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Becerra-Tomás N, Markozannes G, Cariolou M, Balducci K, Vieira R, Kiss S, Aune D, Greenwood DC, Dossus L, Copson E, Renehan AG, Bours M, Demark-Wahnefried W, Hudson MM, May AM, Odedina FT, Skinner R, Steindorf K, Tjønneland A, Velikova G, Baskin ML, Chowdhury R, Hill L, Lewis SJ, Seidell J, Weijenberg MP, Krebs J, Cross AJ, Tsilidis KK, Chan DSM. Post-diagnosis adiposity and colorectal cancer prognosis: A Global Cancer Update Programme (CUP Global) systematic literature review and meta-analysis. Int J Cancer 2024; 155:400-425. [PMID: 38692659 DOI: 10.1002/ijc.34905] [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: 07/21/2023] [Revised: 12/15/2023] [Accepted: 01/17/2024] [Indexed: 05/03/2024]
Abstract
The adiposity influence on colorectal cancer prognosis remains poorly characterised. We performed a systematic review and meta-analysis on post-diagnosis adiposity measures (body mass index [BMI], waist circumference, waist-to-hip ratio, weight) or their changes and colorectal cancer outcomes. PubMed and Embase were searched through 28 February 2022. Random-effects meta-analyses were conducted when at least three studies had sufficient information. The quality of evidence was interpreted and graded by the Global Cancer Update Programme (CUP Global) independent Expert Committee on Cancer Survivorship and Expert Panel. We reviewed 124 observational studies (85 publications). Meta-analyses were possible for BMI and all-cause mortality, colorectal cancer-specific mortality, and cancer recurrence/disease-free survival. Non-linear meta-analysis indicated a reverse J-shaped association between BMI and colorectal cancer outcomes (nadir at BMI 28 kg/m2). The highest risk, relative to the nadir, was observed at both ends of the BMI distribution (18 and 38 kg/m2), namely 60% and 23% higher risk for all-cause mortality; 95% and 26% for colorectal cancer-specific mortality; and 37% and 24% for cancer recurrence/disease-free survival, respectively. The higher risk with low BMI was attenuated in secondary analyses of RCTs (compared to cohort studies), among studies with longer follow-up, and in women suggesting potential methodological limitations and/or altered physiological state. Descriptively synthesised studies on other adiposity-outcome associations of interest were limited in number and methodological quality. All the associations were graded as limited (likelihood of causality: no conclusion) due to potential methodological limitations (reverse causation, confounding, selection bias). Additional well-designed observational studies and interventional trials are needed to provide further clarification.
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Affiliation(s)
- Nerea Becerra-Tomás
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Georgios Markozannes
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - Margarita Cariolou
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Katia Balducci
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Rita Vieira
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Sonia Kiss
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Nutrition, Oslo New University College, Oslo, Norway
- Department of Research, The Cancer Registry of Norway, Oslo, Norway
| | - Darren C Greenwood
- Leeds Institute for Data Analytics, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Laure Dossus
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Ellen Copson
- Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Andrew G Renehan
- The Christie NHS Foundation Trust, Manchester Cancer Research Centre, NIHR Manchester Biomedical Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Martijn Bours
- Department of Epidemiology, GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Wendy Demark-Wahnefried
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Melissa M Hudson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Roderick Skinner
- Department of Paediatric and Adolescent Haematology/Oncology, Great North Children's Hospital and Translational and Clinical Research Institute, and Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Diet, Cancer and Health, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Galina Velikova
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | | | - Rajiv Chowdhury
- Department of Global Health, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Lynette Hill
- World Cancer Research Fund International, London, UK
| | - Sarah J Lewis
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jaap Seidell
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Matty P Weijenberg
- Department of Epidemiology, GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - John Krebs
- Department of Biology, University of Oxford, Oxford, UK
| | - Amanda J Cross
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Konstantinos K Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - Doris S M Chan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
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Zhou H, Tian L, Wu Y, Liu S. Computed tomography-measured body composition can predict long-term outcomes for stage I-III colorectal cancer patients. Front Oncol 2024; 14:1420917. [PMID: 39040454 PMCID: PMC11260682 DOI: 10.3389/fonc.2024.1420917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 06/20/2024] [Indexed: 07/24/2024] Open
Abstract
Background There remains a pressing need to identify biomarkers capable of reliably predicting prognostic outcomes for colorectal cancer (CRC) patients. As several body composition parameters have recently been reported to exhibit varying levels of prognostic significance in particular cancers, the present study was devised to assess the ability of body composition to predict long-term outcomes for CRC patients with different stages of disease. Methods In total, this retrospective analysis enrolled 327 stage I-III CRC patients whose medical records were accessed for baseline demographic and clinical data. Primary outcomes for these patients included disease-free and overall survival (DFS and OS). The prognostic performance of different musculature, visceral, and subcutaneous fat measurements from preoperative computed tomography (CT) scans was assessed. Results Over the course of follow-up, 93 of the enrolled patients experienced recurrent disease and 39 died. Through multivariate Cox regression analyses, the visceral/subcutaneous fat area (V/S) ratio was found to be independently associated with patient DFS (HR=1.93, 95% CI: 1.24-3.01, P=0.004), and the skeletal muscle index (SMI) as an independent predictor for OS (HR=0.43, 95% CI: 0.21-0.89, P=0.023). Through subgroup analyses, higher V/S ratios were found to be correlated with reduced DFS among patients with stage T3/4 (P=0.011), lymph node metastasis-positive (P=0.002), and TNM stage III (P=0.002) disease, whereas a higher SMI was associated with better OS in all T stages (P=0.034, P=0.015), lymph node metastasis-positive cases (P=0.020), and in patients with TNM stage III disease (P=0.020). Conclusion Both the V/S ratio and SMI offer potential utility as clinical biomarkers associated with long-term CRC patient prognosis. A higher V/S ratio and a lower SMI are closely related to poorer outcomes in patients with more advanced disease.
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Affiliation(s)
| | | | | | - Sibin Liu
- Radiology Department, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei, China
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Chiloiro G, Cintoni M, Palombaro M, Romano A, Reina S, Pulcini G, Corvari B, Di Franco S, Meldolesi E, Egidi G, Grassi F, Raoul P, Rinninella E, Gasbarrini A, Mele MC, Gambacorta MA. Impact of body composition parameters on radiation therapy compliance in locally advanced rectal cancer: A retrospective observational analysis. Clin Transl Radiat Oncol 2024; 47:100789. [PMID: 38741926 PMCID: PMC11089307 DOI: 10.1016/j.ctro.2024.100789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 04/12/2024] [Accepted: 04/27/2024] [Indexed: 05/16/2024] Open
Abstract
Background The impact of body composition and sarcopenia in locally advanced rectal cancer (LARC) is still unclear, even several studies have been published on this issue. Our study aims to analyze the impact of sarcopenia on neoadjuvant chemoradiotherapy (nCRT) tolerance and survival outcomes. Methods This is a retrospective, monocentric study where LARC patients treated between 2010 and 2020 were enrolled. A single slice, from the pre-therapy simulation computed tomography (CT) scan, was used to perform the body composition analysis with dedicated software. The primary endpoint was the impact of body composition on radiotherapy (RT) interruption secondarily on overall survival (OS), disease-free survival (DFS), and local control (LC). Results The study included 628 LARC patients (40.9 % female, mean age 63.4 years): 24 % had low skeletal muscle index (SMI), 30 % had low muscle density (MD) and 17 (10.3 % of obese) were sarcopenic obese. Higher BMI (OR 2.38, 95 % CI 1.36-4.01) and lower SMI (0.73, 95 % CI 0.55-0.94) resulted as independent predictors of RT interruption. Sarcopenic obesity (HR 2.83, 95 % CI 1.24-6.45) was related to worse OS, while MD (0.96, 95 % CI 0.93-0.98), and higher SMI (0.97, 95 % CI 0.95-0.99) were related to better OS; a lower MD remained also associated even in adjusted multivariable analysis (0.96, 95 % CI0.93-0.98). Moreover, higher visceral adipose tissue (VAT) resulted associated with worse DFS (1.02, 95 % CI 1.01-1.03), while higher SMI was related to better Local Control (0.96, 95 % CI 0.93-0.99). Conclusions Body composition analysis, particularly of muscle and fat masses, may be a useful tool for better management of LARC patients undergoing RT. Increased collaboration between radiation oncologists and clinical nutritionists is advisable, to enable early nutritional support of LARC.
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Affiliation(s)
- Giuditta Chiloiro
- UOC Radioterapia, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Marco Cintoni
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
- Centro di Ricerca e Formazione in Nutrizione Umana, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Marta Palombaro
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Angela Romano
- UOC Radioterapia, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Sara Reina
- UOC Radioterapia, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Gabriele Pulcini
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Barbara Corvari
- UOC Radioterapia, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Silvia Di Franco
- UOC Radioterapia, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Elisa Meldolesi
- UOC Radioterapia, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Gabriele Egidi
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Futura Grassi
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Pauline Raoul
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Emanuele Rinninella
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Antonio Gasbarrini
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- UOC Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Maria Cristina Mele
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
- Centro di Ricerca e Formazione in Nutrizione Umana, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Maria Antonietta Gambacorta
- UOC Radioterapia, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Song M, Liu Z, Wu F, Nie T, Heng Y, Xu J, Huang N, Wu X, Cao Y, Hu G. Serum tumor marker and CT body composition scoring system predicts outcomes in colorectal cancer surgical patients. Eur Radiol 2024:10.1007/s00330-024-10849-7. [PMID: 38913246 DOI: 10.1007/s00330-024-10849-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 04/29/2024] [Accepted: 06/03/2024] [Indexed: 06/25/2024]
Abstract
OBJECTIVE To investigate the prognostic value of preoperative body composition and serum tumor markers (STM) in patients undergoing surgical treatment for colorectal cancer (CRC) and to establish the prognostic score for patients with CRC. METHODS This study enrolled 365 patients (training set 245, validation set 120) with CRC who underwent surgical resection. The predictive value of various body composition features and STM for determining CRC prognosis were compared. A novel index score based on the independent risk factors from Cox regression for CRC patients was established and evaluated for its usefulness. RESULTS Multivariate Cox regression showed that low skeletal muscle radiodensity (SMD) (p = 0.020), low subcutaneous fat area (SFA) (p = 0.029), high carcinoembryonic antigen (CEA) (p = 0.008), and high alpha-fetoprotein (AFP) (p = 0.039) were all independent prognostic factors for poor overall survival (OS). The multifactorial analysis indicated that high intermuscular fat area (IMFA) (p = 0.033) and high CEA (p = 0.009) were independent prognostic factors for poor disease-free survival (DFS). Based on these findings, two scoring systems for OS and DFS were established in the training datasets. CRC patients who scored higher on the new scoring systems had lower OS and DFS (both p < 0.001) as shown in the Kaplan-Meier survival curves in the training and validation datasets. CONCLUSION In predicting the prognosis of CRC patients, SFA and SMD are superior to other body composition measurements. A scoring system based on body composition and STM can have prognostic value and clinical applicability. CLINICAL RELEVANCE STATEMENT This scoring system, combining body composition and serum tumor markers, may help predict postoperative survival of CRC patients and help clinicians make well-informed decisions regarding the treatment of patients. KEY POINTS Colorectal cancer prognosis can be related to body composition. High intermuscular fat area and CEA were independent prognostic factors for poor disease-free survival. This scoring system, based on body composition and tumor markers, can prognosticate for colorectal cancer patients.
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Affiliation(s)
- Mingming Song
- Department of General Surgery, The Second People's Hospital of Hefei Affiliated to Bengbu Medical University, Hefei, 230011, China
- Department of General Surgery, The Second People's Hospital of Hefei, Hefei, 230011, China
| | - Zhihao Liu
- China Medical University, Shenyang, 110122, China
| | - Feihong Wu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Tong Nie
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Yixin Heng
- Department of General Surgery, The First Affiliated Hospital of Shihezi University, Shihezi, 832000, P.R. China
| | - Jiaxin Xu
- Department of General Surgery, The First Affiliated Hospital of Shihezi University, Shihezi, 832000, P.R. China
| | - Ning Huang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xiaoyu Wu
- Department of General Surgery, The First Affiliated Hospital of Shihezi University, Shihezi, 832000, P.R. China
| | - Yinghao Cao
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- National Local Joint Laboratory for Advanced Textile Processing and Clean Production, Wuhan Textile University, Wuhan, 430073, China.
| | - Gang Hu
- Department of General Surgery, The Second People's Hospital of Hefei Affiliated to Bengbu Medical University, Hefei, 230011, China.
- Department of General Surgery, The Second People's Hospital of Hefei, Hefei, 230011, China.
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Cho HJ, Kang J. Sarcopenia diagnosis in patients with colorectal cancer: a review of computed tomography-based assessments and emerging ways to enhance practicality. Ann Surg Treat Res 2024; 106:305-312. [PMID: 38868590 PMCID: PMC11164660 DOI: 10.4174/astr.2024.106.6.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/09/2024] [Accepted: 04/19/2024] [Indexed: 06/14/2024] Open
Abstract
Traditionally, cancer treatment has focused on the stages of the disease; however, recent studies have highlighted the importance of considering the overall health status of patients in the prognosis of cancer. Loss of skeletal muscle, known as sarcopenia, has been found to significantly affect outcomes in many different types of cancers, including colorectal cancer. In this review, we discuss the guidelines for diagnosing sarcopenia, with a specific focus on CT-based assessments. Many groups worldwide, including those in Europe and Asia, have introduced their own diagnostic guidelines for sarcopenia. Seemingly similar yet subtle discrepancies, particularly in the cutoff values used, limit the use of these guidelines in the general population, warranting a more universal guideline. Although CT-based measurements, such as skeletal muscle index and radiodensity, have shown promise in predicting outcomes, the lack of standardized values in these measurements hinders their universal adoption. To overcome these limitations, innovative approaches are being developed to assess changes in muscle mass trajectories and introduce new indices, such as skeletal and appendicular muscle gauges. Additionally, machine learning models have shown superior performance in predicting sarcopenic status, providing an alternative to CT-based diagnosis, particularly after surgery. CT has tremendous benefits and a significant role in visually as well as quantitatively retrieving information on patient body composition. In order to compensate for the limitation of standard cutoff value, 3-dimensional analysis of the CT, artificial intelligence-based body composition analysis, as well as machine learning algorithms for data interpretation and analysis have been proposed and are being utilized. In conclusion, despite the varying definitions of sarcopenia, CT-based measurements coupled with machine-learning models are promising for evaluating patients with cancer. Standardization efforts can improve diagnostic accuracy, reduce the reliance on CT examinations, and make sarcopenia assessments more accessible in clinical settings.
