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Aleixo GFP, Hess DL, Fowler ME, Giri S, Williams GR. Racial differences in body composition and survival among older adults with gastrointestinal malignancies. J Geriatr Oncol 2024; 15:101747. [PMID: 38513310 DOI: 10.1016/j.jgo.2024.101747] [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] [Received: 11/28/2023] [Revised: 02/03/2024] [Accepted: 03/07/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION Muscle and adipose tissue measures can be quantified from routinely obtained computed tomography (CT) images and are predictors of chemotherapy-related toxicities and survival among patients with gastrointestinal (GI) malignancies. Most studies to date have consisted of predominantly White patients, and the role of body composition among minoritized racial groups is unknown. We examined racial differences in body composition and survival among patients with GI malignancies. MATERIALS AND METHODS This was a prospective cohort study of patients with GI malignancies. Single slices of axial CT images from L3 segments were analyzed using Slice-O-Matic software. The skeletal muscle area (cm2) was divided by height to obtain the skeletal muscle index (SMI, cm2/m2). Skeletal muscle radiodensity (SMD) in Hounsfield units (HU) was used for muscle composition. We compared body composition parameters between non-Hispanic (NH)-White and NH-Black participants. Cox models were used to examine the impact of body composition on survival. We proposed new race-specific cutoffs for body composition using optimal stratification. RESULTS Five hundred forty patients were included, of which 24% were NH-Black. In Cox models stratified by race, each 5 cm2/m2 decrease in SMI was associated with increase in risk of all-cause mortality in NH-Black patients (hazard ratio [HR] 1.25; 95% confidence interval [CI] 1.04-1.49 p = 0.02). With the existing cut points, neither sarcopenia nor myosteatosis was associated with worse survival. Using a new cutoff for sarcopenia in NH-Black patients, NH-Black patients with sarcopenia (HR 2.31 95%CI 1.10-4.88 p = 0.03) and myosteatosis (HR 2.63 95% CI 1.25-5.53 p = 0.01) had worse survival. DISCUSSION NH-Black older patients with GI cancers and sarcopenia or myosteatosis have worse overall survival.
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Affiliation(s)
- Gabriel F P Aleixo
- University of Pennsylvania, Department of Hematology and Oncology, Philadelphia, PA, United States of America.
| | - Daniel L Hess
- The University of Alabama at Birmingham, Department of Medicine, Birmingham, AL, United States of America
| | - Mackenzie E Fowler
- The University of Alabama at Birmingham, Department of Epidemiology, Birmingham, AL, United States of America
| | - Smith Giri
- The University of Alabama at Birmingham, O'Neal Comprehensive Cancer Center, Birmingham, AL, United States of America
| | - Grant R Williams
- The University of Alabama at Birmingham, O'Neal Comprehensive Cancer Center, Birmingham, AL, United States of America
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Machado MAD, Moraes TF, Anjos BHL, Alencar NRG, Chang TMC, Santana BCRF, Menezes VO, Vieira LO, Brandão SCS, Salvino MA, Netto EM. Association between increased Subcutaneous Adipose Tissue Radiodensity and cancer mortality: Automated computation, comparison of cancer types, gender, and scanner bias. Appl Radiat Isot 2024; 205:111181. [PMID: 38244325 DOI: 10.1016/j.apradiso.2024.111181] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 12/17/2023] [Accepted: 01/04/2024] [Indexed: 01/22/2024]
Abstract
PURPOSE Body composition analysis using computed tomography (CT) is proposed as a predictor of cancer mortality. An association between subcutaneous adipose tissue radiodensity (SATr) and cancer-specific mortality was established, while gender effects and equipment bias were estimated. METHODS 7,475 CT studies were selected from 17 cohorts containing CT images of untreated cancer patients who underwent follow-up for a period of 2.1-118.8 months. SATr measures were collected from published data (n = 6,718) or calculated according to CT images using a deep-learning network (n = 757). The association between SATr and mortality was ascertained for each cohort and gender using the p-value from either logistic regression or ROC analysis. The Kruskal-Wallis test was used to analyze differences between gender distributions, and automatic segmentation was evaluated using the Dice score and five-point Likert quality scale. Gender effect, scanner bias and changes in the Hounsfield unit (HU) to detect hazards were also estimated. RESULTS Higher SATr was associated with mortality in eight cancer types (p < 0.05). Automatic segmentation produced a score of 0.949 while the quality scale measurement was good to excellent. The extent of gender effect was 5.2 HU while the scanner bias was 10.3 HU. The minimum proposed HU change to detect a patient at risk of death was between 5.6 and 8.3 HU. CONCLUSIONS CT imaging provides valuable assessments of body composition as part of the staging process for several cancer types, saving both time and cost. Gender specific scales and scanner bias adjustments should be carried out to successfully implement SATr measures in clinical practice.
