|
51
|
Cereda E, Tancredi R, Klersy C, Lobascio F, Crotti S, Masi S, Cappello S, Stobäus N, Tank M, Cutti S, Arcaini L, Bonzano E, Colombo S, Pedrazzoli P, Norman K, Caccialanza R. Muscle weakness as an additional criterion for grading sarcopenia-related prognosis in patients with cancer. Cancer Med 2021; 11:308-316. [PMID: 34894098 PMCID: PMC8729063 DOI: 10.1002/cam4.4362] [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: 08/05/2021] [Revised: 10/05/2021] [Accepted: 10/05/2021] [Indexed: 12/19/2022] Open
Abstract
Background Low muscle strength has been pointed out as a key characteristic of sarcopenia, but the prognostic significance of muscle function next to reduced skeletal muscle mass (SMM) in patients with cancer has been scantily investigated. Methods Data on muscle strength by handgrip (HG) dynamometry and total‐body SMM estimated by bioelectrical impedance analysis (BIA) of Italian and German patients with cancer observed prospectively until death or censoring were analysed (N = 1076). Patients were stratified in four risk categories based on low HG (<10th percentiles of age and gender‐specific normative values) and low total‐body SMM according to SMM index cutoffs (<10.75 and <6.75 kg/m2 in men and women, respectively). Results During a median follow‐up of 58 months [25th–75th percentile, 37–60], 566 patients had died. Patients presenting low HG in combination or not with low SMM were characterised by shorter median survival (12.7 vs. 27.2 months, respectively; p < 0.001) compared to those with low SMM/normal HG and normal SMM/normal HG (>60 months for both). After adjusting for sex, age, body mass index and percentage of weight loss, disease's stage, performance status and type of cancer, compared to reference category (normal HG and SMM; N = 210) the hazard ratios were: low SMM/normal HG (N = 342), 0.83 [95% confidence interval, CI, 0.67–1.02] (p = 0.073); normal SMM/low HG (N = 158), 1.19 [95% CI, 1.07–1.32] (p = 0.002); low SMM/low HG (N = 366), 1.39 [95% CI, 1.27–1.53] (p < 0.001). Conclusions Muscle weakness was found to be a more powerful predictor of survival than BIA‐estimated SMM and should be considered as an additional key feature of sarcopenia in patients with cancer. Low muscle strength has been pointed out as a key characteristic of sarcopenia, but the prognostic significance of muscle function next to reduced skeletal muscle mass (SMM) in patients with cancer has been scantily investigated. Muscle weakness was found to be a more powerful predictor of survival than SMM and should be considered as additional key feature of sarcopenia in patients with cancer.
Collapse
Affiliation(s)
- Emanuele Cereda
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Richard Tancredi
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo and Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Catherine Klersy
- Biometry and Clinical Epidemiology Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Federica Lobascio
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Silvia Crotti
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sara Masi
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Silvia Cappello
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Nicole Stobäus
- Clinical Research Unit, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Maja Tank
- Medizinisches Versorgungszentrum Hämatologie-Onkologie Tempelhof, Berlin, Germany.,Research Group on Geriatrics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Sara Cutti
- Medical Direction, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Luca Arcaini
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo and Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Elisabetta Bonzano
- Radiation Oncology Department, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Sara Colombo
- Radiation Oncology Department, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Paolo Pedrazzoli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo and Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Kristina Norman
- Research Group on Geriatrics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Department of Nutrition and Gerontology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Deutschland
| | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| |
Collapse
|
|
52
|
Berardi G, Colasanti M, Meniconi RL, Ferretti S, Guglielmo N, Mariano G, Burocchi M, Campanelli A, Scotti A, Pecoraro A, Angrisani M, Ferrari P, Minervini A, Gasparoli C, Wakabayashi G, Ettorre GM. The Applications of 3D Imaging and Indocyanine Green Dye Fluorescence in Laparoscopic Liver Surgery. Diagnostics (Basel) 2021; 11:2169. [PMID: 34943406 PMCID: PMC8700092 DOI: 10.3390/diagnostics11122169] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/19/2021] [Accepted: 11/21/2021] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic liver resections have gained widespread popularity among hepatobiliary surgeons and is nowadays performed for both standard and more complex hepatectomies. Given the increased technical challenges, preoperative planning and intraoperative guidance is pivotal in laparoscopic surgery to safely carry out complex and oncologically safe hepatectomies. Modern tools can help both preoperatively and intraoperatively and allow surgeons to perform more precise hepatectomies. Preoperative 3D reconstructions and printing as well as augmented reality can increase the knowledge of the specific anatomy of the case and therefore plan the surgery accordingly and tailor the procedure on the patient. Furthermore, the indocyanine green retention dye is an increasingly used tool that can nowadays improve the precision during laparoscopic hepatectomies, especially when considering anatomical resection. The use of preoperative modern imaging and intraoperative indocyanine green dye are key to successfully perform complex hepatectomies such as laparoscopic parenchymal sparing liver resections. In this narrative review, we discuss the aspects of preoperative and intraoperative tools that are nowadays increasingly used in experienced hepatobiliary centers.
