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Umehara T, Kaneguchi A, Yamasaki T, Kito N. Exploratory study of factors associated with probable respiratory sarcopenia in elderly subjects. Respir Investig 2024; 62:773-777. [PMID: 38972233 DOI: 10.1016/j.resinv.2024.06.009] [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: 04/09/2024] [Revised: 06/18/2024] [Accepted: 06/30/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND The diagnostic criteria for respiratory sarcopenia have been recently reported. However, no studies have clarified the characteristics of skeletal muscle impairment of the limbs in subjects with respiratory sarcopenia. This study aimed to explore the factors, including skeletal muscle, associated with probable respiratory sarcopenia in elderly subjects. METHODS Subjects were classified into the probable respiratory sarcopenia group and nonrespiratory sarcopenia group. Probable respiratory sarcopenia was defined as the concurrent presence of respiratory muscle weakness (as less than the predicted value calculated from age, sex, and height) and low skeletal muscle mass (<7.0 kg/m2 in males and 5.7 kg/m2 in females). The following factors were measured: respiratory muscle strength, skeletal muscle mass index, muscle thickness and echo intensity of the rectus femoris, extracellular-to-intracellular water ratio, hand grip strength, 5 sit-to-stand, knee extension strength, bone mineral density, age, sex, body mass index, degree of frailty, presence or absence of medical history, presence or absence of habitual exercise, period of time since the start of exercise, and number of hours of exercise at a time. The association subjects with probable respiratory sarcopenia were analyzed using hierarchical logistic regression analysis. RESULTS Twenty-six with probable respiratory sarcopenia and 54 with nonrespiratory sarcopenia were included. Hierarchical logistic regression analysis revealed that echo intensity was a significant predictor of probable respiratory sarcopenia. The odds ratio for echo intensity was 2.54 (95% confidence interval: 1.04-6.23). CONCLUSIONS Our results suggest that a decrease in muscle quality in the lower extremity is associated with probable respiratory sarcopenia.
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Affiliation(s)
- Takuya Umehara
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan.
| | - Akinori Kaneguchi
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan
| | - Takahiro Yamasaki
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan; Well-being and Wellness Center, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan
| | - Nobuhiro Kito
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan; Well-being and Wellness Center, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan
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Chen K, Chen Q, Xu L. Incidence and influencing factors for respiratory sarcopenia in older adults: The first longitudinal evidence from the CHARLS. Geriatr Gerontol Int 2024. [PMID: 39171638 DOI: 10.1111/ggi.14964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 07/14/2024] [Accepted: 08/04/2024] [Indexed: 08/23/2024]
Abstract
AIM Respiratory sarcopenia (RS) has been newly defined in a position paper by four professional organizations in Japan, and it is necessary to examine its incidence and influencing factors using this new definition. So far, little work has been undertaken; we therefore conducted a longitudinal study to fill this gap. METHODS Our data were extracted from the China Health and Retirement Longitudinal Study. A total of 4301 older adults with complete data and without RS were chosen in 2011, of whom 3065 were followed up until 2015. The presence of low respiratory muscle strength plus low appendicular skeletal muscles mass was defined as RS based on t. A logistic regression model was used to identify the influencing factors for incident RS. RESULTS After an average of 4 years of follow-up, the cumulative incidence of RS was 5.2%, and it was particularly high in participants aged >80 (20.9%). Logistic regression analysis showed that being unmarried/divorced/widowed (odds ratio [OR] = 1.85, 95% confidence interval [CI] = 1.28-2.66, P = 0.001), not having dyslipidemia (OR = 0.35, 95% CI = 0.19-0.65, P = 0.001), having digestive disease (OR = 1.56, 95% CI = 1.11-2.19, P = 0.010), asthma (OR = 2.77, 95% CI = 1.55-4.94, P = 0.001), edentulism (OR = 1.73, 95% CI = 1.24-2.42, P = 0.001), low handgrip strength (OR = 2.82, 95% CI = 1.99-3.99, P < 0.001), or low 5-m gait speed (OR = 1.92, 95% CI = 1.23-3.01, P = 0.004) were associated with a greater likelihood of developing RS. After further adjustment for age and body mass index, asthma, edentulism, and low handgrip strength remained significant. CONCLUSIONS The identification and management of older adults with the influencing factors described above could be important in preventing RS. Geriatr Gerontol Int 2024; ••: ••-••.
