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Aringhieri G, Astrea G, Marfisi D, Fanni SC, Marinella G, Pasquariello R, Ricci G, Sansone F, Sperti M, Tonacci A, Torri F, Matà S, Siciliano G, Neri E, Santorelli FM, Conte R. Convolutional Neural Network-Based Automated Segmentation of Skeletal Muscle and Subcutaneous Adipose Tissue on Thigh MRI in Muscular Dystrophy Patients. J Funct Morphol Kinesiol 2024; 9:123. [PMID: 39051284 DOI: 10.3390/jfmk9030123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 07/08/2024] [Accepted: 07/08/2024] [Indexed: 07/27/2024] Open
Abstract
We aim to develop a deep learning-based algorithm for automated segmentation of thigh muscles and subcutaneous adipose tissue (SAT) from T1-weighted muscle MRIs from patients affected by muscular dystrophies (MDs). From March 2019 to February 2022, adult and pediatric patients affected by MDs were enrolled from Azienda Ospedaliera Universitaria Pisana, Pisa, Italy (Institution 1) and the IRCCS Stella Maris Foundation, Calambrone-Pisa, Italy (Institution 2), respectively. All patients underwent a bilateral thighs MRI including an axial T1 weighted in- and out-of-phase (dual-echo). Both muscles and SAT were manually and separately segmented on out-of-phase image sets by a radiologist with 6 years of experience in musculoskeletal imaging. A U-Net1 and U-Net3 were built to automatically segment the SAT, all the thigh muscles together and the three muscular compartments separately. The dataset was randomly split into the on train, validation, and test set. The segmentation performance was assessed through the Dice similarity coefficient (DSC). The final cohort included 23 patients. The estimated DSC for U-Net1 was 96.8%, 95.3%, and 95.6% on train, validation, and test set, respectively, while the estimated accuracy for U-Net3 was 94.1%, 92.9%, and 93.9%. Both of the U-Nets achieved a median DSC of 0.95 for SAT segmentation. The U-Net1 and the U-Net3 achieved an optimal agreement with manual segmentation for the automatic segmentation. The so-developed neural networks have the potential to automatically segment thigh muscles and SAT in patients affected by MDs.
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Affiliation(s)
- Giacomo Aringhieri
- Department of Translational Research and New Technology in Medicine and Surgery, Academic Radiology, University of Pisa, 56126 Pisa, Italy
| | - Guja Astrea
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, 56128 Pisa, Italy
| | - Daniela Marfisi
- Institute of Clinical Physiology, National Research Council of Italy (IFC-CNR), 56124 Pisa, Italy
| | - Salvatore Claudio Fanni
- Department of Translational Research and New Technology in Medicine and Surgery, Academic Radiology, University of Pisa, 56126 Pisa, Italy
| | - Gemma Marinella
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, 56128 Pisa, Italy
| | - Rosa Pasquariello
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, 56128 Pisa, Italy
| | - Giulia Ricci
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Francesco Sansone
- Institute of Clinical Physiology, National Research Council of Italy (IFC-CNR), 56124 Pisa, Italy
| | - Martina Sperti
- Department of Neurology, Careggi University Hospital, University of Florence, 50134 Florence, Italy
| | - Alessandro Tonacci
- Institute of Clinical Physiology, National Research Council of Italy (IFC-CNR), 56124 Pisa, Italy
| | - Francesca Torri
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Sabrina Matà
- SOD Neurologia 1, Dipartimento Neuromuscolo-Scheletrico e Degli Organi di Senso, Azienda Ospedaliera Universitaria Careggi, 50134 Florence, Italy
| | - Gabriele Siciliano
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Emanuele Neri
- Department of Translational Research and New Technology in Medicine and Surgery, Academic Radiology, University of Pisa, 56126 Pisa, Italy
| | | | - Raffaele Conte
- Institute of Clinical Physiology, National Research Council of Italy (IFC-CNR), 56124 Pisa, Italy
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Chan WL, Yun HKB, Cheung EE, Liu M, Hou LY, Lam KO, Wong IYH, Chiu WHK, Law S, Kwong D. Association of sarcopenia with severe chemotherapy toxicities and survival in patients with advanced gastric cancer. Oncologist 2024:oyae123. [PMID: 38885304 DOI: 10.1093/oncolo/oyae123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/01/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Sarcopenia or skeletal muscle depletion is a poor prognostic factor for gastric cancer (GC). However, existing cutoff values of skeletal muscle index (SMI) for defining sarcopenia have been found to have limitations when clinically applied. This study aimed to determine the optimal cutoff for SMI to predict severe toxicities of chemotherapy and overall survival (OS) in patients with advanced GC. METHODS Patients with metastatic gastric adenocarcinoma who received first-line palliative chemotherapy between January 2014 and December 2021 at Queen Mary Hospital, Hong Kong, were included in this study. The SMI was determined via a pre-chemotherapy computed tomography scan. Optimal cutoff points of SMI were identified by recursive partitioning analysis. Univariate and multivariate analyses evaluating risk factors of severe chemotherapy toxicities and OS were also performed. RESULTS A total of 158 patients (male: 108 (68.4%), median age: 65.3) were included. The SMI cutoff to define low SMI was ≤33 cm2/m2 for males and ≤28 cm2/m2 for females; 30 patients (19.0%) had low SMI. Patients with low SMI had a higher incidence of hematological toxicities (63.3% vs 32.0%, P = .001) and non-hematological toxicities (66.7% vs 36.7%, P = .003). Multivariable analysis indicated that low SMI and low serum albumin (≤28 g/L) were independent predictive factors of hematological toxicity, while low SMI and neutrophil-lymphocyte ratio ≥5 were predictive factors of non-hematological toxicity. Moreover, patients with low SMI had a significantly shorter OS (P = .011), lower response rate to chemotherapy (P = .045), and lower utilization of subsequent lines of treatment (P < .001). CONCLUSIONS Using pre-chemotherapy SMI cutoff (≤33 cm2/m2 for males and 28 cm2/m2 for females) one can identify individuals with a higher risk of severe chemotherapy toxicities and worse prognosis.
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Affiliation(s)
- Wing-Lok Chan
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Ho-Kwan Bryan Yun
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Emina Edith Cheung
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Michelle Liu
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Li-Yu Hou
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Ka-On Lam
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Ian Yu-Hong Wong
- Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | | | - Simon Law
- Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Dora Kwong
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
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Yi J, Hahn S, Oh K, Lee YH. Sarcopenia prediction using shear-wave elastography, grayscale ultrasonography, and clinical information with machine learning fusion techniques: feature-level fusion vs. score-level fusion. Sci Rep 2024; 14:2769. [PMID: 38307965 PMCID: PMC10837421 DOI: 10.1038/s41598-024-52614-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/21/2024] [Indexed: 02/04/2024] Open
Abstract
This study aimed to develop and evaluate a sarcopenia prediction model by fusing numerical features from shear-wave elastography (SWE) and gray-scale ultrasonography (GSU) examinations, using the rectus femoris muscle (RF) and categorical/numerical features related to clinical information. Both cohorts (development, 70 healthy subjects; evaluation, 81 patients) underwent ultrasonography (SWE and GSU) and computed tomography. Sarcopenia was determined using skeletal muscle index calculated from the computed tomography. Clinical and ultrasonography measurements were used to predict sarcopenia based on a linear regression model with the least absolute shrinkage and selection operator (LASSO) regularization. Furthermore, clinical and ultrasonography features were combined at the feature and score levels to improve sarcopenia prediction performance. The accuracies of LASSO were 70.57 ± 5.00-81.54 ± 4.83 (clinical) and 69.00 ± 4.52-69.73 ± 5.47 (ultrasonography). Feature-level fusion of clinical and ultrasonography (accuracy, 70.29 ± 6.63 and 83.55 ± 4.32) showed similar performance with clinical features. Score-level fusion by AdaBoost showed the best performance (accuracy, 73.43 ± 6.57-83.17 ± 5.51) in the development and evaluation cohorts, respectively. This study might suggest the potential of machine learning fusion techniques to enhance the accuracy of sarcopenia prediction models and improve clinical decision-making in patients with sarcopenia.
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Affiliation(s)
- Jisook Yi
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Seok Hahn
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Kangrok Oh
- Department of Radiology, Research Institute of Radiological Science, and Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, South Korea.
| | - Young Han Lee
- Department of Radiology, Research Institute of Radiological Science, and Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, South Korea.
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Shah R, Polen-De C, McGree M, Fought A, Kumar A. Re-Evaluating Chemotherapy Dosing Strategies for Ovarian Cancer: Impact of Sarcopenia. Curr Oncol 2023; 30:9501-9513. [PMID: 37999108 PMCID: PMC10670337 DOI: 10.3390/curroncol30110688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/25/2023] Open
Abstract
We investigated the impact of sarcopenia on adjuvant chemotherapy dosing in advanced epithelial ovarian cancer (EOC). The chemotherapy dosing and toxicity of 173 eligible patients who underwent cytoreductive surgery and adjuvant chemotherapy at a single institution were analyzed. Patients with a skeletal muscle index less than 39 cm2/m2 measured on a CT scan were considered sarcopenic. Sarcopenic and non-sarcopenic patients were compared with regard to relative dose intensity (RDI), completion of scheduled chemotherapy, toxicity, and survival. A total of 62 (35.8%) women were sarcopenic. Sarcopenic women were less likely to complete at least six cycles of chemotherapy (83.9% vs. 95.5%, p = 0.02). The mean RDI for both carboplatin (80.4% vs. 89.4%, p = 0.03) and paclitaxel (91.9% vs. 104.1%, p = 0.03) was lower in sarcopenic patients compared to non-sarcopenic patients. Despite these differences in chemotherapy, there was no difference in neutropenia or median overall survival (3.99 vs. 4.57 years, p = 0.62) between the sarcopenic and non-sarcopenic women, respectively. This study highlights the importance of considering lean body mass instead of body weight or surface area in chemotherapy dosing formulas for sarcopenic women with advanced EOC. Further research is needed to optimize chemotherapy strategies based on individual body composition, potentially leading to improved dosing strategies in this population.
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Affiliation(s)
- Rushi Shah
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN 55905, USA;
| | - Clarissa Polen-De
- Department of Gynecologic Oncology, Summa Health, Akron, OH 44304, USA;
| | - Michaela McGree
- Department of Quantitative Health Sciences, Division Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN 55905, USA; (M.M.); (A.F.)
| | - Angela Fought
- Department of Quantitative Health Sciences, Division Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN 55905, USA; (M.M.); (A.F.)
| | - Amanika Kumar
- Department of Obstetrics and Gynecology, Division of Gynecological Surgery, Mayo Clinic, Rochester, MN 55905, USA
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Xie K, He D, Zhao T, Liu T, Tang M. Gastric Cancer with Sarcopenia: an Area Worth Focusing On. Curr Treat Options Oncol 2023; 24:1305-1327. [PMID: 37464229 DOI: 10.1007/s11864-023-01122-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 07/20/2023]
Abstract
OPINION STATEMENT Gastric cancer (GC) is the fifth most common cancer and the third leading cause of cancer death worldwide, which seriously endangers human health. A number of studies have shown that sarcopenia occurs more frequently in patients with gastric cancer than in the general population and can significantly affect the disease status and survival of patients, which is of great significance in predicting the prognosis of gastric cancer. Patients with gastric cancer may suffer sarcopenia no matter before or after surgery, and the pathogenesis is complex. Abnormal nutrient metabolism and reduced exercise are the leading causes. In addition, surgical treatment and chemotherapy for gastric cancer might participate in the physiological and pathological mechanism of sarcopenia. Generally speaking, exercise and nutritional therapy are the main prevention and treatment methods for sarcopenia. But more prospective evidence is needed to establish reasonable interventions, and other drug treatments are in their infancy. For the diagnostic criteria of sarcopenia, the cut-off values of the skeletal muscle mass index obtained from CT images vary widely and need to be standardized and unified. We also need to explore simple predictors to facilitate sarcopenia risk assessment. More research is needed to formulate more appropriate treatments for gastric cancer patients with sarcopenia.
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Affiliation(s)
- Kaiqiang Xie
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- The Hunan Institute of Pharmacy Practice and Clinical Research, Changsha, 410008, China
- Institute of Hospital Pharmacy, Central South University, Changsha, 410008, China
| | - Danling He
- Xiangya School of Pharmaceutical Sciences, Central South University, Changsha, 410008, China
| | - Tingyu Zhao
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- The Hunan Institute of Pharmacy Practice and Clinical Research, Changsha, 410008, China
- Institute of Hospital Pharmacy, Central South University, Changsha, 410008, China
| | - Ting Liu
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- The Hunan Institute of Pharmacy Practice and Clinical Research, Changsha, 410008, China
- Institute of Hospital Pharmacy, Central South University, Changsha, 410008, China
| | - Mimi Tang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
- The Hunan Institute of Pharmacy Practice and Clinical Research, Changsha, 410008, China.
- Institute of Hospital Pharmacy, Central South University, Changsha, 410008, China.
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Park SE, Kim DH, Kim DK, Ha JY, Jang JS, Choi JH, Hwang IG. Feasibility and safety of exercise during chemotherapy in people with gastrointestinal cancers: a pilot study. Support Care Cancer 2023; 31:561. [PMID: 37668738 PMCID: PMC10480261 DOI: 10.1007/s00520-023-08017-6] [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: 12/07/2022] [Accepted: 08/23/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE Sarcopenia is a poor prognostic factor in cancer patients, and exercise is one of the treatments to improve sarcopenia. However, there is currently insufficient evidence on whether exercise can improve sarcopenia in patients with advanced cancers. This study examined the feasibility of exercise in advanced gastrointestinal (GI) cancer patients treated with palliative chemotherapy. METHODS Between 2020 and 2021, 30 patients were enrolled in a resistance and aerobic exercise program for six weeks. The exercise intervention program (EIP) consisted of low, moderate, and high intensity levels. Patients were asked to select the intensity level according to their ability. The primary endpoint was the feasibility of the EIP measured by compliance during the six weeks. A compliance of over 50% was considered acceptable. The secondary endpoints were changes in weight and muscle mass, safety, quality of life (QoL) and overall survival (OS). RESULTS The median age of the study's participants was 60 (30-77). The total compliance to the EIP was 63.3% (19/30 patients). Sixteen (53.3%) patients had a compliance of over 80%. The attrition rate was 30.0% (9/30). The mean exercise time was 41.4 min, and the aerobic exercise was 92.3% and the resistant exercise was 73.7%, and both exercise was 66.5%. Most patients performed the moderate intensity level exercises at home or near their home. The mean skeletal muscle index (SMI) was 43.5 cm2/m2 pre-chemotherapy and 42.2 cm2/m2 after six weeks of chemotherapy, with a decrease of -1.2 ± 2.8 cm2/m2 (-3.0%) (p = 0.030). In the poor compliance group, the mean SMI decrease was -2.8 ± 3.0 cm2/m2 which was significantly different (p = 0.033); however, in the good compliance group, the mean SMI decrease was -0.5 ± 2.5 cm2/m2 which was maintained over the six weeks (p = 0.337). The good compliance group had a significantly longer median OS compared with the poor compliance group (25.3 months vs. 7.9 months, HR = 0.306, 95% CI = 0.120-0.784, p = 0.014). The QoL showed a better score for insomnia (p = 0.042). There were no serious adverse events. CONCLUSIONS The EIP during palliative chemotherapy in advanced GI cancer patients showed good compliance. In the good compliance group, muscle mass and physical functions were maintained for six weeks. The EIP was safe, and the QoL was maintained. Based on this study, further research in exercise intervention in advanced cancer patients is needed. CLINICAL TRIAL REGISTRATION The clinical trial registration number is KCT 0005615 (CRIS, https://cris.nih.go.kr/cris/en/ ); registration date, 23rd Nov 2020.