Collapse
Affiliation(s)
- Giammauro Berardi
- Department of General, Hepatobiliary and Pancreatic Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital, 00151 Rome, Italy; (M.C.); (R.L.M.); (S.F.); (N.G.); (G.M.); (M.B.); (A.C.); (A.S.); (A.P.); (M.A.); (P.F.); (A.M.); (C.G.); (G.M.E.)
| | - Marco Colasanti
- Department of General, Hepatobiliary and Pancreatic Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital, 00151 Rome, Italy; (M.C.); (R.L.M.); (S.F.); (N.G.); (G.M.); (M.B.); (A.C.); (A.S.); (A.P.); (M.A.); (P.F.); (A.M.); (C.G.); (G.M.E.)
| | - Roberto Luca Meniconi
- Department of General, Hepatobiliary and Pancreatic Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital, 00151 Rome, Italy; (M.C.); (R.L.M.); (S.F.); (N.G.); (G.M.); (M.B.); (A.C.); (A.S.); (A.P.); (M.A.); (P.F.); (A.M.); (C.G.); (G.M.E.)
| | - Stefano Ferretti
- Department of General, Hepatobiliary and Pancreatic Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital, 00151 Rome, Italy; (M.C.); (R.L.M.); (S.F.); (N.G.); (G.M.); (M.B.); (A.C.); (A.S.); (A.P.); (M.A.); (P.F.); (A.M.); (C.G.); (G.M.E.)
| | - Nicola Guglielmo
- Department of General, Hepatobiliary and Pancreatic Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital, 00151 Rome, Italy; (M.C.); (R.L.M.); (S.F.); (N.G.); (G.M.); (M.B.); (A.C.); (A.S.); (A.P.); (M.A.); (P.F.); (A.M.); (C.G.); (G.M.E.)
| | - Germano Mariano
- Department of General, Hepatobiliary and Pancreatic Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital, 00151 Rome, Italy; (M.C.); (R.L.M.); (S.F.); (N.G.); (G.M.); (M.B.); (A.C.); (A.S.); (A.P.); (M.A.); (P.F.); (A.M.); (C.G.); (G.M.E.)
| | - Mirco Burocchi
- Department of General, Hepatobiliary and Pancreatic Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital, 00151 Rome, Italy; (M.C.); (R.L.M.); (S.F.); (N.G.); (G.M.); (M.B.); (A.C.); (A.S.); (A.P.); (M.A.); (P.F.); (A.M.); (C.G.); (G.M.E.)
| | - Alessandra Campanelli
- Department of General, Hepatobiliary and Pancreatic Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital, 00151 Rome, Italy; (M.C.); (R.L.M.); (S.F.); (N.G.); (G.M.); (M.B.); (A.C.); (A.S.); (A.P.); (M.A.); (P.F.); (A.M.); (C.G.); (G.M.E.)
| | - Andrea Scotti
- Department of General, Hepatobiliary and Pancreatic Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital, 00151 Rome, Italy; (M.C.); (R.L.M.); (S.F.); (N.G.); (G.M.); (M.B.); (A.C.); (A.S.); (A.P.); (M.A.); (P.F.); (A.M.); (C.G.); (G.M.E.)
