1
|
Oikawa KH, Juliani FL, Carrilho LAO, Pozzuto L, Padilha DMH, Silveira MN, Costa FO, Macedo LT, da Cunha Júnior AD, Mendes MCS, Carvalheira JBC. Abdominal adiposity as a prognosis biomarker of clinical outcome in metastatic colorectal cancer. Nutrition 2023; 107:111913. [PMID: 36563436 DOI: 10.1016/j.nut.2022.111913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/07/2022] [Accepted: 11/12/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Adipose tissue distribution and radiodensity are associated with prognosis in many types of cancer. However, the roles of adipose tissue distribution and radiodensity in patients with metastatic colorectal cancer (mCRC) remain unclear. The aim of this study was to assess the prognostic effect of adiposity and adipose tissue radiodensities in patients with mCRC. METHODS Patients with mCRC who received first-line palliative chemotherapy and had a computed tomography (CT) scan at the third lumbar vertebra (L3) level, admitted between January 2010 and December 2018, were sequentially enrolled. Body composition was assessed using CT-derived measurements. Univariate and multivariate logistic regression analyses and Kaplan-Meier curves were used to determine prognostic values. RESULTS The study included 237 patients. Cox analyses demonstrated that high subcutaneous adipose tissue (SAT) index was associated with a lower risk for death (hazard ratio [HR], 0.51; 95% confidence interval [CI], 0.29-0.88; Ptrend < 0.025). There was no significant association between visceral adipose tissue (VAT) index tertiles and overall survival. However, high VAT and SAT radiodensities were significantly associated with increased mortality (HR, 1.80; 95% CI, 1.12-2.89; Ptrend < 0.030 and HR, 1.85; 95% CI, 1.19-2.86; Ptrend < 0.021, respectively). CONCLUSIONS A higher SAT index in patients with mCRC was associated with a favorable overall survival outcome, whereas higher SAT and VAT radiodensities were associated with an increased risk for death, supporting that early nutritional intervention may improve mCRC prognosis.
Collapse
|
2
|
Fang P, Zhou J, Xiao X, Yang Y, Luan S, Liang Z, Li X, Zhang H, Shang Q, Zeng X, Yuan Y. The prognostic value of sarcopenia in oesophageal cancer: A systematic review and meta-analysis. J Cachexia Sarcopenia Muscle 2023; 14:3-16. [PMID: 36415154 PMCID: PMC9891912 DOI: 10.1002/jcsm.13126] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/22/2022] [Accepted: 10/25/2022] [Indexed: 11/25/2022] Open
Abstract
The loss of skeletal muscle mass and function is defined as sarcopenia, which might develop in elderly patients with cancers. It has been indicated as a potential negative factor in the survival of patients with malignant tumours. The aim of this systematic review and meta-analysis was to evaluate the associations between sarcopenia and survival outcomes or postoperative complications in patients with oesophageal cancer (EC). Web of Science, Embase, Medline, and Cochrane Library databases were searched until 10 May 2022, using keywords: sarcopenia, oesophageal cancer, and prognosis. Studies investigating the prognostic value of sarcopenia on EC survival were included. Forest plots and summary effect models were used to show the result of this meta-analysis. The quality of included studies was evaluated with the Newcastle-Ottawa Scale (NOS). A total of 1436 studies were identified from the initial search of four databases, and 41 studies were included for the final quantitative analysis. This meta-analysis revealed a significant association between sarcopenia and overall survival (OS) [hazard ratios (HR):1.68, 95% confidence interval (CI):1.54-1.83, P = 0.004, I2 = 41.7%] or disease-free survival (DFS) 1.97 (HR: 1.97, 95% CI: 1.44-2.69, P = 0.007, I2 = 61.9%) of EC patients. Subgroup analysis showed that sarcopenia remained a consistent negative predictor of survival when stratified by different treatment methods, populations, or sarcopenia measurements. Sarcopenia was also a risk factor for postoperative complications with a pooled odds ratio of 1.47 (95% CI: 1.21-1.77, P = 0.094, I2 = 32.7%). The NOS scores of all included studies were ≥6, and the quality of the evidence was relatively high. The results from the study suggested that sarcopenia was significantly associated with both survival outcomes and postoperative complications in EC patients. Sarcopenia should be appropriately diagnosed and treated for improving short-term and long-term outcomes of patients with EC.