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Affiliation(s)
- Kangkang Chen
- Department of Non-communicable Diseases Control and Prevention, Shaoxing Center for Disease Control and Prevention, Shaoxing, China
| | - Qifeng Chen
- Department of Non-communicable Diseases Control and Prevention, Shaoxing Center for Disease Control and Prevention, Shaoxing, China
| | - Laichao Xu
- Department of Non-communicable Diseases Control and Prevention, Shaoxing Center for Disease Control and Prevention, Shaoxing, China
- Administrative Office, Shaoxing Center for Disease Control and Prevention, Shaoxing, China
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Sawaya Y, Hirose T, Shiba T, Sato R, Yin L, Kubo A, Urano T. Decrease in the usual walking speed and body fat percentage associated with a deterioration in long-term care insurance certification levels. PeerJ 2024; 12:e17529. [PMID: 38915385 PMCID: PMC11195544 DOI: 10.7717/peerj.17529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/17/2024] [Indexed: 06/26/2024] Open
Abstract
Background In Japan, the number of older adults requiring long-term care insurance (LTCI) is increasing and the cost is becoming a social problem. In these fields, the role of geriatric rehabilitation includes maintaining the physical function and LTCI certification levels. The prevalence of sarcopenia is high among older adults requiring LTCI certification, and there are many opportunities to assess the handgrip strength, walking speed, and muscle mass. This study aimed to identify sarcopenia-related assessments sensitive to transitions in LTCI certification levels and determine cut-off values to predict them. Methods This prospective cohort study analyzed 98 daycare users (mean age ± standard error: 78.5 ± 0.8 years) between March 2019 and 2023. The participants received LTCI certification before the study, and their levels were renewed between baseline and follow-up (six months later). The measurements included handgrip strength, usual walking speed, body composition, and SARC-F score. Participants were classified into maintenance, deterioration, and improvement groups according to the changes in their LTCI certification levels. We identified factors contributing to the deterioration of LTCI certification levels using baseline and before and after comparisons, multivariate analyses, and receiver operating characteristic analyses. Results No significant differences were observed in the baseline data among the groups. Only the deterioration group showed significant changes in the usual walking speed (baseline: 0.64 ± 0.25 m/s, follow-up: 0.53 ± 0.21 m/s, P = 0.008) and body fat percentage (baseline: 29.2 ± 9.9%, follow-up: 27.7 ± 10.3%, P = 0.047). Binomial logistic regression showed that changes in usual walking speed (P = 0.042) and body fat percentage (P = 0.011) were significantly associated with the deterioration of LTCI certification levels, even after adjustment. The cutoff values of change to discriminate the deterioration of LTCI certification levels were -0.14 m/s at the usual walking speed (P = 0.047) and -1.0% for body fat percentage (P = 0.029). Conclusions Decreases in usual walking speed and body fat percentage may predict worse certification levels in older adults requiring LTCI.
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Affiliation(s)
- Yohei Sawaya
- Department of Physical Therapy, School of Health Sciences, International University of Health and Welfare, Otawara, Tochigi, Japan
- Nishinasuno General Home Care Center, Department of Day Rehabilitation, Care Facility for the Elderly “Maronie-en”, Nasushiobara, Tochigi, Japan
| | - Tamaki Hirose
- Department of Physical Therapy, School of Health Sciences, International University of Health and Welfare, Otawara, Tochigi, Japan
- Nishinasuno General Home Care Center, Department of Day Rehabilitation, Care Facility for the Elderly “Maronie-en”, Nasushiobara, Tochigi, Japan
| | - Takahiro Shiba
- Integrated Facility for Medical and Long-term care, Care Facility for the Elderly “Maronie-en”, Nasushiobara, Tochigi, Japan
| | - Ryo Sato
- Nishinasuno General Home Care Center, Department of Day Rehabilitation, Care Facility for the Elderly “Maronie-en”, Nasushiobara, Tochigi, Japan
| | - Lu Yin
- Integrated Facility for Medical and Long-term care, Care Facility for the Elderly “Maronie-en”, Nasushiobara, Tochigi, Japan
| | - Akira Kubo
- Department of Physical Therapy, School of Health Sciences at Odawara, International University of Health and Welfare, Odawara, Kanagawa, Japan
| | - Tomohiko Urano
- Nishinasuno General Home Care Center, Department of Day Rehabilitation, Care Facility for the Elderly “Maronie-en”, Nasushiobara, Tochigi, Japan
- Integrated Facility for Medical and Long-term care, Care Facility for the Elderly “Maronie-en”, Nasushiobara, Tochigi, Japan
- Department of Geriatric Medicine, School of Medicine, International University of Health and Welfare, Narita, Chiba, Japan