| | - Alessandra Pecoraro
- Department of General, Hepatobiliary and Pancreatic Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital, 00151 Rome, Italy; (M.C.); (R.L.M.); (S.F.); (N.G.); (G.M.); (M.B.); (A.C.); (A.S.); (A.P.); (M.A.); (P.F.); (A.M.); (C.G.); (G.M.E.)
| | - Marco Angrisani
- Department of General, Hepatobiliary and Pancreatic Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital, 00151 Rome, Italy; (M.C.); (R.L.M.); (S.F.); (N.G.); (G.M.); (M.B.); (A.C.); (A.S.); (A.P.); (M.A.); (P.F.); (A.M.); (C.G.); (G.M.E.)
| | - Paolo Ferrari
- Department of General, Hepatobiliary and Pancreatic Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital, 00151 Rome, Italy; (M.C.); (R.L.M.); (S.F.); (N.G.); (G.M.); (M.B.); (A.C.); (A.S.); (A.P.); (M.A.); (P.F.); (A.M.); (C.G.); (G.M.E.)
| | - Andrea Minervini
- Department of General, Hepatobiliary and Pancreatic Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital, 00151 Rome, Italy; (M.C.); (R.L.M.); (S.F.); (N.G.); (G.M.); (M.B.); (A.C.); (A.S.); (A.P.); (M.A.); (P.F.); (A.M.); (C.G.); (G.M.E.)
| | - Camilla Gasparoli
- Department of General, Hepatobiliary and Pancreatic Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital, 00151 Rome, Italy; (M.C.); (R.L.M.); (S.F.); (N.G.); (G.M.); (M.B.); (A.C.); (A.S.); (A.P.); (M.A.); (P.F.); (A.M.); (C.G.); (G.M.E.)
| | - Go Wakabayashi
- Center for Advanced Treatment of HPB Diseases, Ageo Central General Hospital, Saitama 362-8588, Japan;
| | - Giuseppe Maria Ettorre
- Department of General, Hepatobiliary and Pancreatic Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital, 00151 Rome, Italy; (M.C.); (R.L.M.); (S.F.); (N.G.); (G.M.); (M.B.); (A.C.); (A.S.); (A.P.); (M.A.); (P.F.); (A.M.); (C.G.); (G.M.E.)
| |
Collapse
|
|
53
|
Hu Q, Mao W, Wu T, Xu Z, Yu J, Wang C, Chen S, Chen S, Xu B, Xu Y, Chen M. High Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Are Associated With Sarcopenia Risk in Hospitalized Renal Cell Carcinoma Patients. Front Oncol 2021; 11:736640. [PMID: 34760698 PMCID: PMC8573165 DOI: 10.3389/fonc.2021.736640] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/28/2021] [Indexed: 01/04/2023] Open
Abstract
Purpose This study aimed i) to identify the best cutoff points of neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) that predict sarcopenia and ii) to illustrate the association between sarcopenia risk and NLR or PLR in renal cell carcinoma (RCC) patients undergoing laparoscopic partial or radical nephrectomy. Methods A total of 343 RCC patients who underwent laparoscopic partial or radical nephrectomy between 2014 and 2019 were enrolled in our study. Sarcopenia was assessed by lumbar skeletal muscle index (SMI). Receiver operating characteristic (ROC) curve was used to identify the best cutoff point of NLR or PLR to predict sarcopenia risk. Univariate and multivariate logistic regression and dose–response analysis curves of restricted cubic spline function were conducted to assess the relationship between sarcopenia and NLR or PLR. Results The best cutoff points of NLR >2.88 or PLR >135.63 were confirmed by the ROC curve to predict sarcopenia risk. Dose–response curves showed that the risk of sarcopenia increased with raising NLR and PLR. Patients with NLR >2.88 or PLR >135.63 had a higher sarcopenia risk than those in the NLR ≤2.8 or PLR ≤135.63 group, respectively. By adjusting for all variables, we found that patients with NLR >2.88 and PLR >135.63 had 149% and 85% higher risk to develop sarcopenia, respectively, than those with NLR ≤2.8 (aOR = 2.49; 95% CI = 1.56–3.98; p < 0.001) or PLR ≤135.63 (aOR = 1.85; 95% CI = 1.16–2.95; p = 0.010). Conclusion In RCC patients receiving laparoscopic partial or radical nephrectomy, NLR and PLR, which were biomarkers of systemic inflammation, were associated with sarcopenia risk.