Collapse
Affiliation(s)
- Pinhao Fang
- Department of Thoracic Surgery, Med+X Center for Informatics, West China HospitalSichuan UniversityChengduChina
| | - Jianfeng Zhou
- Department of Thoracic Surgery, Med+X Center for Informatics, West China HospitalSichuan UniversityChengduChina
| | - Xin Xiao
- Department of Thoracic Surgery, Med+X Center for Informatics, West China HospitalSichuan UniversityChengduChina
| | - Yushang Yang
- Department of Thoracic Surgery, Med+X Center for Informatics, West China HospitalSichuan UniversityChengduChina
| | - Siyuan Luan
- Department of Thoracic Surgery, Med+X Center for Informatics, West China HospitalSichuan UniversityChengduChina
| | - Zhiwen Liang
- Department of Thoracic Surgery, Med+X Center for Informatics, West China HospitalSichuan UniversityChengduChina
| | - Xiaokun Li
- Department of Thoracic Surgery, Med+X Center for Informatics, West China HospitalSichuan UniversityChengduChina
| | - Hanlu Zhang
- Department of Thoracic Surgery, Med+X Center for Informatics, West China HospitalSichuan UniversityChengduChina
| | - Qixin Shang
- Department of Thoracic Surgery, Med+X Center for Informatics, West China HospitalSichuan UniversityChengduChina
| | - Xiaoxi Zeng
- West China Biomedical Big Data Center, Med+X Center for Informatics, West China HospitalSichuan UniversityChengduChina
| | - Yong Yuan
- Department of Thoracic Surgery, Med+X Center for Informatics, West China HospitalSichuan UniversityChengduChina
| |
Collapse
|
3
|
Lascala F, da Silva Moraes BK, Mendes MCS, de Carvalho MB, Branbilla SR, da Cunha Júnior AD, Lopes LR, Andreollo NA, Macedo LT, Prado CM, Carvalheira JBC. Prognostic value of myosteatosis and systemic inflammation in patients with resectable gastric cancer: A retrospective study. Eur J Clin Nutr 2023; 77:116-126. [PMID: 36076067 DOI: 10.1038/s41430-022-01201-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/13/2022] [Accepted: 08/16/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND/OBJECTIVES The association between systemic inflammation and myosteatosis upon diagnosis of gastric cancer (GC) and whether these factors could predict survival outcomes is not clear. Our aim was to explore the association between systemic inflammation and myosteatosis upon diagnosis of GC, specially whether the co-occurrence of these factors could predict survival outcomes. SUBJECTS/METHODS Computed tomography (CT) was performed at the level of the third lumbar vertebra for body composition analysis in 280 patients with GC. Myoesteatosis was defined as the lowest tertile of the muscle radiodensity distribution or based on clinical significance using optimal stratification analysis. Inflammatory indexes were measured, including the neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte and lymphocyte-to-monocyte ratios. RESULTS Patients with low skeletal muscle (SM) radiodensity were more likely to be older than 65 years, have a higher body mass index and have diabetes. They also had higher intermuscular visceral and subcutaneous adipose tissue areas and indexes. The highest tertile of SM radiodensity was associated with better disease-free survival (DFS) (HR = 0.51, 95% CI [0.31, 0.84], ptrend = 0.020) and overall survival (OS) (HR = 0.49, 95% CI [0.29, 0.82], ptrend = 0.022). Patients with NLR > 2.3 and myosteatosis had the worst DFS and OS (HR = 2.77, 95% CI [1.54, 5.00], p = 0.001; HR = 3.31, 95% CI [1.79, 6.15], p < 0.001, respectively). CONCLUSION Co-occurrence of myosteatosis and inflammation increased disease progression and death risk by almost three times. These regularly obtained biomarkers might improve prognostic risk prediction in resectable GC.
Collapse
Affiliation(s)
- Fabiana Lascala
- Division of Oncology, Department of anesthesiology, oncology and radiology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Bruna Karoline da Silva Moraes
- Division of Oncology, Department of anesthesiology, oncology and radiology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Maria Carolina Santos Mendes
- Division of Oncology, Department of anesthesiology, oncology and radiology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Mariluce Barbosa de Carvalho
- Division of Oncology, Department of anesthesiology, oncology and radiology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Sandra Regina Branbilla
- Division of Oncology, Department of anesthesiology, oncology and radiology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Ademar Dantas da Cunha Júnior
- Division of Oncology, Department of anesthesiology, oncology and radiology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
- Hematology and Oncology Clinics, Cancer Hospital of Cascavel, União Oeste de Estudos e Combate ao Câncer (UOPECCAN), Cascavel, PR, Brazil
- Department of Internal Medicine, State University of Western Paraná (UNIOESTE), Cascavel, PR, Brazil
| | - Luiz Roberto Lopes
- Division of Gastrointestinal Surgery, Department of Surgery, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Nelson Adami Andreollo
- Division of Gastrointestinal Surgery, Department of Surgery, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Lígia Traldi Macedo
- Division of Oncology, Department of anesthesiology, oncology and radiology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Carla M Prado
- Human Nutrition Research Unit, Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - José Barreto Campello Carvalheira
- Division of Oncology, Department of anesthesiology, oncology and radiology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil.
| |
Collapse
|
4
|
Fang T, Gong Y, Wang Y. Prognostic values of myosteatosis for overall survival in patients with gastric cancers: A meta-analysis with trial sequential analysis. Nutrition 2023; 105:111866. [PMID: 36368263 DOI: 10.1016/j.nut.2022.111866] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 09/27/2022] [Accepted: 10/02/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Gastric cancer is among the most common and lethal cancers worldwide. Recently, studies have reported that myosteatosis is a prognosticator for adverse survival outcomes in patients with gastric cancer, but with inconsistent conclusions. Therefore, this meta-analysis aimed to systematically quantify the predictive power of myosteatosis for overall survival in the gastric cancer setting. METHODS A systematic literature earch was conducted based on three databases (PubMed/Medline, EMBASE, and Web of Science) from inception until November 30, 2021. This meta-analysis pooled the hazard ratios and their 95% confidence intervals of mortality risk in patients with gastric cancer with myosteatosis versus nonmyosteatosis using a fixed-effects model. RESULTS Twelve studies of 5904 patients were included. Myosteatosis was associated with higher mortality risk (hazard ratio: 1.46; 95% confidence interval, 1.32-1.61; P < 0.001; I2 = 23.8%) in the gastric cancer setting. The results of the subgroup analysis revealed that patients with myosteatosis undergoing surgery had significantly shortened overall survival. Overall, the results of this meta-analysis are robust to sensitivity and trial sequential analyses. CONCLUSIONS Myosteatosis was identified as a strong predictor of reduced overall survival in the gastric cancer population.
Collapse
Affiliation(s)
- Te Fang
- Department of Anesthesiology, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yang Gong
- University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Yue Wang
- Department of Clinical Nutrition, First Affiliated Hospital of China Medical University, Shenyang, China.
