bavaghar-Zaeimi F, Nourouzpour S, Granton JT, Thenganatt J, McInnis M, McRae K, Donahoe L, Rozenberg D. CLINICAL IMPLICATIONS OF BODY COMPOSITION AND EXERCISE CAPACITY FOLLOWING PULMONARY ENDARTERECTOMY. Ann Thorac Surg 2021; 113:444-451. [PMID: 33667463 DOI: 10.1016/j.athoracsur.2021.01.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 12/15/2020] [Accepted: 01/27/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pulmonary endarterectomy (PEA) is a curative procedure for patients with chronic thromboembolic pulmonary hypertension. Body composition and exercise capacity have been associated with adverse outcomes in patients undergoing cardiothoracic surgeries, but their significance with PEA is unclear. We evaluated the association of body composition and 6-minute walk distance (6MWD) with disease severity, hospital length of stay, discharge disposition and post-operative functional recovery. METHODS Retrospective, single-center cohort study of patients who underwent PEA (Jan/2014-Dec/2017). Body composition (skeletal muscle mass and adiposity cross sectional area, body mass index) was quantified using thoracic computed tomography with Slice-O-Matic software. Association of body composition measures and 6MWD with clinical outcomes was evaluated using multivariable regression models. RESULTS 127 patients (58±14 years; 42% males, Body Mass Index: 31±7 kg/m2, 6MWD: 361±165 m) were included. Muscle and 6MWD were associated with disease severity measures. Of those surviving hospitalization (n=125), a greater 6MWD was associated with a shorter hospital stay (1.9 median days per 100m, p<0.001) and higher likelihood of being discharged directly home from hospital (OR: 2.1 per 100m, p= 0.004), independent of age, sex and body mass index. Those with a lower pre-operative 6MWD (per 100m) had a greater increase in their post-operative 6MWD (52m, p< 0.0001), independent of age, sex, and body mass index. Body composition measures were not associated with hospital outcomes or exercise capacity in the first-year post-operatively. CONCLUSIONS Exercise capacity was a more prognositc marker of PEA outcomes compared to body composition. Future research is needed to explore pre-PEA rehabilitation strategies.
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Affiliation(s)
| | - Marc de Perrot
- Dept of Medicine, University of Toronto; Thoracic Surgery, Chronic Thromboembolic Pulmonary Hypertension Program, University Health Network (UHN)
| | - Fatemeh Bavaghar-Zaeimi
- Thoracic Surgery, Chronic Thromboembolic Pulmonary Hypertension Program, University Health Network (UHN)
| | | | - John T Granton
- Dept of Medicine, University of Toronto; Respirology, Pulmonary Hypertension Program, UHN
| | - John Thenganatt
- Dept of Medicine, University of Toronto; Respirology, Pulmonary Hypertension Program, UHN
| | | | | | - Laura Donahoe
- Dept of Medicine, University of Toronto; Thoracic Surgery, Chronic Thromboembolic Pulmonary Hypertension Program, University Health Network (UHN)
| | - Dmitry Rozenberg
- Dept of Medicine, University of Toronto; Respirology, Lung Transplant Program, Toronto General Research Institute, UHN.