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Affiliation(s)
- Hye Jung Cho
- Department of Surgery, Division of Colorectal Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jeonghyun Kang
- Department of Surgery, Division of Colorectal Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Su Q, Shen J. Predictive role of preoperative sarcopenia for long-term survival in rectal cancer patients: A meta-analysis. PLoS One 2024; 19:e0303494. [PMID: 38771764 PMCID: PMC11108127 DOI: 10.1371/journal.pone.0303494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/25/2024] [Indexed: 05/23/2024] Open
Abstract
PURPOSE To identify the predictive role of sarcopenia in long-term survival among rectal cancer patients who underwent surgery based on available evidence. METHODS The Medline, EMBASE and Web of Science databases were searched up to October 20, 2023, for relevant studies. Overall survival (OS), disease-free survival (DFS) and cancer-specific survival (CSS) were the endpoints. Hazard ratios (HRs) and 95% confidence intervals (CIs) were combined to evaluate the association between sarcopenia and survival. RESULTS Fifteen studies with 4283 patients were included. The pooled results demonstrated that preoperative sarcopenia significantly predicted poorer OS (HR = 2.07, 95% CI = 1.67-2.57, P<0.001), DFS (HR = 1.85, 95% CI = 1.39-2.48, P<0.001) and CSS (HR = 1.83, 95% CI = 1.31-2.56, P<0.001). Furthermore, subgroup analysis based on neoadjuvant therapy indicated that sarcopenia was a risk factor for worse OS and DFS in patients who received (OS: HR = 2.44, P<0.001; DFS: HR = 2.16, P<0.001) but not in those who did not receive (OS: HR = 2.44, P<0.001; DDFS: HR = 1.86, P = 0.002) neoadjuvant chemoradiotherapy. In addition, subgroup analysis based on sample size and ethnicity showed similar results. CONCLUSION Preoperative sarcopenia is significantly related to poor survival in surgical rectal cancer patients and could serve as a novel and valuable predictor of long-term prognosis in these patients.
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Affiliation(s)
- Qiutong Su
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Jia Shen
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
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Jurdana M, Cemazar M. Sarcopenic obesity in cancer. Radiol Oncol 2024; 58:1-8. [PMID: 38378031 PMCID: PMC10878777 DOI: 10.2478/raon-2024-0011] [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: 11/02/2023] [Accepted: 12/04/2023] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Sarcopenic obesity is a relatively new term. It is a clinical condition characterized by sarcopenia (loss of muscle mass and function) and obesity (increase in fat mass) that mainly affects older adults. As the incidence of sarcopenia and obesity increases worldwide, sarcopenic obesity is becoming a greater problem also in cancer patients. In fact, sarcopenic obesity is associated with poorer treatment outcomes, longer hospital stays, physical disability, and shorter survival in several cancers. Oxidative stress, lipotoxicity, and systemic inflammation, as well as altered expression of skeletal muscle anti-inflammatory myokines in sarcopenic obesity, are also associated with carcinogenesis. CONCLUSIONS Reported prevalence of sarcopenic obesity in cancer varies because of heterogeneity in definitions and variability in diagnostic criteria used to estimate the prevalence of sarcopenia and obesity. Therefore, the aim of this review is to describe the definitions, prevalence, and diagnostic criteria as well as the mechanisms that cancer has in common with sarcopenic obesity.
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Affiliation(s)
- Mihaela Jurdana
- Faculty of Health Sciences, University of Primorska, Izola, Slovenia
| | - Maja Cemazar
- Faculty of Health Sciences, University of Primorska, Izola, Slovenia
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
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Nishikawa T, Taira T, Kakizawa N, Ohno R, Nagasaki T. Negative impact of sarcopenia on survival in elderly patients with colorectal cancer receiving surgery: A propensity‑score matched analysis. Oncol Lett 2024; 27:91. [PMID: 38268777 PMCID: PMC10804374 DOI: 10.3892/ol.2024.14224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/01/2023] [Indexed: 01/26/2024] Open
Abstract
Sarcopenia is a prognostic factor for patients with colorectal cancer and is commonly seen in elderly patients. The purpose of the present study was to demonstrate the impact of preoperative sarcopenia on the short- and long-term outcomes of curative surgery for treating colorectal cancer in elderly patients. Between 2016 and 2020, patients aged ≥80 years with colorectal cancer were investigated. The total muscle cross-sectional area was calculated using computed tomography imaging at the mid-3rd lumbar vertebra. Elder sarcopenia was identified using sex-specific cut-offs. Out of 106 elderly colorectal cancer patients, 27 patients were diagnosed with elder sarcopenia. Patients with elder sarcopenia had a reduced body mass index (19.7±2.5 vs. 22.5±2.9 kg/m2; P<0.01), an advanced pN stage (P<0.01) and an advanced stage (stage 3) (P=0.029). Elder sarcopenia had a negative impact on relapse-free survival (3-year, 78.4 vs. 91.1%; P=0.049) and overall survival (3-year, 73.0 vs. 93.9%; P=0.022). Propensity score-matched analysis was performed, matching 27 patients in each group to remove selection bias, which demonstrated elder sarcopenia had a negative impact on overall survival (3-year, 73.0 vs. 100%; P<0.01). Overall, elder sarcopenia was prevalent in 25% of elderly patients with colorectal cancer that received curative surgery, and it was a poor prognostic indicator in this patient population.
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Affiliation(s)
- Takeshi Nishikawa
- Department of Gastrointestinal Surgery, Saitama Cancer Center, Ina-machi, Saitama 362-0806, Japan
| | - Tetsuro Taira
- Department of Gastrointestinal Surgery, Saitama Cancer Center, Ina-machi, Saitama 362-0806, Japan
| | - Nao Kakizawa
- Department of Gastrointestinal Surgery, Saitama Cancer Center, Ina-machi, Saitama 362-0806, Japan
| | - Riki Ohno
- Department of Gastrointestinal Surgery, Saitama Cancer Center, Ina-machi, Saitama 362-0806, Japan
| | - Toshiya Nagasaki
- Department of Gastrointestinal Surgery, Saitama Cancer Center, Ina-machi, Saitama 362-0806, Japan
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9
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Tang H, Lian R, Li R, Jiang J, Yang M. Landscape and research trends of sarcopenic obesity research: A bibliometric analysis. Heliyon 2024; 10:e24696. [PMID: 38304815 PMCID: PMC10831793 DOI: 10.1016/j.heliyon.2024.e24696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/04/2023] [Accepted: 01/12/2024] [Indexed: 02/03/2024] Open
Abstract
Background Sarcopenic obesity (SO) is a condition characterized by the coexistence of sarcopenia (loss of muscle mass and function) and obesity. This condition has emerged as a public health concern, particularly with the aging population. Despite an approximately 30-year history of SO research, detailed quantitative analysis of existing research was never undertaken. We aimed to depict the landscape of SO research using bibliometric analysis of literature. Methods We searched the Web of Science Core Collection on January 15, 2023. The following bibliometric indicators were included: publication trend, the most influential country, the most active discipline, productive institutions, productive journals, prolific and highly cited authors, and highly cited publications. We constructed co-authorship network to explore individual-level, institutional-level, and international-level collaborative patterns in the VOSviewer or Sci2 software. Furthermore, keywords co-occurrence network was extracted by the VOSviewer software, and the burst-detection analysis of keywords was performed using the CiteSpace software. Results A total of 2023 original articles were retrieved for data analysis. The publications increased dramatically in the last decade. The United States had the highest number of publications on SO (n = 904). The Seoul National University Hospital was the most prolific institution (n = 54) among the 2675 institutions analyzed. As for journals, Clinical Nutrition had the highest number of publications on SO (n = 75). Kim JH was the most prolific author (n = 25), while Cederholm T authored the most cited publication (9381 citations). More than 80 disciplines were involved in SO research, of which, "Geriatrics and Gerontology" was the most activated discipline. The European Working Group on Sarcopenia in Older People (EWGSOP) consensus was the most cited publication (7209 citations). Moreover, the hotspots of SO have been shifting from its biology, prevalence, and risk factors to its outcomes, prognostic factors, complications, and quality of life. Its relationships also evolved from being between SO and aging to being between SO and other diseases. Conclusions Our study provided a comprehensive landscape of SO research, which may help researchers better identify key information and research trends in this field.
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Affiliation(s)
- Huiyu Tang
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Rongna Lian
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Runjie Li
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jiaojiao Jiang
- Rehabilitation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ming Yang
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Lin WL, Wu LM, Huang WT, Guo HR, Chen JJ. Age as a modifier of the effects of sarcopenia on survival among colon cancer patients after surgery. J Surg Oncol 2023; 128:1121-1132. [PMID: 37592877 DOI: 10.1002/jso.27405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/06/2023] [Accepted: 07/16/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Studies have been conducted to evaluate whether sarcopenia is a predictor for survival in patients with colon cancer postsurgery, but findings have been inconsistent, and effects of age were seldom evaluated. METHODS We recruited 133 patients with resectable colon cancer who underwent surgery between January 2014 and December 2017 at a teaching hospital to evaluate the effects of sarcopenia on survival, after adjusting for age and other potential predictors, including visceral adiposity (VA). RESULTS Preoperative sarcopenia was associated with worse overall survival (OS: 62.3% vs. 83.8%, p = 0.04) and longer hospital stay (20.6 vs. 14.9 days, p < 0.01) while VA was not. Cox proportional hazards regressions showed that sarcopenia was associated with an adjusted hazard ratio (HR) of 2.91 (95% confidence interval [CI]: 1.08-7.86) after adjustment for other independent risk factors, but was not associated with disease free survival. In stratified analyses, we found that sarcopenia was an independent factor for worse OS (adjusted HR = 1.94; 95% CI: 1.11-3.38) among patients >70 years, but not among patients ≤70 years (HR = 0.48; 95% CI: 0.55-4.55). CONCLUSIONS Age appeared to be a modifier of the effects of sarcopenia on OS among colon cancer patients postsurgery.
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Affiliation(s)
- Wen-Li Lin
- Center for Quality Management, Chi Mei Hospital, Liouying, Tainan, Taiwan
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Li-Min Wu
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wen-Tsung Huang
- Division of Hematology and Oncology, Chi Mei Hospital, Liouying, Tainan, Taiwan
| | - How-Ran Guo
- Department of Environmental and Occupational Health, National Cheng Kung University, Tainan, Taiwan
- Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Jyh-Jou Chen
- Division of Gastroenterology and Hepatology, Chi Mei Hospital, Liouying, Tainan, Taiwan
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11
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He J, Luo W, Huang Y, Song L, Mei Y. Sarcopenia as a prognostic indicator in colorectal cancer: an updated meta-analysis. Front Oncol 2023; 13:1247341. [PMID: 37965475 PMCID: PMC10642225 DOI: 10.3389/fonc.2023.1247341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/09/2023] [Indexed: 11/16/2023] Open
Abstract
Background Sarcopenia, often observed in the elderly, is associated with declining skeletal muscle mass and impaired muscle function. This condition has been consistently linked to a less favorable prognosis in various malignancies. Computed tomography (CT) is a frequently employed modality for evaluating skeletal muscle mass, enabling the measurement of the skeletal muscle index (SMI) at the third lumbar vertebra (L3) level. This measurement serves as a defining criterion for sarcopenia. The meta-analysis dealt with evaluating the promise sarcopenia held as a prognostic indicator in individuals with colorectal cancer. Methods Research relevant to the subject was determined by systematically searching PubMed, Embase, Web of Science, WANFANG, and CNKI (up to June 11, 2023, published studies). In this meta-analysis, the incidence of sarcopenia in individuals with colorectal cancer was combined to analyze the disease-free survival (DFS), overall survival (OS), and cancer-specific survival (CSS) of these individuals with and without sarcopenia. The included research was evaluated for quality per the Newcastle-Ottawa Scale (NOS) score. In the multivariate analysis of each study, the direct extraction of hazard ratio (HR) with a 95% confidence interval (CI) was executed. STATA 11.0 was applied to integrate and statistically analyze the data. Results Overall 20 articles participated in this meta-analysis. A 34% incidence of sarcopenia was noted in colorectal cancer. The presence of sarcopenia denoted a decrease in OS (HR=1.72,95% CI=1.45-2.03), DFS (HR=1.42,95% CI=1.26-1.60) and CSS (HR=1.48,95% CI=1.26-1.75) in individuals with colorectal cancer. In addition, the subgroup analysis depicted a pattern consistent with the overall analysis results. Conclusion CT-defined sarcopenia exhibits promise as an indicator of survival prognosis in individuals with colorectal cancer. Future studies need a more rigorous definition of sarcopenia to further verify these findings. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023431435.