| |
Collapse
|
5
|
Jogiat UM, Bédard ELR, Sasewich H, Turner SR, Eurich DT, Filafilo H, Baracos V. Sarcopenia reduces overall survival in unresectable oesophageal cancer: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle 2022; 13:2630-2636. [PMID: 36151845 PMCID: PMC9745498 DOI: 10.1002/jcsm.13082] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 08/02/2022] [Accepted: 08/18/2022] [Indexed: 12/24/2022] Open
Abstract
Sarcopenia measured through body composition analysis is emerging as an important prognosticator among various malignancies, including oesophageal cancer. Skeletal muscle index (SMI) as determined by the third lumbar vertebrae on cross-sectional CT images has been demonstrated as a predictor of overall survival in oesophageal cancer, using pre-defined cut off values for sarcopenia. However, this is largely within the setting of resectable disease. The primary objective of this systematic review and meta-analysis was to determine the effect of sarcopenia defined by SMI on overall-survival in patients with unresectable oesophageal cancer. On 30 January 2021, a systematic search of the literature was conducted to identify the role of SMI among patients with unresectable oesophageal cancer, with overall survival as the primary outcome. Databases included MEDLINE, EMBASE, Scopus, Web of Science, and Cochrane Library. Inclusion criteria included age >18, diagnosis of oesophageal cancer, and non-operative management. A meta-analysis was conducted using RevMan 5.4.1 using an inverse variance, random effects model. After the removal of duplicates, 2755 unique search results were obtained. Manual screening of titles and abstracts resulted in 287 full text articles that were reviewed. Of these, five studies met the inclusion criteria with data evaluating the effect of sarcopenia defined by SMI on overall survival. A total of 783 patients, the majority of which were male (n = 638, 81%), with a mean age of 68 ± 2.3 years were included. 641 (82%) patients were diagnosed with squamous cell carcinoma. Sarcopenia, as determined by SMI using pre-defined cut-off values, was reported in 517 patients (66%). Meta-analysis demonstrated decreased overall survival in the sarcopenia group compared with the non-sarcopenia group (HR = 1.51; 95% CI 1.21-1.89; P = 0.0003; I2 = 0%; Figure 1). No significant publication bias was noted on assessment of funnel plot and Egger's test (P = 0.295). Sarcopenia as defined by SMI is predictive of overall survival among patients with nonoperative oesophageal cancer. Further analysis on the effect of sarcopenia on treatment related adverse effects and complications, particularly related to chemotherapy, radiotherapy, and oesophageal stenting, is needed to identify the degree of prognostication offered by body composition analysis. Studies on the modifiability of sarcopenia will help determine the utility of nutritional interventions.
Collapse
Affiliation(s)
- Uzair M Jogiat
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Eric L R Bédard
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Hannah Sasewich
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Simon R Turner
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Heather Filafilo
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Vickie Baracos
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
6
|
Sivakumar J, Forshaw MJ, Lam S, Peters CJ, Allum WH, Whibley J, Sinclair RCF, Snowden CP, Hii MW, Sivakumar H, Read M. Identifying the limitations of cardiopulmonary exercise testing prior to esophagectomy using a pooled analysis of patient-level data. Dis Esophagus 2022; 35:6524743. [PMID: 35138383 DOI: 10.1093/dote/doac005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/28/2021] [Indexed: 12/11/2022]
Abstract
Preoperative cardiopulmonary exercise testing (CPET) provides an objective assessment of aerobic fitness in patients undergoing surgery. While peak oxygen uptake during exercise (VO2peak) and anaerobic threshold have demonstrated a moderate correlation with the development of complications following esophagectomy, no clinically useful threshold values have been defined. By pooling patient level data from existing studies, we aimed to define optimal thresholds for preoperative CPET parameters to predict patients at high risk of postoperative complications. Studies reporting on the relationship between preoperative CPET variables and post-esophagectomy complications were determined from a comprehensive literature search. Patient-level data were obtained from six contributing centers for pooled-analyses. Outcomes of interest included cardiopulmonary and non-cardiopulmonary complications, unplanned intensive care unit readmission, and 90-day and 12-month all-cause mortality. Receiver operating characteristic curves and logistic regression models estimated the predictive value of CPET parameters for each individual outcome of interest. This analysis comprised of 621 patients who underwent CPET prior to esophagectomy during the period from January 2004 to March 2017. For both anaerobic threshold and VO2peak, none of the receiver operating characteristic curves achieved an area under the curve value > 0.66 for the outcomes of interest. The discriminatory ability of CPET for determining high-risk patients was found to be poor in patients undergoing an esophagectomy. CPET may only carry an adjunct role to clinical decision-making.
Collapse
Affiliation(s)
- Jonathan Sivakumar
- Department of Surgery, The University of Melbourne, Melbourne, Australia.,Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Matthew J Forshaw
- Department of Upper Gastrointestinal Surgery, Glasgow Royal Infirmary, Glasgow, UK
| | - Stephen Lam
- Department of Upper Gastrointestinal Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - Christopher J Peters
- Department of Surgery and Cancer, Imperial College London of St Mary's Hospital, London, UK
| | | | - Jessica Whibley
- Department of Physiotherapy, Royal Marsden Hospital, London, UK
| | - Rhona C F Sinclair
- Department of Anaesthesia, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | | | - Michael W Hii
- Department of Surgery, The University of Melbourne, Melbourne, Australia.,Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Harry Sivakumar
- Department of Anaesthesia, The Alfred Hospital, Melbourne, Australia
| | - Matthew Read
- Department of Surgery, The University of Melbourne, Melbourne, Australia.,Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Melbourne, Australia
| |
Collapse
|
7
|
McGovern J, Dolan RD, Horgan PG, Laird BJ, McMillan DC. Computed tomography-defined low skeletal muscle index and density in cancer patients: observations from a systematic review. J Cachexia Sarcopenia Muscle 2021; 12:1408-1417. [PMID: 34664431 PMCID: PMC8718024 DOI: 10.1002/jcsm.12831] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 09/09/2021] [Accepted: 09/11/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Computed tomography (CT) analysis of body composition has garnered interest as a potential prognostic tool in those with cancer. A range of pre-defined thresholds currently exist within the literature to define low skeletal muscle mass and density. The aim of the present systematic review was to assess the prevalence of low skeletal muscle index (SMI) and density (SMD) within the literature, across a range of common solid tumours. METHODS A systematic search of PubMed was carried out to identify studies reporting CT analysis of SMI and SMD in patients with colorectal, oesophageal, gastric, hepatobiliary, pancreatic, breast, and lung cancer. The type of cancer, whether curative or non-curative disease, the anthropomorphic parameter studied, threshold used to define low SMI and SMD, and the prevalence of these anthropomorphic measurements within the population were recorded. RESULTS Of the 160 studies included, 156 reported an assessment of SMI and 35 reported assessment of SMD. The median prevalence of low SMI was 43% (30.1-57.1) and low SMD 49.4% (31.7-58.5) across the entire cohort. There was little variation in the prevalence of low SMI and SMD when studies were divided into curative and non-curative cohorts-40.7% (27.5-51.3) vs. 48.4% (30.9-60.1) and 37.8% (32.2-52.2) vs. 55.3% (38.5-64.7) respectively. When divided into colorectal, oesophageal, gastric, hepatobiliary, pancreatic, breast and lung cancers, similar prevalence of low SMI (46.0% %, 49.8%, 35.7%, 41.1%, 32.3%, 34%, and 49.5%) and low SMD were also observed (52.1%, 54.3%, 71.2%, 56.8%, 55.3%, and 52.6%). This was maintained when studies were stratified into cohorts by threshold used-low SMI (Martin 48.9%, Prado 49.9%, and Others 36.0%) and low SMD (Martin 52.4% and Others 48.6%). CONCLUSIONS Low SMI and SMD are endemic across a range of cancer types and disease stage, challenging pre-existing dogma of the determinants of prevalence.