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Affiliation(s)
- Song Ee Park
- Department of Internal Medicine, Chung-Ang University Gwang-Myeong Hospital, Chung-Ang University College of Medicine, Seoul, Korea
- Chung-Ang University Integrated Oncology and Palliative Care Research Institute, Seoul, Korea
| | - Du Hwan Kim
- Chung-Ang University Integrated Oncology and Palliative Care Research Institute, Seoul, Korea
- Department of Rehabilitation Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Don-Kyu Kim
- Department of Rehabilitation Medicine, Chung-Ang University Gwang-Myeong Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Joo Young Ha
- Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Joung-Soon Jang
- Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu Gyuonggido, Korea
| | - Jin Hwa Choi
- Chung-Ang University Integrated Oncology and Palliative Care Research Institute, Seoul, Korea.
- Department of Radiation Oncology, Chung-Ang University College of Medicine, 84 Heukseok-Ro, Dongjak-Gu, Seoul, 06973, South Korea.
| | - In Gyu Hwang
- Chung-Ang University Integrated Oncology and Palliative Care Research Institute, Seoul, Korea.
- Department of Internal Medicine, Chung-Ang University College of Medicine, 84 Heukseok-Ro, Dongjak-Gu, Seoul, 06973, South Korea.
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Han Y, Wu J, Ji R, Tan H, Tian S, Yin J, Xu J, Chen X, Liu W, Cui H. Preoperative sarcopenia combined with prognostic nutritional index predicts long-term prognosis of radical gastrectomy with advanced gastric cancer: a comprehensive analysis of two-center study. BMC Cancer 2023; 23:751. [PMID: 37580693 PMCID: PMC10424379 DOI: 10.1186/s12885-023-11251-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/03/2023] [Indexed: 08/16/2023] Open
Abstract
PURPOSE This study aims to investigate the predictive value of the combined index smni(skeletal muscle index (SMI)-prognostic nutrition index(PNI)) for the postoperative survival of patients with advanced gastric cancer(AGC). METHODS 650 patients with AGC from two centers (290 cases from the First Affiliated Hospital of Dalian University and 360 points from the Fujian Medical University Union Hospital) were selected as the study subjects based on unified screening criteria. Clinical data, preoperative abdominal CT images, results of hematology-related examinations, tumor-related characteristics, and surgical and follow-up data of the patients were collected and organized. The L3 vertebral level muscle area was measured using computer-assisted measurement techniques, and the skeletal muscle index(SMI) was calculated based on this measurement. The prognostic nutrition index (PNI) was calculated based on serum albumin and lymphocyte count indicators. The Kaplan-Meier survival analysis of data from the First Affiliated Hospital was used to determine that SMI and PNI are significantly correlated with the postoperative survival rate of patients with advanced gastric cancer. Based on this, a novel combined index smni was fitted and stratified for risk. Cox proportional hazards regression analysis was used to determine that the index smni is an independent prognostic risk factor for patients with AGC after surgery. The ROC curve was used to describe the predictive ability of the new combined index and its importance and predictive power in predicting postoperative survival of patients with AGC, which was verified in the data of Fujian Medical University Union Hospital. RESULT The Kaplan-Meier curve analysis of the combined indicator smni Is clearly associated with long-term survival(3-year OS (P < 0.001) and DSS (P < 0.001)), univariate analysis and multivariate analysis showed that smni was an independent prognostic risk factor, The ROC curve for the first center 3-year OS(AUC = 0.678), DSS(AUC = 0.662) show good predictive ability and were validated in the second center. CONCLUSION The combined index smni has a good predictive ability for the postoperative survival rate of patients with AGC and is expected to provide a new reference basis and more accurate and scientific guidance for the postoperative management and treatment of patients with AGC.
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Affiliation(s)
- Yubo Han
- Department of General Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Ju Wu
- Fujian Medical University Union Hospital, Department of Gastric Surgery, Fuzhou, China
| | - Rui Ji
- Department of General Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Hao Tan
- Department of General Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Simiao Tian
- Department of Medical Record and Statistics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Jiajun Yin
- Department of General Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Jian Xu
- Department of General Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Xi Chen
- Department of General Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Wenfei Liu
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China.
| | - Hongzhang Cui
- Department of General Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, China.
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Wang Y, Li L, Pan Q, Zhong Y, Zou X. Psoas Muscle Morphology as a Sarcopenia Marker to Predict Outcomes of Geriatric Trauma Patients: A Systematic Review and Meta-analysis. Geriatr Orthop Surg Rehabil 2023; 14:21514593231195244. [PMID: 37581175 PMCID: PMC10423450 DOI: 10.1177/21514593231195244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/16/2023] Open
Abstract
Objective To provide pooled evidence on the association between central sarcopenia and risk of mortality and/or complications among geriatric patients with moderate to severe trauma. Methods We conducted a systematic search in PubMed, EMBASE, and Scopus databases for relevant observational studies documenting the association of central sarcopenia with the risk of mortality and/or complications in geriatric patients with moderate to severe trauma. The studies reported computerized tomography (CT) based assessments of the psoas muscle cross-sectional area. We used a random effects model for the analysis and reported effect sizes as pooled odds ratios (ORs) or hazards ratios (HRs) along with 95% confidence intervals. Results We analyzed data from 13 studies and found an association between the presence of psoas muscle size reduction and the risk of in-hospital mortality (OR, 1.47; 95% CI, 1.13, 1.90). In addition, we found increased risk of mortality within 24 months of follow-up in patients with sarcopenia (HR, 2.40; 95% CI, 1.11-5.17). We found each unit increase in psoas muscle cross-sectional area to be significantly associated with reduced risk of mortality within 24 months of follow-up (HR, .92; 95% CI, .90-.95). Patients with sarcopenia also had an increased risk of complications (OR, 1.69; 95% CI, 1.08-2.63). Conclusion Central sarcopenia, assessed using psoas muscle morphology, among geriatric patients with moderate to severe trauma appears to be significantly associated with increased risks of mortality and complications.
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Affiliation(s)
- Yang Wang
- Respiratory Digestive Geriatrics, Huzhou Third People’s Hospital, Huzhou, China
| | - Lei Li
- Respiratory Digestive Geriatrics, Huzhou Third People’s Hospital, Huzhou, China
| | - Qinmei Pan
- Respiratory Digestive Geriatrics, Huzhou Third People’s Hospital, Huzhou, China
| | - Ying Zhong
- Respiratory Digestive Geriatrics, Huzhou Third People’s Hospital, Huzhou, China
| | - Xinmei Zou
- Respiratory Digestive Geriatrics, Huzhou Third People’s Hospital, Huzhou, China
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Ghidini M, Hochster H, Doi T, Van Cutsem E, Makris L, Takahashi O, Benhadji KA, Mansoor W. Body weight loss as a prognostic and predictive factor in previously treated patients with metastatic gastric cancer: post hoc analyses of the randomized phase III TAGS trial. Gastric Cancer 2023; 26:626-637. [PMID: 37106214 PMCID: PMC10284730 DOI: 10.1007/s10120-023-01393-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Body weight loss (BWL) is a negative prognostic factor in metastatic gastric or gastroesophageal junction cancer (mGC/GEJC). In the phase III TAGS study, trifluridine/tipiracil improved survival versus placebo in third- or later-line mGC/GEJC. These retrospective analyses examined the association of early BWL with survival outcomes in TAGS. METHODS Efficacy and safety were assessed in patients who experienced < 3% or ≥ 3% BWL from treatment start until day 1 of cycle 2 (early BWL). The effect of early BWL on overall survival (OS) was assessed by univariate and multivariate analyses. RESULTS Body weight data were available for 451 of 507 (89%) patients in TAGS. In the trifluridine/tipiracil and placebo arms, respectively, 74% (224/304) and 65% (95/147) experienced < 3% BWL, whereas 26% (80/304) and 35% (52/147) experienced ≥ 3% BWL at cycle 1 end. Median OS was longer in < 3% BWL versus ≥ 3% BWL subgroups (6.5 vs 4.9 months for trifluridine/tipiracil; 6.0 vs 2.5 months for placebo). In univariate analyses, an unadjusted HR of 0.58 (95% CI, 0.46-0.73) for the < 3% vs ≥ 3% BWL subgroup indicated a strong prognostic effect of early BWL. Multivariate analyses confirmed early BWL as both prognostic (P < 0.0001) and predictive (interaction P = 0.0003) for OS. Similar results were obtained for progression-free survival. Any-cause grade ≥ 3 adverse events were reported in 77% and 82% of trifluridine/tipiracil-treated and 45% and 67% of placebo-treated patients with < 3% and ≥ 3% BWL, respectively. CONCLUSIONS In TAGS, early BWL was a strong negative prognostic factor for OS in patients with mGC/GEJC receiving third- or later-line treatment.
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Affiliation(s)
- Michele Ghidini
- Oncology Division, Azienda Socio Sanitaria Territoriale di Cremona, Azienda Ospedaliera di Cremona, Viale Concordia 1, 26100, Cremona, Italy.
| | - Howard Hochster
- Gastrointestinal Oncology, Rutgers Cancer Institute, New Brunswick, NJ, USA
| | - Toshihiko Doi
- Department of Experimental Therapeutics, National Cancer Center Hospital East, Chiba, Japan
| | - Eric Van Cutsem
- Digestive Oncology, University Hospitals Gasthuisberg, Leuvain, Belgium
| | | | | | | | - Wasat Mansoor
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
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10
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Choi EJ, Baek DH, Lee HS, Song GA, Kim TO, Park YE, Lee CM, Lee JH. The effect of biological agent on body composition in patients with Crohn's disease. BMC Gastroenterol 2023; 23:100. [PMID: 36997863 PMCID: PMC10064761 DOI: 10.1186/s12876-023-02742-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 03/23/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Crohn's disease (CD) is associated with altered body composition, affecting clinical outcomes. We evaluated the impact of biologics on body composition in CD patients. METHODS This multicenter longitudinal study across four Korean university hospitals conducted from January 2009 to August 2021 retrospectively reviewed data of CD patients with abdominal computed tomography (CT) before and after the biologic treatment. Skeletal muscle area (SMA), visceral fat area (VFA), and subcutaneous fat area (SFA) of the third lumbar vertebra (L3) on CT were measured. Myopenia was defined as L3 skeletal muscle index (SMI) of < 49 and < 31 cm2/m2 for men and women, respectively. RESULTS Among 112 participants, 79 (70.5%) had myopenia. In the myopenia group, all body composition parameters were significantly increased after the biologic treatment: SMI (37.68 vs. 39.40 cm2/m2; P < 0.001), VFA (26.12 vs. 54.61 cm2; P < 0.001), SFA (44.29 vs. 82.42 cm2; P < 0.001), while no significant differences were observed in the non-myopenia group. In multivariate analysis, penetrating CD (hazard ratio, 5.40; P = 0.020) was the independent prognostic factor for surgery. Operation-free survival rate tended to decrease in the myopenia group (Log-rank test, P = 0.090). CONCLUSIONS Biological agents can increase all body composition parameters in CD patients with myopenia. These patients are more likely to experience surgery.
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Affiliation(s)
- Eun Jeong Choi
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-Ro, Busanjin-Gu, Busan, 47392, Korea
| | - Dong Hoon Baek
- Department of Internal Medicine, Pusan National University College of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hong Sub Lee
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-Ro, Busanjin-Gu, Busan, 47392, Korea.
| | - Geun Am Song
- Department of Internal Medicine, Pusan National University College of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Tae Oh Kim
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Yong Eun Park
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Chang Min Lee
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Jong Hoon Lee
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
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11
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Couderc AL, Liuu E, Boudou-Rouquette P, Poisson J, Frelaut M, Montégut C, Mebarki S, Geiss R, ap Thomas Z, Noret A, Pierro M, Baldini C, Paillaud E, Pamoukdjian F. Pre-Therapeutic Sarcopenia among Cancer Patients: An Up-to-Date Meta-Analysis of Prevalence and Predictive Value during Cancer Treatment. Nutrients 2023; 15:nu15051193. [PMID: 36904192 PMCID: PMC10005339 DOI: 10.3390/nu15051193] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/18/2023] [Accepted: 02/21/2023] [Indexed: 03/08/2023] Open
Abstract
This study will address the prevalence of pre-therapeutic sarcopenia (PS) and its clinical impact during cancer treatment among adult cancer patients ≥ 18 years of age. A meta-analysis (MA) with random-effect models was performed via a MEDLINE systematic review, according to the PRISMA statement, focusing on articles published before February 2022 that reported observational studies and clinical trials on the prevalence of PS and the following outcomes: overall survival (OS), progression-free survival (PFS), post-operative complications (POC), toxicities (TOX), and nosocomial infections (NI). A total of 65,936 patients (mean age: 45.7-85 y) with various cancer sites and extensions and various treatment modes were included. Mainly defined by CT scan-based loss of muscle mass only, the pooled prevalence of PS was 38.0%. The pooled relative risks were 1.97, 1.76, 2.70, 1.47, and 1.76 for OS, PFS, POC, TOX, and NI, respectively (moderate-to-high heterogeneity, I2: 58-85%). Consensus-based algorithm definitions of sarcopenia, integrating low muscle mass and low levels of muscular strength and/or physical performance, lowered the prevalence (22%) and heterogeneity (I2 < 50%). They also increased the predictive values with RRs ranging from 2.31 (OS) to 3.52 (POC). PS among cancer patients is prevalent and strongly associated with poor outcomes during cancer treatment, especially when considering a consensus-based algorithm approach.
