Clinical utility of psoas muscle volume in assessment of sarcopenia in patients with early-stage non-small cell lung cancer

Effects of computed tomography-defined sarcopenia on patients undergoing transcatheter aortic valve implantation

OBJECTIVES

Stratifying patients with aortic stenosis is crucial for improving their lifetime management. Several studies analysed computed tomography (CT)-defined sarcopenia in patients undergoing transcatheter aortic valve implantation (TAVI). However, the criteria for CT-defined sarcopenia are heterogeneous among these studies. Mostly, they primarily evaluated short-term outcomes; research focusing on long-term outcomes, related to lifetime management in patients with aortic stenosis, is rare. We assessed the effects of CT-defined sarcopenia on the short- and long-term outcomes in patients undergoing TAVI using three different sarcopenia criteria, including two traditional criteria and a novel criterion.

METHODS

In this retrospective study, we enrolled 360 patients. Three different sarcopenia criteria (skeletal muscle index [SMI], psoas muscle area [PMA], and psoas muscle volume index [PVI]) were applied to assess safety and early and long-term clinical outcomes.

RESULTS

SMI-, PMA-, and PVI-sarcopenia were diagnosed in 244 (67.7%), 246 (68.3%), and 161 (44.7%) patients, respectively. However, PMA-sarcopenia was associated with poor long-term survival after TAVI. Furthermore, PVI-sarcopenia was associated with lower safety at 30 days and poor long-term survival. Using Cox regression hazard models, PVI-sarcopenia tended to be a risk factor of overall survival (hazards ratio: 1.49, p = 0.052).

CONCLUSIONS

In patients undergoing TAVI, CT-defined sarcopenia using PVI-based criteria was a reliable predictor of poor outcomes. This finding might facilitate stratification of patients undergoing TAVI.

Psoas Muscle Volume Is a Useful Predictor of Postoperative Outcome in Elderly Patients With Non-Small Cell Lung Cancer

BACKGROUND

As the population ages, the number of elderly lung cancer patients has been increasing. While surgery is the best treatment for resectable lung cancer, elderly patients often have multiple comorbidities, making accurate preoperative risk assessment crucial when formulating an appropriate treatment plan. This study aims to explore how psoas muscle volume relates to postoperative outcomes in elderly lung cancer patients.

METHODS

This single-center, retrospective study included 344 elderly (≥ 75) patients who underwent complete surgical resection for non-small cell cancer between 2010 and 2023. The psoas muscle volume index (PVI, cm3/m3) was measured using a 3-dimensional imaging workstation based on preoperative computed tomography images and grouped based on the median value for each gender. Postoperative complications and survival rates were then compared between the groups.

RESULTS

The median PVI was 60.5 cm3/m3 for males and 47.7 cm3/m3 for females. The PVI-high group had significantly fewer complications (15.6%) than the PVI-low group (37.1%) (p < 0.001). The 5-year overall survival (OS) rate was higher in the PVI-high group (80.5%) than in the PVI-low group (66.7%) (p = 0.01). Multivariate analyses showed that PVI-high was an independent predictor of lower complication risk (odds ratio 0.28, p < 0.001) and an independent factor that improved OS (hazard ratio 0.60, p = 0.042).

CONCLUSIONS

PVI in elderly lung cancer patients is associated with postoperative complications and survival.

Use of 3D-CT-derived psoas major muscle volume in defining sarcopenia in colorectal cancer

BACKGROUND

Sarcopenia is characterized by reduced skeletal muscle volume and is a condition that is prevalent among elderly patients and associated with poor prognosis as a comorbidity in malignancies. Given the aging population over 80 years old in Japan, an understanding of malignancies, including colorectal cancer (CRC), complicated by sarcopenia is increasingly important. Therefore, the focus of this study is on a novel and practical diagnostic approach of assessment of psoas major muscle volume (PV) using 3-dimensional computed tomography (3D-CT) in diagnosis of sarcopenia in patients with CRC.

METHODS

The subjects were 150 patients aged ≥ 80 years with CRC who underwent primary tumor resection at Juntendo University Hospital between 2004 and 2017. 3D-CT measurement of PV and conventional CT measurement of the psoas major muscle cross-sectional area (PA) were used to identify sarcopenia (group S) and non-sarcopenia (group nS) cases. Clinicopathological characteristics, operative results, postoperative complications, and prognosis were compared between these groups.

RESULTS

The S:nS ratios were 15:135 for the PV method and 52:98 for the PA method. There was a strong positive correlation (r = 0.66, p < 0.01) between PVI (psoas major muscle volume index) and PAI (psoas major muscle cross-sectional area index), which were calculated by dividing PV or PA by the square of height. Surgical results and postoperative complications did not differ significantly in the S and nS groups defined using each method. Overall survival was worse in group S compared to group nS identified by PV (p < 0.01), but not significantly different in groups S and nS identified by PA (p = 0.77). A Cox proportional hazards model for OS identified group S by PV as an independent predictor of a poor prognosis (p < 0.05), whereas group S by PA was not a predictor of prognosis (p = 0.60).

CONCLUSIONS

The PV method for identifying sarcopenia in elderly patients with CRC is more practical and sensitive for prediction of a poor prognosis compared to the conventional method.