Collapse
Affiliation(s)
- Josh McGovern
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow, UK
| | - Ross D Dolan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow, UK
| | - Paul G Horgan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow, UK
| | - Barry J Laird
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Donald C McMillan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow, UK
| |
Collapse
|
8
|
Scopel Poltronieri T, de Paula NS, Chaves GV. Skeletal muscle radiodensity and cancer outcomes: A scoping review of the literature. Nutr Clin Pract 2021; 37:1117-1141. [PMID: 34752653 DOI: 10.1002/ncp.10794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Patients with cancer are more prone to experience myosteatosis than healthy individuals. The aim of this review was to summarize the methodologies applied for low skeletal muscle radiodensity (SMD) assessment in oncology patients, as well as to describe the major findings related to SMD and cancer outcomes. This scoping review included studies that were published until November 2020 in English, Portuguese, or Spanish; were performed in humans diagnosed with cancer, adult and/or elderly, of both sexes; investigated SMD through computed tomography of the region between the third and fifth lumbar vertebrae, considering at least two muscular groups; and evaluated clinical and/or surgical outcomes. Eighty-eight studies met the inclusion criteria (n = 37,583 patients). Survival was the most evaluated outcome. Most studies reported a significant association between low SMD and unfavorable outcomes. However, this relationship was not clear for survival, antineoplastic treatment, and surgical complications, potentially because of the unstandardized approaches for the assessment of SMD and inadequate study design. Future studies should address these issues to provide an in-depth understanding of the clinical relevance of SMD in cancer outcomes as well as how SMD is influenced by individuals and tumor-related characteristics in patients with cancer.
Collapse
Affiliation(s)
- Taiara Scopel Poltronieri
- Department of Nutrition, Cancer Hospital II, National Cancer Institute José Alencar Gomes da Silva (INCA), Rio de Janeiro, Rio de Janeiro, Brazil.,Postgraduate Program in Medical Sciences, Endocrinology, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Nathália Silva de Paula
- Department of Nutrition, Cancer Hospital II, National Cancer Institute José Alencar Gomes da Silva (INCA), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gabriela Villaça Chaves
- Department of Nutrition, Cancer Hospital II, National Cancer Institute José Alencar Gomes da Silva (INCA), Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
9
|
Wang Y, Tian G, Chen S, Li N. Myosteatosis reduces overall survival in patients with digestive system malignancies: a meta-analysis with trial sequential analysis. Nutr Res 2021; 94:25-33. [PMID: 34583210 DOI: 10.1016/j.nutres.2021.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 12/11/2022]
Abstract
The impact of myosteatosis on the outcomes of digestive malignancies has gained great attention recently. However, studies on the impact of myosteatosis show inconsistent results. We conducted a meta-analysis to clarify the relationship between myosteatosis and the overall survival of digestive cancer patients. The systematic literature search was conducted on PubMed/MEDLINE, Web of Science, and Embase from inception through March 27, 2021. Meta-analysis was performed using the random-effects model. Out of 3451 studies screened, 47 studies including 21,194 patients passed the screening criteria. The average prevalence of myosteatosis was 46.4%. Patients with myosteatosis had 44% increased mortality risk compared with non-myosteatosis patients (HR: 1.44, 95% CI: 1.33-1.55, P < .05). The predictive value of myosteatosis held regardless of country zone, study design, statistical model, Newcastle-Ottawa Scale (NOS) scores, treatment, sample size, and tumor stage. Nevertheless, the predictive value of myosteatosis was only evident for patients with esophagogastric cancers, cholangiocarcinoma/pancreatic cancers, or colorectal cancers. Overall, the results of this meta-analysis were robust based on sensitivity, subgroup, meta-regression, and trial sequential analyses and suggested that myosteatosis predicted worse overall survival (OS) in digestive malignancies patients.
Collapse
|
10
|
Han J, Harrison L, Patzelt L, Wu M, Junker D, Herzig S, Berriel Diaz M, Karampinos DC. Imaging modalities for diagnosis and monitoring of cancer cachexia. EJNMMI Res 2021; 11:94. [PMID: 34557972 PMCID: PMC8460705 DOI: 10.1186/s13550-021-00834-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 09/06/2021] [Indexed: 12/23/2022] Open
Abstract
Cachexia, a multifactorial wasting syndrome, is highly prevalent among advanced-stage cancer patients. Unlike weight loss in healthy humans, the progressive loss of body weight in cancer cachexia primarily implicates lean body mass, caused by an aberrant metabolism and systemic inflammation. This may lead to disease aggravation, poorer quality of life, and increased mortality. Timely detection is, therefore, crucial, as is the careful monitoring of cancer progression, in an effort to improve management, facilitate individual treatment and minimize disease complications. A detailed analysis of body composition and tissue changes using imaging modalities—that is, computed tomography, magnetic resonance imaging, (18F) fluoro-2-deoxy-d-glucose (18FDG) PET and dual-energy X-ray absorptiometry—shows great premise for charting the course of cachexia. Quantitative and qualitative changes to adipose tissue, organs, and muscle compartments, particularly of the trunk and extremities, could present important biomarkers for phenotyping cachexia and determining its onset in patients. In this review, we present and compare the imaging techniques that have been used in the setting of cancer cachexia. Their individual limitations, drawbacks in the face of clinical routine care, and relevance in oncology are also discussed.