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Affiliation(s)
- Anne-Laure Couderc
- Internal Medicine Geriatrics and Therapeutic Unit, APHM, 13009 Marseille, France
- CNRS, EFS, ADES, Aix-Marseille University, 13015 Marseille, France
| | - Evelyne Liuu
- Department of Geriatrics, CHU Poitiers, 86000 Poitiers, France
- CIC1402 INSERM Unit, Poitiers University Hospital, 86000 Poitiers, France
| | - Pascaline Boudou-Rouquette
- Ariane Program, Department of Medical Oncology, Cochin Hospital, Paris Cancer Institute CARPEM, APHP, 75014 Paris, France
- INSERM U1016-CNRS UMR8104, Cochin Institute, Paris Cancer Institute CARPEM, Paris Cité University, 75015 Paris, France
| | - Johanne Poisson
- Department of Geriatrics, Georges Pompidou European Hospital, Paris Cancer Institute CARPEM, APHP, 75015 Paris, France
- Faculty of Health, Paris Cité University, 75006 Paris, France
| | - Maxime Frelaut
- Department of Medical Oncology, Gustave Roussy Institute, 94805 Villejuif, France
| | - Coline Montégut
- Internal Medicine Geriatrics and Therapeutic Unit, APHM, 13009 Marseille, France
- Coordination Unit for Geriatric Oncology (UCOG), PACA West, 13009 Marseille, France
| | - Soraya Mebarki
- Department of Geriatrics, Georges Pompidou European Hospital, Paris Cancer Institute CARPEM, APHP, 75015 Paris, France
| | - Romain Geiss
- Department of Medical Oncology, Curie Institute, 92210 Saint-Cloud, France
| | - Zoé ap Thomas
- Department of Cancer Medicine, Gustave Roussy Institute, 94805 Villejuif, France
| | - Aurélien Noret
- Department of Geriatrics, Georges Pompidou European Hospital, Paris Cancer Institute CARPEM, APHP, 75015 Paris, France
| | - Monica Pierro
- Department of Geriatrics, Georges Pompidou European Hospital, Paris Cancer Institute CARPEM, APHP, 75015 Paris, France
| | - Capucine Baldini
- Drug Development Department, Gustave Roussy Institute, 94805 Villejuif, France
| | - Elena Paillaud
- Department of Geriatrics, Georges Pompidou European Hospital, Paris Cancer Institute CARPEM, APHP, 75015 Paris, France
- INSERM, IMRB, Clinical, Epidemiology and Ageing, Université Paris-Est Creteil, 94010 Creteil, France
| | - Frédéric Pamoukdjian
- Department of Geriatrics, Avicenne Hospital, APHP, 93000 Bobigny, France
- INSERM UMR_S942 Cardiovascular Markers in Stressed Conditions MASCOT, Sorbonne Paris Nord University, 93000 Bobigny, France
- Correspondence:
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12
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Aduse-Poku L, Karanth SD, Wheeler M, Yang D, Washington C, Hong YR, Manini TM, Fabregas JC, Cheng TYD, Braithwaite D. Associations of Total Body Fat Mass and Skeletal Muscle Index with All-Cause and Cancer-Specific Mortality in Cancer Survivors. Cancers (Basel) 2023; 15:1081. [PMID: 36831420 PMCID: PMC9953880 DOI: 10.3390/cancers15041081] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
Purpose: The importance of body composition on cancer outcomes is of great clinical interest. Measures of body composition that differentiate fat mass from skeletal muscle mass can help redefine our understanding of body composition for cancer survival. We investigated whether the risk of all-cause and cancer-specific mortality differ by levels of total fat mass and sarcopenia status in cancer survivors. Our secondary aim was a subgroup analysis assessing the role of race within these associations. Methods: Participants included 1682 adult cancer survivors who had undergone a dual-energy X-ray absorptiometry (DXA) examination to measure body composition, from the 1999-2006 and 2011-2018 National Health and Nutrition Examination Survey (NHANES). Total fat mass was categorized into tertiles (we assessed high vs. low tertiles), and sarcopenia was considered as having an appendicular skeletal muscle mass index less than 7.26 kg/m2 for males and less than 5.45 kg/m2 for females. Multivariable Cox proportional hazard models estimated the adjusted hazard ratio (aHR) and 95% confidence interval (CI). Results: The mean age of study participants was 61.9 years, and they were followed up for an average of 9.67 years. The prevalence of sarcopenia was 25.0% (N = 304), and 33.4% (N = 561) had a high total fat mass. Participants with a higher fat mass (aHR = 1.30, 95% CI = 1.06-1.61) and with sarcopenia (aHR = 1.51, 95% CI = 1.22-1.88) had a 30% and 51% increased risk of all-cause mortality compared to participants with a low fat mass and with no sarcopenia, respectively. Further, sarcopenia (aHR = 1.74, 95% CI = 1.23-2.29) was associated with a higher risk of cancer-specific mortality in cancer survivors. The association between sarcopenia and all-cause mortality was twice as strong in Black people (aHR = 2.99, 95% CI = 1.39-6.06) compared to White people (aHR = 1.53, 95% CI = 1.19-1.95). Conclusions: Our findings show the opposing relations of fat mass and appendicular skeletal muscle mass index with mortality in a national sample of cancer survivors, and that the relationships may differ by race. These results emphasize the importance of maintaining a healthy body composition among cancer survivors.
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Affiliation(s)
- Livingstone Aduse-Poku
- Department of Epidemiology, University of Florida, 2004 Mowry Rd., Gainesville, FL 32610, USA
| | - Shama D. Karanth
- University of Florida Health Cancer Center, University of Florida, 2004 Mowry Rd., Gainesville, FL 32610, USA
- Aging & Geriatric Research, Institute on Aging, 2004 Mowry Rd., Gainesville, FL 32610, USA
| | - Meghann Wheeler
- Department of Epidemiology, University of Florida, 2004 Mowry Rd., Gainesville, FL 32610, USA
| | - Danting Yang
- Department of Epidemiology, University of Florida, 2004 Mowry Rd., Gainesville, FL 32610, USA
| | - Caretia Washington
- Department of Epidemiology, University of Florida, 2004 Mowry Rd., Gainesville, FL 32610, USA
| | - Young-Rock Hong
- Department of Health Services Research, Management, & Policy, 1225 Center Dr., Gainesville, FL 32610, USA
| | - Todd M. Manini
- Department Health Outcomes & Biomedical Informatics, Institute on Aging, 2004 Mowry Rd., Gainesville, FL 32611, USA
| | - Jesus C. Fabregas
- Division of Hematology & Oncology, College of Medicine, University of Florida, 2000 SW Archer Rd., Gainesville, FL 32608, USA
| | - Ting-Yuan David Cheng
- Division of Cancer Prevention and Control, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Dejana Braithwaite
- Department of Epidemiology, University of Florida, 2004 Mowry Rd., Gainesville, FL 32610, USA
- University of Florida Health Cancer Center, University of Florida, 2004 Mowry Rd., Gainesville, FL 32610, USA
- Department of Surgery, University of Florida, 1600 SW Archer Rd., Gainesville, FL 32608, USA
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13
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CT-derived body composition measurements as predictors for neoadjuvant treatment tolerance and survival in gastroesophageal adenocarcinoma. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:211-219. [PMID: 36209446 DOI: 10.1007/s00261-022-03695-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/21/2022] [Accepted: 09/26/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE Treatment for gastroesophageal adenocarcinomas can result in significant morbidity and mortality. The purpose of this study is to supplement methods for choosing treatment strategy by assessing the relationship between CT-derived body composition, patient, and tumor features, and clinical outcomes in this population. METHODS Patients with neoadjuvant treatment, biopsy-proven gastroesophageal adenocarcinoma, and initial staging CTs were retrospectively identified from institutional clinic encounters between 2000 and 2019. Details about patient, disease, treatment, and outcomes (including therapy tolerance and survival) were extracted from electronic medical records. A deep learning semantic segmentation algorithm was utilized to measure cross-sectional areas of skeletal muscle (SM), visceral fat (VF), and subcutaneous fat (SF) at the L3 vertebra level on staging CTs. Univariate and multivariate analyses were performed to assess the relationships between predictors and outcomes. RESULTS 142 patients were evaluated. Median survival was 52 months. Univariate and multivariate analysis showed significant associations between treatment tolerance and SM and VF area, SM to fat and VF to SF ratios, and skeletal muscle index (SMI) (p = 0.004-0.04). Increased survival was associated with increased body mass index (BMI) (p = 0.01) and increased SMI (p = 0.004). A multivariate Cox model consisting of BMI, SMI, age, gender, and stage demonstrated that patients in the high-risk group had significantly lower survival (HR = 1.77, 95% CI = 1.13-2.78, p = 0.008). CONCLUSION CT-based measures of body composition in patients with gastroesophageal adenocarcinoma may be independent predictors of treatment complications and survival and can supplement methods for assessing functional status during treatment planning.
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14
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He X, Zhou S, Li H, Gou Y, Jia D. Prognostic role of pretreatment skeletal muscle index in gastric cancer patients: A meta-analysis. Pathol Oncol Res 2023; 29:1611055. [PMID: 37168049 PMCID: PMC10164928 DOI: 10.3389/pore.2023.1611055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/12/2023] [Indexed: 05/13/2023]
Abstract
Background: The association between pretreatment skeletal muscle index (SMI) and long-term survival of gastric cancer patients remains unclear up to now. The aim of this meta-analysis was to identify the prognostic value of pretreatment SMI in gastric cancer. Methods: The PubMed, EMBASE and Web of Science electronic databases were searched up to 5 June 2022 for relevant studies. The primary outcome was overall survival (OS) and the second outcomes were disease-free survival (DFS) and cancer-specific survival (CSS). The hazard ratios (HRs) and 95% confidence intervals (CIs) were combined to assess the relationship between pretreatment SMI and survival of gastric cancer patients. All statistical analyses were conducted by STATA 15.0 software. Results: A total of 31 retrospective studies involving 12,434 patients were enrolled in this meta-analysis. The pooled results demonstrated that lower pretreatment was significantly associated with poorer OS (HR = 1.53, p < 0.001). Besides, lower pretreatment SMI was also related with worse DFS (HR = 1.39, p < 0.001) and CSS (HR = 1.96, p < 0.001). Conclusion: Pretreatment SMI was significantly associated with prognosis of gastric cancer patients and lower SMI predicted worse survival. However, more prospective high-quality studies are still needed to verify our findings.
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Affiliation(s)
- Xiaohong He
- Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- Outpatient Department, West China Hospital, Sichuan University/West China School of Nusing Sichuan University, Chengdu, China
| | - Sicheng Zhou
- Outpatient Department, West China Hospital, Sichuan University/West China School of Nusing Sichuan University, Chengdu, China
| | - Hongjun Li
- Outpatient Department, West China Hospital, Sichuan University/West China School of Nusing Sichuan University, Chengdu, China
| | - Yue Gou
- Outpatient Department, West China Hospital, Sichuan University/West China School of Nusing Sichuan University, Chengdu, China
- *Correspondence: Yue Gou, ; Dan Jia,
| | - Dan Jia
- Outpatient Department, West China Hospital, Sichuan University/West China School of Nusing Sichuan University, Chengdu, China
- *Correspondence: Yue Gou, ; Dan Jia,
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15
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Impact of body composition on survival of PD-1/PD-L1-treated metastatic gastro-esophageal junction/gastric cancer. Gastric Cancer 2022; 25:1123-1124. [PMID: 35779127 DOI: 10.1007/s10120-022-01320-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/22/2022] [Indexed: 02/07/2023]
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16
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Liu T, Yi X, Ge J, Zhang J, Tan F, Song K, Liu H, Tang M. Preoperative computed tomography-determined sarcopenia is a reliable prognostic factor in patients with gastric cancer after radical gastrectomy: A sex-specific analysis. Front Nutr 2022; 9:884586. [PMID: 36352903 PMCID: PMC9637908 DOI: 10.3389/fnut.2022.884586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 09/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background The predictive role of sarcopenia in cancer prognosis is an area of increasing concern. However, the influence of sex difference on the predictive role of sarcopenia in cancer prognosis has not been clearly defined. This retrospective cohort study investigated the effect of preoperative sarcopenia on the long-term outcomes of patients with gastric cancer (GC) based on sexual dimorphism. Methods Preoperative abdominal computed tomography (CT) scans from 379 GC patients who underwent radical gastrectomy were carefully analyzed. The patients were categorized into sarcopenia and non-sarcopenia groups according to the L3 skeletal muscle index (L3 SMI) measured on CT scans. Moreover, other indexes which can be used to evaluate the muscle area or the muscle quality, including skeletal muscle area (SMA), visceral fat area (VFA), subcutaneous fat area (SFA), skeletal muscle radiation attenuation (SM-RA), visceral fat index (VFI), subcutaneous fat index (SFI), and subcutaneous and visceral ratio (SV), were obtained from CT scans. Results There were 254 men and 125 women included in our study. After calculation, we defined sex-specific SMI-related mortality cutoff as 39.73 and 32.97 cm2/m2 for men and women. Univariable analysis showed that pathological tumor-node-metastasis (pTNM), depth of invasion, lymph node metastasis, differentiation degree, preoperative sarcopenia (for men), SMA (for men), L3 SMI, SFA (for women), SFI (for women), SV (for women), and SM-RA (especially for men) were significant independent predictors of overall survival (OS). Multivariable analysis showed that pTNM, depth of invasion, poor differentiation, and SM-RA were significantly associated with 5-year OS in GC patients. However, CT-determined sarcopenia was associated with significantly worse OS only in men, and SFA was significantly associated with 5-year OS only in women. Conclusion SM-RA is a reliable prognostic factor in patients with GC after radical gastrectomy. The impact of indexes mentioned above on survival outcomes is dependent on sex. CT-determined preoperative sarcopenia, a muscle-related indicator, was associated with outcomes in men. Adipose-related indicator (SFA), instead, was associated with outcomes in women.
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Affiliation(s)
- Ting Liu
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoping Yi
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Jie Ge
- Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Jinwei Zhang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Fengbo Tan
- Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Kun Song
- Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Heli Liu
- Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Heli Liu,
| | - Mimi Tang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Mimi Tang,
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Fukushima H, Koga F. Impact of sarcopenia in bladder preservation therapy for muscle-invasive bladder cancer patients: a narrative review. Transl Androl Urol 2022; 11:1433-1441. [PMID: 36386266 PMCID: PMC9641057 DOI: 10.21037/tau-22-355] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 09/14/2022] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Muscle-invasive bladder cancer (MIBC) is a biologically aggressive disease and its prognosis is poor. Radical cystectomy (RC) with urinary diversion and lymph node dissection is the gold standard treatment for MIBC patients. Accumulating evidence indicates that sarcopenia, the degenerative and systemic loss of skeletal muscle mass, is a significant predictor of higher rates of mortality and perioperative complications following RC. Recently, bladder preservation therapy has been offered as an alternative in appropriately selected MIBC patients who desire to preserve their bladders and those unfit or unwilling for RC. Here, we performed a narrative review on the impact of sarcopenia on oncological outcomes and complication rates in MIBC patients treated with bladder preservation therapy. METHODS A literature review was performed using the PubMed and Scopus databases. KEY CONTENT AND FINDINGS We identified two studies reported the impact of sarcopenia on responses to trimodal therapy and survival outcomes in MIBC patients. Consolidative partial cystectomy was performed in patients who achieved clinical complete response (CR) to trimodal therapy in one of the two studies. In both studies, CR rates to trimodal therapy are comparable between sarcopenic and non-sarcopenic patients. Sarcopenia was not significantly associated with shorter survival after completing bladder preservation therapy in either study. For complication rates of bladder preservation therapy, one study showed equivalent complication rates of consolidative partial cystectomy between sarcopenic and non-sarcopenic patients. In addition, in another small series of trimodal therapy, sarcopenic patients showed a higher rate of complications of trimodal therapy compared with non-sarcopenic patients. CONCLUSIONS According to the result of our literature review, sarcopenia would not affect responses to trimodal therapy and prognosis in MIBC patients treated with bladder preservation therapy. Although the effect of sarcopenia on complication rates of bladder preservation therapy is inconclusive due to limited evidence, bladder preservation therapy could be a viable alternative option in carefully selected MIBC patients regardless of the presence of sarcopenia.
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Affiliation(s)
- Hiroshi Fukushima
- Department of Urology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Fumitaka Koga
- Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo, Japan
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Johal J, Han CY, Joseph R, Munn Z, Agbejule OA, Crawford-Williams F, Wallen MP, Chan RJ, Hart NH. Dietary Supplements in People with Metastatic Cancer Who Are Experiencing Malnutrition, Cachexia, Sarcopenia, and Frailty: A Scoping Review. Nutrients 2022; 14:nu14132642. [PMID: 35807823 PMCID: PMC9268679 DOI: 10.3390/nu14132642] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 02/01/2023] Open
Abstract
Cancer-associated malnutrition, or cachexia, stemming from cancer or its treatments, is particularly prevalent in metastatic cancers, and is often interrelated with sarcopenia and frailty. Evidence suggests that dietary supplements play a role in managing these conditions. As metastatic cancer cells are associated with notable genomic and phenotypic alterations, response to dietary supplements may differ between metastatic and non-metastatic cancers. However, research in this area is lacking. This scoping review aims to identify the dietary supplements that have been studied in patients with metastatic cancers and malnutrition-related conditions, along with their proposed effects, mechanisms, outcome measures, and tools used. A systematic search was conducted across databases, including MEDLINE, EMBASE, CINAHL, and clinical trial registries. Of the initial 6535 records screened, a total of 48 studies were included, covering a range of dietary supplements—vitamins, minerals, antioxidants, proteins, amino acids, fatty acids, fiber, and others. While the types of dietary supplements included varied across cancer types, omega-3 and carnitine were investigated most often. Proposed relevant attributes of dietary supplements included their antioxidant, anti-inflammatory, anti-cancer, and immunomodulatory properties. Overall, there was a paucity of interventional studies, and more randomized controlled trials are warranted.