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Kawaguchi Y, Hanaoka J, Ohshio Y, Okamoto K, Kaku R, Hayashi K, Shiratori T, Akazawa A. Does sarcopenia affect postoperative short- and long-term outcomes in patients with lung cancer?-a systematic review and meta-analysis. J Thorac Dis 2021; 13:1358-1369. [PMID: 33841929 PMCID: PMC8024851 DOI: 10.21037/jtd-20-3072] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Lung cancer patients frequently suffer from sarcopenia, and reports on the association of resectable lung cancer and their postoperative outcomes are increasing. Information on whether sarcopenia has any impact on short- and long-term postoperative outcomes in patients surgically treated for non-small cell lung cancer remains insufficient. Furthermore, reports vary regarding the pathological stage, surgical procedure, diagnostic tool of sarcopenia, cut-off value, prognosis, and postoperative complications. We believe that sarcopenia assessment should be included as one of the factors which affect the surgical outcomes of lung cancer. Thus, we conducted a review and meta-analysis to ascertain the association between sarcopenia and postoperative outcomes. Methods We performed a systematic literature search in PubMed/MEDLINE. Studies included cases defined sarcopenia, received lung cancer surgery, assessed postoperative complications, and prognosis. The pooled odds ratios for survival and postoperative complications, with 95% confidence intervals, were generated using Review manager 5.3. Results A total of ten retrospective studies were eligible for this meta-analysis, including a total of 2,643 non-small cell lung cancer patients. All reviews used skeletal muscle mass as a diagnostic tool for sarcopenia. Sarcopenia was associated with worse survival outcomes and increased postoperative complications in patients with resected lung cancer. Conclusions Sarcopenia is an independent risk factor for postoperative death and postoperative complications in patients who have undergone surgery. It is necessary to explore the mechanism of sarcopenia and optimal intervention, such as exercise, nutrition, or drug therapy.
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Affiliation(s)
- Yo Kawaguchi
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Jun Hanaoka
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Yasuhiko Ohshio
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Keigo Okamoto
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Ryosuke Kaku
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Kazuki Hayashi
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Takuya Shiratori
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Akira Akazawa
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
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Miura A, Yamamoto H, Sato H, Tomioka Y, Shiotani T, Suzawa K, Miyoshi K, Otani S, Okazaki M, Sugimoto S, Yamane M, Toyooka S. The prognostic impact of sarcopenia on elderly patients undergoing pulmonary resection for non-small cell lung cancer. Surg Today 2021; 51:1203-1211. [PMID: 33559731 DOI: 10.1007/s00595-020-02221-1] [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: 09/14/2020] [Accepted: 11/22/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE The number of elderly patients who undergo surgery is increasing, even though they are at a high risk due to a decreased physical strength. Furthermore, sarcopenia is generally associated with a poor prognosis in patients with non-small cell lung cancer (NSCLC). METHODS This study included NSCLC patients ≥ 65 years old who underwent pulmonary resection in our hospital between 2012 and 2015. Sarcopenia was assessed using the psoas muscle mass index based on computed tomography at the level of the third lumbar vertebra. We elucidated the impact of sarcopenia on short- and long-term outcomes after surgery. RESULTS We enrolled 259 patients, including 179 with sarcopenia. Patients with sarcopenia before surgery tended to have postoperative complications (p = 0.0521), although they did not show a poor prognosis. In patients with sarcopenia, a multivariate analysis revealed that postoperative complications and the progression of sarcopenia 1 year after surgery were significant risk factors for a poor prognosis (p = 0.0169 and 0.00370, respectively). CONCLUSIONS The progression of sarcopenia after surgery is associated with a poor prognosis in elderly NSCLC patients with sarcopenia. A strategy to prevent postoperative progressive sarcopenia may be necessary for improving the clinical outcome of this population.