Collapse
Affiliation(s)
- Jessie Han
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts Der Isar, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Luke Harrison
- Institute for Diabetes and Cancer, Helmholtz Center Munich, 85764, Neuherberg, Germany.,German Center for Diabetes Research (DZD), 85764, Neuherberg, Germany
| | - Lisa Patzelt
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts Der Isar, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Mingming Wu
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts Der Isar, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Daniela Junker
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts Der Isar, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Stephan Herzig
- Institute for Diabetes and Cancer, Helmholtz Center Munich, 85764, Neuherberg, Germany.,German Center for Diabetes Research (DZD), 85764, Neuherberg, Germany.,Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital, Heidelberg, Germany.,Chair of Molecular Metabolic Control, Technical University of Munich, Munich, Germany
| | - Mauricio Berriel Diaz
- Institute for Diabetes and Cancer, Helmholtz Center Munich, 85764, Neuherberg, Germany.,German Center for Diabetes Research (DZD), 85764, Neuherberg, Germany
| | - Dimitrios C Karampinos
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts Der Isar, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| |
Collapse
|
11
|
Ahn H, Kim DW, Ko Y, Ha J, Shin YB, Lee J, Sung YS, Kim KW. Updated systematic review and meta-analysis on diagnostic issues and the prognostic impact of myosteatosis: A new paradigm beyond sarcopenia. Ageing Res Rev 2021; 70:101398. [PMID: 34214642 DOI: 10.1016/j.arr.2021.101398] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/22/2021] [Accepted: 06/28/2021] [Indexed: 02/07/2023]
Abstract
Myosteatosis, which is excessive fat infiltration in the skeletal muscle, is now considered a distinct disease from sarcopenia. Advances in imaging technique have made muscle parameters an evaluable biomarker, and many studies have proved association between myosteatosis and aging or disease process. However, the diagnosis and clinical impact of myosteatosis have not been well established. Thus, we aim to provide a systematic summary with a qualitive review of 73 eligible studies regarding these issues. First, the most widely used modality to diagnose myosteatosis is abdominal computed tomography, based on evaluation of the muscle radiodensity of the total abdominal muscle area predominantly at the L3 vertebral level. However, there was significant heterogeneity in the diagnostic methods and cutoff values used to diagnose myosteatosis (32 different cutoff values among 73 studies). Second, the clinical impact of myosteatosis on prognosis was very straightforward, and most studies have shown a negative impact of myosteatosis on overall survival and complications related to underlying diseases. However, the mechanism of the myosteatosis on mortality has not been explored well, and metabolic dysfunction (i.e. insulin resistance, systemic inflammation) would be a possible explanation. Providing systemic review of current issues can elucidate future directions for developing standardized diagnosis and management of myosteatosis.
Collapse
|
12
|
da Cunha AD, Silveira MN, Takahashi MES, de Souza EM, Mosci C, Ramos CD, Brambilla SR, Pericole FV, Prado CM, Mendes MCS, Carvalheira JBC. Adipose tissue radiodensity: A new prognostic biomarker in people with multiple myeloma. Nutrition 2021; 86:111141. [PMID: 33596528 DOI: 10.1016/j.nut.2021.111141] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/19/2020] [Accepted: 12/29/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Standard prognostic markers based on individual characteristics of individuals with multiple myeloma (MM) remain scarce. Body-composition features have often been associated with survival outcomes in different cancers. However, the association of adipose tissue radiodensity with MM prognosis has not yet, to our knowledge, been explored. METHODS Computed tomography at the third lumbar vertebra was used for body-composition analysis, including adipose tissue radiodensity, in 91 people with MM. Additionally, fludeoxyglucose F 18 (18F-FDG) positron emission tomography was used to assess adipose tissue 18F-FDG uptake. Proinflammatory cytokine and adipokine levels were measured. RESULTS Event-free survival and overall survival were both shorter in participants with high subcutaneous adipose tissue (SAT) radiodensity. Those in the highest SAT radiodensity tertile had an independently higher risk for both overall survival (hazard ratio, 4.55; 95% confidence interval, 1.26-16.44; Ptrend = 0.036) and event-free survival (hazard ratio, 3.08; 95% confidence interval, 1.02-9.27; Ptrend = 0.035). Importantly, higher SAT radiodensity was significantly correlated with increased 18F-FDG adipose tissue uptake and proinflammatory cytokine (tumor necrosis factor and interleukin-6) levels, and with decreased leptin levels. CONCLUSIONS SAT radiodensity may serve as a biomarker to predict host-related metabolic and proinflammatory milieu, which ultimately correlates with MM prognosis.
Collapse
Affiliation(s)
- Ademar Dantas da Cunha
- Division of Oncology, Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil; Hematology and Oncology Clinics, Cancer Hospital of Cascavel, União Oeste de Estudos e Combate ao Câncer (UOPECCAN), Cascavel, Brazil; Department of Internal Medicine, State University of Western Paraná (UNIOESTE), Cascavel, Brazil
| | - Marina Nogueira Silveira
- Division of Oncology, Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | | | - Edna Marina de Souza
- Center of Biomedical Engineering, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Camila Mosci
- Division of Nuclear Medicine, Department of Radiology, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Celso Dario Ramos
- Division of Nuclear Medicine, Department of Radiology, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Sandra Regina Brambilla
- Division of Oncology, Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Fernando Vieira Pericole
- Hematology and Blood Transfusion Center, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Carla M Prado
- Human Nutrition Research Unit, Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Maria Carolina Santos Mendes
- Division of Oncology, Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - José Barreto Campello Carvalheira
- Division of Oncology, Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil.