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Affiliation(s)
- Jolyn Johal
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA 5042, Australia; (J.J.); (C.Y.H.); (R.J.); (O.A.A.); (F.C.-W.); (M.P.W.); (R.J.C.)
| | - Chad Yixian Han
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA 5042, Australia; (J.J.); (C.Y.H.); (R.J.); (O.A.A.); (F.C.-W.); (M.P.W.); (R.J.C.)
| | - Ria Joseph
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA 5042, Australia; (J.J.); (C.Y.H.); (R.J.); (O.A.A.); (F.C.-W.); (M.P.W.); (R.J.C.)
| | - Zachary Munn
- Joanna Briggs Institute (JBI), The University of Adelaide, Adelaide, SA 5001, Australia;
| | - Oluwaseyifunmi Andi Agbejule
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA 5042, Australia; (J.J.); (C.Y.H.); (R.J.); (O.A.A.); (F.C.-W.); (M.P.W.); (R.J.C.)
| | - Fiona Crawford-Williams
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA 5042, Australia; (J.J.); (C.Y.H.); (R.J.); (O.A.A.); (F.C.-W.); (M.P.W.); (R.J.C.)
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
| | - Matthew P. Wallen
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA 5042, Australia; (J.J.); (C.Y.H.); (R.J.); (O.A.A.); (F.C.-W.); (M.P.W.); (R.J.C.)
- School of Science, Psychology and Sport, Federation University, Mount Helen, VIC 3350, Australia
| | - Raymond J. Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA 5042, Australia; (J.J.); (C.Y.H.); (R.J.); (O.A.A.); (F.C.-W.); (M.P.W.); (R.J.C.)
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
| | - Nicolas H. Hart
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA 5042, Australia; (J.J.); (C.Y.H.); (R.J.); (O.A.A.); (F.C.-W.); (M.P.W.); (R.J.C.)
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
- Exercise Medicine Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA 6160, Australia
- Precision Medicine (Cancer), South Australian Health and Medical Research Institute, Adelaide, SA 5001, Australia
- Correspondence:
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19
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Effect of Muscle Loss but Not Fat Loss during Primary Debulking Surgery and Chemotherapy on Prognosis of Patients with Ovarian Cancer. J Clin Med 2022; 11:jcm11113184. [PMID: 35683568 PMCID: PMC9181028 DOI: 10.3390/jcm11113184] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/27/2022] [Accepted: 06/02/2022] [Indexed: 02/04/2023] Open
Abstract
Although the negative effect of muscle loss during invasive treatment has been widely reported in patients with cancer, its value in patients with ovarian cancer is not clear. Therefore, this study was conducted to clarify whether muscle loss during cytoreductive surgery and chemotherapy affects prognosis in patients with ovarian cancer. We retrospectively recruited 58 patients with ovarian cancer who underwent site reductive surgery and chemotherapy at Shimane University Hospital from March 2006 to November 2013 and for whom pre- and postoperative computed tomography were available. Skeletal muscle changes and fat mass volume during primary debulking surgery and chemotherapy were subsequently investigated at the level of the third lumbar vertebra. Muscle and fat mass loss occurred independently in half of the patients. Muscle loss, but not fat loss, was associated with disease-free survival (p = 0.041 and p = 0.794, respectively) and poor overall survival (p = 0.033 and p = 0.61, respectively). Cancer therapy is invasive and causes compositional changes in the body, such as muscle and fat loss. During cancer therapy, muscle loss, but not fat loss, may be associated with worse prognosis in ovarian cancer.
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20
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Meyer HJ, Wienke A, Surov A. Sarcopenia as a Prognostic Marker for Survival in Gastric Cancer Patients Undergoing Palliative Chemotherapy. A Systematic Review and Meta Analysis. Nutr Cancer 2022; 74:3518-3526. [DOI: 10.1080/01635581.2022.2077387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Alexey Surov
- Department of Radiology and Nuclear Medicine, University of Magdeburg, Magdeburg, Germany
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21
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Chen Q, Lu J, Lu X, Yao XJ, Zhang XP, Wang SY, Guo JH. The Prognostic Value of Sarcopenia and Myosteatosis in Biliary Tract Cancer After Palliative Treatment With Radiation-Emitting Metallic Stent. Front Surg 2022; 9:852137. [PMID: 35558381 PMCID: PMC9086514 DOI: 10.3389/fsurg.2022.852137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Radiation-emitting metallic stent (REMS) placement is increasingly used for malignant biliary obstruction (MBO) caused by unresectable biliary tract carcinoma (UBTC) in clinical practice. The study is aimed to evaluate the prognostic value of sarcopenia, myosteatosis, and their combination on overall survival (OS) in patients treated with REMS for UBTC. Methods Patients diagnosed with UBTC who underwent REMS placement between January 2013 and May 2021 were included consecutively in this retrospective study. Sarcopenia and myosteatosis were defined based on skeletal muscle index (SMI) and skeletal muscle attenuation (SMA), respectively, which were measured by computer tomography (CT) images on the level of the third lumbar vertebral body before REMS placement. Patients were categorized into two groups by sex-specific cutoff value for sarcopenia and myosteatosis, and OS rates were compared between the groups. Univariate and multivariate cox regression analyses were used to assess factors associated with OS. Results Data of 135 patients included were retrospectively reviewed and analyzed. Median OS was 7.17 months in total cohort. Patients in the sarcopenia group had significant poorer OS than those in the non-sarcopenia group (median: 3.23 vs. 11.60 months, p < 0.001). OS was shorter in patients with myosteatosis than those without myosteatosis (median: 4.40 vs. 9.17 months, p < 0.001). Sarcopenia (odds ratio [OR] = 9.61; 95% CI = 5.41–17.09; p < 0.001) and myosteatosis (OR = 1.70; 95% CI = 1.13–2.57; p = 0.012) were significantly associated with OS. Combining sarcopenia and myosteatosis (CSM) showed a better predictive accuracy in OS than either one (area under curves: CSM vs. sarcopenia = 0.760 vs. 0.698, p = 0.049; CSM vs. myosteatosis = 0.760 vs. 0.671, p = 0.006). Conclusion Sarcopenia and myosteatosis are negative predictors of survival in patients who underwent REMS placement for UBTC. CSM seemed to show a better prognostic value than either sarcopenia or myosteatosis alone. They can be used preoperatively for risk evaluation.
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Affiliation(s)
- Qi Chen
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Jian Lu
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Xun Lu
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
- Surgical Research Center, Institute of Urology, School of Medicine, Southeast University, Nanjing, China
| | - Xi-Juan Yao
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Xuan-Pu Zhang
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Shang-Yuan Wang
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Jin-He Guo
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
- *Correspondence: Jin-He Guo
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22
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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.
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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
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23
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Luo S, Ran Y, Liu L, Huang H, Tang X, Fan Y. Classification of gastric cancerous tissues by a residual network based on optical coherence tomography images. Lasers Med Sci 2022; 37:2727-2735. [PMID: 35344109 DOI: 10.1007/s10103-022-03546-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 03/10/2022] [Indexed: 11/26/2022]
Abstract
Optical coherence tomography (OCT) is a noninvasive, radiation-free, and high-resolution imaging technology. The intraoperative classification of normal and cancerous tissue is critical for surgeons to guide surgical operations. Accurate classification of gastric cancerous OCT images is beneficial to improve the effect of surgical treatment based on the deep learning method. The OCT system was used to collect images of cancerous tissues removed from patients. An intelligent classification method of gastric cancerous tissues based on the residual network is proposed in this study and optimized with the ResNet18 model. Four residual blocks are used to reset the model structure of ResNet18 and reduce the number of network layers to identify cancerous tissues. The model performance of different residual networks is evaluated by accuracy, precision, recall, specificity, F1 value, ROC curve, and model parameters. The classification accuracies of the proposed method and ResNet18 both reach 99.90%. Also, the model parameters of the proposed method are 44% of ResNet18, which occupies fewer system resources and is more efficient. In this study, the proposed deep learning method was used to automatically recognize OCT images of gastric cancerous tissue. This artificial intelligence method could help promote the clinical application of gastric cancerous tissue classification in the future.
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Affiliation(s)
- Site Luo
- Key Laboratory for Micro/Nano Optoelectronic Devices of Ministry of Education & Hunan Provincial Key Laboratory of Low-Dimensional Structural Physics and Devices, School of Physics and Electronics, Hunan University, Changsha, 410082, China
| | - Yuchen Ran
- School of Life Science, Beijing Institute of Technology, Beijing, 100081, China
| | - Lifei Liu
- School of Life Science, Beijing Institute of Technology, Beijing, 100081, China
| | - Huihui Huang
- Key Laboratory for Micro/Nano Optoelectronic Devices of Ministry of Education & Hunan Provincial Key Laboratory of Low-Dimensional Structural Physics and Devices, School of Physics and Electronics, Hunan University, Changsha, 410082, China
| | - Xiaoying Tang
- School of Life Science, Beijing Institute of Technology, Beijing, 100081, China
- Institute of Engineering Medicine, Beijing Institute of Technology, Beijing, 100081, China
| | - Yingwei Fan
- Institute of Engineering Medicine, Beijing Institute of Technology, Beijing, 100081, China.
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24
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Deep learning based sarcopenia prediction from shear-wave ultrasonographic elastography and gray scale ultrasonography of rectus femoris muscle. Sci Rep 2022; 12:3596. [PMID: 35246589 PMCID: PMC8897437 DOI: 10.1038/s41598-022-07683-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/15/2022] [Indexed: 12/13/2022] Open
Abstract
We aim to evaluate the performance of a deep convolutional neural network (DCNN) in predicting the presence or absence of sarcopenia using shear-wave elastography (SWE) and gray-scale ultrasonography (GSU) of rectus femoris muscle as an imaging biomarker. This retrospective study included 160 pair sets of GSU and SWE images (n = 160) from December 2018 and July 2019. Two radiologists scored the echogenicity of muscle on GSU (4-point score). Among them, 141 patients underwent CT and their L3 skeletal muscle index (SMI) were measured to categorize the presence or absence of sarcopenia. For DCNN, we used three CNN architectures (VGG19, ResNet-50, DenseNet 121). The accuracies of DCNNs for sarcopenia classification were 70.0–80.0% (based on SWE) and 65.0–75.0% (based on GSU). The DCNN application to SWE images highlights the utility of deep-learning base SWE for sarcopenia prediction. DCNN application to SWE images might be a potentially useful biomarker to predict sarcopenic status.
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25
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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.
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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
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26
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Moon J, Lee J, Lee DW, Shin HJ, Lee S, Kang Y, Kim NY, Park HS. Impact of Body Composition on Postoperative Outcomes in Patients Undergoing Robotic Nipple-Sparing Mastectomy with Immediate Breast Reconstruction. Curr Oncol 2022; 29:350-359. [PMID: 35049705 PMCID: PMC8774547 DOI: 10.3390/curroncol29010031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/10/2022] [Accepted: 01/10/2022] [Indexed: 11/16/2022] Open
Abstract
Nipple-areolar complex (NAC)-related complications are common during nipple-sparing mastectomy (NSM), with obesity as a risk factor. Although the incidence of NAC-related complications after robotic NSM (RNSM) with immediate breast reconstruction (IBR) is lower than that after conventional NSM, it remains one of the most unwanted complications. We aimed to evaluate body composition-based risk factors for NAC-related complications after RNSM with IBR. Data of 92 patients with breast cancer who underwent RNSM with IBR using direct-to-implant or tissue expander from November 2017 to September 2020 were analyzed retrospectively. Risk factors for NAC-related complications were identified with a focus on body composition using preoperative transverse computed tomography at the third lumbar vertebra level. Postoperative complications were assessed for 6 months. The most common complication was NAC ischemia, occurring in 15 patients (16%). Multivariate analysis revealed a low skeletal muscle index/total adipose tissue index (SMI/TATI) ratio as an independent NAC ischemia risk factor. An increase in the SMI/TATI ratio by one decreased the incidence of NAC ischemia by 0.940-fold (p = 0.030). A low SMI/TATI ratio is a risk factor for postoperative NAC ischemia in patients undergoing RNSM with IBR for breast cancer. Preoperative body composition-focused evaluation is more valuable than simple body mass index assessment.
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Affiliation(s)
- Jiae Moon
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Jeea Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Dong Won Lee
- Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Hye Jung Shin
- Biostatistics Collaboration Unit, Department of Research Affairs, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Sumin Lee
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, National Health Insurance Service Ilsan Hospital, Goyang 10444, Korea; (S.L.); (Y.K.)
| | - Yhenseung Kang
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, National Health Insurance Service Ilsan Hospital, Goyang 10444, Korea; (S.L.); (Y.K.)
| | - Na Young Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 03722, Korea;
- Correspondence: (N.Y.K.); (H.S.P.); Tel.: +82-2-2228-4435 (N.Y.K.); +82-2-2228-2100 (H.S.P.)
| | - Hyung Seok Park
- Department of Surgery, Yonsei University College of Medicine, Seoul 03722, Korea;
- Correspondence: (N.Y.K.); (H.S.P.); Tel.: +82-2-2228-4435 (N.Y.K.); +82-2-2228-2100 (H.S.P.)
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27
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Kim SI, Chung JY, Paik H, Seol A, Yoon SH, Kim TM, Kim HS, Chung HH, Cho JY, Kim JW, Lee M. Prognostic role of computed tomography-based, artificial intelligence-driven waist skeletal muscle volume in uterine endometrial carcinoma. Insights Imaging 2021; 12:192. [PMID: 34928453 PMCID: PMC8688657 DOI: 10.1186/s13244-021-01134-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/26/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To investigate the impact of computed tomography (CT)-based, artificial intelligence-driven waist skeletal muscle volume on survival outcomes in patients with endometrial cancer. METHODS We retrospectively identified endometrial cancer patients who received primary surgical treatment between 2014 and 2018 and whose pre-treatment CT scans were available (n = 385). Using an artificial intelligence-based tool, the skeletal muscle area (cm2) at the third lumbar vertebra (L3) and the skeletal muscle volume (cm3) at the waist level were measured. These values were converted to the L3 skeletal muscle index (SMI) and volumetric SMI by normalisation with body height. The relationships between L3, volumetric SMIs, and survival outcomes were evaluated. RESULTS Setting 39.0 cm2/m2 of L3 SMI as cut-off value for sarcopenia, sarcopenia (< 39.0 cm2/m2, n = 177) and non-sarcopenia (≥ 39.0 cm2/m2, n = 208) groups showed similar progression-free survival (PFS; p = 0.335) and overall survival (OS; p = 0.241). Using the median value, the low-volumetric SMI group (< 206.0 cm3/m3, n = 192) showed significantly worse PFS (3-year survival rate, 77.3% vs. 88.8%; p = 0.004) and OS (3-year survival rate, 92.8% vs. 99.4%; p = 0.003) than the high-volumetric SMI group (≥ 206.0 cm3/m3, n = 193). In multivariate analyses adjusted for baseline body mass index and other factors, low-volumetric SMI was identified as an independent poor prognostic factor for PFS (adjusted HR, 1.762; 95% CI, 1.051-2.953; p = 0.032) and OS (adjusted HR, 5.964; 95% CI, 1.296-27.448; p = 0.022). CONCLUSIONS Waist skeletal muscle volume might be a novel prognostic biomarker in patients with endometrial cancer. Assessing body composition before treatment can provide important prognostic information for such patients.