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Boontanom N, Kooncumchoo P, Yuenyongchaiwat K. Cardiorespiratory Performance, Physical Activity, and Depression in Thai Older Adults with Sarcopenia and No Sarcopenia: A Matched Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:724. [PMID: 38928970 PMCID: PMC11204289 DOI: 10.3390/ijerph21060724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 05/29/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Older adults have a high risk for musculoskeletal, cardiorespiratory, and mental health problems. We compared respiratory muscle strength, cardiovascular endurance, physical activity (PA), and depression between older adults with and without sarcopenia. METHODS This matched case-control study included 200 Thai older adults (100 participants with and without sarcopenia). According to the Asian Working Group for Sarcopenia 2019, participants completed a handgrip dynamometer, a 6 m walk test, and bioimpedance analysis for sarcopenia screening. Individuals were required to evaluate their cardiovascular endurance and respiratory muscle strength and complete a set of questionnaires (i.e., depression and PA). Participants with and without sarcopenia were compared using a t-test, and ANOVA was used for subgroup analysis. RESULTS Participants with sarcopenia had significantly lower inspiratory muscle strength (p < 0.001), functional capacity (p = 0.032), PA (p < 0.001), and higher depression scores (p < 0.001) than those without sarcopenia. Respiratory muscle strength and PA were significantly reduced in those with severe sarcopenia, followed by those with sarcopenia, possible sarcopenia, and no sarcopenia. Older adults with severe sarcopenia had higher depression scores than those with sarcopenia, possible sarcopenia, or no sarcopenia. CONCLUSIONS Older adults with sarcopenia may exhibit lower cardiorespiratory performance, less PA, and higher depression than those without sarcopenia.
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Affiliation(s)
- Nuntiya Boontanom
- Physiotherapy Department, Faculty of Allied Health Sciences, Thammasat University, Pathum Thani 12120, Thailand
| | - Patcharee Kooncumchoo
- Physiotherapy Department, Faculty of Allied Health Sciences, Thammasat University, Pathum Thani 12120, Thailand
- Center of Excellence in Creative Engineering Design and Development, Thammasat University, Pathum Thani 12120, Thailand
| | - Kornanong Yuenyongchaiwat
- Physiotherapy Department, Faculty of Allied Health Sciences, Thammasat University, Pathum Thani 12120, Thailand
- Thammasat University Research Unit for Physical Therapy in Respiratory and Cardiovascular Systems, Thammasat University, Pathum Thani 12120, Thailand
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Jiroumaru T, Hyodo Y, Mori K, Hattori T, Wachi M, Shichiri N, Fujikawa T. Relationship between respiratory muscle strength and dynamic balance in older persons requiring care or support: Focusing on the maximal single step length test and maximal double step length test as dynamic balance indices. Gait Posture 2024; 109:64-69. [PMID: 38281431 DOI: 10.1016/j.gaitpost.2023.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 12/10/2023] [Accepted: 12/28/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND Falls are a major health problem. The relationship between dynamic balance related to falls and respiratory muscle strength related to sarcopenia and frailty is poorly understood. RESEARCH QUESTION How do dynamic balance measures, such as maximal single step length test (MSL) and maximal double step length test (MDST), and respiratory muscle strength measures, such as maximal inspiratory (PImax) and maximal expiratory (PEmax), related to the requirement for long-term care or support in older people who live in the community? METHODS This was a cross-sectional study of 39 older people (17 men, 22 women) aged ≥ 65 years community-dwelling who were certified as requiring long-term care or support under the Japanese system. The participants' PImax, PEmax, MSL, and MDST results were recorded. The measurement data were evaluated using Pearson's correlation coefficients and multiple regression analysis. RESULTS MDST showed a positive correlation with PImax (r = 0.430, p = 0.006) but no correlation with PEmax. MSL showed no correlation with PImax or PEmax. A positive correlation was found between MDST and MSL (r = 0.851, p < 0.001), and multiple regression analysis with MDST as the dependent variable and PImax and MST as independent variables showed significant differences for MSL (p < 0.001) and PImax (p = 0.027). SIGNIFICANCE In older people requiring long-term care or support, MDST had a greater association with inspiratory muscle strength compared with MSL. These results suggest the importance of inspiratory muscle strength training and MDST assessment in the prevention of falls in older people requiring long-term care or support.