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Affiliation(s)
- Jie He
- Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan, China
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
- Key Laboratory of Geriatric Respiratory Diseases of Sichuan Higher Education Institutes, Chengdu, Sichuan, China
| | - Wei Luo
- Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan, China
- Radiology Department, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Yuanyuan Huang
- Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan, China
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
- Key Laboratory of Geriatric Respiratory Diseases of Sichuan Higher Education Institutes, Chengdu, Sichuan, China
| | - Lingmeng Song
- Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan, China
- Medical Department, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Yang Mei
- Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan, China
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
- Key Laboratory of Geriatric Respiratory Diseases of Sichuan Higher Education Institutes, Chengdu, Sichuan, China
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12
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Saino Y, Kawase F, Nagano A, Ueshima J, Kobayashi H, Murotani K, Inoue T, Nagami S, Suzuki M, Maeda K. Diagnosis and prevalence of sarcopenic obesity in patients with colorectal cancer: A scoping review. Clin Nutr 2023; 42:1595-1601. [PMID: 37480796 DOI: 10.1016/j.clnu.2023.06.025] [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: 04/27/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND & AIMS Sarcopenic obesity (SO) is associated with worse outcomes in patients with colorectal cancer (CRC); however, the diagnostic methods and prevalence of SO vary among studies. Therefore, we conducted this scoping review to investigate the diagnosis of SO in CRC, identify the associated problems, and determine its prevalence. METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews reporting guidelines. A literature search was performed by two independent reviewers on studies that diagnosed SO in CRC using the MEDLINE, EMBASE, CINAHL, CENTRAL, Web of Science, and Ichushi-Web (in Japanese) databases. Observational, longitudinal, cross-sectional, and clinical trials written in English or Japanese as of July 2022 were included. Studies that did not define SO were excluded from the analysis. The study protocol was pre-registered in Figshare. RESULTS In total, 670 studies were identified, 22 of which were included. Eighteen studies used sarcopenia in combination with obesity to diagnose SO. Sarcopenia was mainly diagnosed using skeletal muscle mass index (SMI), and only one combined with grip strength or gait speed. Obesity was diagnosed based on the body mass index (BMI; n = 11), followed by visceral fat area (VFA; n = 5). The overall prevalence of SO in patients with CRC was 15% (95%CI, 11-21%). The prevalence of SO in surgical resection and colorectal cancer liver metastases was 18% (95%CI, 12-25%) and 11% (95%CI, 3-36%), respectively. CONCLUSIONS SO in patients with CRC was mainly diagnosed based on a combination of SMI and BMI, and muscle strength and body composition were rarely evaluated. The prevalence of SO was approximately 15%, depending on the diagnostic methods used. Since SO in patients with CRC is associated with poor prognosis, further research on diagnostic methods for the early detection of SO and its clinical outcomes is needed.
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Affiliation(s)
- Yoko Saino
- Department of Clinical Nutrition, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto, Tokyo 135-8550, Japan; Department of Nutrition and Metabolism, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.
| | - Fumiya Kawase
- Department of Nutrition, Asuke Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, 20 Nakata, Yagami-cho, Toyota, Aichi 444-2351, Japan.
| | - Ayano Nagano
- Department of Nursing, Nishinomiya Kyoritsu Neurosurgical Hospital, 11-1 Imazuyamanaka-cho, Nishinomiya, Hyogo 663-8211, Japan.
| | - Junko Ueshima
- Department of Nutritional Service, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa, Tokyo 141-8625, Japan.
| | - Haruko Kobayashi
- General Incorporated Association Manabi Public Library, 306 Wakabadai, Meito, Nagoya, Aichi 465-0015, Japan.
| | - Kenta Murotani
- Biostatistics Center, Kurume University. 67, Asahimachi, Kurume, Fukuoka 830-0011, Japan.
| | - Tatsuro Inoue
- Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimami, Kita-ku, Niigata 950-3198, Japan.
| | - Shinsuke Nagami
- Department of Speech-Language Pathology and Audiology, Faculty of Rehabilitation, Kawasaki University of Medical Welfare, 288 Matsushima, Kurashiki, Okayama 701-0193, Japan.
| | - Mizue Suzuki
- Department of Rehabilitation, Faculty of Allied Health Sciences, Yamato University, 2-5-1 Katayama, Suita, Osaka 564-0082, Japan.
| | - Keisuke Maeda
- Nutrition Therapy Support Center, Aichi Medical University Hospital1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan; Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, Aichi 474-8511, Japan.
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13
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Tolonen A, Kerminen H, Lehtomäki K, Huhtala H, Bärlund M, Österlund P, Arponen O. Association between Computed Tomography-Determined Loss of Muscle Mass and Impaired Three-Month Survival in Frail Older Adults with Cancer. Cancers (Basel) 2023; 15:3398. [PMID: 37444508 DOI: 10.3390/cancers15133398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/06/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
As patients with solid (non-hematological) cancers and a life expectancy of <3 months rarely benefit from oncological treatment, we examined whether the CT-determined loss of muscle mass is associated with an impaired 3-month overall survival (OS) in frail ≥75-year-old patients with cancer. Frailty was assessed with G8-screening and comprehensive geriatric assessment in older adults at risk of frailty. The L3-level skeletal (SMI) and psoas (PMI) muscle indexes were determined from routine CT scans. Established and optimized SMI and PMI cut-offs were used. In the non-curative treatment group (n = 58), 3-month OS rates for normal and low SMI were 95% and 64% (HR 9.28; 95% CI 1.2-71) and for PMI 88%, and 60%, respectively (HR 4.10; 1.3-13). A Cox multivariable 3-month OS model showed an HR of 10.7 (1.0-110) for low SMI, 2.34 (0.6-9.8) for ECOG performance status 3-4, 2.11 (0.5-8.6) for clinical frailty scale 5-9, and 0.57 (0.1-2.8) for males. The 24-month OS rates in the curative intent group (n = 21) were 91% and 38% for the normal and low SMI groups, respectively. In conclusion, CT-determined low muscle mass is independently associated with an impaired 3-month OS and, alongside geriatric assessment, could aid in oncological versus best supportive care decision-making in frail patients with non-curable cancers.
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Affiliation(s)
- Antti Tolonen
- Department of Radiology, Tampere University Hospital, Kuntokatu 2, 33520 Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33520 Tampere, Finland
| | - Hanna Kerminen
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33520 Tampere, Finland
- Centre of Geriatrics, Tampere University Hospital, Kuntokatu 2, 33520 Tampere, Finland
- Gerontology Research Center (GEREC), Tampere University, Arvo Ylpön Katu 34, 33520 Tampere, Finland
| | - Kaisa Lehtomäki
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33520 Tampere, Finland
- Department of Oncology, Tays Cancer Centre, Tampere University Hospital, Teiskontie 35, 33520 Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Kalevantie 5, 33014 Tampere, Finland
| | - Maarit Bärlund
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33520 Tampere, Finland
- Department of Oncology, Tays Cancer Centre, Tampere University Hospital, Teiskontie 35, 33520 Tampere, Finland
| | - Pia Österlund
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33520 Tampere, Finland
- Department of Oncology, Tays Cancer Centre, Tampere University Hospital, Teiskontie 35, 33520 Tampere, Finland
- Department of Oncology, Comprehensive Cancer Center, Helsinki University Hospital, University of Helsinki, Haartmaninkatu 4, 00290 Helsinki, Finland
- Department of Gastrointestinal Oncology, Tema Cancer, Karolinska Universitetssjukhuset, Eugeniavägen 3, 17176 Solna, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Solnavägen 1, 17177 Solna, Sweden
| | - Otso Arponen
- Department of Radiology, Tampere University Hospital, Kuntokatu 2, 33520 Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33520 Tampere, Finland
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14
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Tschann P, Weigl MP, Clemens P, Szeverinski P, Attenberger C, Kowatsch M, Jäger T, Emmanuel K, Brock T, Königsrainer I. Sarcopenic Obesity Is a Risk Factor for Worse Oncological Long-Term Outcome in Locally Advanced Rectal Cancer Patients: A Retrospective Single-Center Cohort Study. Nutrients 2023; 15:nu15112632. [PMID: 37299595 DOI: 10.3390/nu15112632] [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: 05/09/2023] [Revised: 05/30/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Malnutrition and skeletal muscle waste (sarcopenia) are known as predictive factors for a poor postoperative outcome. Paradoxically, obesity seems to be associated with a survival advantage in wasting diseases such as cancer. Thus, the interpretation of body composition indices and their impact on rectal cancer therapy has become more and more complex. The aim of this study was to evaluate body composition indices in locally advanced rectal cancer patients prior to therapy and their impact on short- and long-term outcomes. METHODS Between 2008 and 2018, 96 patients were included in this study. Pre-therapeutic CT scans were used to evaluate visceral and subcutaneous fat mass, as well as muscle mass. Body composition indices were compared to body mass index, morbidity, anastomotic leakage rate, local recurrency rate, and oncological long-term outcomes. RESULTS Increased visceral fat (p < 0.01), subcutaneous fat (p < 0.01), and total fat mass (p = 0.001) were associated with overweight. Skeletal muscle waste (sarcopenia) (p = 0.045), age (p = 0.004), comorbidities (p < 0.01), and sarcopenic obesity (p = 0.02) were significantly associated with increased overall morbidity. The anastomotic leakage rate was significantly influenced when comorbidities were present (p = 0.006). Patients with sarcopenic obesity showed significantly worse disease-free (p = 0.04) and overall survival (p = 0.0019). The local recurrency rate was not influenced by body composition indices. CONCLUSION Muscle waste, older age, and comorbidities were demonstrated as strong risk factors for increased overall morbidity. Sarcopenic obesity was associated with worse DFS and OS. This study underlines the role of nutrition and appropriate physical activity prior to therapy.
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Affiliation(s)
- Peter Tschann
- Department of General- and Thoracic Surgery, Academic Teaching Hospital, 6800 Feldkirch, Austria
| | - Markus P Weigl
- Department of General- and Thoracic Surgery, Academic Teaching Hospital, 6800 Feldkirch, Austria
| | - Patrick Clemens
- Department of Radio-Oncology, Academic Teaching Hospital, 6800 Feldkirch, Austria
| | - Philipp Szeverinski
- Institute of Medical Physics, Academic Teaching Hospital, 6800 Feldkirch, Austria
| | | | - Matthias Kowatsch
- Institute of Medical Physics, Academic Teaching Hospital, 6800 Feldkirch, Austria
| | - Tarkan Jäger
- Department of Surgery, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Klaus Emmanuel
- Department of Surgery, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Thomas Brock
- Department of General- and Thoracic Surgery, Academic Teaching Hospital, 6800 Feldkirch, Austria
| | - Ingmar Königsrainer
- Department of General- and Thoracic Surgery, Academic Teaching Hospital, 6800 Feldkirch, Austria
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15
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Jung J, Lee J, Lim JH, Kim YC, Ban TH, Park WY, Kim KM, Kim K, Lee SW, Shin SJ, Han SS, Kim DK, Ko Y, Kim KW, Kim H, Park JY. The effects of muscle mass and quality on mortality of patients with acute kidney injury requiring continuous renal replacement therapy. Sci Rep 2023; 13:7311. [PMID: 37147326 PMCID: PMC10162987 DOI: 10.1038/s41598-023-33716-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/18/2023] [Indexed: 05/07/2023] Open
Abstract
This study examined the effects of muscle mass on mortality in patients with acute kidney injury requiring continuous renal replacement therapy. It was conducted in eight medical centers between 2006 and 2021. The data of 2200 patients over the age of 18 years with acute kidney injury who required continuous renal replacement therapy were retrospectively collected. Skeletal muscle areas, categorized into normal and low attenuation muscle areas, were obtained from computed tomography images at the level of the third lumbar vertebra. Cox proportional hazards models were used to investigate the association between mortality within 1, 3, and 30 days and skeletal muscle index. Sixty percent of patients were male, and the 30-day mortality rate was 52%. Increased skeletal muscle areas/body mass index was associated with decreased mortality risk. We also identified a 26% decreased risk of low attenuation muscle area/body mass index on mortality. We established that muscle mass had protective effects on the mortality of patients with acute kidney injury requiring continuous renal replacement therapy. This study showed that muscle mass is a significant determinant of mortality, even if the density is low.
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Affiliation(s)
- Jiyun Jung
- Clinical Trial Center, Dongguk University Ilsan Hospital, Goyang, South Korea
- Research Center for Chronic Disease and Environmental Medicine, Dongguk University College of Medicine, Gyeongju, South Korea
| | - Jangwook Lee
- Research Center for Chronic Disease and Environmental Medicine, Dongguk University College of Medicine, Gyeongju, South Korea
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - Jeong-Hoon Lim
- Department of Internal Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Tae Hyun Ban
- Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Woo Yeong Park
- Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea
| | - Kyeong Min Kim
- Department of Internal Medicine, Daejeon Eulji Medical Center, Eulji University, Daejeon, South Korea
| | - Kipyo Kim
- Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine, Incheon, South Korea
| | - Sung Woo Lee
- Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University, Gyeonggi-Do, South Korea
| | - Sung Joon Shin
- Research Center for Chronic Disease and Environmental Medicine, Dongguk University College of Medicine, Gyeongju, South Korea
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea
- Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, South Korea
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Yousun Ko
- Biomedical Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, South Korea
| | - Kyung Won Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyosang Kim
- Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
| | - Jae Yoon Park
- Research Center for Chronic Disease and Environmental Medicine, Dongguk University College of Medicine, Gyeongju, South Korea.
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea.
- Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, South Korea.
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16
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Portale G, Bartolotta P, Azzolina D, Gregori D, Fiscon V. Prognostic role of platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte, and lymphocyte-to-monocyte ratio in operated rectal cancer patients: systematic review and meta-analysis. Langenbecks Arch Surg 2023; 408:85. [PMID: 36781510 DOI: 10.1007/s00423-023-02786-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 12/30/2022] [Indexed: 02/15/2023]
Abstract
BACKGROUND Inflammation plays an important role in tumor growth. Novel serum blood biomarkers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR), have been proposed as useful prognostic indexes in cancer patients. However, their role in rectal cancer is controversial. METHODS A comprehensive literature review was conducted including MEDLINE/Pubmed, EMBASE, SCOPUS, and the Cochrane Database of Systematic Reviews through May 2022. The systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Quality was appraised with the Methodological Index for Non-Randomized Studies (MINORS) tool. Aim of the study was to summarize available literature on PLR, NLR, and LMR in patients with rectal cancer undergoing resection. RESULTS Forty-seven observational studies (14,205 patients) were included; there were 42 retrospective and 5 prospective cohort studies with an average MINORS score of 14.6 (range: 12-18). Worse overall survival was associated with high NLR (HR 1.81; 95%CI 1.52-2.15; p < 0.001), high PLR (HR 1.24; 95%CI 1.06-1.46; p = 0.009), and low LMR (HR 0.67; 95%CI 0.49-0.91; p = 0.01). High NLR and low LMR were also associated with disease-free-survival (HR 1.68; 95%CI 1.35-2.08; p < 0.001 and HR 0.71; 95%CI 0.58-0.87; p < 0.001, respectively). CONCLUSIONS NLR, PLR, and LMR are independent clinical predictors for overall survival in patients with rectal cancer treated with curative surgery. NLR and LMR are also good predictors for disease free survival. These biomarkers, which are readily available, appear optimal prognostic indexes and may help clinicians predict the prognosis of rectal cancer and develop individualized treatment strategies.