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Affiliation(s)
- Se Ik Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Joo Yeon Chung
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Haerin Paik
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Aeran Seol
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Soon Ho Yoon
- Department of Radiology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
- Department of Radiology, UMass Memorial Medical Center, Worcester, MA, 01605, USA
| | - Taek Min Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Hee Seung Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Hyun Hoon Chung
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Jeong Yeon Cho
- Department of Radiology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Jae-Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Maria Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, 03080, Republic of Korea.
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28
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McGovern J, Dolan RD, Horgan PG, Laird BJ, McMillan DC. Computed tomography-defined low skeletal muscle index and density in cancer patients: observations from a systematic review. J Cachexia Sarcopenia Muscle 2021; 12:1408-1417. [PMID: 34664431 PMCID: PMC8718024 DOI: 10.1002/jcsm.12831] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 09/09/2021] [Accepted: 09/11/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Computed tomography (CT) analysis of body composition has garnered interest as a potential prognostic tool in those with cancer. A range of pre-defined thresholds currently exist within the literature to define low skeletal muscle mass and density. The aim of the present systematic review was to assess the prevalence of low skeletal muscle index (SMI) and density (SMD) within the literature, across a range of common solid tumours. METHODS A systematic search of PubMed was carried out to identify studies reporting CT analysis of SMI and SMD in patients with colorectal, oesophageal, gastric, hepatobiliary, pancreatic, breast, and lung cancer. The type of cancer, whether curative or non-curative disease, the anthropomorphic parameter studied, threshold used to define low SMI and SMD, and the prevalence of these anthropomorphic measurements within the population were recorded. RESULTS Of the 160 studies included, 156 reported an assessment of SMI and 35 reported assessment of SMD. The median prevalence of low SMI was 43% (30.1-57.1) and low SMD 49.4% (31.7-58.5) across the entire cohort. There was little variation in the prevalence of low SMI and SMD when studies were divided into curative and non-curative cohorts-40.7% (27.5-51.3) vs. 48.4% (30.9-60.1) and 37.8% (32.2-52.2) vs. 55.3% (38.5-64.7) respectively. When divided into colorectal, oesophageal, gastric, hepatobiliary, pancreatic, breast and lung cancers, similar prevalence of low SMI (46.0% %, 49.8%, 35.7%, 41.1%, 32.3%, 34%, and 49.5%) and low SMD were also observed (52.1%, 54.3%, 71.2%, 56.8%, 55.3%, and 52.6%). This was maintained when studies were stratified into cohorts by threshold used-low SMI (Martin 48.9%, Prado 49.9%, and Others 36.0%) and low SMD (Martin 52.4% and Others 48.6%). CONCLUSIONS Low SMI and SMD are endemic across a range of cancer types and disease stage, challenging pre-existing dogma of the determinants of prevalence.
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Affiliation(s)
- Josh McGovern
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow, UK
| | - Ross D Dolan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow, UK
| | - Paul G Horgan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow, UK
| | - Barry J Laird
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Donald C McMillan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow, UK
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Ge Z, Wang M, Liu Q. Segmentation of Gastric Computerized Tomography Images under Intelligent Algorithms in Evaluation of Efficacy of Decitabine Combined with Paclitaxel in Treatment of Gastric Cancer. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:8023490. [PMID: 34745511 PMCID: PMC8566038 DOI: 10.1155/2021/8023490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/22/2021] [Indexed: 11/28/2022]
Abstract
To analyze the evaluation of artificial intelligence algorithm combined with gastric computed tomography (CT) image in clinical chemotherapy for advanced gastric cancer, 112 patients with advanced gastric cancer were selected as the research object. Among which, 56 patients in the experimental group received paclitaxel (PTX) combined with decitabine sequential decitabine maintenance therapy. Fifty-six patients in the control group received first-line treatment with decitabine combined with cisplatin. The image segmentation algorithm based on fast interactive dictionary selection was used to process gastric CT images. Complete response (CR), partial response (PR), stable disease (SD), progressive disease (PD), response rate (RR), disease control rate (DCR), and overall survival (OS) after treatment were recorded. The true-positive rate (TPR) and coincidence ratio (CR) of the proposed algorithm for image segmentation were significantly higher than those of the mean shift algorithm and the iCoseg algorithm. The mean edge distance (MED) and edge distance variance (EDV) were significantly lower than the mean shift algorithm and the iCoseg algorithm, and the differences were considerable (P < 0.05). The number of CR (5 cases), PR (13 cases), RR (18 cases), and DCR (44 cases) in the experimental group was significantly higher than that in the control group, while the number of PD (12 cases) was significantly lower than that in the control group (P < 0.05). The number of patients complicated with hematological toxicity, leucopenia, thrombocytopenia, and digestive tract reaction in the experimental group was less than that in the control group (P < 0.05). From the comparison of long-term efficacy, the survival rate of patients in both groups showed a decreasing trend within 24 months, but the decreasing trend of survival rate of patients in the experimental group was better than that in the control group. In short, the proposed algorithm had better segmentation performance than traditional algorithms. Compared with first-line treatment with decitabine and cisplatin, PTX in combination with decitabine sequential citabine maintenance regimens had better disease control rates, lower toxicity, and more effective improvements in patient quality of life and longer survival in patients with advanced gastric cancer.
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Affiliation(s)
- Zhenghui Ge
- Department of Gastroenterology, The People's Hospital of Danyang, Affiliated Danyang Hospital of Nantong University, Danyang 212300, Jiangsu, China
| | - Mengyun Wang
- Department of Imaging, Huai'an Second People's Hospital, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an 223002, Jiangsu, China
| | - Qun Liu
- Department of Neurology, Lianshui County People's Hospital, Lianshui 223400, Jiangsu, China
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30
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Ricciardolo AA, De Ruvo N, Serra F, Prampolini F, Solaini L, Battisti S, Missori G, Fenocchi S, Rossi EG, Sorrentino L, Salati M, Spallanzani A, Cautero N, Pecchi A, Ercolani G, Gelmini R. Strong impact of sarcopenia as a risk factor of survival in resected gastric cancer patients: first Italian report of a Bicentric study. Updates Surg 2021; 74:283-293. [PMID: 34699033 DOI: 10.1007/s13304-021-01175-4] [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: 04/23/2021] [Accepted: 09/20/2021] [Indexed: 12/15/2022]
Abstract
Gastric cancer (GC) accounts for 4% of all cancers in Europe. Sarcopenia is a complex syndrome characterized by a loss of muscle mass and function associated with age, often present in neoplastic patients. Recently, several studies have shown a significant association between sarcopenia and poor prognosis in various pathological conditions. The current observational retrospective study investigates the association between sarcopenia and overall survival (OS) and recurrence-free survival (RFS) in patients with GC undergoing up-front surgery with curative intent. Resected GC patients' clinical records and CT images were retrospectively assessed. The preoperative CT calculation of the skeletal muscle index (SMI) at L3 level allowed us to categorize patients as sarcopenic or not. Kaplan-Meyer and univariate and multivariate Cox regression analyses were performed to determine the difference in survival and presence of independent prognostic factors. Fifty-five patients, 28 male and 27 female, out of 298 studied for gastric cancer were enrolled in the current study from two cancer referral centers in Italy. The preoperative CT calculation of the SMI at L3 level allowed us to identify 39 patients with and 16 without sarcopenia. A statistically significant difference between the sarcopenic and non-sarcopenic groups was observed in both OS and RFS (p < 0.023; p < 0.006). Moreover, sarcopenia was strongly correlated to a higher risk of recurrence in univariate and multivariate analysis (p < 0.02). Sarcopenia can be considered a critical risk factor for survival in patients with resectable GC treated with up-front surgery. Identifying sarcopenic patients at the time of diagnosis would direct selection of patients who could benefit from early nutritional and/or physical treatments able to increase their muscle mass and possibly improve the prognosis. More extensive multicenter studies are needed to address this issue.
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Affiliation(s)
- A A Ricciardolo
- Department of General and Specialistic Surgery, Unit of General, Emergency and Oncological Surgery, Policlinico, AOU of Modena University of Modena and Reggio Emilia, Via del Pozzo 71, 41125, Modena, Italy
| | - N De Ruvo
- Department of General and Specialistic Surgery, Unit of General, Emergency and Oncological Surgery, Policlinico, AOU of Modena University of Modena and Reggio Emilia, Via del Pozzo 71, 41125, Modena, Italy.
| | - F Serra
- Department of General and Specialistic Surgery, Unit of General, Emergency and Oncological Surgery, Policlinico, AOU of Modena University of Modena and Reggio Emilia, Via del Pozzo 71, 41125, Modena, Italy
| | - F Prampolini
- Department of Radiology, AOU of Modena, University of Modena and Reggio Emilia, via del Pozzo 71, 41125 Modena Italy, Modena, Italy
| | - L Solaini
- Department Of Medical and Surgical Sciences, University of Bologna, Morgagni-Pierantoni Hospital, Forli, Italy
| | - S Battisti
- Istituto Scientifico Romagnolo Per Lo Studio E La Cura Dei Tumori (IRST) IRCCS, Meldola, Italy
| | - G Missori
- Department of General and Specialistic Surgery, Unit of General, Emergency and Oncological Surgery, Policlinico, AOU of Modena University of Modena and Reggio Emilia, Via del Pozzo 71, 41125, Modena, Italy
| | - S Fenocchi
- Department of General and Specialistic Surgery, Unit of General, Emergency and Oncological Surgery, Policlinico, AOU of Modena University of Modena and Reggio Emilia, Via del Pozzo 71, 41125, Modena, Italy
| | - E G Rossi
- Department of General and Specialistic Surgery, Unit of General, Emergency and Oncological Surgery, Policlinico, AOU of Modena University of Modena and Reggio Emilia, Via del Pozzo 71, 41125, Modena, Italy
| | - L Sorrentino
- Department of General and Specialistic Surgery, Unit of General, Emergency and Oncological Surgery, Policlinico, AOU of Modena University of Modena and Reggio Emilia, Via del Pozzo 71, 41125, Modena, Italy
| | - M Salati
- Department of Oncology, AOU of Modena, University of Modena and Reggio Emilia, via del Pozzo 71, 41125 Modena Italy, Modena, Italy
| | - A Spallanzani
- Department of Oncology, AOU of Modena, University of Modena and Reggio Emilia, via del Pozzo 71, 41125 Modena Italy, Modena, Italy
| | - N Cautero
- Department of General and Specialistic Surgery, Unit of General, Emergency and Oncological Surgery, Policlinico, AOU of Modena University of Modena and Reggio Emilia, Via del Pozzo 71, 41125, Modena, Italy
| | - A Pecchi
- Department of Radiology, AOU of Modena, University of Modena and Reggio Emilia, via del Pozzo 71, 41125 Modena Italy, Modena, Italy
| | - G Ercolani
- Department Of Medical and Surgical Sciences, University of Bologna, Morgagni-Pierantoni Hospital, Forli, Italy
| | - R Gelmini
- Department of General and Specialistic Surgery, Unit of General, Emergency and Oncological Surgery, Policlinico, AOU of Modena University of Modena and Reggio Emilia, Via del Pozzo 71, 41125, Modena, Italy
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Park K, Kim NY, Kim KJ, Oh C, Chae D, Kim SY. A Simple Risk Scoring System for Predicting the Occurrence of Aspiration Pneumonia After Gastric Endoscopic Submucosal Dissection. Anesth Analg 2021; 134:114-122. [PMID: 34673667 DOI: 10.1213/ane.0000000000005779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Aspiration pneumonia after endoscopic submucosal dissection (ESD) is rare, but can be fatal. We aimed to investigate risk factors and develop a simple risk scoring system for aspiration pneumonia. METHODS We retrospectively reviewed medical records of 7833 patients who underwent gastric ESD for gastric neoplasm under anesthesiologist-directed sedation. Candidate risk factors were screened and assessed for significance using a least absolute shrinkage and selection operator (LASSO)-based method. Top significant factors were incorporated into a multivariable logistic regression model, whose prediction performance was compared with those of other machine learning models. The final risk scoring system was created based on the estimated odds ratios of the logistic regression model. RESULTS The incidence of aspiration pneumonia was 1.5%. The logistic regression model showed comparable performance to the best predictive model, extreme gradient boost (area under receiver operating characteristic curve [AUROC], 0.731 vs 0.740). The estimated odds ratios were subsequently used for the development of the clinical scoring system. The final scoring system exhibited an AUROC of 0.730 in the test dataset with risk factors: age (≥70 years, 4 points), male sex (8 points), body mass index (≥27 kg/m2, 4 points), procedure time (≥80 minutes, 5 points), lesion in the lower third of the stomach (5 points), tumor size (≥10 mm, 3 points), recovery time (≥35 minutes, 4 points), and desaturation during ESD (9 points). For patients with total scores ranging between 0 and 33 points, aspiration pneumonia probabilities spanned between 0.1% and 17.9%. External validation using an additional cohort of 827 patients yielded AUROCs of 0.698 for the logistic regression model and 0.680 for the scoring system. CONCLUSIONS Our simple risk scoring system has 8 predictors incorporating patient-, procedure-, and sedation-related factors. This system may help clinicians to stratify patients at risk of aspiration pneumonia after ESD.
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Affiliation(s)
| | - Na Young Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ki Jun Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chaerim Oh
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | - So Yeon Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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Han Q, Kim SI, Yoon SH, Kim TM, Kang HC, Kim HJ, Cho JY, Kim JW. Impact of Computed Tomography-Based, Artificial Intelligence-Driven Volumetric Sarcopenia on Survival Outcomes in Early Cervical Cancer. Front Oncol 2021; 11:741071. [PMID: 34631578 PMCID: PMC8499694 DOI: 10.3389/fonc.2021.741071] [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] [Received: 07/14/2021] [Accepted: 09/03/2021] [Indexed: 12/25/2022] Open
Abstract
The purpose of this study was to investigate the impact of sarcopenia and body composition change during primary treatment on survival outcomes in patients with early cervical cancer. We retrospectively identified patients diagnosed with 2009 International Federation of Gynecology and Obstetrics stage IB1-IIA2 cervical cancer who underwent primary radical hysterectomy between 2007 and 2019. From pre-treatment CT scans (n = 306), the skeletal muscle area at the third lumbar vertebra (L3) and the waist skeletal muscle volume were measured using an artificial intelligence-based tool. These values were converted to the L3 and volumetric skeletal muscle indices by normalization. We defined L3 and volumetric sarcopenia using 39.0 cm2/m2 and the first quartile (Q1) value, respectively. From pre- and post-treatment CT scan images (n = 192), changes (%) in waist skeletal muscle and fat volumes were assessed. With the use of Cox regression models, factors associated with progression-free survival (PFS) and overall survival (OS) were analyzed. Between the L3 sarcopenia and non-sarcopenia groups, no differences in PFS and OS were observed. In contrast, volumetric sarcopenia was identified as a poor prognostic factor for PFS (adjusted hazard ratio [aHR], 1.874; 95% confidence interval [CI], 1.028-3.416; p = 0.040) and OS (aHR, 3.001; 95% CI, 1.016-8.869; p = 0.047). During primary treatment, significant decreases in waist skeletal muscle (median, -3.9%; p < 0.001) and total fat (median, -5.3%; p < 0.001) were observed. Of the two components, multivariate analysis revealed that the waist fat gain was associated with worse PFS (aHR, 2.007; 95% CI, 1.009-3.993; p = 0.047). The coexistence of baseline volumetric sarcopenia and waist fat gain further deteriorated PFS (aHR, 2.853; 95% CI, 1.257-6.474; p = 0.012). In conclusion, baseline volumetric sarcopenia might be associated with poor survival outcomes in patients with early cervical cancer undergoing primary RH. Furthermore, sarcopenia patients who gained waist fat during primary treatment were at a high risk of disease recurrence.