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Affiliation(s)
- Takumi Jiroumaru
- Department of Physical Therapy, School of Health Sciences, Bukkyo University, 7 Nishinokyohigashitoganocho, Kyoto Nakagyo-ku, Kyoto 604-8418, Japan.
| | - Yutaro Hyodo
- Kanazawa Orthopaedic and Sports Medicine Clinic, Ritto, Shiga, Japan
| | - Kenji Mori
- Kanazawa Orthopaedic and Sports Medicine Clinic, Ritto, Shiga, Japan
| | - Tomoka Hattori
- Kanazawa Orthopaedic and Sports Medicine Clinic, Ritto, Shiga, Japan
| | - Michio Wachi
- Bukkyo University, Kyoto Nakagyo-ku, Kyoto, Japan
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Sato S, Miyazaki S, Tamaki A, Yoshimura Y, Arai H, Fujiwara D, Katsura H, Kawagoshi A, Kozu R, Maeda K, Ogawa S, Ueki J, Wakabayashi H. Respiratory sarcopenia: A position paper by four professional organizations. Geriatr Gerontol Int 2023; 23:5-15. [PMID: 36479799 DOI: 10.1111/ggi.14519] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/16/2022] [Accepted: 11/20/2022] [Indexed: 12/13/2022]
Abstract
We defined respiratory sarcopenia as a coexistence of respiratory muscle weakness and decreased respiratory muscle mass. Although respiratory muscle function is indispensable for life support, its evaluation has not been included in the regular assessment of respiratory function or adequately evaluated in clinical practice. Considering this situation, we prepared a position paper outlining basic knowledge, diagnostic and assessment methods, mechanisms, involvement in respiratory diseases, intervention and treatment methods, and future perspectives on respiratory sarcopenia, and summarized the current consensus on respiratory sarcopenia. Respiratory sarcopenia is diagnosed when respiratory muscle weakness and decreased respiratory muscle mass are observed. If respiratory muscle mass is difficult to measure, we can use appendicular skeletal muscle mass as a surrogate. Probable respiratory sarcopenia is defined when respiratory muscle weakness and decreased appendicular skeletal muscle mass are observed. If only respiratory muscle strength is decreased without a decrease in respiratory function, the patient is diagnosed with possible respiratory sarcopenia. Respiratory muscle strength is assessed using maximum inspiratory pressure and maximum expiratory pressure. Ultrasonography and computed tomography are commonly used to assess respiratory muscle mass; however, there are insufficient data to propose the cutoff values for defining decreased respiratory muscle mass. It was jointly prepared by the representative authors and authorized by the Japanese Society for Respiratory Care and Rehabilitation, Japanese Association on Sarcopenia and Frailty, Japanese Society of Respiratory Physical Therapy and Japanese Association of Rehabilitation Nutrition. Geriatr Gerontol Int 2023; 23: 5-15.
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Affiliation(s)
- Susumu Sato
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Akira Tamaki
- Department of Physical Therapy, School of Rehabilitation, Hyogo Medical University, Kobe, Japan
| | - Yoshihiro Yoshimura
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
| | - Dai Fujiwara
- Department of Rehabilitation Medicine, Saka General Hospital, Miyagi, Japan
| | - Hideki Katsura
- Department of Respiratory Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Ryo Kozu
- Department of Physical Therapy Science, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Keisuke Maeda
- Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Sumito Ogawa
- Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Jun Ueki
- Clinical Research Unit of Respiratory Pathophysiology, Graduate School of Health Care and Nursing, Juntendo University, Chiba, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan
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Sawaya Y, Hirose T, Ishizaka M, Shiba T, Sato R, Kubo A, Urano T. Patterns of Changes in Respiratory Muscle Strength over 1 Year in Non-Sarcopenia, Sarcopenia, and Severe Sarcopenia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16571. [PMID: 36554450 PMCID: PMC9779222 DOI: 10.3390/ijerph192416571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/27/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
In this prospective longitudinal cohort study, we explored the characteristics of older people with lower respiratory muscle strength, according to sarcopenia severity, over the course of 1 year. The maximum expiratory pressure (MEP), grip strength, walking speed, and skeletal muscle mass index of 58 participants (28 men, 30 women; mean age, 76.9 ± 7.7 years) were measured at baseline and at the 1-year follow-up. Participants were classified into a decreased MEP group (n = 29; MEP decreased by ≥10% after 1 year) and a non-decreased MEP group (n = 29; MEP decreased by <10%). Sarcopenia status in the mild direction at baseline was significantly associated with MEP decline after one year. Repeated two-way analysis of variance showed significant main effects of measurement time (p < 0.001) and severity of sarcopenia (p = 0.026), as well as a significant interaction effect (p = 0.006). Surprisingly, MEP decreased significantly in the non-sarcopenia and sarcopenia groups, but not in the severe sarcopenia group. Thus, individuals without sarcopenia and those with moderate sarcopenia at baseline are predisposed to MEP decline and should be closely monitored for signs of such decline and associated adverse events.