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Affiliation(s)
- Giuseppe Portale
- Department of General Surgery, Azienda Euganea ULSS 6, Via Casa Di Ricovero 40, 35013, Cittadella, Padua, Italy.
| | - Patrizia Bartolotta
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35121, Padua, Italy
| | - Danila Azzolina
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35121, Padua, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35121, Padua, Italy
| | - Valentino Fiscon
- Department of General Surgery, Azienda Euganea ULSS 6, Via Casa Di Ricovero 40, 35013, Cittadella, Padua, Italy
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Bong JW, Na Y, Ju Y, Cheong C, Kang S, Lee SI, Min BW. Nomogram for predicting the overall survival of underweight patients with colorectal cancer: a clinical study. BMC Gastroenterol 2023; 23:39. [PMID: 36782150 PMCID: PMC9923908 DOI: 10.1186/s12876-023-02669-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 02/07/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND An underweight individual is defined as one whose Body Mass Index (BMI) is < 18.5 kg/m2. Currently, the prognosis in patients with colorectal cancer (CRC) who are also underweight is unclear. METHODS Information on South Korean patients who underwent curative resection for CRC without distant metastasis was collected from health insurance registry data between January 2014 and December 2016. We compared the overall survival (OS) of underweight and non-underweight (BMI ≥ 18.5 kg/m2) patients after adjusting for confounders using propensity score matching. A nomogram to predict OS in the underweight group was constructed using the significant risk factors identified in multivariate analysis. The predictive and discriminative capabilities of the nomogram for predicting 3- and 5-year OS in the underweight group were validated and compared with those of the tumor, node, and metastasis (TNM) staging system in the training and validation sets. RESULTS A total of 23,803 (93.6%) and 1,644 (6.4%) patients were assigned to the non-underweight and underweight groups, respectively. OS was significantly worse in the underweight group than in the non-underweight group for each pathological stage (non-underweight vs. underweight: stage I, 90.1% vs. 77.1%; stage IIA, 85.3% vs. 67.3%; stage IIB/C, 74.9% vs. 52.1%; and stage III, 73.2% vs. 59.4%, P < 0.001). The calibration plots demonstrated that the nomogram exhibited satisfactory consistency with the actual results. The concordance index (C-index) and area under the receiver operating characteristic curve (AUC) of the nomogram exhibited better discriminatory capability than those of the TNM staging system (C-index, nomogram versus TNM staging system: training set, 0.713 versus 0.564, P < 0.001; validation set, 0.691 versus 0.548, P < 0.001; AUC for 3- and 5- year OS, nomogram versus TNM staging system: training set, 0.748 and 0.741 versus 0.610 and 0.601; validation set, 0.715 and 0.753 versus 0.586 and 0.579, respectively). CONCLUSIONS Underweight patients had worse OS than non-underweight patients for all stages of CRC. Our nomogram can guide prognostic predictions and the treatment plan for underweight patients with CRC.
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Affiliation(s)
- Jun Woo Bong
- grid.411134.20000 0004 0474 0479Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-Ro, Guro-Gu, Seoul, 08308 Republic of Korea
| | - Younghyun Na
- grid.411134.20000 0004 0474 0479Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-Ro, Guro-Gu, Seoul, 08308 Republic of Korea
| | - Yeonuk Ju
- grid.411134.20000 0004 0474 0479Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-Ro, Guro-Gu, Seoul, 08308 Republic of Korea
| | - Chinock Cheong
- grid.411134.20000 0004 0474 0479Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-Ro, Guro-Gu, Seoul, 08308 Republic of Korea
| | - Sanghee Kang
- grid.411134.20000 0004 0474 0479Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-Ro, Guro-Gu, Seoul, 08308 Republic of Korea
| | - Sun Il Lee
- grid.411134.20000 0004 0474 0479Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-Ro, Guro-Gu, Seoul, 08308 Republic of Korea
| | - Byung Wook Min
- Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-Ro, Guro-Gu, Seoul, 08308, Republic of Korea.
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18
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Portale G, Zuin M, Spolverato YC, Bartolotta P, Gregori D, Rettore C, Cancian L, Morabito A, Sava T, Fiscon V. Prognostic effect of sarcopenia in patients undergoing laparoscopic rectal cancer resection. ANZ J Surg 2023. [PMID: 36757847 DOI: 10.1111/ans.18269] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 02/10/2023]
Abstract
BACKGROUND The importance of body composition, in particular skeletal muscle mass, as risk factor affecting survival of cancer patients has recently gained increasing attention. The relationship between sarcopenia and oncological outcomes has become a topic of research in particular in patients with gastrointestinal cancer. However, there are few studies addressing this issue in colorectal cancer, and even less specifically focused on rectal cancer, in particular in Western countries. The aim of this study was to evaluate the prognostic relevance of preoperative skeletal mass index (SMI) on long-term outcomes in patients undergoing laparoscopic curative resection for rectal cancer. METHODS SMI data and clinicopathological characteristics of rectal cancer patients in a 15-year period (June 2005-December 2020) were evaluated; patients with metastatic disease at surgery were excluded; overall and disease-free survival as well as recurrence were evaluated. RESULTS Hundred and sixty-five patients were included in the study. Sarcopenia was identified in 30 (18%) patients. Multivariate analysis identified sarcopenia (HR = 3.28, CI = 1.33-8.11, P = 0.015), along with age (HR = 1.06, CI = 1.02-1.10, P = 0.002) and stage III (HR = 2.63, CI = 1.13-6.08, P < 0.03) as independent risk factors for overall survival. CONCLUSION Long-term results of rectal cancer patients undergoing curative resection are affected by their preoperative skeletal muscle status. Larger studies including comprehensive data on muscle strength along with SMI are awaited to confirm these results on both Eastern and Western rectal cancer patient populations before strategies to reverse muscle depletion can be extensively applied.
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Affiliation(s)
- Giuseppe Portale
- Department of General Surgery, Azienda Euganea ULSS 6, Cittadella, Italy
| | - Matteo Zuin
- Department of General Surgery, Azienda Euganea ULSS 6, Cittadella, Italy
| | | | - Patrizia Bartolotta
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Carlo Rettore
- Department of Radiology, Azienda Euganea ULSS 6, Cittadella, Italy
| | - Luca Cancian
- Department of Radiology, Azienda Euganea ULSS 6, Cittadella, Italy
| | - Alberto Morabito
- Department of Oncology, Azienda Euganea ULSS 6, Cittadella, Italy
| | - Teodoro Sava
- Department of Oncology, Azienda Euganea ULSS 6, Cittadella, Italy
| | - Valentino Fiscon
- Department of General Surgery, Azienda Euganea ULSS 6, Cittadella, Italy
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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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20
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Liu J, Yu X, Huang X, Lai Q, Chen J. Associations of muscle and adipose tissue parameters with long-term outcomes in middle and low rectal cancer: a retrospective cohort study. Cancer Imaging 2023; 23:5. [PMID: 36635737 PMCID: PMC9835251 DOI: 10.1186/s40644-022-00514-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 12/19/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To investigate the role of preoperative body composition analysis for muscle and adipose tissue distribution on long-term oncological outcomes in patients with middle and low rectal cancer (RC) who received curative intent surgery. METHODS A total of 155 patients with middle and low rectal cancer who underwent curative intent surgery between January 2014 and December 2016 were included for the final analysis. Skeletal muscle area (SMA), skeletal muscle radiodensity (SMD), visceral fat area (VFA) and mesorectal fat area (MFA) were retrospectively measured using preoperative CT images. To standardize the area according to patient stature, SMA was divided by the square of the height (m2) and the skeletal muscle mass index (SMI, cm2/m2) was obtained. Each median values of the distribution in male and female served as cut-off point for SMI, SMD, VFA, and MFA, respectively. Univariate and multivariate analysis were performed to evaluate the association between body composition and long-term oncological outcomes. Overall survival (OS) measured in months from the day of primary surgery until death for any cause. Disease-free survival (DFS) was defined as the interval between surgery and tumor recurrence. The Kaplan-Meier method with log-rank testing was used to validate prognostic biomarkers. Intraclass correlation coefficient (ICC) was used to evaluate interobserver and intraobserver reproducibility for SMA, SMD, MFA,VFA. RESULTS During the follow-up period, 42 (27.1%) patients had tumor recurrence; 21 (13.5%) patients died. The sex-specific median value of SMI was 28.6 cm2/m2 for females and 48.2 cm2/m2 for males. The sex-specific median value of SMD was 34.7 HU for females and 37.4 HU for males. The sex-specific median value of VFA was 123.1 cm2 for females and 123.2 cm2 for males. The sex-specific median value of MFA was 13.8 cm2 for females and 16.0 cm2 for males. In the Cox regression multivariate analysis, SMI (P = 0.036), SMD (P = 0.022), and postoperative complications grades (P = 0.042) were significantly different between death group and non-death group; SMD (P = 0.011) and MFA (P = 0.022) were significantly different between recurrence group and non-recurrence group. VFA did not show any significant differences. By the Kaplan-Meier method with log-rank testing, DFS was significantly longer in patients with high-MFA (P = 0.028) and shorter in patients with low-SMD (P = 0.010), OS was significantly shorter in patients with low-SMI (P = 0.034) and low-SMD (P = 0.029). CONCLUSIONS Quantitative evaluation of skeletal muscle mass and adipose tissue distributions at initial diagnosis were important predictors for long-term oncologic outcomes in RC patients. SMD and SMI were independent factors for predicting OS in patients with middle and low rectal cancer who had radical surgery. SMD and MFA were independent factors for predicting DFS in patients with middle and low rectal cancer who had radical surgery.
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Affiliation(s)
- Jiyang Liu
- grid.256112.30000 0004 1797 9307Department of Radiology, Quanzhou First Hospital Affiliated to Fujian Medical University, 248-252 N, Dong Street, Quanzhou City, Fujian Province China
| | - Xiongfeng Yu
- grid.488542.70000 0004 1758 0435Department of Radiology, Second Affiliated Hospital of Fujian Medical University, 34 N, Zhong-Shan-Bei Street, Quanzhou City, Fujian Province China
| | - Xueqing Huang
- grid.256112.30000 0004 1797 9307Department of Radiology, Quanzhou First Hospital Affiliated to Fujian Medical University, 248-252 N, Dong Street, Quanzhou City, Fujian Province China
| | - Qingquan Lai
- grid.488542.70000 0004 1758 0435Department of Radiology, Second Affiliated Hospital of Fujian Medical University, 34 N, Zhong-Shan-Bei Street, Quanzhou City, Fujian Province China
| | - Jieyun Chen
- grid.256112.30000 0004 1797 9307Department of Radiology, Quanzhou First Hospital Affiliated to Fujian Medical University, 248-252 N, Dong Street, Quanzhou City, Fujian Province China
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21
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Serial Changes in Body Composition and the Association with Disease Activity during Treatment in Patients with Crohn's Disease. Diagnostics (Basel) 2022; 12:diagnostics12112804. [PMID: 36428862 PMCID: PMC9689369 DOI: 10.3390/diagnostics12112804] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives: To analyze serial changes in body composition and investigate the association between body composition changes and disease activity changes in patients with Crohn’s disease (CD). Methods: Seventy-one patients with CD who had been treated and followed-up at our institution were included. Two to four computed tomography images were acquired at baseline, and the 2−5-year, 5−8-year, and last follow-ups were selected per patient for body composition and disease activity analyses. Visceral fat area (VFA), skeletal muscle index (SMI; skeletal muscle area/height2), and subcutaneous fat area (SFA) were assessed using an artificial-intelligence-driven fully automated method. Disease activity was assessed using a modified computed tomography scoring system and the Simple Endoscopic Score for Crohn’s Disease. The associations between body composition, disease activity, and remission were investigated. Results: The mean age was 29.83 ± 11.27 years; most patients were men (48/71, 67.6%); and the median follow-up was 144 (12−264) months. Overall, VFA and SFA gradually increased, while SMI decreased during the follow-up. Sarcopenia was associated with the female sex, higher disease activities at baseline (p = 0.01) and the last follow-up (p = 0.001). SMI and SFA inversely correlated with the disease activity, i.e., the more severe the disease activity, the lower the SMI and SFA (p < 0.05). SMI at the last follow-up was the only significant predictor of remission (OR = 1.21, 95% confidence interval: 1.03−1.42, p = 0.021). Conclusion: SMI decreased while VFA and SFA increased during the treatment follow-up in patients with CD. Sarcopenia was associated with higher disease activity, and SMI and SFA inversely correlated with disease activity. SMI at the last follow-up was the significant factor for remission.
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22
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Haehl E, Alvino L, Rühle A, Zou J, Fabian A, Grosu AL, Nicolay NH. Sarcopenia as a Prognostic Marker in Elderly Head and Neck Squamous Cell Carcinoma Patients Undergoing (Chemo-)Radiation. Cancers (Basel) 2022; 14:cancers14225536. [PMID: 36428629 PMCID: PMC9688610 DOI: 10.3390/cancers14225536] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/03/2022] [Accepted: 11/07/2022] [Indexed: 11/12/2022] Open
Abstract
Sarcopenia is associated with reduced survival and increased toxicity in malignant diseases. The prevalence of sarcopenia increases with age and is an important cause of functional decline. We analyzed sarcopenia and sarcopenia dynamics in elderly head-and-neck squamous cell carcinoma (HNSCC) patients undergoing (chemo)radiation. Skeletal muscle mass of 280 elderly HNSCC-patients (>65 yrs) receiving curative (chemo)radiation was manually outlined and quantified on CT scans at the level of the C3 (C3MA). Cross-sectional muscle area at L3 (L3MA) was calculated and normalized to height (L3MI). Frequency distributions of clinical parameters as well as overall survival (OS), progression-free survival (PFS) and locoregional control (LRC) were calculated regarding sarcopenia. Calculated L3MA correlated with pretherapeutic hemoglobin-levels (ρ = 0.280) bodyweight (ρ = 0.702) and inversely with patient-age (ρ = −0.290). Sarcopenic patients featured larger tumors (T3/4 69.0% vs. 52.8%, p < 0.001), a higher burden of comorbidity (age-adjusted Charlson Comorbidity Index 4.8 vs. 4.2, p = 0.015) and more severe chronic toxicities (CTCAE grade 3/4 24.0% vs. 11.8%, p = 0.022). OS was significantly deteriorated in sarcopenic patients with a median of 23 vs. 91 months (logrank p = 0.002) (HR 1.79, CI 1.22−2.60, p = 0.003) and sarcopenia remained an independent prognostic factor for reduced OS in the multivariate analysis (HR 1.64, CI 1.07−2.52, p = 0.023). After therapy, 33% of previously non-sarcopenic patients developed sarcopenia, while 97% of pre-treatment sarcopenic remained sarcopenic. Median bodyweight decreased by 6.8%, whereas median calculated L3MA decreased by 2.4%. In contrast to pretherapeutic, post-therapeutic sarcopenia is no prognosticator for reduced OS. Pretherapeutic sarcopenia is a significant prognostic factor in elderly HNSCC patients undergoing (chemo-)radiation and should be considered in pretherapeutic decision-making. Its role as a predictive marker for tailored supportive interventions merits further prospective evaluation.