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Affiliation(s)
- Qingling Han
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
| | - Se Ik Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
| | - Soon Ho Yoon
- Department of Radiology, UMass Memorial Medical Center, Worcester, MA, United States
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Taek Min Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyun-Cheol Kang
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, South Korea
| | - Hak Jae Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, South Korea
| | - Jeong Yeon Cho
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Jae-Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
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33
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Trussardi Fayh AP, de Sousa IM. Comparison of revised EWGSOP2 criteria of sarcopenia in patients with cancer using different parameters of muscle mass. PLoS One 2021; 16:e0257446. [PMID: 34520502 PMCID: PMC8439478 DOI: 10.1371/journal.pone.0257446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 09/01/2021] [Indexed: 01/06/2023] Open
Abstract
Calf circumference (CC) has been established as a marker of muscle mass (MM) with good performance for predicting survival in individuals with cancer. The study aims to determine the prevalence of sarcopenia according to the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria and to evaluate the accuracy of sarcopenia using low CC relative to MM assessment by computed tomography (CT) at third lumbar vertebra level (L3) as a reference. Cross-sectional study with cancer patients aged ≥ 60 years. Data included socio-demographic, clinical and anthropometric variables. MM was assessed by CC and by CT images at the L3. Sarcopenia was diagnosed according to the EWGSOP2 criteria: a) low handgrip strength (HGS) + reduced MM evaluated by CT; and b) low HGS + low CC. Pearson's correlation, accuracy, sensitivity, specificity, positive predictive and negative predictive value were analyzed. A total of 108 patients were evaluated, age of 70.6 ± 7.4 years (mean ± standard deviation). The prevalence of sarcopenia was of 24.1% (low MM) and 25.9% (low CC). The Kappa test showed a substantial agreement (K = 0.704), 81% sensitivity, and 92% specificity. Although the EWGSOP2 advises that we should use CC measures in the algorithm for sarcopenia when no other MM diagnostic methods are available, the findings allow the use of CC instead of MM by CT in cancer patients.
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Affiliation(s)
- Ana Paula Trussardi Fayh
- Postgraduate Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
- Postgraduate Program in Nutrition, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
- Postgraduate Program in Physical Education, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
- * E-mail:
| | - Iasmin Matias de Sousa
- Postgraduate Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
- Postgraduate Program in Nutrition, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
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34
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Kim J, Han SH, Kim HI. Detection of sarcopenic obesity and prediction of long-term survival in patients with gastric cancer using preoperative computed tomography and machine learning. J Surg Oncol 2021; 124:1347-1355. [PMID: 34490899 PMCID: PMC9290491 DOI: 10.1002/jso.26668] [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] [Received: 06/17/2021] [Revised: 07/27/2021] [Accepted: 08/29/2021] [Indexed: 12/30/2022]
Abstract
Background Previous studies evaluating the prognostic value of computed tomography (CT)‐derived body composition data have included few patients. Thus, we assessed the prevalence and prognostic value of sarcopenic obesity in a large population of gastric cancer patients using preoperative CT, as nutritional status is a predictor of long‐term survival after gastric cancer surgery. Methods Preoperative CT images were analyzed for 840 gastric cancer patients who underwent gastrectomy between March 2009 and June 2018. Machine learning algorithms were used to automatically detect the third lumbar (L3) vertebral level and segment the body composition. Visceral fat area and skeletal muscle index at L3 were determined and used to classify patients into obesity, sarcopenia, or sarcopenic obesity groups. Results Out of 840 patients (mean age = 60.4 years; 526 [62.6%] men), 534 (63.5%) had visceral obesity, 119 (14.2%) had sarcopenia, and 48 (5.7%) patients had sarcopenic obesity. Patients with sarcopenic obesity had a poorer prognosis than those without sarcopenia (hazard ratio [HR] = 3.325; 95% confidence interval [CI] = 1.698–6.508). Multivariate analysis identified sarcopenic obesity as an independent risk factor for increased mortality (HR = 2.608; 95% CI = 1.313–5.179). Other risk factors were greater extent of gastrectomy (HR = 1.928; 95% CI = 1.260–2.950), lower prognostic nutritional index (HR = 0.934; 95% CI = 0.901–0.969), higher neutrophil count (HR = 1.101; 95% CI = 1.031–1.176), lymph node metastasis (HR = 6.291; 95% CI = 3.498–11.314), and R1/2 resection (HR = 4.817; 95% CI = 1.518–9.179). Conclusion Body composition analysis automated by machine learning predicted long‐term survival in patients with gastric cancer.
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Affiliation(s)
- Jaehyuk Kim
- Molecular Imaging, Medical Biophysics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,CAE Group, Hardware Solution Team, Health and Medical Equipment Business, Samsung Electronics Co. Ltd., Seoul, South Korea
| | - Seung Hee Han
- Molecular Imaging, Medical Biophysics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Hyoung-Il Kim
- Molecular Imaging, Medical Biophysics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.,Division of Upper Gastrointestinal Surgery, Gastric Cancer Center, Yonsei Cancer Center, Seoul, South Korea
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35
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Jullien M, Tessoulin B, Ghesquières H, Oberic L, Morschhauser F, Tilly H, Ribrag V, Lamy T, Thieblemont C, Villemagne B, Gressin R, Bouabdallah K, Haioun C, Damaj G, Fornecker LM, Schiano De Colella JM, Feugier P, Hermine O, Cartron G, Bonnet C, André M, Bailly C, Casasnovas RO, Le Gouill S. Deep-Learning Assessed Muscular Hypodensity Independently Predicts Mortality in DLBCL Patients Younger Than 60 Years. Cancers (Basel) 2021; 13:cancers13184503. [PMID: 34572728 PMCID: PMC8466314 DOI: 10.3390/cancers13184503] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/27/2021] [Accepted: 09/03/2021] [Indexed: 01/06/2023] Open
Abstract
Simple Summary Cachexia is a major cause of mortality in cancer patients and is characterized by a continuous skeletal muscle loss. Muscle depletion assessed by computed tomography (CT) is a predictive marker in solid tumors but has never been assessed in non-Hodgkin’s lymphoma. Despite software improvements, its measurement remains highly time-consuming and cannot be performed in clinical practice. We report the development of a CT segmentation algorithm based on convolutional neural networks. It automates the extraction of anthropometric data from pretherapeutic CT to assess precise body composition of young diffuse large B cell lymphoma (DLBCL) patients at the time of diagnosis. In this population, muscle hypodensity appears to be an independent risk factor for mortality, and can be estimated at diagnosis with this new tool. Abstract Background. Muscle depletion (MD) assessed by computed tomography (CT) has been shown to be a predictive marker in solid tumors, but has not been assessed in non-Hodgkin’s lymphomas. Despite software improvements, MD measurement remains highly time-consuming and cannot be used in clinical practice. Methods. This study reports the development of a Deep-Learning automatic segmentation algorithm (DLASA) to measure MD, and investigate its predictive value in a cohort of 656 diffuse large B cell lymphoma (DLBCL) patients included in the GAINED phase III prospective trial (NCT01659099). Results. After training on a series of 190 patients, the DLASA achieved a Dice coefficient of 0.97 ± 0.03. In the cohort, the median skeletal muscle index was 50.2 cm2/m2 and median muscle attenuation (MA) was 36.1 Hounsfield units (HU). No impact of sarcopenia was found on either progression free survival (PFS) or overall survival (OS). Muscular hypodensity, defined as MA below the tenth percentile according to sex, was associated with a lower OS and PFS, respectively (HR = 2.80 (95% CI 1.58–4.95), p < 0.001, and HR = 2.22 (95% CI 1.43–3.45), p < 0.001). Muscular hypodensity appears to be an independent risk factor for mortality in DLBCL and because of DLASA can be estimated in routine practice.
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Affiliation(s)
- Maxime Jullien
- Department of Hematology, Nantes University Hospital, INSERM CRCINA Nantes-Angers, NeXT Université de Nantes, 44000 Nantes, France; (M.J.); (B.T.)
| | - Benoit Tessoulin
- Department of Hematology, Nantes University Hospital, INSERM CRCINA Nantes-Angers, NeXT Université de Nantes, 44000 Nantes, France; (M.J.); (B.T.)
| | - Hervé Ghesquières
- Department of Hematology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Claude Bernard Lyon-1 University, 69310 Pierre Bénite, France;
| | - Lucie Oberic
- Department of Hematology, IUC Toulouse Oncopole, 31000 Toulouse, France;
| | - Franck Morschhauser
- Department of Hematology, Univ. Lille, CHU Lille, EA 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, 59000 Lille, France;
| | - Hervé Tilly
- Department of Hematology, Centre H. Becquerel, 76000 Rouen, France;
| | - Vincent Ribrag
- Department of Hematology, Gustave Roussy, Université Paris-Saclay, 94800 Villejuif, France;
| | - Thierry Lamy
- Department of Hematology, University Hospital of Rennes, 35000 Rennes, France;
| | - Catherine Thieblemont
- Department of Hematology, APHP, Hopital Saint Louis, Université Paris Diderot, 75011 Paris, France;
| | - Bruno Villemagne
- Department of Hematology, Hopital Departemental de Vendée, 85000 La Roche sur Yon, France;
| | - Rémy Gressin
- Department of Hematology, CHU Grenoble, 38000 Grenoble, France;
| | - Kamal Bouabdallah
- Department of Hematology, University Hospital of Bordeaux, F-33000 Bordeaux, France;
| | - Corinne Haioun
- Lymphoïd Malignancies Unit, Hôpital Henri Mondor, AP-HP, 94000 Créteil, France;
| | - Gandhi Damaj
- Department of Hematology, Institut D’hématologie de Basse Normandie, 14000 Caen, France;
| | - Luc-Matthieu Fornecker
- Department of Hematology, Institut de Cancérologie Strasbourg Europe (ICANS), University Hospital of Strasbourg, 67000 Strasbourg, France;
| | | | - Pierre Feugier
- Department of Hematology, University Hospital of Nancy, 54000 Nancy, France;
| | - Olivier Hermine
- Department of Hematology, Hopital Necker, F-75015 Paris, France;
| | - Guillaume Cartron
- Department of Clinical Hematology, University Hospital of Montpellier, UMR-CNRS 5535, 34000 Montpellier, France;
| | - Christophe Bonnet
- Department of Hematology, CHU Liege, Liege University, 4000 Liege, Belgium;
| | - Marc André
- Department of Hematology, CHU UCL Namur, Université Catholique de Louvain, 5000 Namur, Belgium;
| | - Clément Bailly
- Department of Nuclear Medicine, University Hospital of Nantes, 44000 Nantes, France;
| | - René-Olivier Casasnovas
- Department of Hematology, University Hospital F. Mitterrand and Inserm UMR 1231, 21000 Dijon, France;
| | - Steven Le Gouill
- Department of Hematology, Nantes University Hospital, INSERM CRCINA Nantes-Angers, NeXT Université de Nantes, 44000 Nantes, France; (M.J.); (B.T.)
- Correspondence: ; Tel.: +33-(0)1-44-32-41-00
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Ahn SS, Yoo BW, Kwon HC, Yoo J, Jung SM, Song JJ, Park YB, Lee SW. Evaluation of body composition using computed tomography in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis. Korean J Intern Med 2021; 36:1221-1232. [PMID: 32806878 PMCID: PMC8435509 DOI: 10.3904/kjim.2020.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/28/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/AIMS Measures of body composition, including visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and skeletal muscle area (SMA), are considered important prognostic factors in chronic diseases. The association of these measures with auto-inflammatory disorders, such as anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV), remains unclear. We investigated the clinical significance of VAT, SAT, and SMA in patients with AAV. METHODS Patients with AAV subjected to chest computed tomography (CT), abdominal CT, or positron emission tomography-CT on diagnosis of AAV were evaluated. Quantitative assessment of VAT, SAT, and SMA was performed at the third lumbar vertebral level and computed by summing the pixel attenuation for tissue-specific Hounsfield units in the corresponding region. Associations of VAT, SAT, and SMA with clinical and laboratory data and clinical outcome measures were evaluated. RESULTS Of the 117 patients, 61 (52.1%) were classified as having microscopic polyangiitis, 28 (23.9%) as granulomatosis with polyangiitis, and 28 (23.9%) as eosinophilic granulomatosis with polyangiitis. VAT significantly correlated with age, weight, body mass index (BMI), and Birmingham Vasculitis Activity Score, whereas SAT correlated with weight, BMI, and creatinine levels. A significant association was found between SMA and age, height, weight, BMI, and the Five-Factor Score. Cox proportional hazards analysis showed that creatinine levels (odds ratio [OR], 1.346; 95% confidence interval [CI], 1.034 to 1.753; p = 0.027) and high VAT (OR, 7.137; 95% CI, 1.343-37.946; p = 0.021) were independently associated with all-cause mortality during follow-up. CONCLUSION Evaluation of VAT using CT is useful for estimating disease activity and all-cause mortality in patients with AAV.
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Affiliation(s)
- Sung Soo Ahn
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Byung-Woo Yoo
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeok Chan Kwon
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Juyoung Yoo
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Min Jung
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jason Jungsik Song
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Beom Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Sang-Won Lee
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Korea
- Correspondence to Sang-Won Lee, M.D. Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Tel: +82-2-2228-1987 Fax: +82-2-393-6884 E-mail:
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Meguro K, Hosono K, Sato M, Sugimoto Y, Takai Y, Kurita Y, Kanoshima K, Shimizu T, Sakai E, Nakajima A. Prognostic Impact of Sarcopenia in Patients With Biliary Tract Cancer Undergoing Chemotherapy. In Vivo 2021; 35:2909-2915. [PMID: 34410986 DOI: 10.21873/invivo.12581] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/02/2021] [Accepted: 07/06/2021] [Indexed: 12/25/2022]
Abstract
AIM Sarcopenia affects the treatment of various cancer types but its impact on chemotherapy efficacy and prognosis in biliary tract cancer remains unclear. Thus, we evaluated whether sarcopenia independently affects the outcome of chemotherapy for biliary tract cancer. PATIENTS AND METHODS Data of 50 patients who underwent chemotherapy for biliary tract cancer at two affiliated centres were retrospectively analysed. The association of clinical factors, including sarcopenia, with overall survival and time to treatment failure was analysed. RESULTS Sarcopenia was an independent factor negatively influencing overall survival and time to treatment failure in univariate and multivariate analyses (median overall survival, sarcopenic vs. non-sarcopenic patients: 10.6 vs. 16.6 months; hazard ratio=2.19, p=0.018; time to treatment failure: 5.3 vs. 13.1 months, hazard ratio=2.50, p=0.019). CONCLUSION Sarcopenia may affect the efficacy of chemotherapy and prognosis in biliary tract cancer. Thus, improving sarcopenia may improve the prognosis of patients with biliary tract cancer undergoing chemotherapy.
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Affiliation(s)
- Koki Meguro
- Gastroenterology Division, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Kunihiro Hosono
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Motokazu Sato
- Gastroenterology Division, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Yuichi Sugimoto
- Gastroenterology Division, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Yusuke Takai
- Gastroenterology Division, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Yusuke Kurita
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Kenji Kanoshima
- Gastroenterology Division, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Tomoki Shimizu
- Gastroenterology Division, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Eiji Sakai
- Gastroenterology Division, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
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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: 4] [Impact Index Per Article: 1.3] [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.