Collapse
Affiliation(s)
- Qiang Hu
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Weipu Mao
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Tiange Wu
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Zhipeng Xu
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Junjie Yu
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Can Wang
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Saisai Chen
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Shuqiu Chen
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, China.,Surgical Research Center, Institute of Urology, Southeast University Medical School, Nanjing, China
| | - Bin Xu
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, China.,Surgical Research Center, Institute of Urology, Southeast University Medical School, Nanjing, China.,Department of Clinical Research, Southeast University Medical School, Nanjing, China
| | - Yueshuang Xu
- Department of Pathology, School of Medicine, Southeast University, Nanjing, China
| | - Ming Chen
- Department of Urology, Zhongda Hospital, Southeast University, Nanjing, China.,Surgical Research Center, Institute of Urology, Southeast University Medical School, Nanjing, China.,Department of Urology, Nanjing Lishui District People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
| |
Collapse
|
|
54
|
Bajrić T, Kornprat P, Faschinger F, Werkgartner G, Mischinger HJ, Wagner D. Sarcopenia and primary tumor location influence patients outcome after liver resection for colorectal liver metastases. Eur J Surg Oncol 2021; 48:615-620. [PMID: 34620509 DOI: 10.1016/j.ejso.2021.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/11/2021] [Accepted: 09/15/2021] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Right-sided and left-sided colorectal cancer (CRC) is known to differ in their molecular carcinogenic pathways. The prevalence of sarcopenia is known to worsen the outcome after hepatic resection. We sought to investigate the prevalence of sarcopenia and its prognostic application according to the primary CRC tumor site. METHODS 355 patients (62% male) who underwent liver resection in our center were identified. Clinicopathologic characteristics and long-term outcomes were stratified by sarcopenia and primary tumor location (right-sided vs. left-sided). Tumors in the coecum, right sided and transverse colon were defined as right-sided, tumors in the left colon and rectum were defined as left-sided. Sarcopenia was assessed using the skeletal muscle index (SMI) with a measurement of the skeletal muscle area at the level L3. RESULTS Patients who underwent right sided colectomy (n = 233, 65%) showed a higher prevalence of sarcopenia (35.2% vs. 23.9%, p = 0.03). These patients also had higher chances for postoperative complications with Clavien Dindo >3 (OR 1.21 CI95% 0.9-1.81, p = 0.05) and higher odds for mortality related to CRC (HR 1.2 CI95% 0.8-1.8, p = 0.03).On multivariable analysis prevalence of sarcopenia remained independently associated with worse overall survival and disease free survival (overall survival: HR 1.47 CI 95% 1.03-2.46, p = 0.03; HR 1.74 CI95% 1.09-3.4, p = 0.05 respectively). CONCLUSION Sarcopenia is known to have a worse prognosis in patients with CRLM and CRC. Depending on the primary location sarcopenia has a variable effect on the outcome after liver resection.
Collapse
Affiliation(s)
- Tarik Bajrić
- Medical University of Graz, Department of Surgery, Division for General and Viszeral Surgery, Austria
| | - Peter Kornprat
- Medical University of Graz, Department of Surgery, Division for General and Viszeral Surgery, Austria
| | - Florian Faschinger
- Medical University of Graz, Department of Surgery, Division for General and Viszeral Surgery, Austria
| | - Georg Werkgartner
- Medical University of Graz, Department of Surgery, Division for General and Viszeral Surgery, Austria
| | - Hans Jörg Mischinger
- Medical University of Graz, Department of Surgery, Division for General and Viszeral Surgery, Austria
| | - Doris Wagner
- Medical University of Graz, Department of Surgery, Division for General and Viszeral Surgery, Austria.