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Affiliation(s)
- Yohei Sawaya
- Department of Physical Therapy, School of Health Sciences, International University of Health and Welfare, 2600-1 Kitakanemaru, Otawara 324-8501, Tochigi, Japan
- Nishinasuno General Home Care Center, Department of Day Rehabilitation, Care Facility for the Elderly “Maronie-en,” 533-11 Iguchi, Nasushiobara 329-2763, Tochigi, Japan
| | - Tamaki Hirose
- Department of Physical Therapy, School of Health Sciences, International University of Health and Welfare, 2600-1 Kitakanemaru, Otawara 324-8501, Tochigi, Japan
- Nishinasuno General Home Care Center, Department of Day Rehabilitation, Care Facility for the Elderly “Maronie-en,” 533-11 Iguchi, Nasushiobara 329-2763, Tochigi, Japan
| | - Masahiro Ishizaka
- Department of Physical Therapy, School of Health Sciences, International University of Health and Welfare, 2600-1 Kitakanemaru, Otawara 324-8501, Tochigi, Japan
| | - Takahiro Shiba
- Nishinasuno General Home Care Center, Department of Day Rehabilitation, Care Facility for the Elderly “Maronie-en,” 533-11 Iguchi, Nasushiobara 329-2763, Tochigi, Japan
| | - Ryo Sato
- Nishinasuno General Home Care Center, Department of Day Rehabilitation, Care Facility for the Elderly “Maronie-en,” 533-11 Iguchi, Nasushiobara 329-2763, Tochigi, Japan
| | - Akira Kubo
- Department of Physical Therapy, School of Health Sciences, International University of Health and Welfare, 2600-1 Kitakanemaru, Otawara 324-8501, Tochigi, Japan
| | - Tomohiko Urano
- Nishinasuno General Home Care Center, Department of Day Rehabilitation, Care Facility for the Elderly “Maronie-en,” 533-11 Iguchi, Nasushiobara 329-2763, Tochigi, Japan
- Department of Geriatric Medicine, School of Medicine, International University of Health and Welfare, 4-3 Kozunomori, Narita 286-8686, Chiba, Japan
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Kubo A, Sawatani Y. [Care facility for the elderly]. Nihon Ronen Igakkai Zasshi 2022; 59:568-571. [PMID: 36476707 DOI: 10.3143/geriatrics.59.568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Akira Kubo
- Department of Physical Therapy, Faculty of Health and Medical Sciences, International University of Health and Welfare, Japan
| | - Yohei Sawatani
- Department of Physical Therapy, Faculty of Health and Medical Sciences, International University of Health and Welfare, Japan
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Faccioli E, Terzi S, Giraudo C, Zuin A, Modugno A, Labella F, Zambello G, Lorenzoni G, Schiavon M, Gregori D, Pasello G, Calabrese F, Dell’Amore A, Rea F. Sarcopenia as a Predictor of Short- and Long-Term Outcomes in Patients Surgically Treated for Malignant Pleural Mesothelioma. Cancers (Basel) 2022; 14:cancers14153699. [PMID: 35954361 PMCID: PMC9367512 DOI: 10.3390/cancers14153699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/17/2022] [Accepted: 07/26/2022] [Indexed: 02/05/2023] Open
Abstract
Simple Summary Malignant pleural mesothelioma (MPM) is an aggressive asbestos-related tumor with a poor prognosis. Surgery, often considered in the context of multimodality treatment, may be burdened by high morbidity, and for this reason, it should be reserved for patients who have a good pre-operative performance status. Sarcopenia, a well-established predictor of negative outcomes in several clinical settings, is still underinvestigated in MPM. The aim of the study is to elucidate the prognostic impact of muscular loss on surgical outcomes in patients with MPM. We demonstrated that, respectively, pre- and post-operative sarcopenia strongly affects the risk of post-operative complications and long-term survival after surgery for MPM. This finding will help clinicians to perform a better selection of patients, taking into consideration the enrollment in dedicated rehabilitation programs before surgery. Abstract Surgery for malignant pleural mesothelioma (MPM) should be reserved only for patients who have a good performance status. Sarcopenia, a well-known predictor of poor outcomes after surgery, is still underinvestigated in MPM. The aim of this study is to evaluate the role of sarcopenia as a predictor of short-and long-term outcomes in patients surgically treated for MPM. In our analysis, we included patients treated with a cytoreductive intent in a multimodality setting, with both pre- and post-operative CT scans without contrast available. We excluded those in whom a complete macroscopic resection was not achieved. Overall, 86 patients were enrolled. Sarcopenia was assessed by measuring the mean muscular density of the bilateral paravertebral muscles (T12 level) on pre-and post-operative CTs; a threshold value of 30 Hounsfield Units (HU) was identified. Sarcopenia was found pre-operatively in 57 (66%) patients and post-operatively in 61 (74%). Post-operative sarcopenic patients had a lower 3-year overall survival (OS) than those who were non-sarcopenic (34.9% vs. 57.6% p = 0.03). Pre-operative sarcopenia was significantly associated with a higher frequency of post-operative complications (65% vs. 41%, p = 0.04). The evaluation of sarcopenia, through a non-invasive method, would help to better select patients submitted to surgery for MPM in a multimodality setting.