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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
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Marín-Ordoñez JA, Osorno-Villegas JC, Fuentes-Díaz CF. Asociación entre sarcopenia medida con el índice del psoas por tomografía abdominal y complicaciones posoperatorias tempranas en pacientes con cáncer gástrico. REVISTA COLOMBIANA DE CIRUGÍA 2021. [DOI: 10.30944/20117582.850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. En Colombia el cáncer gástrico representa un problema de salud pública teniendo en cuenta su alta incidencia y sus elevadas tasas de mortalidad. Cerca del 15 % de los pacientes sufren una pérdida significativa de peso, lo que se asocia con un incremento en la morbilidad y mortalidad.
Método. Se realizó un estudio de corte transversal, con el objetivo de determinar la presencia de sarcopenia a través de la medición del índice del psoas por tomografía computarizada y su asociación con morbimortalidad postoperatoria temprana en pacientes con cáncer gástrico. Se incluyeron los pacientes con cáncer gástrico admitidos entre el 1° de enero de 2014 y el 31 de agosto de 2019 en el Hospital Militar Central, en Bogotá, D.C., Colombia. Se hizo un análisis descriptivo, un análisis bivariado y un análisis de regresión logística univariado para determinar la asociación de sarcopenia y complicaciones a 30 días. Todos los análisis fueron realizados en R®.
Resultados. Se estudiaron 70 pacientes, encontrando una frecuencia de sarcopenia de 54,3 % (n=38), edad media de 69 años (RIC 54 - 74), mayor proporción de hombres 68,6 % (n=48), siendo menor en el grupo de sarcopenia 55,3 % (n=21), índice de psoas de 0,63 mm (RIC 0,55 - 0,7), mortalidad 2,9 % (n=2) y asociación de sarcopenia con desenlaces a 30 días (OR 1,2; IC95% 0,59 - 2,4).
Discusión. Se encontraron resultados similares a los informados en la literatura mundial, con una mortalidad inferior al 3 %. En este estudio, la sarcopenia no se asoció con la aparición de complicaciones a 30 días.
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Kim YJ, Choi J, Moon J, Sung KR, Choi J. A Sarcopenia Detection System Using an RGB-D Camera and an Ultrasound Probe: Eye-in-Hand Approach. BIOSENSORS 2021; 11:243. [PMID: 34356714 PMCID: PMC8301760 DOI: 10.3390/bios11070243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/11/2021] [Accepted: 07/14/2021] [Indexed: 12/28/2022]
Abstract
Skeletal muscle mass deficiency and quality degradation constitute sarcopenia for elderly people. Sarcopenia can result in musculoskeletal damage and accompany various metabolic problems, which make early sarcopenia diagnosis important. Various modalities, such as computed tomography (CT) and magnetic resonance imaging (MRI), have been developed for screening sarcopenia. Recently, ultrasound scanning was suggested for screening sarcopenia because of its safety, usability, and cost effectiveness. However, there has been no standardized assessment methodology for screening sarcopenia with ultrasound scanning. Therefore, prior to this study, we developed a four-degrees-of-freedom (DOF) sarcopenia detection system using an RGB-D camera and an ultrasound probe to automatically scan the human thigh without operator dependency. However, due to the eye-to-hand approach with the RGB-D camera, the system has limited usability for clinical trials. Therefore, in this study we modified the system such that it became eye-in-hand by attaching the RGB-D camera to the upper part of the system with an enhanced arc fitting algorithm. The modified system and enhanced algorithm were verified by an in-vitro test with bean curd-gelatin phantom. The results showed that the thickness of bean curd in the gelatin phantom was maintained at approximately 12.7 ± 0.35 mm over the 71.5∘ scanning range with 2.49 ± 0.15 N radial force at various thickness measuring points.
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Affiliation(s)
- Yeoun-Jae Kim
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea;
| | - Jueun Choi
- Department of Biomedical Engineering, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.C.); (J.M.)
| | - Jungwoo Moon
- Department of Biomedical Engineering, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.C.); (J.M.)
| | - Kyung Rim Sung
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Jaesoon Choi
- Department of Biomedical Engineering, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.C.); (J.M.)
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Kim N, Yu JI, Lim DH, Lee J, Kim ST, Hong JY, Kang WK, Jeong WK, Kim KM. Prognostic Impact of Sarcopenia and Radiotherapy in Patients With Advanced Gastric Cancer Treated With Anti-PD-1 Antibody. Front Immunol 2021; 12:701668. [PMID: 34305941 PMCID: PMC8298191 DOI: 10.3389/fimmu.2021.701668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/23/2021] [Indexed: 12/14/2022] Open
Abstract
Background We explored the combined effects of sarcopenia (SAR) and radiotherapy (RT) on outcomes in patients with advanced gastric cancer (AGC) treated with immune-checkpoint blockade (ICB). Methods Among 185 patients with AGC treated with ICB, we defined SAR as skeletal muscle index <49 cm2/m2 for men and <31 cm2/m2 for women; 93 patients met criteria. We defined high neutrophil-to-lymphocyte ratio (hNLR) as NLR≥3. Palliative RT was performed in 37 patients (20%) before ICB. Results We frequently observed hNLR in patients with SAR (53% vs. 35%, p = 0.02). The median overall survival (OS) for the entire cohort was 5 months. Stratification by risk factors of SAR or hNLR revealed a significant difference in median OS (0 [N = 60] vs. 1 [N = 76] vs. 2 [N = 49]: 7.6 vs. 6.4 vs. 2.2 months, p < 0.001). Patients with microsatellite instability-high (MSI-H, N = 19) or Epstein-Barr virus (EBV)-positive tumors (N = 13) showed favorable outcomes compared to those with microsatellite stable (MSS, N = 142) tumors (median OS, not reached vs. 16.8 vs. 3.8 months, respectively). The benefit of RT was evident in patients with both SAR and hNLR (median OS, 3.1 vs. 1.3 months, p = 0.02) and MSS/EBV-negative tumor (median OS, 6.5 vs. 3.5 months, p = 0.03), but outcomes after RT in MSI-H tumor were not significantly different. In multivariable analysis, SAR/hNLR, molecular subtypes, and a history of RT were associated with OS (all p < 0.05). Conclusions We demonstrated the negative predictive value of SAR/hNLR on outcomes after ICB for AGC, and the history of RT could overcome the negative impact of SAR/hNLR and the MSS/EBV-negative subtype.
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Affiliation(s)
- Nalee Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jeong Il Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Do Hoon Lim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jeeyun Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung Tae Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jung Yong Hong
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Won Ki Kang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Woo Kyoung Jeong
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyoung-Mee Kim
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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The prevalence and the impact of sarcopenia in digestive cancers. A Systematic Review. ACTA ACUST UNITED AC 2021; 59:328-344. [PMID: 34218540 DOI: 10.2478/rjim-2021-0026] [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: 05/03/2021] [Indexed: 01/06/2023]
Abstract
Introduction: Sarcopenia is characterized by a decrease in skeletal muscle mass, associated with low muscle strength and/or poor physical performance. Assessing the prevalence of sarcopenia among digestive cancers and establishing the impact that sarcopenia has on the postoperative evolution of digestive tumors may be a central pillar in improving postoperative outcomes by caring for perioperative sarcopenia.This brief review aimed to evaluate the prevalence of sarcopenia in digestive cancer patients.Method and materials: PubMed database was searched for" sarcopenia" AND" digestive cancers" from January 1st, 2010, through September 30th, 2020. PRISMA guideline was used for this systematic review. After the selection process, 31 complete studies were included in our review.Assessment of sarcopenia diagnosis for the studies included in this systematic review was based on a computed tomographic calculation of the skeletal muscle index at the third lumbar vertebra.Results: Among a total of 11651 patients with digestive cancers, the prevalence of sarcopenia was 43.68%.The highest prevalence of sarcopenic patients was in esophageal (70.4%) and hepatic (60.3%) cancer, following by biliary tract (49.3%), pancreatic (45.70%), colorectal (42.83%), cancer, and gastric cancer (32.05%) with the lowest prevalence.The results of studies conducted by now regarding the prevalence of sarcopenia in digestive cancers and its relevance in the evolution of these cancers are discordant and uneven.Some studies show that the presence of sarcopenia in patients with digestive cancers is associated with an increased rate of postoperative complications, increased toxicity of chemotherapeutics and increased mortality. Other studies, do not find sarcopenia as an independent risk factor associated with negative consequences in the course of patients with digestive cancers.Conclusions: Sarcopenia is prevalent in digestive cancers. There is still no consensus about the impact of sarcopenia on the treatment of digestive cancers. Further studies are needed to evaluate the real consequences of sarcopenia in digestive cancers.
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Yang MC, Wang YC, Chen IS, Huang WC. Thickness of rectus abdominis measured by ultrasound in critically ill patients after abdominal surgery: A retrospective cohort study. Eur J Anaesthesiol 2021; 38:684-691. [PMID: 33399371 DOI: 10.1097/eja.0000000000001407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Early identification of patients at high risk of prolonged mechanical ventilation is important in critical care. Sarcopenia, the loss of muscle mass and function, has been reported to be associated with extended mechanical ventilation and prolonged ICU stay. Although ultrasound is noninvasive and widely used in critical care, there is no standard method of using it to assess sarcopenia. OBJECTIVES The study aims to investigate the relationship between outcomes of critically ill patients and the ratio of BMI to the thickness of rectus abdominis measured by a standardised ultrasound examination. DESIGN A retrospective cohort study. SETTING Surgical ICU of a tertiary referral hospital, from October 2017 to June 2018. The thickness of rectus abdominis (RA) was measured while performing extended focused assessment sonography for trauma. BMI was divided by the thickness of rectus abdominis over the upper abdomen to derive the BMI-RA thickness ratio. PATIENTS Sixteen male and 11 female patients admitted to ICU after major abdominal surgery. MAIN OUTCOME MEASURES The primary outcome was in-hospital mortality, and the secondary outcomes were durations of mechanical ventilation, ICU stay and hospital stay. The disease severity, serum albumin level and BMI-RA thickness ratio were also analysed. RESULTS Ultrasound measurement was easy to perform without adverse effects. The BMI-RA thickness ratio was significantly higher in nonsurvivors and was associated with ICU stay, hospital stay and duration of mechanical ventilation. Multivariable logistic regression showed that the BMI-RA thickness ratio was a predictor of in-hospital mortality. CONCLUSION The BMI-RA thickness ratio is related to the outcomes of patients transferred to ICU after major abdominal surgery. Measuring the thickness of rectus abdominis by ultrasound is well tolerated and easy to perform in surgical ICU. Larger prospective studies are required to confirm current findings.
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Affiliation(s)
- Ming-Chieh Yang
- From the Division of Critical Care Medicine, E-Da Cancer Hospital (M-CY), Department of Surgery, Kaohsiung Veterans General Hospital (I-SC), Department of Critical Care Medicine, Kaohsiung Veterans General Hospital (Y-CW, W-CH), School of Medicine, National Yang-Ming University (M-CY, W-CH) and Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan (W-CH)
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Matsunaga T, Satio H, Miyauchi W, Shishido Y, Miyatani K, Murakami Y, Hanaki T, Kihara K, Yamamoto M, Tokuyasu N, Takano S, Sakamoto T, Hasegawa T, Fujiwara Y. Impact of skeletal muscle mass in patients with recurrent gastric cancer. World J Surg Oncol 2021; 19:170. [PMID: 34116681 PMCID: PMC8196500 DOI: 10.1186/s12957-021-02283-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/02/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND We retrospectively examined the relationship among skeletal muscle mass index (SMI), prognosis, and chemotherapy side effects in patients with recurrent gastric cancer (RGC). METHODS Sixty-seven patients who developed recurrence after undergoing curative gastrectomy for gastric cancer at Tottori University Hospital and received palliative chemotherapy were included in this study. Pretreatment computed tomography was performed to measure the skeletal muscle mass (SMM) and cross-sectional SMM at the third lumbar vertebra. We focused on haematologic toxicity (neutropenia, thrombocytopenia, and anaemia), febrile neutropenia, and gastrointestinal toxicity (diarrhoea, vomiting, and stomatitis) as the side effects of chemotherapy. RESULTS Median SMIs for males and females (43.9 and 34.7 cm2/m2, respectively) were used as cutoff values. The patients were classified into high (SMIHigh; n = 34) and low SMI groups (SMILow; n = 33). The SMILow group included more patients treated with monotherapy (P = 0.016) compared with the SMIHigh group, had a significantly lower number of chemotherapy lines (P = 0.049), and had a significantly higher incidence of grade 3 or 4 side effects (P = 0.010). The median survival rate was significantly higher in the SMIHigh group (17.8 vs 15.8 months; P = 0.034). In the univariate analysis, body mass index, SMI, histological type, and prognostic nutritional index were identified as prognostic indicators. The multivariate analysis identified SMI (P = 0.037) and histological type (P = 0.028) as independent prognostic factors. CONCLUSION The incidence of grade 3 or 4 side effects was significantly higher in patients with SMILow RGC. SMI was a useful prognostic marker of RGC.
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Affiliation(s)
- Tomoyuki Matsunaga
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan.
| | - Hiroaki Satio
- Department of Surgery, Japanese Red Cross Tottori Hospital, 117 Shotoku-cho, Tottori, 680-8517, Japan
| | - Wataru Miyauchi
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Yuji Shishido
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Kozo Miyatani
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Yuki Murakami
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Takehiko Hanaki
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Kyoichi Kihara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Manabu Yamamoto
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Naruo Tokuyasu
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Shuichi Takano
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Teruhisa Sakamoto
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Toshimichi Hasegawa
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Yoshiyuki Fujiwara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan
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Choi H, Hong N, Park N, Kim CO, Kim HC, Choi JY, Youm Y, Rhee Y. Computed Tomography-Derived Skeletal Muscle Radiodensity Predicts Peak Weight-Corrected Jump Power in Older Adults: The Korean Urban Rural Elderly (KURE) Study. Calcif Tissue Int 2021; 108:764-774. [PMID: 33566115 DOI: 10.1007/s00223-021-00812-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 01/16/2021] [Indexed: 01/06/2023]
Abstract
Computed tomography (CT)-derived skeletal muscle area (SMA) and skeletal muscle radiodensity (SMD) reflect distinctive quantitative and qualitative characteristics of skeletal muscles. However, data on whether CT-based muscle parameters, especially SMD, can predict muscle function is limited. In a prospective cohort, 1523 community-dwelling older adults who underwent abdominal CT scans and the countermovement two-legged jumping test on a ground reaction force platform were analyzed (mean age 74.7 years, 65.1% women). SMA and SMD were measured at third lumbar vertebra level (L3). Individuals with low jump power (peak weight-corrected jump power < 23.8 W/kg in men and < 19.0 W/kg in women using clinically validated threshold) were older; had lower SMA, SMD, and maximal grip strength values; and had lower chair rise test and timed up and go test performance than those without low jump power. SMD was positively associated with peak weight-corrected jump power (adjusted β = 0.33 and 0.23 per 1 HU increase in men and women, respectively, p < 0.001). One HU decrement in SMD was associated with 10% elevated odds of low jump power (adjusted OR [aOR] 1.10, p < 0.001) after adjusting for age, sex, height, inflammation, and insulin resistance markers, whereas the association of SMA with low jump power was attenuated (aOR 1.00, p = 0.721). SMD showed better discrimination for low jump power than SMA (AUC 0.699 vs. 0.617, p < 0.001), with additional improvement when added to SMA and conventional risk factors (AUC 0.745 to 0.773, p < 0.001). Therefore, CT-measured L3 SMD can be a sensitive surrogate marker for muscle function along with SMA in older adults, which merits further investigation.