| |
Collapse
|
|
55
|
Wang L, Jiao XF, Wu C, Li XQ, Sun HX, Shen XY, Zhang KZ, Zhao C, Liu L, Wang M, Bu YL, Li JW, Xu F, Chang CL, Lu X, Gao W. Trimetazidine attenuates dexamethasone-induced muscle atrophy via inhibiting NLRP3/GSDMD pathway-mediated pyroptosis. Cell Death Discov 2021; 7:251. [PMID: 34537816 PMCID: PMC8449784 DOI: 10.1038/s41420-021-00648-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 08/23/2021] [Accepted: 09/07/2021] [Indexed: 01/19/2023] Open
Abstract
Skeletal muscle atrophy is one of the major side effects of high dose or sustained usage of glucocorticoids. Pyroptosis is a novel form of pro-inflammatory programmed cell death that may contribute to skeletal muscle injury. Trimetazidine, a well-known anti-anginal agent, can improve skeletal muscle performance both in humans and mice. We here showed that dexamethasone-induced atrophy, as evidenced by the increase of muscle atrophy F-box (Atrogin-1) and muscle ring finger 1 (MuRF1) expression, and the decrease of myotube diameter in C2C12 myotubes. Dexamethasone also induced pyroptosis, indicated by upregulated pyroptosis-related protein NLR family pyrin domain containing 3 (NLRP3), Caspase-1, and gasdermin-D (GSDMD). Knockdown of NLRP3 or GSDMD attenuated dexamethasone-induced myotube pyroptosis and atrophy. Trimetazidine treatment ameliorated dexamethasone-induced muscle pyroptosis and atrophy both in vivo and in vitro. Activation of NLRP3 using LPS and ATP not only increased the cleavage and activation of Caspase-1 and GSDMD, but also increased the expression levels of atrophy markers MuRF1 and Atrogin-1 in trimetazidine-treated C2C12 myotubes. Mechanically, dexamethasone inhibited the phosphorylation of PI3K/AKT/FoxO3a, which could be attenuated by trimetazidine. Conversely, co-treatment with a PI3K/AKT inhibitor, picropodophyllin, remarkably increased the expression of NLRP3 and reversed the protective effects of trimetazidine against dexamethasone-induced C2C12 myotube pyroptosis and atrophy. Taken together, our study suggests that NLRP3/GSDMD-mediated pyroptosis might be a novel mechanism for dexamethasone-induced skeletal muscle atrophy. Trimetazidine might be developed as a potential therapeutic agent for the treatment of dexamethasone-induced muscle atrophy.
Collapse
Affiliation(s)
- Li Wang
- Department of Geriatrics, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China.,Key Laboratory for Aging & Disease, Nanjing Medical University, Nanjing, China
| | - Xin-Feng Jiao
- Department of Geriatrics, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China.,Key Laboratory for Aging & Disease, Nanjing Medical University, Nanjing, China
| | - Cheng Wu
- Key Laboratory for Aging & Disease, Nanjing Medical University, Nanjing, China.,Department of Geriatrics, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao-Qing Li
- Key Laboratory for Aging & Disease, Nanjing Medical University, Nanjing, China.,Department of Geriatrics, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hui-Xian Sun
- Department of Geriatrics, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China.,Department of Geriatrics, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xi-Yu Shen
- Department of Geriatrics, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China.,Department of Geriatrics, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kang-Zhen Zhang
- Department of Geriatrics, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China.,Department of Geriatrics, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Can Zhao
- Department of Geriatrics, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China.,Department of Geriatrics, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Li Liu
- Department of Geriatrics, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China.,Department of Geriatrics, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Man Wang
- Department of Geriatrics, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China.,Department of Geriatrics, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yun-Ling Bu
- Department of Geriatrics, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China.,Department of Geriatrics, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jia-Wen Li
- Department of Geriatrics, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China.,Department of Geriatrics, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fan Xu