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Affiliation(s)
- Erik Haehl
- Department of Radiation Oncology, University of Freiburg—Medical Center, Robert-Koch-Str. 3, 79106 Freiburg, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (dkfz), Neuenheimer Feld 280, 69120 Heidelberg, Germany
- Department of Radiation Oncology, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Luisa Alvino
- Department of Radiation Oncology, University of Freiburg—Medical Center, Robert-Koch-Str. 3, 79106 Freiburg, Germany
| | - Alexander Rühle
- Department of Radiation Oncology, University of Freiburg—Medical Center, Robert-Koch-Str. 3, 79106 Freiburg, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (dkfz), Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Jiadai Zou
- Department of Radiation Oncology, University of Freiburg—Medical Center, Robert-Koch-Str. 3, 79106 Freiburg, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (dkfz), Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Alexander Fabian
- Department of Radiation Oncology, University of Freiburg—Medical Center, Robert-Koch-Str. 3, 79106 Freiburg, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (dkfz), Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Anca-Ligia Grosu
- Department of Radiation Oncology, University of Freiburg—Medical Center, Robert-Koch-Str. 3, 79106 Freiburg, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (dkfz), Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Nils H. Nicolay
- Department of Radiation Oncology, University of Freiburg—Medical Center, Robert-Koch-Str. 3, 79106 Freiburg, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (dkfz), Neuenheimer Feld 280, 69120 Heidelberg, Germany
- Department of Radiation Oncology, University of Leipzig Medical Center, Stephanstr. 9a, 04103 Leipzig, Germany
- Correspondence:
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23
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Kim YI, Park IJ, Kim CW, Yoon YS, Lim SB, Yu CS, Kim JC, Lee Y, Kim H, Chung S, Choi CM, Lee HJ, Kim KW, Ko Y, Yun SC, Jo MW, Lee JW. Lifestyle interventions after colorectal cancer surgery using a mobile digital device: A study protocol for a randomized controlled trial. Medicine (Baltimore) 2022; 101:e31264. [PMID: 36254015 PMCID: PMC9575786 DOI: 10.1097/md.0000000000031264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND In treating colorectal cancer, surgical techniques and adjuvant treatments have advanced over the past century, but relatively less attention has been given to improve health-related quality of life (HRQOL). Recent studies report a significant association between cancer recurrence and patient lifestyle after surgery, hence emphasizing the need to assist patients to reduce this risk through appropriate lifestyle choices. The proposed study will evaluate the effects of digital interventions on lifestyle after surgery for colorectal cancer using mobile applications. METHODS A randomized controlled trial design was proposed. A total of 320 patients diagnosed with colorectal cancer aged between 20 and 70 years were to be enrolled and randomized in equal numbers into 4 groups (3 groups assigned to different mobile applications and a control group). Surveys that evaluate HRQOL, physical measurements, and metabolic parameters (fasting glucose, hemoglobin A1C, triglyceride, high-density lipoprotein cholesterol), and fat/muscle mass measurements by abdominal computed tomography (CT), will be conducted prior to surgery and every 6 months post-surgery for 18 months. Statistical analysis will be used to compare the outcomes between groups. DISCUSSION Results from this study could provide evidence that easily accessible mobile applications can influence patient lifestyles. Results showing minimal effects of such applications could also be constructive for improving healthcare-related applications.
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Affiliation(s)
- Young Il Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Ja Park
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- *Correspondence: In Ja Park, Department of Colon and Rectal Surgery, Asan Medical Center, University of College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea (e-mail: )
| | - Chan Wook Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Sik Yoon
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seok-Byung Lim
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Sik Yu
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Cheon Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yura Lee
- Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Harin Kim
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seockhoon Chung
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang-Min Choi
- Department of Pulmonology and Critical Care Medicine, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea
| | - Hui Jeong Lee
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung Won Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yousun Ko
- Biomedical Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | - Sung-Cheol Yun
- Division of Epidemiology and Biostatics, Clinical Research Center, Asan Medical Center, Seoul, Korea
| | - Min-Woo Jo
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Won Lee
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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24
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Cheng E, Kirley J, Cespedes Feliciano EM, Caan BJ. Adiposity and cancer survival: a systematic review and meta-analysis. Cancer Causes Control 2022; 33:1219-1246. [PMID: 35971021 PMCID: PMC10101770 DOI: 10.1007/s10552-022-01613-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 07/07/2022] [Indexed: 10/28/2022]
Abstract
PURPOSE The increasing availability of clinical imaging tests (especially CT and MRI) that directly quantify adipose tissue has led to a rapid increase in studies examining the relationship of visceral, subcutaneous, and overall adiposity to cancer survival. To summarize this emerging body of literature, we conducted a systematic review and meta-analysis of imaging-measured as well as anthropometric proxies for adipose tissue distribution and cancer survival across a wide range of cancer types. METHODS Using keywords related to adiposity, cancer, and survival, we conducted a systematic search of the literature in PubMed and MEDLINE, Embase, and Web of Science Core Collection databases from database inception to 30 June 2021. We used a random-effect method to calculate pooled hazard ratios (HR) and corresponding 95% confidence intervals (CI) within each cancer type and tested for heterogeneity using Cochran's Q test and the I2 test. RESULTS We included 203 records for this review, of which 128 records were utilized for quantitative analysis among 10 cancer types: breast, colorectal, gastroesophageal, head and neck, hepatocellular carcinoma, lung, ovarian, pancreatic, prostate, and renal cancer. We found that imaging-measured visceral, subcutaneous, and total adiposity were not significantly associated with increased risk of overall mortality, death from primary cancer, or cancer progression among patients diagnosed with these 10 cancer types; however, we found significant or high heterogeneity for many cancer types. For example, heterogeneity was similarly high when the pooled HRs (95% CI) for overall mortality associated with visceral adiposity were essentially null as in 1.03 (0.55, 1.92; I2 = 58%) for breast, 0.99 (0.81, 1.21; I2 = 71%) for colorectal, versus when they demonstrated a potential increased risk 1.17 (0.85, 1.60; I2 = 78%) for hepatocellular carcinoma and 1.62 (0.90, 2.95; I2 = 84%) for renal cancer. CONCLUSION Greater adiposity at diagnosis (directly measured by imaging) is not associated with worse survival among cancer survivors. However, heterogeneity and other potential limitations were noted across studies, suggesting differences in study design and adiposity measurement approaches, making interpretation of meta-analyses challenging. Future work to standardize imaging measurements and data analyses will strengthen research on the role of adiposity in cancer survival.
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Affiliation(s)
- En Cheng
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Jocelyn Kirley
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | | | - Bette J Caan
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
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Bao QR, Crimì F, Valotto G, Chiminazzo V, Bergamo F, Prete AA, Galuppo S, El Khouzai B, Quaia E, Pucciarelli S, Urso EDL. Obesity may not be related to pathologic response in locally advanced rectal cancer following neoadjuvant chemoradiotherapy. Front Oncol 2022; 12:994444. [PMID: 36249024 PMCID: PMC9556820 DOI: 10.3389/fonc.2022.994444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background The aim of this study is to evaluate the correlation between body mass index (BMI) and body fat composition (measured with radiological fat parameters (RFP)) and pathological response after neoadjuvant chemoradiotherapy for locally advanced rectal cancer patients. The secondary aim of the study was to assess the role of BMI and RFP on major surgical complications, overall survival (OS), and disease-free survival (DFS). Methods All patients who underwent surgical resection following nCRT between 2005 and 2017 for mid-low rectal cancer were retrospectively collected. Visceral fat area (VFA), superficial fat area (SFA), visceral/superficial fat area ratio (V/S), perinephric fat thickness (PNF), and waist circumference (WC) were estimated by baseline CT scan. Predictors of pathologic response and postoperative complications were investigated using logistic regression analysis. The correlations between BMI and radiologic fat parameters and survival were investigated using the Kaplan-Meier method and log-rank test. Results Out of 144 patients included, a complete (TRG1) and major (TRG1+2) pathologic response was reported in 32 (22%) and 60 (45.5%) cases, respectively. A statistically significant correlation between BMI and all the RFP was found. At a median follow-up of 60 (35-103) months, no differences in terms of OS and DFS were found considering BMI and radiologic fat parameters. At univariable analysis, neither BMI nor radiologic fat parameters were predictors of complete or major pathologic response; nevertheless, VFA, V/S>1, and BMI were predictors of postoperative major complications. Conclusions We found no associations between BMI and body fat composition and pathological response to nCRT, although VFA, V/S, and BMI were predictors of major complications. BMI and RFP are not related to worse long-term OS and DFS.
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Affiliation(s)
- Quoc Riccardo Bao
- General Surgery 3, Department of Surgical- Oncological and Gastroenterological Sciences DiSCOG, University of Padova, Padova, Italy,*Correspondence: Quoc Riccardo Bao,
| | - Filippo Crimì
- Institute of Radiology - Department of Medicine, University of Padova, Padova, Italy
| | - Giovanni Valotto
- General Surgery 3, Department of Surgical- Oncological and Gastroenterological Sciences DiSCOG, University of Padova, Padova, Italy
| | - Valentina Chiminazzo
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Francesca Bergamo
- Unit of Medical Oncology 1, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | | | - Sara Galuppo
- Radiotherapy Unit, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - Badr El Khouzai
- Radiotherapy Unit, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - Emilio Quaia
- Institute of Radiology - Department of Medicine, University of Padova, Padova, Italy
| | - Salvatore Pucciarelli
- General Surgery 3, Department of Surgical- Oncological and Gastroenterological Sciences DiSCOG, University of Padova, Padova, Italy
| | - Emanuele Damiano Luca Urso
- General Surgery 3, Department of Surgical- Oncological and Gastroenterological Sciences DiSCOG, University of Padova, Padova, Italy
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Simillis C, Taylor B, Ahmad A, Lal N, Afxentiou T, Powar MP, Smyth EC, Fearnhead NS, Wheeler J, Davies RJ. A systematic review and meta-analysis assessing the impact of body mass index on long-term survival outcomes after surgery for colorectal cancer. Eur J Cancer 2022; 172:237-251. [DOI: 10.1016/j.ejca.2022.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 05/02/2022] [Accepted: 05/15/2022] [Indexed: 01/27/2023]
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Wang P, Wang S, Ma Y, Li H, Liu Z, Lin G, Li X, Yang F, Qiu M. Sarcopenic obesity and therapeutic outcomes in gastrointestinal surgical oncology: A meta-analysis. Front Nutr 2022; 9:921817. [PMID: 35938099 PMCID: PMC9355157 DOI: 10.3389/fnut.2022.921817] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background Sarcopenic obesity (SO) has been indicated as a scientific and clinical priority in oncology. This meta-analysis aimed to investigate the impacts of preoperative SO on therapeutic outcomes in gastrointestinal surgical oncology. Methods We searched the PubMed, EMBASE, and Cochrane Library databases through March 4th 2022 to identify cohort studies. Endpoints included postoperative complications and survival outcomes. Newcastle Ottawa Scale was used for quality assessment. Heterogeneity and publication bias were assessed. Subgroup analyses and sensitivity analyses were performed. Results Twenty-six studies (8,729 participants) with moderate to good quality were included. The pooled average age was 65.6 [95% confidence interval (CI) 63.7-67.6] years. The significant heterogeneity in SO definition and diagnosis among studies was observed. Patients with SO showed increased incidences of total complications (odds ratio 1.30, 95% CI: 1.03-1.64, P = 0.030) and major complications (Clavien-Dindo grade ≥ IIIa, odds ratio 2.15, 95% CI: 1.39-3.32, P = 0.001). SO was particularly associated with the incidence of cardiac complications, leak complications, and organ/space infection. SO was also predictive of poor overall survival (hazard ratio 1.73, 95% CI: 1.46-2.06, P < 0.001) and disease-free survival (hazard ratio 1.41, 95% CI: 1.20-1.66, P < 0.001). SO defined as sarcopenia in combination with obesity showed greater association with adverse outcomes than that defined as an increased ratio of fat mass to muscle mass. A low prevalence rate of SO (< 10%) was associated with increased significance for adverse outcomes compared to the high prevalence rate of SO (> 20%). Conclusion The SO was associated with increased complications and poor survival in gastrointestinal surgical oncology. Interventions aiming at SO have potentials to promote surgery benefits for patients with gastrointestinal cancers. The heterogeneity in SO definition and diagnosis among studies should be considered when interpreting these findings. Systematic Review Registration [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=255286], identifier [CRD42021255286].