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Affiliation(s)
- Akihiro Miura
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Hiromasa Yamamoto
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan. .,Department of Thoracic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Hiroki Sato
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Yasuaki Tomioka
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.,Organ Transplant Center, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Toshio Shiotani
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.,Organ Transplant Center, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Ken Suzawa
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.,Department of Thoracic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Kentaroh Miyoshi
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.,Department of Thoracic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Shinji Otani
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.,Department of Thoracic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Mikio Okazaki
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.,Department of Thoracic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Seiichiro Sugimoto
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.,Organ Transplant Center, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Masaomi Yamane
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.,Department of Thoracic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Shinichi Toyooka
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.,Department of Thoracic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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22
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Kim EY, Kim YJ, Kim YS, Kim KW, Jeon JY, Kim KG. Prognostic significance of radiodensity-based skeletal muscle quantification using preoperative CT in resected non-small cell lung cancer. J Thorac Dis 2021; 13:754-761. [PMID: 33717547 PMCID: PMC7947473 DOI: 10.21037/jtd-20-2344] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Sarcopenia is associated with poor prognosis in lung cancer. Skeletal muscle area can be quantified based on radiodensity of CT scan. The purpose of this study was to evaluate the prognostic significance of radiodensity-based detailed skeletal muscle quantification on outcomes after surgery of non-small cell lung cancer (NSCLC). Methods Single cross-sectional area of the skeletal muscle (−29 to 150 HU) at the 3rd lumbar vertebra (L3) level retrospectively measured on preoperative CT for NSCLC patients (n=272), who underwent surgical resection during 2011 to 2016. The diagnosis of sarcopenia was made when a L3 muscle index (L3MI; L3 muscle area/height2) of less than 55 cm2/m2 for men and less than 39 cm2/m2 for women. Skeletal muscle was subsequently classified based on radiodensity level as low attenuation muscle (−29 to <30 HU) and high attenuation muscle (30 to 150 HU). Using a maximal-chi-squared test, low attenuation muscle accounted less than 24.5% of the total muscle, which was considered healthy muscle. Data on clinical characteristics (demographic information, TNM stage, histology) and prognosis (disease-free survival; DFS, and overall survival; OS) were collected. Results Sarcopenia was found 22.4% in preoperative CT (32.9% for men and 6.5% for women). The prevalence of patients with healthy muscle was 15.4% (21.3% for men and 6.5% for women). There was no significant difference between the 3-year DFS rate (77.0% vs. 67.0%, P=0.142) or 3-year OS rate (84.8% vs. 87.9%, P=0.576) between patients with and without sarcopenia. However, patients with healthy muscle tend to show longer 3-year DFS rate (79.4% vs. 67.2%, P=0.094) and 3-year OS rate (92.6% vs. 86.1%, P=0.176). In the multivariable analysis, healthy muscle was one of the independent prognosticators for a 3-year DFS rate (HR, 0.50, P=0.035), along with R1 resection (HR, 5.90, P<0.001), pathologic T stage (HR, 2.69, P<0.001), and pathologic N stage (HR, 2.43, P<0.001). Conclusions The proportion of low attenuation muscle was associated with DFS in resected lung cancer patients. Further investigation is needed to establish whether radiodensity-based detailed skeletal muscle quantification could be early biomarker to predict prognosis in NSCLC.
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Affiliation(s)
- Eun Young Kim
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Young Jae Kim
- Department of Biomedical Engineering, Gachon University College of Medicine, Incheon, Korea
| | - Young Saing Kim
- Department of Internal medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Kun Woo Kim
- Department of Thoracic and Cardiovascular Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Ji Young Jeon
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Kwang Gi Kim
- Department of Biomedical Engineering, Gachon University College of Medicine, Incheon, Korea
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23
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Mele MC, Rinninella E, Cintoni M, Pulcini G, Di Donato A, Grassi F, Trestini I, Pozzo C, Tortora G, Gasbarrini A, Bria E. Nutritional Support in Lung Cancer Patients: The State of the Art. Clin Lung Cancer 2020; 22:e584-e594. [PMID: 33303399 DOI: 10.1016/j.cllc.2020.10.008] [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: 06/16/2020] [Revised: 10/07/2020] [Accepted: 10/15/2020] [Indexed: 12/18/2022]
Abstract
Lung cancer (LC) represents the most commonly diagnosed neoplasm worldwide for both sexes and is the leading cause of cancer mortality. Malnutrition is a comorbidity frequently found in neoplastic patients, but it remains often underestimated and thus undertreated. In this review, we aimed to investigate the incidence of malnutrition among LC patients according to different screening and assessment tools, to evaluate the impact of weight loss and body composition on survival, and to analyze the efficacy of different nutritional interventions in this setting. Although malnutrition, weight loss, and body composition changes can affect survival and other clinical outcomes in LC patients, the role of nutritional interventions is not yet strongly proven, and further studies are recommended. Nevertheless, screening, assessing, and eventually treating malnutrition in LC patients are strongly recommended, according to the most recent nutritional intervention guidelines for oncology patients.