- Department of Geriatrics, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China.,Department of Geriatrics, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chen-Lu Chang
- Department of Geriatrics, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China.,Department of Geriatrics, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiang Lu
- Department of Geriatrics, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China. .,Department of Geriatrics, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| | - Wei Gao
- Department of Geriatrics, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China. .,Department of Geriatrics, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| |
Collapse
|
|
56
|
Impact of Sarcopenia on Acute Kidney Injury after Infrarenal Abdominal Aortic Aneurysm Surgery: A Propensity Matching Analysis. Nutrients 2021; 13:nu13072212. [PMID: 34199110 PMCID: PMC8308481 DOI: 10.3390/nu13072212] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 02/07/2023] Open
Abstract
Background: Sarcopenia contributes to increased morbidity and mortality in patients undergoing surgery for abdominal aortic aneurysms (AAA). However, few reports have demonstrated whether sarcopenia would affect the development of postoperative acute kidney injury (AKI) in these patients. This study aimed to examine whether sarcopenia is associated with AKI and morbidity and mortality after infrarenal AAA operation. Methods: We retrospectively analysed 379 patients who underwent infrarenal AAA surgery. The diagnosis of sarcopenia was performed using the skeletal muscle index, which was calculated from axial computed tomography at the level of L3. The patients were separated into those with sarcopenia (n = 104) and those without sarcopenia (n = 275). We applied multivariable and Cox regression analyses to evaluate the risk factors for AKI and overall mortality. A propensity score matching (PSM) evaluation was done to assess the postoperative results. Results: The incidence of AKI was greater in sarcopenia than non-sarcopenia group before (34.6% vs. 15.3%; p < 0.001) and after the PSM analysis (34.6% vs. 15.4%; p = 0.002). Multivariable analysis revealed sarcopenia to be associated with AKI before (p = 0.010) and after PSM (p = 0.016). Sarcopenia was also associated with overall mortality before (p = 0.048) and after PSM (p = 0.032). A Kaplan–Meier analysis revealed that overall mortality was elevated patients with sarcopenia before and after PSM than in those without (log-rank test, p < 0.001, p = 0.022). Conclusions: Sarcopenia was associated with increased postoperative AKI incidence and overall mortality among individuals who underwent infrarenal AAA operation.
Collapse
|
|
57
|
Diao YK, Liang L, Yang T. Association of Sarcopenia and Body Composition With Postoperative 90-Day Morbidity After Liver Resection for Malignant Tumors. JAMA Surg 2021; 156:590. [PMID: 33760048 DOI: 10.1001/jamasurg.2021.0231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Yong-Kang Diao
- Department of Hepatobiliary, Pancreatic and Minimal Invasive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China.,Key Laboratory of Tumor Molecular Diagnosis and Individualized Medicine of Zhejiang Province, Hangzhou, China
| | - Lei Liang
- Department of Hepatobiliary, Pancreatic and Minimal Invasive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China.,Key Laboratory of Tumor Molecular Diagnosis and Individualized Medicine of Zhejiang Province, Hangzhou, China
| | - Tian Yang
- Department of Hepatobiliary, Pancreatic and Minimal Invasive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China.,Key Laboratory of Tumor Molecular Diagnosis and Individualized Medicine of Zhejiang Province, Hangzhou, China
| |
Collapse
|
|
58
|
Berardi G, Colasanti M, Ettorre GM. Association of Sarcopenia and Body Composition With Postoperative 90-Day Morbidity After Liver Resection for Malignant Tumors-Reply. JAMA Surg 2021; 156:590-591. [PMID: 33760017 DOI: 10.1001/jamasurg.2021.0234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Giammauro Berardi
- Department of General Surgery and Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | - Marco Colasanti
- Department of General Surgery and Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | - Giuseppe Maria Ettorre
- Department of General Surgery and Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| |
Collapse
|
|
59
|
The Role of Visceral Obesity, Sarcopenia and Sarcopenic Obesity on Surgical Outcomes After Liver Resections for Colorectal Metastases. World J Surg 2021; 45:2218-2226. [PMID: 33842995 PMCID: PMC8154807 DOI: 10.1007/s00268-021-06073-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2021] [Indexed: 12/18/2022]