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Affiliation(s)
- Peiyu Wang
- Department of Thoracic Surgery, Thoracic Oncology Institute, Peking University People’s Hospital, Beijing, China
| | - Shaodong Wang
- Department of Thoracic Surgery, Thoracic Oncology Institute, Peking University People’s Hospital, Beijing, China
| | - Yi Ma
- Department of Thoracic Surgery, Thoracic Oncology Institute, Peking University People’s Hospital, Beijing, China
| | - Haoran Li
- Department of Thoracic Surgery, Thoracic Oncology Institute, Peking University People’s Hospital, Beijing, China
| | - Zheng Liu
- Department of Thoracic Surgery, Thoracic Oncology Institute, Peking University People’s Hospital, Beijing, China
| | - Guihu Lin
- Department of Thoracic Surgery, China Aerospace Science and Industry Corporation 731 Hospital, Beijing, China
| | - Xiao Li
- Department of Thoracic Surgery, Thoracic Oncology Institute, Peking University People’s Hospital, Beijing, China
| | - Fan Yang
- Department of Thoracic Surgery, Thoracic Oncology Institute, Peking University People’s Hospital, Beijing, China
| | - Mantang Qiu
- Department of Thoracic Surgery, Thoracic Oncology Institute, Peking University People’s Hospital, Beijing, China
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Conti C, Turri G, Gecchele G, Conci S, Zamboni GA, Ruzzenente A, Guglielmi A, Pedrazzani C. Sarcobesity Index Predicts Poor Disease-Specific Survival After Resection for Colorectal Cancer. J Surg Res 2022; 279:398-408. [PMID: 35835033 DOI: 10.1016/j.jss.2022.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 06/08/2022] [Accepted: 06/13/2022] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Sarcobesity (SO) is traditionally defined as the association between low muscle mass and obesity and has been reported to worsen prognosis after curative resection for colorectal cancer (CRC). This study aimed to propose a new definition of SO based on computed tomography measurements of the skeletal muscle area (SMA) and visceral adipose tissue (VAT) and to assess its implications on long-term survival after curative resection for stage I-III CRC. METHODS We retrospectively analyzed 506 patients with stage I-III CRC who underwent surgery between January 2010 and December 2019. Preoperative computed tomography images were analyzed and the sarcobesity index (SI) was calculated for each patient as the VAT/SMA ratio. The optimal cutoff value for predicting survival was determined using time-dependent receiver operating characteristic analysis. Overall survival and disease-specific survival (DSS) were compared between SO (SI > 1.25) and non-SO (SI ≤ 1.25) patients. The rates and modes of recurrence were also compared between the two groups. RESULTS Three hundred (59.3%) patients were identified to be sarcobese. No differences in short-term outcomes and administration of adjuvant chemotherapy were found, except for a longer length of stay in patients with SO. In a univariable analysis, SO was associated with a worse 5-y overall survival and DSS, considering the whole population and stages II and III separately. A multivariable analysis confirmed SO to be an independent risk factor for DSS (hazard ratio 2.29; 95% confidence interval 1.13-4.62, P = 0.02). Although the overall recurrence rate did not differ between the groups, a significantly higher rate of recurrence at multiple sites was observed in patients with SO (P = 0.01). CONCLUSIONS The SI, defined as per the VAT/SMA ratio, seems to be a reliable tool for identifying patients with worse DSS after potentially curative surgery for stage I-III CRC.
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Affiliation(s)
- Cristian Conti
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Unit of General and Hepatobiliary Surgery, University of Verona, Verona, Italy
| | - Giulia Turri
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Unit of General and Hepatobiliary Surgery, University of Verona, Verona, Italy
| | - Gabriele Gecchele
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Unit of General and Hepatobiliary Surgery, University of Verona, Verona, Italy
| | - Simone Conci
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Unit of General and Hepatobiliary Surgery, University of Verona, Verona, Italy
| | - Giulia A Zamboni
- Department of Diagnostic and Public Health, Section of Radiology, University of Verona, Verona, Italy
| | - Andrea Ruzzenente
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Unit of General and Hepatobiliary Surgery, University of Verona, Verona, Italy
| | - Alfredo Guglielmi
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Unit of General and Hepatobiliary Surgery, University of Verona, Verona, Italy
| | - Corrado Pedrazzani
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Unit of General and Hepatobiliary Surgery, University of Verona, Verona, Italy.
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Zhu Y, Guo X, Zhang Q, Yang Y. Prognostic value of sarcopenia in patients with rectal cancer: A meta-analysis. PLoS One 2022; 17:e0270332. [PMID: 35749415 PMCID: PMC9231737 DOI: 10.1371/journal.pone.0270332] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 06/09/2022] [Indexed: 01/06/2023] Open
Abstract
Background Sarcopenia is usually characterized by the loss of skeletal muscle mass and impaired muscle function which is commonly seen in the elderly. It has been found to be associated with poorer prognoses in many types of cancer. Computed tomography (CT) scan is frequently used to assess skeletal muscle mass and further calculate skeletal muscle index (SMI) at the third lumbar vertebra level (L3), which is used to define sarcopenia. The purpose of this meta-analysis was to assess the prognostic value of sarcopenia for overall survival (OS) in patients with rectal cancer. Methods We performed a systematic search to find relevant studies published up to 14 January 2021 in PubMed, Embase, Web of science and Scopus. In our meta-analysis, studies comparing OS in rectal cancer patients with sarcopenia versus those without were included. Quality assessment for included studies was evaluated according to the Quality in Prognosis Studies (QUIPS) tool. We directly extracted hazard ratios (HRs) with 95% confidence intervals (CIs) in both univariate and multivariate analyses from each study. The Cochrane Collaboration’s Review Manager 5.4 software was applied to analyze data. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines and website GRADEpro. Results Finally, a total of 7 studies involving 2377 patients were included. The pooled HRs were 2.10 (95% CI 1.33–3.32, P = 0.001) and 2.37 (95% CI 1.13–4.98, P = 0.02) using random-effects models in univariate and multivariate analyses, respectively. The results showed a significant association between sarcopenia and OS in patients with rectal cancer. The quality of the evidence for OS was moderate for both univariate and multivariate analyses. Conclusion CT-defined sarcopenia is an independent predictor for worse OS in patients with rectal cancer. Future studies with a more stringent definition of sarcopenia are required to further confirm our findings.
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Affiliation(s)
- Yueli Zhu
- Department of Geriatrics, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaoming Guo
- Department of Neurosurgery, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Qin Zhang
- Department of Geriatrics, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- * E-mail: (YY); (QZ)
| | - Yunmei Yang
- Department of Geriatrics, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- * E-mail: (YY); (QZ)
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CT-Derived Body Composition Assessment as a Prognostic Tool in Oncologic Patients: From Opportunistic Research to Artificial Intelligence-Based Clinical Implementation. AJR Am J Roentgenol 2022; 219:671-680. [PMID: 35642760 DOI: 10.2214/ajr.22.27749] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
CT-based body composition measures are well established in research settings as prognostic markers in oncologic patients. Numerous retrospective studies have shown the role of objective measurements extracted from abdominal CT images of skeletal muscle, abdominal fat, and bone mineral density in providing more accurate assessments of frailty and cancer cachexia in comparison with traditional clinical methods. Quantitative CT-based measurements of liver fat and aortic atherosclerotic calcification have received relatively less attention in cancer care but also provide prognostic information. Patients with cancer routinely undergo serial CT scans for staging, treatment response, and surveillance, providing the opportunity for performing quantitative body composition assessment as part of routine clinical care. The emergence of fully automated artificial intelligence-based segmentation and quantification tools to replace earlier time-consuming manual and semi-automated methods for body composition analysis will allow these opportunistic measures to transition from the research realm to clinical practice. With continued investigation, the measurements may ultimately be applied to achieve more precise risk stratification as a component of personalized oncologic care.
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Pickhardt PJ. Value-added Opportunistic CT Screening: State of the Art. Radiology 2022; 303:241-254. [PMID: 35289661 PMCID: PMC9083232 DOI: 10.1148/radiol.211561] [Citation(s) in RCA: 80] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/24/2021] [Accepted: 08/27/2021] [Indexed: 12/13/2022]
Abstract
Opportunistic CT screening leverages robust imaging data embedded within abdominal and thoracic scans that are generally unrelated to the specific clinical indication and have heretofore gone largely unused. This incidental imaging information may prove beneficial to patients in terms of wellness, prevention, risk profiling, and presymptomatic detection of relevant disease. The growing interest in CT-based opportunistic screening relates to a confluence of factors: the objective and generalizable nature of CT-based body composition measures, the emergence of fully automated explainable AI solutions, the sheer volume of body CT scans performed, and the increasing emphasis on precision medicine and value-added initiatives. With a systematic approach to body composition and other useful CT markers, initial evidence suggests that their ability to help radiologists assess biologic age and predict future adverse cardiometabolic events rivals even the best available clinical reference standards. Emerging data suggest that standalone "intended" CT screening over an unorganized opportunistic approach may be justified, especially when combined with established cancer screening. This review will discuss the current status of opportunistic CT screening, including specific body composition markers and the various disease processes that may be impacted. The remaining hurdles to widespread clinical adoption include generalization to more diverse patient populations, disparate technical settings, and reimbursement.
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Affiliation(s)
- Perry J. Pickhardt
- From the Department of Radiology, The University of Wisconsin School
of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave,
Madison, WI 53792-3252
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32
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Gao Q, Hu K, Gao J, Shang Y, Mei F, Zhao L, Chen F, Ma B. Prevalence and prognostic value of sarcopenic obesity in cancer patients: a systematic review and meta-analysis. Nutrition 2022; 101:111704. [DOI: 10.1016/j.nut.2022.111704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 01/02/2022] [Accepted: 04/11/2022] [Indexed: 10/18/2022]
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Giani A, Famularo S, Fogliati A, Riva L, Tamini N, Ippolito D, Nespoli L, Braga M, Gianotti L. Skeletal muscle wasting and long-term prognosis in patients undergoing rectal cancer surgery without neoadjuvant therapy. World J Surg Oncol 2022; 20:51. [PMID: 35216606 PMCID: PMC8881874 DOI: 10.1186/s12957-021-02460-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/29/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Derangement of body composition has been associated with dismal long-term survival in several gastrointestinal cancers including rectal tumors treated with neoadjuvant therapies. The role of specific preoperative anthropometric indexes on the oncologic outcomes of patients undergoing upfront surgery for rectal cancer has not been investigated. The aim of the study is to evaluate the association of body composition and overall survival in this specific cohort. METHODS Lumbar computed tomography images, obtained within the 30 days previous to surgery, between January 2009 and December 2016, were used to calculate population-specific thresholds of muscle mass (sarcopenia), subcutaneous and visceral adiposity, visceral obesity, sarcopenic obesity, and myosteatosis. These body composition variables were related with overall survival (OS), tumor-specific survival (TSS), and disease-free survival (DFS). OS, TSS, and DFS were evaluated by the Kaplan-Meier method. Cox regression analysis was used to identify independent predictors of mortality, tumor-specific mortality, and recurrence, and data were presented as hazard ratio (HR) and 95% confidence interval (CI). RESULTS During the study period, 411 patients underwent rectal resection for cancer, and among these, 129 were without neoadjuvant chemoradiation. The median follow-up was 96.7 months. At the end of the follow-up, 41 patients (31.8%) had died; of these, 26 (20.1%) died for tumor-related reasons, and 36 (27.1%) experienced disease recurrence. One-, three-, and five-year OS was 95.7%, 86.0%, and 76.8% for non-sarcopenic patients versus 82.4%, 58.8%, and 40.0% for sarcopenic ones respectively (p < 0.001). Kaplan-Meier survival curves comparing sarcopenic and non-sarcopenic patients showed a significant difference in terms of OS (log-rank < 0.0001). Through multivariate Cox regression, overall mortality risk was associated only with sarcopenia (HR 1.96; 95%CI 1.03-3.74; p = 0.041). Disease stage IV and III (HR 13.75; 95% CI 2.89-65.6; p < 0.001 and HR 4.72; 95% CI 1.06-21.1; p = 0.043, respectively) and sarcopenia (HR 2.62; 95% CI 1.22-5.6; p = 0.013) were independently associated with TSS. The other body composition indexes investigated showed no significant association with prognosis. CONCLUSIONS These results support the inclusion of body composition assessment for prognostic stratification of rectal cancer patients undergoing upfront resection.
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Affiliation(s)
- Alessandro Giani
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Surgery, San Gerardo Hospital, Monza, Italy
| | - Simone Famularo
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Surgery, San Gerardo Hospital, Monza, Italy
| | - Alessandro Fogliati
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Surgery, San Gerardo Hospital, Monza, Italy
| | - Luca Riva
- Department of Radiology, San Gerardo Hospital Via Pergolesi 33, 20900, Monza, Italy
| | - Nicolò Tamini
- Department of Surgery, San Gerardo Hospital, Monza, Italy
| | - Davide Ippolito
- Department of Radiology, San Gerardo Hospital Via Pergolesi 33, 20900, Monza, Italy
| | - Luca Nespoli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Surgery, San Gerardo Hospital, Monza, Italy
| | - Marco Braga
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Surgery, San Gerardo Hospital, Monza, Italy
| | - Luca Gianotti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
- Department of Surgery, San Gerardo Hospital, Monza, Italy.
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Sarcopenic obesity: what about in cancer setting? Nutrition 2022; 98:111624. [DOI: 10.1016/j.nut.2022.111624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 01/18/2022] [Accepted: 01/27/2022] [Indexed: 11/20/2022]
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Verhoek OG, Jungblut L, Lauk O, Blüthgen C, Opitz I, Frauenfelder T, Martini K. Sarcopenia, Precardial Adipose Tissue and High Tumor Volume as Outcome Predictors in Surgically Treated Pleural Mesothelioma. Diagnostics (Basel) 2022; 12:99. [PMID: 35054268 PMCID: PMC8774409 DOI: 10.3390/diagnostics12010099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/22/2021] [Accepted: 12/28/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND We evaluated the prognostic value of Sarcopenia, low precardial adipose-tissue (PAT), and high tumor-volume in the outcome of surgically-treated pleural mesothelioma (PM). METHODS From 2005 to 2020, consecutive surgically-treated PM-patients having a pre-operative computed tomography (CT) scan were retrospectively included. Sarcopenia was assessed by CT-based parameters measured at the level of the fifth thoracic vertebra (TH5) by excluding fatty-infiltration based on CT-attenuation. The findings were stratified for gender, and a threshold of the 33rd percentile was set to define sarcopenia. Additionally, tumor volume as well as PAT were measured. The findings were correlated with progression-free survival and long-term mortality. RESULTS Two-hundred-seventy-eight PM-patients (252 male; 70.2 ± 9 years) were included. The mean progression-free survival was 18.6 ± 12.2 months, and the mean survival time was 23.3 ± 24 months. Progression was associated with chronic obstructive pulmonary disease (COPD) (p = <0.001), tumor-stage (p = 0.001), and type of surgery (p = 0.026). Three-year mortality was associated with higher patient age (p = 0.005), presence of COPD (p < 0.001), higher tumor-stage (p = 0.015), and higher tumor-volume (p < 0.001). Kaplan-Meier statistics showed that sarcopenic patients have a higher three-year mortality (p = 0.002). While there was a negative correlation of progression-free survival and mortality with tumor volume (r = 0.281, p = 0.001 and r = -0.240, p < 0.001; respectively), a correlation with PAT could only be shown for epithelioid PM (p = 0.040). CONCLUSIONS Sarcopenia as well as tumor volume are associated with long-term mortality in surgically treated PM-patients. Further, while there was a negative correlation of progression-free survival and mortality with tumor volume, a correlation with PAT could only be shown for epithelioid PM.