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Affiliation(s)
- Maria Cristina Mele
- UOSD di Nutrizione Avanzata in Oncologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emanuele Rinninella
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Cintoni
- Scuola di Specializzazione in Scienza dell'Alimentazione, Università di Roma Tor Vergata, Rome, Italy.
| | - Gabriele Pulcini
- UOSD di Nutrizione Avanzata in Oncologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Agnese Di Donato
- UOSD di Nutrizione Avanzata in Oncologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Futura Grassi
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Ilaria Trestini
- Oncologia Medica, Università di Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Carmelo Pozzo
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Oncologia Medica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giampaolo Tortora
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Oncologia Medica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Gasbarrini
- UOC di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emilio Bria
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Oncologia Medica, Università Cattolica del Sacro Cuore, Rome, Italy
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24
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Madariaga MLL, Troschel FM, Best TD, Knoll SJ, Gaissert HA, Fintelmann FJ. Low Thoracic Skeletal Muscle Area Predicts Morbidity After Pneumonectomy for Lung Cancer. Ann Thorac Surg 2020; 109:907-913. [DOI: 10.1016/j.athoracsur.2019.10.041] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 10/03/2019] [Accepted: 10/14/2019] [Indexed: 12/20/2022]
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25
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Ferguson MK, Mitzman B, Derstine B, Lee SM, Pienta MJ, Wang SC, Lin J. A Morphomic Index Is an Independent Predictor of Survival After Lung Cancer Resection. Ann Thorac Surg 2019; 109:873-878. [PMID: 31862495 DOI: 10.1016/j.athoracsur.2019.10.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 09/17/2019] [Accepted: 10/18/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Sarcopenia, visceral fat volume, and bone density have been associated with lung cancer survival. We developed a morphomic index based on computed tomographic measurements of these components, and assessed its relationship to survival after lung cancer resection. METHODS Patients who underwent lung cancer resection from 1995 to 2014 were evaluated. A morphomic index (range of 0 to 3) was developed as the sum of the scores for three body components-dorsal muscle area, vertebral trabecular bone density, and visceral fat area-measured at vertebral levels T10 to T12, with a point assigned to each component when in the lowest tercile. The relationship of the morphomic index to overall survival was assessed by the log rank test. Overall survival was assessed using Cox proportional hazards models adjusted for relevant covariates. RESULTS We included 944 patients (451 women; 48%). The mean age was 66.4 ± 10.3 years. Median follow-up was 4.5 years. Median survival was associated with the morphomic index scores on univariate analysis (P < .001). Morphomic index scores of 2 (P = .026) and 3 (P = .004) referenced to score 0 or 1 were independent predictors of survival on Cox regression analysis. CONCLUSIONS A morphomic index is an independent predictor of survival after lung cancer resection. The index may help in calibrating patient expectations and in shared decision making regarding lung cancer surgery.
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Affiliation(s)
- Mark K Ferguson
- Department of Surgery, University of Chicago, Chicago, Illinois.
| | - Brian Mitzman
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York
| | - Brian Derstine
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Sang Mee Lee
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Michael J Pienta
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Stewart C Wang
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Jules Lin
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
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26
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Kidd AC, Skrzypski M, Jamal-Hanjani M, Blyth KG. Cancer cachexia in thoracic malignancy: a narrative review. Curr Opin Support Palliat Care 2019; 13:316-322. [PMID: 31592847 DOI: 10.1097/spc.0000000000000465] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Thoracic malignancies are amongst the most lethal of all cancers. Cancer cachexia lacks unanimously accepted diagnostic criteria, and therefore is referenced to as a conceptual framework whereby cancer cachexia is 'an ongoing loss of skeletal muscle mass (termed sarcopenia), with or without loss of fat mass that cannot be reversed by conventional nutritional support and leads to progressive functional impairment'. This review summarises the current evidence base in this field, including imaging techniques currently used to define sarcopenia, inflammatory and metabolic changes associated with the syndrome and ongoing research into potential treatment strategies. RECENT FINDINGS Sarcopenia is a key component of the cancer cachexia syndrome. It is common in patients with both early-stage and advanced NSCLC. Patients with sarcopenia have more treatment-related side effects and poorer overall survival compared with nonsarcopenic patients. SUMMARY Early identification of cancer cachexia may facilitate stratification of patients most-at-risk and initiation of emerging anticachexia treatments. If these are proven to be effective, this strategy has the potential to improve tolerance to anti-cancer therapies, improving the quality of life, and perhaps the survival, of patients with thoracic malignancies.