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Affiliation(s)
- Heewon Choi
- Yonsei University College of Medicine, Seoul, South Korea
| | - Namki Hong
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Narae Park
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Chang Oh Kim
- Division of Geriatrics, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Young Choi
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Yoosik Youm
- Department of Sociology, Yonsei University College of Social Sciences, Seoul, South Korea
| | - Yumie Rhee
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
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46
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Maddalena C, Ponsiglione A, Camera L, Santarpia L, Pasanisi F, Bruzzese D, Panico C, Fiore G, Camardella S, Caramia T, Farinaro A, De Placido S, Carlomagno C. Prognostic role of sarcopenia in metastatic colorectal cancer patients during first-line chemotherapy: A retrospective study. World J Clin Oncol 2021; 12:355-366. [PMID: 34131567 PMCID: PMC8173330 DOI: 10.5306/wjco.v12.i5.355] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 01/31/2021] [Accepted: 03/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Sarcopenia is a condition characterized by decreased skeletal muscle mass due to physiological ageing or to a concomitant disease such as neoplasia. In cancer patients, a low lean body mass is suggested to be a negative prognostic factor for survival and for the development of dose-limiting chemotherapy toxicities irrespective of disease stage.
AIM To evaluate the prognostic role of sarcopenia in patients with metastatic colorectal cancer (mCRC) undergoing first-line chemotherapy.
METHODS Our retrospective analysis included 56 mCRC patients who received first-line chemotherapy from 2014 to 2017 at the Medical Oncology Unit of our hospital. Computerized scans were performed before starting chemotherapy and at the first disease reassessment. Sarcopenia was assessed using the skeletal mass index = muscle area in cm2/(height in m2) calculated at the L3 vertebra. Overall survival and objective response rate were evaluated. Toxicities were analyzed during the first four cycles of therapy and graded according to Common Terminology Criteria for Adverse Events version 4.0. A loss of skeletal muscle mass ≥ 5% was considered indicative of deterioration in muscle condition.
RESULTS Median age was 67 years and 35.7% of patients were ≥ 70 years old. Fourteen patients (25%) were sarcopenic at baseline computed tomography (CT) scan (7/33 men; 7/23 women); 5/14 sarcopenic patients were ≥ 70 years old. Median follow-up was 26.8 mo (3.8-66.8 mo) and median overall survival was 27.2 mo (95%CI: 23.3-37.3). Sarcopenia was not correlated to overall survival (P = 0.362), to higher toxicities reported during the first 4 cycles of chemotherapy (P = 1.0) or to response to treatment (P = 0.221). At the first disease reassessment, a skeletal muscle loss (SML) ≥ 5% was found in 17 patients (30.3%) 3 of whom were already sarcopenic at baseline CT scan, while 7 patients became sarcopenic. SML was not correlated to overall survival (P = 0.961). No statistically significant correlation was found between baseline sarcopenia and age (P = 1.0), body mass index (P = 0.728), stage at diagnosis (P = 0.355) or neutrophil/lymphocyte ratio (P = 0.751).
CONCLUSION Neither baseline sarcopenia nor SML affected survival. In addition, baseline sarcopenia was not related to worse treatment toxicity. However, these results must be interpreted with caution due to the limited sample size.
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Affiliation(s)
- Chiara Maddalena
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Andrea Ponsiglione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples 80131, Italy
| | - Luigi Camera
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples 80131, Italy
| | - Lidia Santarpia
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Fabrizio Pasanisi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Dario Bruzzese
- Department of Public Health, University of Naples Federico II, Naples 80131, Italy
| | - Camilla Panico
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples 80131, Italy
| | - Giovanni Fiore
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Simona Camardella
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Tolomeo Caramia
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Alessia Farinaro
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Sabino De Placido
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
| | - Chiara Carlomagno
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Italy
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47
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Unintentional weight loss: what radiologists need to know and what clinicians want to know. Abdom Radiol (NY) 2021; 46:2236-2250. [PMID: 33386448 DOI: 10.1007/s00261-020-02908-6] [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: 10/24/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
Unintentional weight loss (UWL) is a common presenting symptom with a wide differential diagnosis. Causes may be organic (e.g., malignancy or gastrointestinal disease) or inorganic (e.g., psychosocial). The purpose of this review is to provide a guide for radiologists and other clinicians to understand the imaging modalities and laboratory studies involved in the diagnosis and treatment of UWL and the evidence supporting their routine use. Cases illustrating both common and uncommon causes of UWL are presented to emphasize both the breadth of pathology that may cause UWL as well as the importance of a multi-modality diagnostic approach. Imaging studies are crucial in the diagnosis of unintentional weight loss, particularly with regard to evaluating for the presence of malignancy. It is important for both the radiologist and other clinicians to understand the relative prevalence of the various causes of UWL and the utility of different imaging modalities in diagnosis and management.
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48
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Lee J, Kim EY, Kim E, Kim KG, Kim YJ, Kim YS, Ahn HK, Lee SW. Longitudinal changes in skeletal muscle mass in patients with advanced squamous cell lung cancer. Thorac Cancer 2021; 12:1662-1667. [PMID: 33829665 PMCID: PMC8169285 DOI: 10.1111/1759-7714.13958] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 03/21/2021] [Indexed: 12/11/2022] Open
Abstract
Background Skeletal muscle depletion (sarcopenia) is associated with poor prognosis in patients with lung cancer. We analyzed changes in skeletal muscle area using serial computed tomography (CT) until the death of patients with advanced squamous cell lung cancer (SQCLC). Methods This retrospective study comprised 70 consecutive patients who underwent palliative chemotherapy for SQCLC. The cross‐sectional area of the skeletal muscle at the level of the first lumbar vertebra (L1) was measured using chest CT. An artificial intelligence algorithm was developed and used for the serial assessment of the muscle area. Sarcopenia was defined as an L1 skeletal muscle index <46 cm2/m2 in men and < 29 cm2/m2 in women. Results The median age was 69 years; 62 patients (89%) had metastatic disease at the time of initial diagnosis. Sarcopenia was present in 58 patients (82.9%) at baseline; all patients experienced net muscle loss over the disease trajectory. The median overall survival was 8.7 (95% confidence interval 5.9–11.5) months. The mean percentage loss of skeletal muscle between the first and last CT was 16.5 ± 11.0%. Skeletal muscle loss accelerated over time and was the highest in the last 3 months of life (p < 0.001). Patients losing skeletal muscle rapidly (upper tertile, >3.24 cm2/month) had shorter overall survival than patients losing skeletal muscle slowly (median, 5.7 vs. 12.0 months, p < 0.001). Conclusions Patients with advanced SQCLC lose a significant amount of skeletal muscle until death. The rate of muscle area reduction is faster at the end of life. Patients with advanced SQCLC lose a significant amount of skeletal muscle until death. The rate of muscle area reduction is faster at the end of life.
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Affiliation(s)
- Jongsoo Lee
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Eun Young Kim
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Eunji Kim
- Department of Biomedical Engineering, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Kwang Gi Kim
- Department of Biomedical Engineering, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Young Jae Kim
- Department of Biomedical Engineering, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Young Saing Kim
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Hee Kyung Ahn
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Sang-Woong Lee
- Division of Software, School of AI-SW, Gachon University, Seongnam, Republic of Korea
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49
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Jones AJ, Campiti VJ, Alwani M, Novinger LJ, Tucker BJ, Bonetto A, Yesensky JA, Sim MW, Moore MG, Mantravadi AV. Sarcopenia is associated with blood transfusions in head and neck cancer free flap surgery. Laryngoscope Investig Otolaryngol 2021; 6:200-210. [PMID: 33869752 PMCID: PMC8035950 DOI: 10.1002/lio2.530] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/29/2020] [Accepted: 01/20/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To determine if sarcopenia is a predictor of blood transfusion requirements in head and neck cancer free flap reconstruction (HNCFFR). METHODS A single-institution, retrospective review was performed of HNCFFR patients with preoperative abdominal imaging from 2014 to 2019. Demographics, comorbidities (modified Charlson Comorbidity Index [mCCI]), skeletal muscle index (cm2/m2), oncologic history, intraoperative data, and 30-day postoperative complications (Clavien-Dindo score [CD]) were collected. Binary logistic regression was performed to determine predictors of transfusion. RESULTS Eighty (33.5%), 66 (27.6%), and 110 (46.0%) of n = 239 total patients received an intraoperative, postoperative, or any perioperative blood transfusion, respectively. Sixty-two (25.9%) patients had sarcopenia. Patients receiving intraoperative transfusions had older age (P = .035), more frequent alcoholism (P = .028) and sarcopenia (P < .001), greater mCCI (P < .001), lower preoperative hemoglobin (P < .001), reconstruction with flaps other than forearm (P = .003), and greater operative times (P = .001), intravenous fluids (P < .001), and estimated blood loss (EBL, P < .001). Postoperative transfusions were associated with major complications (CD ≥ 3; P < .001). Multivariate regression determined sarcopenia (P = .023), mCCI (P = .013), preoperative hemoglobin (P = .002), operative time (P = .036), and EBL (P < .001) as independent predictors of intraoperative transfusion requirements. Postoperative transfusions were predicted by preoperative hemoglobin (P = .007), osseous flap (P = .036), and CD ≥ 3 (P < .001). A perioperative transfusion was predicted by sarcopenia (P = .021), preoperative hemoglobin (P < .001), operative time (P = .008), and CD ≥ 3 (P = .018). CONCLUSION Sarcopenia is associated with increased blood transfusions in HNCFFR. Patients should be counseled preoperatively on the associated risks, and the increased blood product requirement should be accounted in resource-limited scenarios. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Alexander Joseph Jones
- Department of Otolaryngology–Head and Neck SurgeryIndiana University School of MedicineIndianapolisIndianaUSA
| | - Vincent J. Campiti
- Department of Otolaryngology–Head and Neck SurgeryIndiana University School of MedicineIndianapolisIndianaUSA
| | - Mohamedkazim Alwani
- Department of Otolaryngology–Head and Neck SurgeryIndiana University School of MedicineIndianapolisIndianaUSA
| | - Leah J. Novinger
- Department of Otolaryngology–Head and Neck SurgeryIndiana University School of MedicineIndianapolisIndianaUSA
| | - Brady Jay Tucker
- Department of Otolaryngology–Head and Neck SurgeryIndiana University School of MedicineIndianapolisIndianaUSA
| | - Andrea Bonetto
- Department of SurgeryIndiana University School of MedicineIndianapolisIndianaUSA
| | - Jessica A. Yesensky
- Department of Otolaryngology–Head and Neck SurgeryIndiana University School of MedicineIndianapolisIndianaUSA
| | - Michael W. Sim
- Department of Otolaryngology–Head and Neck SurgeryIndiana University School of MedicineIndianapolisIndianaUSA
| | - Michael G. Moore
- Department of Otolaryngology–Head and Neck SurgeryIndiana University School of MedicineIndianapolisIndianaUSA
| | - Avinash V. Mantravadi
- Department of Otolaryngology–Head and Neck SurgeryIndiana University School of MedicineIndianapolisIndianaUSA
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50
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Catanese S, Aringhieri G, Vivaldi C, Salani F, Vitali S, Pecora I, Massa V, Lencioni M, Vasile E, Tintori R, Balducci F, Falcone A, Cappelli C, Fornaro L. Role of Baseline Computed-Tomography-Evaluated Body Composition in Predicting Outcome and Toxicity from First-Line Therapy in Advanced Gastric Cancer Patients. J Clin Med 2021; 10:jcm10051079. [PMID: 33807648 PMCID: PMC7961444 DOI: 10.3390/jcm10051079] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/22/2021] [Accepted: 02/26/2021] [Indexed: 01/06/2023] Open
Abstract
Sarcopenia is recognised as a predictor of toxicity and survival in localised and locally advanced gastric cancer (GC). Its prognostication power in advanced unresectable or metastatic GC (aGC) is debated. The survival impact of visceral and subcutaneous fat distribution (visceral fat area (VFA)/subcutaneous fat area (SFA)) is ambiguous. Our aim was to determine the influence of body composition parameters (BCp) on toxicity and survival in aGC patients undergoing palliative treatment. BCp were retrospectively assessed by baseline computed tomography for 78 aGC patients who received first-line chemotherapy from March 2010 to January 2017. Correlations between BCp and toxicity and survival were calculated by χ2-test and by log-rank-test and Cox-model, respectively. Sarcopenia fails to show association with progression-free survival (PFS) (p = 0.44) and overall survival (OS) (p = 0.88). However, sarcopenia influences the development of high-grade neutropenia (p = 0.048) and mucositis (p = 0.054). VFA/SFA (high vs. all the rest) results as a strong predictor of objective response (p = 0.02) and outcome (PFS, p = 0.001; OS, p = 0.02). At multivariate analysis for PFS, prognostic factors are VFA/SFA (p = 0.03) and a neutrophil–lymphocyte ratio >3. The same factors remain significant for OS (each p = 0.03) along with Eastern Cooperative Oncology Group (ECOG) performance status (p = 0.008) and number of metastatic sites ≥2 (p < 0.001). In our cohort of aGC, VFA/SFA exhibit a robust impact on survival, with a higher sensitivity than sarcopenia.
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Affiliation(s)
- Silvia Catanese
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy; (S.C.); (F.S.); (V.M.); (M.L.); (E.V.); (A.F.); (L.F.)
| | - Giacomo Aringhieri
- Department of Translational Research and New Surgical and Medical Technologies, University of Pisa, Via Savi 6, 56126 Pisa, Italy; (G.A.); (R.T.); (F.B.)
- Diagnostic and Interventional Radiology, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy; (S.V.); (C.C.)
| | - Caterina Vivaldi
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy; (S.C.); (F.S.); (V.M.); (M.L.); (E.V.); (A.F.); (L.F.)
- Department of Translational Research and New Surgical and Medical Technologies, University of Pisa, Via Savi 6, 56126 Pisa, Italy; (G.A.); (R.T.); (F.B.)
- Correspondence: ; Tel.: +39-050-992466
| | - Francesca Salani
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy; (S.C.); (F.S.); (V.M.); (M.L.); (E.V.); (A.F.); (L.F.)
| | - Saverio Vitali
- Diagnostic and Interventional Radiology, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy; (S.V.); (C.C.)
| | - Irene Pecora
- Unit of Medical Oncology, Ospedale della Misericordia di Grosseto, Azienda Usl Sud Est, Via Senese 161, 58100 Grosseto, Italy;
| | - Valentina Massa
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy; (S.C.); (F.S.); (V.M.); (M.L.); (E.V.); (A.F.); (L.F.)
| | - Monica Lencioni
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy; (S.C.); (F.S.); (V.M.); (M.L.); (E.V.); (A.F.); (L.F.)
| | - Enrico Vasile
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy; (S.C.); (F.S.); (V.M.); (M.L.); (E.V.); (A.F.); (L.F.)
| | - Rachele Tintori
- Department of Translational Research and New Surgical and Medical Technologies, University of Pisa, Via Savi 6, 56126 Pisa, Italy; (G.A.); (R.T.); (F.B.)
| | - Francesco Balducci
- Department of Translational Research and New Surgical and Medical Technologies, University of Pisa, Via Savi 6, 56126 Pisa, Italy; (G.A.); (R.T.); (F.B.)
| | - Alfredo Falcone
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy; (S.C.); (F.S.); (V.M.); (M.L.); (E.V.); (A.F.); (L.F.)
- Department of Translational Research and New Surgical and Medical Technologies, University of Pisa, Via Savi 6, 56126 Pisa, Italy; (G.A.); (R.T.); (F.B.)
| | - Carla Cappelli
- Diagnostic and Interventional Radiology, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy; (S.V.); (C.C.)
| | - Lorenzo Fornaro
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy; (S.C.); (F.S.); (V.M.); (M.L.); (E.V.); (A.F.); (L.F.)
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