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Affiliation(s)
- Oliver Guido Verhoek
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland; (O.G.V.); (L.J.); (C.B.); (T.F.)
- Faculty of Medicine, University of Zurich, Rämistrasse 71, 8006 Zurich, Switzerland; (O.L.); (I.O.)
| | - Lisa Jungblut
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland; (O.G.V.); (L.J.); (C.B.); (T.F.)
- Faculty of Medicine, University of Zurich, Rämistrasse 71, 8006 Zurich, Switzerland; (O.L.); (I.O.)
| | - Olivia Lauk
- Faculty of Medicine, University of Zurich, Rämistrasse 71, 8006 Zurich, Switzerland; (O.L.); (I.O.)
- Department of Thoracic Surgery, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Christian Blüthgen
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland; (O.G.V.); (L.J.); (C.B.); (T.F.)
- Faculty of Medicine, University of Zurich, Rämistrasse 71, 8006 Zurich, Switzerland; (O.L.); (I.O.)
| | - Isabelle Opitz
- Faculty of Medicine, University of Zurich, Rämistrasse 71, 8006 Zurich, Switzerland; (O.L.); (I.O.)
- Department of Thoracic Surgery, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Thomas Frauenfelder
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland; (O.G.V.); (L.J.); (C.B.); (T.F.)
- Faculty of Medicine, University of Zurich, Rämistrasse 71, 8006 Zurich, Switzerland; (O.L.); (I.O.)
| | - Katharina Martini
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland; (O.G.V.); (L.J.); (C.B.); (T.F.)
- Faculty of Medicine, University of Zurich, Rämistrasse 71, 8006 Zurich, Switzerland; (O.L.); (I.O.)
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Tolonen A, Pakarinen T, Sassi A, Kyttä J, Cancino W, Rinta-Kiikka I, Pertuz S, Arponen O. Methodology, clinical applications, and future directions of body composition analysis using computed tomography (CT) images: A review. Eur J Radiol 2021; 145:109943. [PMID: 34839215 DOI: 10.1016/j.ejrad.2021.109943] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/06/2021] [Accepted: 08/24/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE OF THE REVIEW We aim to review the methods, current research evidence, and future directions in body composition analysis (BCA) with CT imaging. RECENT FINDINGS CT images can be used to evaluate muscle tissue, visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) compartments. Manual and semiautomatic segmentation methods are still the gold standards. The segmentation of skeletal muscle tissue and VAT and SAT compartments is most often performed at the level of the 3rd lumbar vertebra. A decreased amount of CT-determined skeletal muscle mass is a marker of impaired survival in many patient populations, including patients with most types of cancer, some surgical patients, and those admitted to the intensive care unit (ICU). Patients with increased VAT are more susceptible to impaired survival / worse outcomes; however, those patients who are critically ill or admitted to the ICU or who will undergo surgery appear to be exceptions. The independent significance of SAT is less well established. Recently, the roles of the CT-determined decrease of muscle mass and increased VAT area and epicardial adipose tissue (EAT) volume have been shown to predict a more debilitating course of illness in patients suffering from severe acute respiratory syndrome coronavirus 2 (COVID-19) infection. SUMMARY The field of CT-based body composition analysis is rapidly evolving and shows great potential for clinical implementation.
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Affiliation(s)
- Antti Tolonen
- Faculty of Medicine and Health Sciences, Tampere University, Kauppi Campus, Arvo Ylpön katu 34, 33520 Tampere, Finland.
| | - Tomppa Pakarinen
- Faculty of Medicine and Health Sciences, Tampere University, Kauppi Campus, Arvo Ylpön katu 34, 33520 Tampere, Finland; Department of Radiology, Tampere University Hospital, Elämänaukio, Kuntokatu 2, 33520 Tampere, Finland
| | - Antti Sassi
- Faculty of Medicine and Health Sciences, Tampere University, Kauppi Campus, Arvo Ylpön katu 34, 33520 Tampere, Finland; Department of Radiology, Tampere University Hospital, Elämänaukio, Kuntokatu 2, 33520 Tampere, Finland
| | - Jere Kyttä
- Faculty of Medicine and Health Sciences, Tampere University, Kauppi Campus, Arvo Ylpön katu 34, 33520 Tampere, Finland
| | - William Cancino
- Connectivity and Signal Processing Group, Universidad Industrial de Santander, Cl. 9 #Cra 27, Bucaramanga, Colombia
| | - Irina Rinta-Kiikka
- Faculty of Medicine and Health Sciences, Tampere University, Kauppi Campus, Arvo Ylpön katu 34, 33520 Tampere, Finland; Department of Radiology, Tampere University Hospital, Elämänaukio, Kuntokatu 2, 33520 Tampere, Finland
| | - Said Pertuz
- Connectivity and Signal Processing Group, Universidad Industrial de Santander, Cl. 9 #Cra 27, Bucaramanga, Colombia
| | - Otso Arponen
- Faculty of Medicine and Health Sciences, Tampere University, Kauppi Campus, Arvo Ylpön katu 34, 33520 Tampere, Finland; Department of Radiology, Tampere University Hospital, Elämänaukio, Kuntokatu 2, 33520 Tampere, Finland
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Park IK, Yang SS, Chung E, Cho ES, Lee HS, Shin SJ, Im YC, Park EJ, Baik SH, Lee KY, Kang J. Skeletal muscle gauge as a prognostic factor in patients with colorectal cancer. Cancer Med 2021; 10:8451-8461. [PMID: 34643052 PMCID: PMC8633260 DOI: 10.1002/cam4.4354] [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: 08/23/2021] [Revised: 09/21/2021] [Accepted: 09/28/2021] [Indexed: 01/06/2023] Open
Abstract
Background Although skeletal muscle index (SMI) and radiodensity (SMD) are well‐known prognostic factors, the clinical impact of the integrated measure, known as skeletal muscle gauge (SMG), has been limited in patients with colorectal cancer (CRC). Patients and Methods A total of 727 and 268 patients with CRC at two tertiary centers were included and allocated into the training and test sets, respectively. Preoperative slice computed tomography images of the third lumbar area were evaluated for SMI and SMD. SMG was calculated as SMI × SMD and expressed as an arbitrary unit (AU). The optimal cutoff SMG value was determined to maximize the overall survival (OS) difference between the groups with respect to sex in the training set. The multivariate Cox proportional hazard model evaluated the association of its clinical significance. Results With regard to SMG, 1640 and 1523 AU were identified as cutoff values for males and females, respectively. The patients with low SMG values showed significantly worse 5‐year OS than those with high SMG values in the two datasets (both p < 0.001). In the multivariate analysis, low SMG was identified as an independent poor prognostic factor of OS in the training set (hazard ratio 2.18, 95% confidence interval 1.43–3.32, p < 0.001) and test set (hazard ratio 1.79, 95% confidence interval 1.07–3.00, p = 0.025), whereas SMI and SMD were not. Conclusion SMG acts synergistically to improve its prognostic predictive accuracy as compared with SMI or SMD alone in patients with CRC. Additional research is warranted to define its significance in different ethnic groups.
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Affiliation(s)
- In Kyu Park
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Song Soo Yang
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Eric Chung
- Department of Anesthesiology, Indiana University, Indianapolis, Indiana, USA
| | - Eun-Suk Cho
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Su-Jin Shin
- Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yeong Cheol Im
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Eun Jung Park
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Hyuk Baik
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kang Young Lee
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeonghyun Kang
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Preoperative computed tomography-assessed sarcopenia as a predictor of complications and long-term prognosis in patients with colorectal cancer: a systematic review and meta-analysis. Langenbecks Arch Surg 2021; 406:1775-1788. [PMID: 34406490 DOI: 10.1007/s00423-021-02274-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 07/12/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND The relationship between computed tomography (CT)-assessed sarcopenia and colorectal cancer (CRC) prognosis varies in different studies. This systematic review aimed to examine the impact of preoperative CT-assessed sarcopenia on complications and long-term survival in CRC patients. METHODS The PubMed, Web of Science, Cochrane Library, and Embase databases were searched for relevant literature up to September 10, 2020. Data and characteristics for each study were extracted. Long-term outcomes were assessed using a comprehensive HR with a 95% CI. Complications were assessed using a comprehensive OR with 95% CI. The heterogeneity and publication bias were also investigated, and subgroup and sensitivity analyses were performed. RESULTS A total of 19 studies comprising 15,889 patients were included. The comprehensive results demonstrated that sarcopenia is significantly associated with overall survival of CRC patients (HR = 1.40, 95% CI = 1.25-1.58, p < 0.001). Patients with sarcopenia have a higher risk of complications compared to those without sarcopenia. In addition, sarcopenia is strongly associated with poor cancer-specific survival (HR = 1.49, 95% CI = 1.32-1.68, p < 0.001) and disease-free survival (HR = 1.59, 95% CI = 1.32-1.92, p < 0.001) in CRC patients. There is no significant relationship between sarcopenia and recurrence-free survival (HR = 1.32, 95% CI = 0.92-1.89, p = 0.126). CONCLUSIONS Preoperative CT-assessed sarcopenia can be employed as an effective predictor of complications and long-term prognosis in CRC patients. Standardization of CT-assessed sarcopenia requires comprehensive consideration of race, muscle mass index, body mass index, and gender.
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Trejo-Avila M, Bozada-Gutiérrez K, Valenzuela-Salazar C, Herrera-Esquivel J, Moreno-Portillo M. Sarcopenia predicts worse postoperative outcomes and decreased survival rates in patients with colorectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis 2021; 36:1077-1096. [PMID: 33481108 DOI: 10.1007/s00384-021-03839-4] [Citation(s) in RCA: 105] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Previous studies have shown an association of sarcopenia with adverse short- and long-term outcomes in multiple gastrointestinal cancer types. We aimed to investigate the prognostic value of sarcopenia on the postoperative outcomes and survival rates of patients with colorectal cancer (CRC). METHODS A systematic literature search was performed using the PubMed, Embase, Cochrane, Google Scholar, and Scopus databases. We included studies that compared postoperative outcomes or survival rates in sarcopenic and non-sarcopenic patients with CRC. RESULTS A total of 44 observational studies, comprising 18,891 patients, were included. The pooled prevalence of sarcopenia was 37% (n = 7009). The pooled analysis revealed an association between sarcopenia and higher risk of total postoperative complications (23 studies, OR = 1.84; 95% CI 1.35-2.49), postoperative severe complications (OR = 1.72; 95% CI 1.10-2.68), postoperative mortality (OR = 3.21; 95% CI 2.01-5.11), postoperative infections (OR = 1.40; 95% CI 1.12-1.76), postoperative cardiopulmonary complications (OR = 2.92; 95% CI 1.96-4.37), and prolonged length of stay (MD = 0.77; 95% CI 0.44-1.11) after colorectal cancer surgery. However, anastomotic leakage showed comparable occurrence between sarcopenic and non-sarcopenic patients (OR = 0.99; 95% CI 0.72 to 1.36). Regarding survival outcomes, sarcopenic patients had significantly shorter overall survival (25 studies, HR = 1.83; 95% CI = 1.57-2.14), disease-free survival (HR = 1.55; 95% CI = 1.29-1.88), and cancer-specific survival (HR = 1.77; 95% CI 1.40-2.23) as compared with non-sarcopenic patients. CONCLUSION Among patients with colorectal cancer, sarcopenia is a strong predictor of increased postoperative complications and worse survival outcomes.
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Affiliation(s)
- Mario Trejo-Avila
- Department of Colorectal Surgery, Hospital General Dr. Manuel Gea González, Calzada de Tlalpan, 4800, Mexico City, Mexico.
| | - Katya Bozada-Gutiérrez
- Department of General and Endoscopic Surgery, Hospital General Dr. Manuel Gea González, Mexico City, Mexico
| | - Carlos Valenzuela-Salazar
- Department of General and Endoscopic Surgery, Hospital General Dr. Manuel Gea González, Mexico City, Mexico
| | - Jesús Herrera-Esquivel
- Department of General and Endoscopic Surgery, Hospital General Dr. Manuel Gea González, Mexico City, Mexico
| | - Mucio Moreno-Portillo
- Department of General and Endoscopic Surgery, Hospital General Dr. Manuel Gea González, Mexico City, Mexico
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40
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Influence of Postoperative Changes in Sarcopenia on Long-Term Survival in Non-Metastatic Colorectal Cancer Patients. Cancers (Basel) 2021; 13:cancers13102410. [PMID: 34067568 PMCID: PMC8156120 DOI: 10.3390/cancers13102410] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary The number of colorectal cancer survivors is increasing due to improvements in oncologic outcomes. Therefore, the risks of metachronous cancer and second cancer are also increased, as well as recurrences. The influence of muscle mass measured as sarcopenia on long-term survival has been studied recently in colorectal cancer patients. Sarcopenia is a factor controllable by lifestyle modification and has gained interest more recently. This study showed an influence of changes in sarcopenia on long-term oncologic outcomes in colorectal cancer and suggests a basis for further investigation of body composition factors, including sarcopenia. Abstract The effect of perioperative sarcopenic changes on prognosis remains unclear. We conducted a retrospective cohort study with 2333 non-metastatic colorectal cancer patients treated between January 2009 and December 2012 at the Asan Medical Center. The body composition at diagnosis was measured via abdominopelvic computed tomography (CT) using Asan-J software. Patients underwent CT scans preoperatively, as well as at 6 months–1 year and 2–3 years postoperatively. The primary outcome was the association between perioperative sarcopenic changes and survival. According to sarcopenic criteria, 1155 (49.5%), 890 (38.2%), and 893 (38.3%) patients had sarcopenia preoperatively, 6 months–1 year, and 2–3 years postoperatively, respectively. The 5-year overall survival (OS) (95.8% vs. 92.1%, hazard ratio (HR) = 2.234, p < 0.001) and 5-year recurrence-free survival (RFS) (93.2% vs. 86.2%, HR = 2.251, p < 0.001) rates were significantly lower in patients with preoperative sarcopenia. Both OS and RFS were lower in patients with persistent sarcopenia 2–3 years postoperatively than in those who recovered (OS: 96.2% vs. 90.2%, p = 0.001; RFS: 91.1% vs. 83.9%, p = 0.002). In multivariate analysis, postoperative sarcopenia was confirmed as an independent factor associated with decreased OS and RFS. Pre- and postoperative sarcopenia and changes in the condition during surveillance were associated with oncological outcomes.