| |
Collapse
|
13
|
da Cunha Júnior AD, Silveira MN, Takahashi MES, de Souza EM, Mosci C, Ramos CD, Brambilla SR, Pericole FV, Prado CM, Mendes MCS, Carvalheira JBC. Visceral adipose tissue glucose uptake is linked to prognosis in multiple myeloma patients: An exploratory study. Clin Nutr 2021; 40:4075-4084. [PMID: 33632534 DOI: 10.1016/j.clnu.2021.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 01/07/2021] [Accepted: 02/05/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The use of computerized tomography to opportunistically assess body composition has highlighted abnormalities such as low muscle mass and high adiposity may be hidden conditions in cancer patients. However, the role of skeletal muscle (SM), subcutaneous (SAT) and visceral (VAT) adipose tissue glucose uptake measured by 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)-CT on patient prognostication is unclear. METHODS Patients with multiple myeloma (MM) with satisfactory image frame for assessing body composition and for semi-quantification of SM, SAT and VAT glucose uptakes were included. Plasmatic pro-inflammatory cytokine and adipokine levels were measured. RESULTS High VAT mean standardized uptake value (SUV) at baseline was associated with shorter event-free survival (EFS) (hazard ratio [HR]: 7.89; 95% confidence interval [CI], 1.58-39.30; P = 0.012) and overall survival (OS) (HR, 15.24; 95% CI, 2.69-86.30; P = 0.002) among patients with newly diagnosed MM, even after adjustment for covariates. The highest tertile of VAT SUV was significantly correlated with worse MM-EFS (HR for the highest vs the lowest tertile 3.71; 95% CI, 1.22-10.56; Ptrend = 0.035) and mortality (HR, 4.41; 95% CI, 1.28-12.77; Ptrend = 0.019). Notably, patients with higher VAT SUV presented with lower VAT area, VAT index, higher SAT SUV, and higher number of individuals with visceral obesity (all P < 0.01). Additionally, we found a negative correlation between VAT mean SUV with leptin (R2 = 0.20, P = 0.003); no correlations were detected between VAT mean SUV and resistin, tumor necrosis factor (TNF) or interleukin (IL)-6. CONCLUSIONS Functional VAT activity estimated by 18F-FDG PET-CT is a relevant prognostic factor in MM patients, specifically, a higher VAT SUV might be an early biomarker of cancer cachexia in these patients.
Collapse
Affiliation(s)
- Ademar Dantas da Cunha Júnior
- Division of Oncology, Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil; Hematology and Oncology Clinics, Cancer Hospital of Cascavel, União Oeste de Estudos e Combate ao Câncer (UOPECCAN), Cascavel, PR, Brazil; Department of Internal Medicine, State University of Western Paraná (UNIOESTE), Cascavel, PR, Brazil
| | - Marina Nogueira Silveira
- Division of Oncology, Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | | | - Edna Marina de Souza
- Center of Biomedical Engineering, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Camila Mosci
- Division of Nuclear Medicine, Department of Radiology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Celso Dario Ramos
- Division of Nuclear Medicine, Department of Radiology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Sandra Regina Brambilla
- Division of Oncology, Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | | | - Carla M Prado
- Human Nutrition Research Unit, Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Maria Carolina Santos Mendes
- Division of Oncology, Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - José Barreto Campello Carvalheira
- Division of Oncology, Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil.
| |
Collapse
|
14
|
Martin A, Freyssenet D. Phenotypic features of cancer cachexia-related loss of skeletal muscle mass and function: lessons from human and animal studies. J Cachexia Sarcopenia Muscle 2021; 12:252-273. [PMID: 33783983 PMCID: PMC8061402 DOI: 10.1002/jcsm.12678] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/22/2020] [Accepted: 12/30/2020] [Indexed: 12/18/2022] Open
Abstract
Cancer cachexia is a complex multi-organ catabolic syndrome that reduces mobility, increases fatigue, decreases the efficiency of therapeutic strategies, diminishes the quality of life, and increases the mortality of cancer patients. This review provides an exhaustive and comprehensive analysis of cancer cachexia-related phenotypic changes in skeletal muscle at both the cellular and subcellular levels in human cancer patients, as well as in animal models of cancer cachexia. Cancer cachexia is characterized by a major decrease in skeletal muscle mass in human and animals that depends on the severity of the disease/model and the localization of the tumour. It affects both type 1 and type 2 muscle fibres, even if some animal studies suggest that type 2 muscle fibres would be more prone to atrophy. Animal studies indicate an impairment in mitochondrial oxidative metabolism resulting from a decrease in mitochondrial content, an alteration in mitochondria morphology, and a reduction in mitochondrial metabolic fluxes. Immuno-histological analyses in human and animal models also suggest that a faulty mechanism of skeletal muscle repair would contribute to muscle mass loss. An increase in collagen deposit, an accumulation of fat depot outside and inside the muscle fibre, and a disrupted contractile machinery structure are also phenotypic features that have been consistently reported in cachectic skeletal muscle. Muscle function is also profoundly altered during cancer cachexia with a strong reduction in skeletal muscle force. Even though the loss of skeletal muscle mass largely contributes to the loss of muscle function, other factors such as muscle-nerve interaction and calcium handling are probably involved in the decrease in muscle force. Longitudinal analyses of skeletal muscle mass by imaging technics and skeletal muscle force in cancer patients, but also in animal models of cancer cachexia, are necessary to determine the respective kinetics and functional involvements of these factors. Our analysis also emphasizes that measuring skeletal muscle force through standardized tests could provide a simple and robust mean to early diagnose cachexia in cancer patients. That would be of great benefit to cancer patient's quality of life and health care systems.