Abstract
Background The impact of body compositions on surgical results is controversially discussed. This study examined whether visceral obesity, sarcopenia or sarcopenic obesity influence the outcome after hepatic resections of synchronous colorectal liver metastases. Methods Ninety-four consecutive patients with primary hepatic resections of synchronous colorectal metastases were identified from a single center database between January 2013 and August 2018. Patient characteristics and 30-day morbidity were retrospectively analyzed. Body fat and skeletal muscle were calculated by planimetry from single-slice CT images at the level of L3. Results Fifty-nine patients (62.8%) underwent minor hepatectomies, and 35 patients underwent major resections (37.2%). Postoperative complications occurred in 60 patients (62.8%) including 35 patients with major complications (Clavien–Dindo grade III–V). The mortality was nil at 30 days and 2.1% at 90 days. The body mass index showed no influence on postoperative outcomes (p = 1.0). Visceral obesity was found in 66 patients (70.2%) and was significantly associated with overall and major complication rates (p = .002, p = .012, respectively). Sarcopenia was observed in 34 patients (36.2%) without a significant impact on morbidity (p = .461), however, with longer hospital stay. Sarcopenic obesity was found in 18 patients (19.1%) and was significantly associated with postoperative complications (p = .014). Visceral obesity, sarcopenia and sarcopenic obesity were all identified as significant risk factors for overall postoperative complications. Conclusion Visceral obesity, sarcopenic obesity and sarcopenia are independent risk factors for overall complications after resections of CRLM. Early recognition of extremes in body compositions could prompt to perioperative interventions and thus improve postoperative outcomes.
Collapse
|
|
60
|
Aprile G, Basile D, Giaretta R, Schiavo G, La Verde N, Corradi E, Monge T, Agustoni F, Stragliotto S. The Clinical Value of Nutritional Care before and during Active Cancer Treatment. Nutrients 2021; 13:nu13041196. [PMID: 33916385 PMCID: PMC8065908 DOI: 10.3390/nu13041196] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 12/18/2022] Open
Abstract
Malnutrition and muscle wasting are frequently reported in cancer patients, either linked to the tumor itself or caused by oncologic therapies. Understanding the value of nutritional care during cancer treatment remains crucial. In fact, cancer-associated sarcopenia plays a key role in determining higher rates of morbidity, mortality, treatment-induced toxicities, prolonged hospitalizations and reduced adherence to anticancer treatment, worsening quality of life and survival. Planning baseline screening to intercept nutritional troubles earlier, organizing timely reassessments, and providing adequate counselling and dietary support, healthcare professional may positively interfere with this process and improve patients' overall outcomes during the whole disease course. Several screening tools have been proposed for this purpose. Nutritional Risk Screening (NRS), Mini Nutritional Assessment (MNA), Patient Generated Subjective Global Assessment (PG-SGA) are the most common studied. Interestingly, second-level tools including skeletal muscle index (SMI) and bioelectric impedance analysis (BIA) provide a more precise assessment of body composition, even if they are more complex. However, nutritional assessment is not currently used in clinical practice and procedures must be standardized in order to improve the efficacy of standard chemotherapy, targeted agents or even checkpoint inhibitors that is potentially linked with the patients' nutritional status. In the present review, we will discuss about malnutrition and the importance of an early nutritional assessment during chemotherapy and treatment with novel checkpoint inhibitors, in order to prevent treatment-induced toxicities and to improve survival outcomes.
Collapse
Affiliation(s)
- Giuseppe Aprile
- Department of Oncology, AULSS8 Berica, 36100 Vicenza, Italy; (D.B.); (R.G.)
- Correspondence: ; Tel.: +39-0444753906
| | - Debora Basile
- Department of Oncology, AULSS8 Berica, 36100 Vicenza, Italy; (D.B.); (R.G.)
| | - Renato Giaretta
- Department of Oncology, AULSS8 Berica, 36100 Vicenza, Italy; (D.B.); (R.G.)