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Silveira EA, da Silva Filho RR, Spexoto MCB, Haghighatdoost F, Sarrafzadegan N, de Oliveira C. The Role of Sarcopenic Obesity in Cancer and Cardiovascular Disease: A Synthesis of the Evidence on Pathophysiological Aspects and Clinical Implications. Int J Mol Sci 2021; 22:4339. [PMID: 33919368 PMCID: PMC8122649 DOI: 10.3390/ijms22094339] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/14/2021] [Accepted: 04/18/2021] [Indexed: 12/20/2022] Open
Abstract
Obesity is globally a serious public health concern and is associated with a high risk of cardiovascular disease (CVD) and various types of cancers. It is important to evaluate various types of obesity, such as visceral and sarcopenic obesity. The evidence on the associated risk of CVD, cancer and sarcopenic obesity, including pathophysiological aspects, occurrence, clinical implications and survival, needs further investigation. Sarcopenic obesity is a relatively new term. It is a clinical condition that primarily affects older adults. There are several endocrine-hormonal, metabolic and lifestyle aspects involved in the occurrence of sarcopenic obesity that affect pathophysiological aspects that, in turn, contribute to CVD and neoplasms. However, there is no available evidence on the role of sarcopenic obesity in the occurrence of CVD and cancer and its pathophysiological interplay. Therefore, this review aims to describe the pathophysiological aspects and the clinical and epidemiological evidence on the role of sarcopenic obesity related to the occurrence and mortality risk of various types of cancer and cardiovascular disease. This literature review highlights the need for further research on sarcopenic obesity to demonstrate the interrelation of these various associations.
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Affiliation(s)
- Erika Aparecida Silveira
- Postgraduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiânia 74605-050, Brazil;
- Department of Epidemiology & Public Health, Institute of Epidemiology & Health Care University College London, London WC1E 6BT, UK;
| | | | - Maria Claudia Bernardes Spexoto
- Postgraduate Program in Food, Nutrition and Health, Faculty of Health Sciences, Federal University of Grande Dourados, Dourados 79.804-970, Brazil;
| | - Fahimeh Haghighatdoost
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Science, Isfahan 815838899, Iran;
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan 8158388994, Iran
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Cesar de Oliveira
- Department of Epidemiology & Public Health, Institute of Epidemiology & Health Care University College London, London WC1E 6BT, UK;
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Hamid HKS, Davis GN, Trejo-Avila M, Igwe PO, Garcia-Marín A. Prognostic and predictive value of neutrophil-to-lymphocyte ratio after curative rectal cancer resection: A systematic review and meta-analysis. Surg Oncol 2021; 37:101556. [PMID: 33819850 DOI: 10.1016/j.suronc.2021.101556] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Neutrophil-to-lymphocyte ratio (NLR) has been shown to be associated with poor prognosis in numerous solid malignancies. Here, we quantify the prognostic value of NLR in rectal cancer patients undergoing curative-intent surgery, and compare it with platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR). METHODS A comprehensive search of several electronic databases was performed through January 2021, to identify studies evaluating the prognostic impact of pretreatment NLR in patients undergoing curative rectal cancer resection. The endpoints were overall survival (OS), disease-free survival (DFS), and clinicopathologic parameters. The pooled hazard ratio (HR) or odds ratio with 95% confidence interval (CI) were calculated. RESULTS Thirty-one studies comprising 7553 patients were assessed. All studies evaluated NLR; thirteen and six evaluated PLR and LMR, respectively. High NLR was associated with worse OS (HR 1.92, 95% CI 1.60-2.30, P < 0.001) and DFS (HR 1.83, 95% CI 1.51-2.22, P < 0.001), and the results were consistent in all subgroup analyses by treatment modality, tumor stage, study location, and NLR cut-off value, except for the subgroups limited to cohorts with cut-off value ≥ 4. The size of effect of NLR on OS and DFS was greater than that of PLR, and similar to that of LMR. Finally, high NLR was associated with lower rate of pathologic complete response. CONCLUSIONS In the setting of curative rectal cancer resection, pretreatment NLR correlates with tumor response to neoadjuvant therapy, and along with LMR, is a robust predictor of poorer prognosis. These biomarkers may thus help risk-stratify patients for individualized treatments and enhanced surveillance.
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Affiliation(s)
- Hytham K S Hamid
- Department of Surgery, East Kent Hospitals NHS Foundation Trust, Ashford, UK.
| | - George N Davis
- Department of Surgery, Dorset County Hospital NHS Foundation Trust, Dorchester, UK
| | - Mario Trejo-Avila
- Department of Surgery, General Hospital Dr. Manuel Gea Gonzalez, Mexico City, Mexico
| | - Patrick O Igwe
- Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
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Zhang Y, Li Z, Jiang L, Xue Z, Ma Z, Kang W, Ye X, Liu Y, Jin Z, Yu J. Marked loss of adipose tissue during neoadjuvant therapy as a predictor for poor prognosis in patients with gastric cancer: A retrospective cohort study. J Hum Nutr Diet 2021; 34:585-594. [PMID: 33491826 DOI: 10.1111/jhn.12861] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/07/2020] [Accepted: 12/22/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The influence of body composition changes during neoadjuvant treatment (NT) on long-term survival in patients with gastric cancer (GC) undergoing radical gastrectomy remains unclear. The present study aimed to explore the association between changes in body composition during NT and survival in patients with GC. METHODS GC patients treated with NT and radical gastrectomy between 2015 and 2018 were included in this retrospective study. Skeletal muscle mass, visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were measured by computer tomography before and after NT. Body composition changes during NT were compared with Kaplan-Meier curves. Univariate and multivariate regression analyses were applied to determine the predictors of overall survival (OS) and disease-free survival (DFS). RESULTS In total, 157 GC patients were studied. A marked loss of adipose tissue was associated with poor nutritional status. The median follow-up time for all patients was 25 months. Patients with marked VAT loss (≥ 35.7%) during NT had significantly shorter OS (p = 0.028) and DFS (p = 0.03). Similarly, poorer OS (p = 0.033) and DFS (p = 0.003) were observed in patients with marked SAT loss (≥ 30.1%) during NT. Changes in skeletal muscle mass and body weight during NT were not associated with survival. Marked VAT loss accompanied by marked SAT loss was an independent predictor of OS (hazards ratio = 2.447; p = 0.045) and DFS (hazards ratio = 2.674; p = 0.018). CONCLUSIONS Patients with locally advanced GC have a worse survival when they experienced marked loss of adipose tissue during NT.
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Affiliation(s)
- Yingjing Zhang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zijian Li
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Jiang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhigang Xue
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhiqiang Ma
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weiming Kang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Ye
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuqin Liu
- Cell Culture Centre, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianchun Yu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Martin D, von der Grün J, Rödel C, Fokas E. Sarcopenia Is Associated With Hematologic Toxicity During Chemoradiotherapy in Patients With Anal Carcinoma. Front Oncol 2020; 10:1576. [PMID: 32903529 PMCID: PMC7437356 DOI: 10.3389/fonc.2020.01576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/21/2020] [Indexed: 12/19/2022] Open
Abstract
Purpose Sarcopenia, defined as a loss of muscle mass and quality, has been associated with impaired oncological outcome and treatment toxicities in several malignancies. However, its role in anal squamous cell carcinoma (ASCC) remains less well explored. Methods/Materials Planning CT scans were used to measure cross-sectional skeletal muscle area (SMA) to calculate the skeletal muscle index (SMI). The association of sarcopenia with clinical and treatment-related parameters, and toxicity was assessed in 114 patients with ASCC that underwent standard 5-Fluorouracil/Mitomycin C chemoradiotherapy (CRT). The prognostic impact of sarcopenia on local relapse-free survival (LRFS), disease-free survival (DFS), and overall survival was examined using a Cox regression analysis. Results 29 (25.4%) patients had sarcopenia. Patients with sarcopenia had lower baseline hemoglobin levels (p = 0.002), worse Karnofsky Performance Status (p = 0.001) lower BMI (p < 0.001), and a significantly lower body surface area (p = 0.03), and lower incidence of involved lymph nodes (p = 0.03). Regarding acute toxicity, sarcopenia was associated with a significantly higher incidence of ≥grade 3leukopenia (OR: 3.5; 95% CI: 1.6-7.5, p = 0.007) and ≥grade 3 thrombopenia (OR: 5.1; 95% CI: 1.3-21, p = 0.018) after CRT. Despite higher hematologic toxicity in sarcopenic patients, total treatment time was similar between patients with and without sarcopenia (median 44 vs 45 days, p = 0.95). There was no significant prognostic impact of sarcopenia on either LRFS, DFS, or OS. Conclusion This is the largest study to assess the impact of sarcopenia on toxicity and oncological outcome in patients with ASCC. Increased clinician awareness of higher hematological toxicity risk is needed for sarcopenic patients with ASCC undergoing CRT to facilitate closer monitoring of side effects and earlier introduction of supportive measures. Further prospective studies are needed to elucidate the prognostic role and impact of sarcopenia on CRT-related toxicity in ASCC.
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Affiliation(s)
- Daniel Martin
- Department of Radiotherapy and Oncology, University Hospital, Goethe University, Frankfurt, Germany.,Frankfurt Cancer Institute, Frankfurt, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Frankfurt, Germany
| | - Jens von der Grün
- Department of Radiotherapy and Oncology, University Hospital, Goethe University, Frankfurt, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Frankfurt, Germany
| | - Claus Rödel
- Department of Radiotherapy and Oncology, University Hospital, Goethe University, Frankfurt, Germany.,Frankfurt Cancer Institute, Frankfurt, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Frankfurt, Germany
| | - Emmanouil Fokas
- Department of Radiotherapy and Oncology, University Hospital, Goethe University, Frankfurt, Germany.,Frankfurt Cancer Institute, Frankfurt, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Frankfurt, Germany
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Zhang XM, Dou QL, Zeng Y, Yang Y, Cheng ASK, Zhang WW. Sarcopenia as a predictor of mortality in women with breast cancer: a meta-analysis and systematic review. BMC Cancer 2020; 20:172. [PMID: 32131764 PMCID: PMC7057618 DOI: 10.1186/s12885-020-6645-6] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 02/17/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Breast cancer is the most commonly diagnosed cancer and the leading cause of cancer death in women worldwide. Recently, studies have been published with inconsistent findings regarding whether sarcopenia is a risk factor for mortality in breast cancer patients. Therefore, the aim of this systematic review and meta-analysis was to systematically assess and quantify sarcopenia as a risk factor for mortality in breast cancer patients. METHODS In a systematic literature review of PubMed, EMBASE, and the Cochrane CENTRAL Library, we searched for observational studies written in English (from database inception until April 30, 2019) that reported an association between sarcopenia and breast cancer in women who were 18 years or older. RESULTS A total of six studies (5497 participants) were included in this meta-analysis. Breast cancer patients with sarcopenia were associated with a significantly higher risk of mortality, compared to breast cancer patients without sarcopenia (pooled HR-hazard ratio = 1.71, 95% CI: 1.25-2.33, I2 = 59.1%). In addition, the results of age subgroup analysis showed that participants younger than 55 years with sarcopenia had a lower risk of mortality than participants aged 55 years and older with sarcopenia (pooled HR = 1.46, 95% CI: 1.24-1.72 versus pooled HR = 1.99, 95% CI: 1.05-3.78), whereas both have an increased risk of mortality compared to non-sarcopenic patients. Subgroup analyses regarding stage at diagnosis revealed an increased risk of mortality in non-metastatic patients compared to participants without sarcopenia (pooled HR = 1.91, 95% CI: 1.32-2.78), whereas the association was not significant in metastatic breast cancer patients. Other subgroup analyses were performed using different follow-up periods (> 5 years versus ≤5 years) and the results were different (pooled HR = 1.81, 95% CI: 1.23-2.65 versus pooled HR = 1.70, 95% CI: 0.80-3.62). CONCLUSIONS The present study found that sarcopenia is a risk factor for mortality among female early breast cancer patients. It is imperative that more research into specific interventions aimed at treating sarcopenia be conducted in the near future in order to provide evidence which could lead to decreased mortality rates in breast cancer patients.
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Affiliation(s)
- Xiao-Ming Zhang
- Department of Emergency, The Affiliated Baoan Hospital of Southern Medical University, The People’s Hospital of Baoan ShenZhen, Shenzhen, Guangdong People’s Republic of China
| | - Qing-Li Dou
- Department of Emergency, The Affiliated Baoan Hospital of Southern Medical University, The People’s Hospital of Baoan ShenZhen, Shenzhen, Guangdong People’s Republic of China
| | - Yingchun Zeng
- Department of Nursing, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yunzhi Yang
- Department of Nursing, The Affiliated Baoan Hospital of Southern Medical University, The People’s Hospital of Baoan ShenZhen, Shenzhen, China
| | - Andy S. K. Cheng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong, China
| | - Wen-Wu Zhang
- Department of Emergency, The Affiliated Baoan Hospital of Southern Medical University, The People’s Hospital of Baoan ShenZhen, Shenzhen, Guangdong People’s Republic of China
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