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Affiliation(s)
- Eleonora Faccioli
- Thoracic Surgery Unit, Department of Cardiac, Thoracic Vascular Sciences and Public Health, University Hospital of Padova, 35128 Padova, Italy; (S.T.); (A.Z.); (G.Z.); (M.S.); (A.D.); (F.R.)
- Correspondence: ; Tel.: +39-049-8212242
| | - Stefano Terzi
- Thoracic Surgery Unit, Department of Cardiac, Thoracic Vascular Sciences and Public Health, University Hospital of Padova, 35128 Padova, Italy; (S.T.); (A.Z.); (G.Z.); (M.S.); (A.D.); (F.R.)
| | - Chiara Giraudo
- Radiology Unit, Department of Medicine, University Hospital of Padova, 35128 Padova, Italy; (C.G.); (A.M.); (F.L.)
| | - Andrea Zuin
- Thoracic Surgery Unit, Department of Cardiac, Thoracic Vascular Sciences and Public Health, University Hospital of Padova, 35128 Padova, Italy; (S.T.); (A.Z.); (G.Z.); (M.S.); (A.D.); (F.R.)
| | - Antonella Modugno
- Radiology Unit, Department of Medicine, University Hospital of Padova, 35128 Padova, Italy; (C.G.); (A.M.); (F.L.)
| | - Francesco Labella
- Radiology Unit, Department of Medicine, University Hospital of Padova, 35128 Padova, Italy; (C.G.); (A.M.); (F.L.)
| | - Giovanni Zambello
- Thoracic Surgery Unit, Department of Cardiac, Thoracic Vascular Sciences and Public Health, University Hospital of Padova, 35128 Padova, Italy; (S.T.); (A.Z.); (G.Z.); (M.S.); (A.D.); (F.R.)
| | - Giulia Lorenzoni
- Biostatistics Unit, Department of Cardiac, Thoracic Vascular Sciences and Public Health, University Hospital of Padova, 35128 Padova, Italy; (G.L.); (D.G.)
| | - Marco Schiavon
- Thoracic Surgery Unit, Department of Cardiac, Thoracic Vascular Sciences and Public Health, University Hospital of Padova, 35128 Padova, Italy; (S.T.); (A.Z.); (G.Z.); (M.S.); (A.D.); (F.R.)
| | - Dario Gregori
- Biostatistics Unit, Department of Cardiac, Thoracic Vascular Sciences and Public Health, University Hospital of Padova, 35128 Padova, Italy; (G.L.); (D.G.)
| | - Giulia Pasello
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, 35128 Padova, Italy;
| | - Fiorella Calabrese
- Pathology Unit, Department of Cardiac, Thoracic Vascular Sciences and Public Health, University Hospital of Padova, 35128 Padova, Italy;
| | - Andrea Dell’Amore
- Thoracic Surgery Unit, Department of Cardiac, Thoracic Vascular Sciences and Public Health, University Hospital of Padova, 35128 Padova, Italy; (S.T.); (A.Z.); (G.Z.); (M.S.); (A.D.); (F.R.)
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiac, Thoracic Vascular Sciences and Public Health, University Hospital of Padova, 35128 Padova, Italy; (S.T.); (A.Z.); (G.Z.); (M.S.); (A.D.); (F.R.)
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