| | - Gessica Schiavo
- Clinical Nutritional Unit, AULSS8 Berica, 36100 Vicenza, Italy;
| | - Nicla La Verde
- Department of Oncology, PO Sacco, ASST Fatebenefratelli Sacco, 20131 Milano, Italy;
| | - Ettore Corradi
- Clinical Nutritional Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy;
| | - Taira Monge
- Clinical Nutrition, S. Giovanni Battista Hospital, 10126 Torino, Italy;
| | - Francesco Agustoni
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Silvia Stragliotto
- Department of Oncology, Istituto Oncologico Veneto—IRCCS, 31033 Padova, Italy;
| |
Collapse
|
|
61
|
Venturini E, Gilchrist S, Corsi E, DI Lorenzo A, Cuomo G, D'Ambrosio G, Pacileo M, D'Andrea A, Canale ML, Iannuzzo G, Sarullo FM, Vigorito C, Barni S, Giallauria F. The core components of cardio-oncology rehabilitation. Panminerva Med 2021; 63:170-183. [PMID: 33528152 DOI: 10.23736/s0031-0808.21.04303-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The increased efficacy of cancer therapy has resulted in greater cancer survival and increasing number of people with cancer and cardiovascular diseases. The sharing of risk factors, the bidirectional relationship between cancer and cardiovascular diseases and the cardiotoxic effect of chemotherapy and radiotherapy, are the cause of the rapid expansion of cardio-oncology. All strategies to preserve cardiovascular health and mitigate the negative effect of cancer therapy, by reducing the cardiovascular risk, must be pursued to enable the timely and complete delivery of anticancer therapy and to achieve the longest remission of the disease. Comprehensive cardiac rehabilitation is an easy-to-use model, even in cancer care, and is the basis of Cardio-Oncology REhabilitation (CORE), an exercise-based multi-component intervention. In addition, CORE, besides using the rationale and knowledge of cardiac rehabilitation, can leverage the network of cardiac rehabilitation services to offer to cancer patients exercise programs, control of risk factors, psychological support, and nutrition counseling. The core components of CORE will be discussed, describing the beneficial effect on cardiorespiratory fitness, quality of life, psychological and physical well-being, and weight management. Furthermore, particular attention will be paid to how CORE can counterbalance the negative effect of therapies in those at heightened cardiovascular risk after a cancer diagnosis. Barriers for implementation, including personal, family, social and of the health care system barriers for a widespread diffusion of the CORE will also be discussed. Finally, there will be a call-to-action, for randomized clinical trials that can test the impact of CORE, on morbidity and mortality.
Collapse
Affiliation(s)
- Elio Venturini
- Unit of Cardiac Rehabilitation, AUSL Toscana Nord-Ovest, Cecina Civil Hospital, Cecina, Livorno, Italy -
| | - Susan Gilchrist
- Department of Clinical Cancer Prevention, Anderson Cancer Center, the University of Texas, Houston, TX, USA.,Department of Cardiology, Anderson Cancer Center, the University of Texas, Houston, TX, USA
| | - Elisabetta Corsi
- Unit of Cardiac Rehabilitation, AUSL Toscana Nord-Ovest, Cecina Civil Hospital, Cecina, Livorno, Italy
| | - Anna DI Lorenzo
- Division of Internal Medicine and Cardiac Rehabilitation, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Gianluigi Cuomo
- Division of Internal Medicine and Cardiac Rehabilitation, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Giuseppe D'Ambrosio
- Division of Internal Medicine and Cardiac Rehabilitation, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Mario Pacileo
- Unit of Cardiology and Intensive Care, Umberto I Hospital, Nocera Inferiore, Salerno, Italy
| | - Antonello D'Andrea
- Unit of Cardiology and Intensive Care, Umberto I Hospital, Nocera Inferiore, Salerno, Italy
| | - Maria L Canale
- Department of Cardiology, AUSL Toscana Nord-Ovest, Versilia Hospital, Lido di Camaiore, Lucca, Italy
| | - Gabriella Iannuzzo
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Filippo M Sarullo
- Unit of Cardiovascular Rehabilitation, Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy
| | - Carlo Vigorito
- Division of Internal Medicine and Cardiac Rehabilitation, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Sandro Barni
- Department of Oncology, ASST Bergamo Ovest, Bergamo, Italy
| | - Francesco Giallauria
- Division of Internal Medicine and Cardiac Rehabilitation, Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Faculty of Sciences and Technology, University of New England, Armidale, Australia
| |
Collapse
|