Collapse
Affiliation(s)
- Agnès Martin
- Inter‐university Laboratory of Human Movement BiologyUniversité de Lyon, University Jean Monnet Saint‐EtienneSaint‐ÉtienneFrance
| | - Damien Freyssenet
- Inter‐university Laboratory of Human Movement BiologyUniversité de Lyon, University Jean Monnet Saint‐EtienneSaint‐ÉtienneFrance
| |
Collapse
|
15
|
Murnane LC, Forsyth AK, Koukounaras J, Pilgrim CH, Shaw K, Brown WA, Mourtzakis M, Tierney AC, Burton PR. Myosteatosis predicts higher complications and reduced overall survival following radical oesophageal and gastric cancer surgery. Eur J Surg Oncol 2021; 47:2295-2303. [PMID: 33640171 DOI: 10.1016/j.ejso.2021.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 01/01/2021] [Accepted: 02/07/2021] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Low muscle attenuation, as governed by increased intramuscular fat infiltration (myosteatosis), may associate with adverse surgical outcomes. We aimed to determine whether myosteatosis is associated with an increased risk of postoperative complications and reduced long-term survival after oesophago-gastric (OG) cancer surgery. METHODS Patients who underwent radical OG cancer surgery with preoperative abdominal computed tomography (CT) imaging were included. Myosteatosis was evaluated using previously defined cut-points for low skeletal muscle attenuation measured by CT. Oncological, surgical, complications, and outcome data were obtained from a prospective database. RESULTS Of 108 patients, 56% (n = 61) had myosteatosis. Patients with myosteatosis were older (69.1 ± 9.1 vs. 62.8 ± 9.8 years, p = 0.001) and had a similar body mass index (BMI) (23.4 ± 5.3 vs. 25.9 ± 6.7 kg/m2, p = 0.766) compared to patients with normal muscle attenuation. Patients with myosteatosis had a higher rate of anastomotic leaks (15% vs. 2%, p = 0.041). On multivariate analysis, myosteatosis was an independent predictor of overall (OR 3.03, 95% CI 1.31-6.99, p = 0.009) and severe complications (OR 4.33, 95% CI 1.26-14.9, p = 0.020). Patients with myosteatosis had reduced 5 year overall (54.1% vs. 83%, p = 0.004) and disease-free (55.2% vs. 87.2%, p = 0.007) survival. CONCLUSION Myosteatosis is associated with a significantly increased risk of overall and severe complications as well as substantially reduced long-term survival. Assessment of muscle attenuation provides analysis beyond standard anthropometrics and may form part of preoperative physiological staging tools used to improve surgical outcomes.
Collapse
Affiliation(s)
- Lisa C Murnane
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia; Department of Nutrition and Dietetics, Alfred Health, Melbourne, Australia.
| | - Adrienne K Forsyth
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Jim Koukounaras
- Department of Radiology, Alfred Health, Melbourne, Australia; Department of Medicine, Monash University, Melbourne, Australia
| | - Charles Hc Pilgrim
- Hepaticopancreaticobiliary Surgery Unit, Alfred Health, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia
| | - Kalai Shaw
- Department of Surgery, Monash University, Melbourne, Australia; Oesophagogastric Bariatric Surgery Unit, Alfred Health, Melbourne, Australia
| | - Wendy A Brown
- Department of Surgery, Monash University, Melbourne, Australia; Oesophagogastric Bariatric Surgery Unit, Alfred Health, Melbourne, Australia
| | - Marina Mourtzakis
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Audrey C Tierney
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia; School of Allied Health, And Health Implementation Science and Technology, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Paul R Burton
- Department of Surgery, Monash University, Melbourne, Australia; Oesophagogastric Bariatric Surgery Unit, Alfred Health, Melbourne, Australia
| |
Collapse
|
16
|
Pozzuto L, Silveira MN, Mendes MCS, Macedo LT, Costa FO, Martinez CAR, Coy CSR, da Cunha Júnior AD, Carvalheira JBC. Myosteatosis Differentially Affects the Prognosis of Non-Metastatic Colon and Rectal Cancer Patients: An Exploratory Study. Front Oncol 2021; 11:762444. [PMID: 34858841 PMCID: PMC8632142 DOI: 10.3389/fonc.2021.762444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/22/2021] [Indexed: 02/05/2023] Open
Abstract
Body composition performed by computed tomography (CT) impacts on cancer patients' prognoses and responses to treatment. Myosteatosis has been related to overall survival (OS) and disease-specific survival in colorectal cancer (CRC); however, the independent impact of the association of myosteatosis with prognosis in colon cancer (CC) and rectal cancer (RC) is still unclear. CT was performed at the L3 level to assess body composition features in 227 patients with CRC. Clinical parameters were collected. Overall survival (OS) was the primary outcome, and the secondary outcome was disease-free survival (DFS). Skeletal muscle attenuation and intramuscular adipose tissue area were associated with DFS (p = 0.003 and p = 0.011, respectively) and OS (p < 0.001 and p < 0.001, respectively) in CC patients but not in RC patients. Only the skeletal muscle area was associated with better prognosis related to OS in RC patients (p = 0.009). When CC and RC were analyzed separately, myosteatosis influenced survival negatively in CC patients, worsening DFS survival (hazard ratio [HR], 2.70; 95% confidence interval [CI], 1.07-6.82; p = 0.035) and OS (HR, 5.76; 95% CI, 1.31-25.40; p = 0.021). By contrast, the presence of myosteatosis did not influence DFS (HR, 1.02; 95% CI, 0.52-2.03; p = 0.944) or OS (HR, 0.76; 95% CI, 0.33-1.77; p = 0.529) in RC patients. Our study revealed the interference of myosteatosis in the therapy and survival of patients with CC but not in those with RC, strengthening the value of grouping the two types of cancer in body composition analyses.