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Affiliation(s)
- Andrew C Kidd
- Institute of Immunity, Infection and Inflammation, University of Glasgow
- Queen Elizabeth University Hospital, Glasgow
| | - Marcin Skrzypski
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Mariam Jamal-Hanjani
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London, UK
| | - Kevin G Blyth
- Institute of Immunity, Infection and Inflammation, University of Glasgow
- Queen Elizabeth University Hospital, Glasgow
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27
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Nishimura JM, Ansari AZ, D’Souza DM, Moffatt-Bruce SD, Merritt RE, Kneuertz PJ. Computed Tomography-Assessed Skeletal Muscle Mass as a Predictor of Outcomes in Lung Cancer Surgery. Ann Thorac Surg 2019; 108:1555-1564. [DOI: 10.1016/j.athoracsur.2019.04.090] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 04/18/2019] [Accepted: 04/22/2019] [Indexed: 12/24/2022]
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28
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Yang M, Shen Y, Tan L, Li W. Prognostic Value of Sarcopenia in Lung Cancer: A Systematic Review and Meta-analysis. Chest 2019; 156:101-111. [PMID: 31128115 DOI: 10.1016/j.chest.2019.04.115] [Citation(s) in RCA: 134] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 03/13/2019] [Accepted: 04/02/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Evidence regarding the association between sarcopenia (skeletal muscle depletion) and outcomes in patients with lung cancer varies across studies. We aimed to systematically review the prognostic value of sarcopenia in lung cancer. METHODS We searched Ovid MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials through July 23, 2018 to identify retrospective or prospective cohort studies. We applied the Quality in Prognostic Studies instrument to assess the risk of bias in individual studies. We examined the heterogeneity and publication bias and performed subgroup analyses and sensitivity analyses. RESULTS We included 13 studies (1,810 participants). The pooled prevalence of sarcopenia was 43% in patients with non-small cell lung cancer (NSCLC) and 52% in patients with small cell lung cancer (SCLC). Sarcopenia was associated with a shorter overall survival (OS) in patients with lung cancer (hazard ratio [HR], 2.23; 95% CI, 1.68-2.94). This association existed for both NSCLC (HR, 2.57; 95% CI, 1.79-3.68) and SCLC (HR, 1.59; 95% CI, 1.17-2.14). Sarcopenia was an independent predictor of shorter OS in both stage I-II NSCLC (HR, 3.23; 95% CI, 1.68-6.23) and stage III-IV NSCLC (HR, 2.19; 95% CI, 1.14-4.24). However, sarcopenia was not an independent predictor of disease-free survival in patients with NSCLC (HR, 1.28; 95% CI, 0.44-3.69). CONCLUSIONS Sarcopenia is highly prevalent in patients with lung cancer (approximately one in two) and an important predictor of impaired OS in patients with SCLC or with different stages of NSCLC.
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Affiliation(s)
- Ming Yang
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Yanjiao Shen
- Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Lingling Tan
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.
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29
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Deng HY, Zha P, Hou L, Huang KL. Does sarcopenia have any impact on survival of patients with surgically treated non-small-cell lung cancer? Interact Cardiovasc Thorac Surg 2019; 29:144-147. [PMID: 30843065 DOI: 10.1093/icvts/ivz039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 12/06/2018] [Accepted: 02/12/2019] [Indexed: 02/05/2023] Open
Affiliation(s)
- Han-Yu Deng
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Panpan Zha
- Department of Endocrinology, West China Hospital, Sichuan University, Chengdu, China
| | - Liang Hou
- Department of Thoracic and Cardiovascular Surgery, First Hospital Affiliated to Medical College of Shihezi University, Shihezi, China
| | - Kai-Li Huang
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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