Collapse
Affiliation(s)
- Lara Pozzuto
- Division of Oncology, Department of Anesthesiology, Oncology and Radiology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Marina Nogueira Silveira
- Division of Oncology, Department of Anesthesiology, Oncology and Radiology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Maria Carolina Santos Mendes
- Division of Oncology, Department of Anesthesiology, Oncology and Radiology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Lígia Traldi Macedo
- Division of Oncology, Department of Anesthesiology, Oncology and Radiology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Felipe Osório Costa
- Division of Oncology, Department of Anesthesiology, Oncology and Radiology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Carlos Augusto Real Martinez
- Division of Gatrointestinal Surgery, Department of Surgery, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Cláudio Saddy Rodrigues Coy
- Division of Gatrointestinal Surgery, Department of Surgery, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Ademar Dantas da Cunha Júnior
- Hematology and Oncology Clinics, Cancer Hospital of Cascavel, União Oeste de Estudos e Combate ao Câncer (UOPECCAN), Cascavel, Brazil
- Department of Internal Medicine, State University of Western Paraná (UNIOESTE), Cascavel, Brazil
| | - José Barreto Campello Carvalheira
- Division of Oncology, Department of Anesthesiology, Oncology and Radiology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
- *Correspondence: José Barreto Campello Carvalheira,
| |
Collapse
|
17
|
Srpcic M, Jordan T, Popuri K, Sok M. Sarcopenia and myosteatosis at presentation adversely affect survival after esophagectomy for esophageal cancer. Radiol Oncol 2020; 54:237-46. [PMID: 32229679 DOI: 10.2478/raon-2020-0016] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/03/2020] [Indexed: 02/07/2023] Open
Abstract
Background Esophageal cancer remains a disease with poor survival and many complications. Measuring muscle mass and quality can identify patients with diminished muscle mass (sarcopenia) and muscle fat infiltration (myosteatosis). We studied the impact of sarcopenia and myosteatosis in resectable esophageal cancer on overall survival and complications. Patients and methods 139 patients received a radical esophagectomy. Skeletal muscle area (SMA) and muscle attenuation (MA) in CT images at L3 level were recorded and groups with and without sarcopenia and myosteatosis were compared for overall survival (OS), perioperative mortality, conduit complications, pleuropulmonary complications, respiratory failure requiring mechanical ventilation and other significant complications. Results Prevalence of sarcopenia and myosteatosis at presentation was 16.5% and 51.8%, respectively. Both were associated with decreased OS. Median survival was 18.3 months (CI 5.4-31.1) vs 31.0 months (CI 7.4-54.6) for sarcopenia/no sarcopenia (log rank p = 0.042) and 19.0 months (CI 13.3-24.7) vs 57.1 months (CI 15.2-99.0) for myosteatosis (log rank p = 0.044), respectively. A relationship between sarcopenia and myosteatosis and other negative outcomes after esophagectomy could not be established. Conclusions Sarcopenia and myosteatosis before esophagectomy are associated with decreased overall survival but not with more frequent perioperative complications. Identification of patients at risk can guide therapeutic decisions and interventions aimed at replenishing muscle reserves.
Collapse
|
18
|
McSharry V, Mullee A, McCann L, Rogers AC, McKiernan M, Brennan DJ. The Impact of Sarcopenia and Low Muscle Attenuation on Overall Survival in Epithelial Ovarian Cancer: A Systematic Review and Meta-analysis. Ann Surg Oncol 2020; 27:3553-3564. [DOI: 10.1245/s10434-020-08382-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Indexed: 12/18/2022]
|
19
|
Gabiatti CTB, Martins MCL, Miyazaki DL, Silva LP, Lascala F, Macedo LT, Mendes MCS, Carvalheira JBC. Myosteatosis in a systemic inflammation-dependent manner predicts favorable survival outcomes in locally advanced esophageal cancer. Cancer Med 2019; 8:6967-6976. [PMID: 31571402 PMCID: PMC6853837 DOI: 10.1002/cam4.2593] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/08/2019] [Accepted: 09/15/2019] [Indexed: 02/05/2023] Open
Abstract
Increased adiposity and its attendant metabolic features as well as systemic inflammation have been associated with prognosis in locally advanced esophageal cancer (LAEC). However, whether myosteatosis and its combination with systemic inflammatory markers are associated with prognosis of esophageal cancer is unknown. Our study aimed to investigate the influence of myosteatosis and its association with systemic inflammation on progression-free survival (PFS) and overall survival (OS) in LAEC patients treated with definitive chemoradiotherapy (dCRT). We retrospectively gathered information on 123 patients with LAEC submitted to dCRT at the University of Campinas Hospital. Computed tomography (CT) images at the level of L3 were analyzed to assess muscularity and adiposity. Systemic inflammation was mainly measured by calculating the neutrophil-to-lymphocyte ratio (NLR). Median PFS for patients with myosteatosis (n = 72) was 11.0 months vs 4.0 months for patients without myosteatosis (n = 51) (hazard ratio [HR]: 0.53; 95% confidence interval [CI], 0.34-0.83; P = .005). Myosteatosis was also independently associated with a favorable OS. Systemic inflammation (NLR > 2.8) was associated with a worse prognosis. The combination of myosteatosis with systemic inflammation revealed that the subgroup of patients with myosteatosis and without inflammation presented less than half the risk of disease progression (HR: 0.47; 95% CI: 0.26-0.85; P = .013) and death (HR: 0.39; 95% CI, 0.21-0.72; P = .003) compared with patients with inflammation. This study demonstrated that myosteatosis without systemic inflammation was independently associated with favorable PFS and OS in LAEC patients treated with dCRT.
Collapse
Affiliation(s)
- Camila T. B. Gabiatti
- Division of OncologyDepartment of Internal MedicineFaculty of Medical SciencesState University of Campinas (UNICAMP)CampinasSPBrazil
| | - Mariane C. L. Martins
- Division of OncologyDepartment of Internal MedicineFaculty of Medical SciencesState University of Campinas (UNICAMP)CampinasSPBrazil
| | - Daniela L. Miyazaki
- Division of OncologyDepartment of Internal MedicineFaculty of Medical SciencesState University of Campinas (UNICAMP)CampinasSPBrazil
| | - Leandro P. Silva
- Division of OncologyDepartment of Internal MedicineFaculty of Medical SciencesState University of Campinas (UNICAMP)CampinasSPBrazil
| | - Fabiana Lascala
- Division of OncologyDepartment of Internal MedicineFaculty of Medical SciencesState University of Campinas (UNICAMP)CampinasSPBrazil
| | - Ligia T. Macedo
- Division of OncologyDepartment of Internal MedicineFaculty of Medical SciencesState University of Campinas (UNICAMP)CampinasSPBrazil
| | - Maria Carolina Santos Mendes
- Division of OncologyDepartment of Internal MedicineFaculty of Medical SciencesState University of Campinas (UNICAMP)CampinasSPBrazil
| | - José Barreto Campello Carvalheira
- Division of OncologyDepartment of Internal MedicineFaculty of Medical SciencesState University of Campinas (UNICAMP)CampinasSPBrazil
| |
Collapse
|