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Affiliation(s)
- Marcos A D Machado
- Department of Radiology, Complexo Hospitalar Universitário Prof. Edgard Santos/ Ebserh, Universidade Federal da Bahia, Salvador, Bahia, Zip code: 40.110-040, Brazil; Nuclear Medicine Department, São Rafael Hospital/ Rededor, Salvador, Bahia, Zip code: 41.253-190, Brazil; Nuclearis Corporation, Recife, Pernambuco, Zip code: 50.030-200, Brazil.
| | - Thauan F Moraes
- Northeast Center for Strategic Technologies, Universidade Federal de Pernambuco, Recife, Pernambuco, Zip code: 50.740-545, Brazil
| | - Bruno H L Anjos
- Nuclearis Corporation, Recife, Pernambuco, Zip code: 50.030-200, Brazil
| | - Nadja R G Alencar
- Radiology and Nuclear Medicine Department, Hospital das Clínicas, Federal University of Pernambuco, Recife, Pernambuco, Zip code: 50.670-901, Brazil
| | - Tien-Man C Chang
- Nuclear Medicine Department, Instituto de Medicina Integrada Fernandes Figueira, Recife, Pernambuco, Zip code: 50.070-902, Brazil
| | - Bruno C R F Santana
- Nuclear Medicine Department, São Rafael Hospital/ Rededor, Salvador, Bahia, Zip code: 41.253-190, Brazil
| | - Vinicius O Menezes
- Nuclear Medicine Department, São Rafael Hospital/ Rededor, Salvador, Bahia, Zip code: 41.253-190, Brazil; Nuclearis Corporation, Recife, Pernambuco, Zip code: 50.030-200, Brazil; Radiology and Nuclear Medicine Department, Hospital das Clínicas, Federal University of Pernambuco/ Ebserh, Recife, Pernambuco, Zip code: 50.670-901, Brazil
| | - Lucas O Vieira
- Nuclear Medicine Department, São Rafael Hospital/ Rededor, Salvador, Bahia, Zip code: 41.253-190, Brazil
| | - Simone C S Brandão
- Radiology and Nuclear Medicine Department, Hospital das Clínicas, Federal University of Pernambuco, Recife, Pernambuco, Zip code: 50.670-901, Brazil
| | - Marco A Salvino
- Complexo Hospitalar Universitário Prof. Edgard Santos/ Ebserh, Universidade Federal da Bahia, Salvador, Bahia, Zip code: 40.110-040, Brazil; Hemathology Department, São Rafael Hospital, Salvador, Bahia, Zip code: 41.253-190, Brazil
| | - Eduardo M Netto
- Infectious Disease Research Laboratory, Complexo Hospitalar Universitário Prof. Edgard Santos/ Ebserh, Universidade Federal da Bahia, Salvador, Bahia, Zip code: 40.110-040, Brazil
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Abdallah NH, Nagayama H, Takahashi N, Gonsalves W, Fonder A, Dispenzieri A, Dingli D, Buadi FK, Lacy MQ, Hobbs M, Gertz MA, Binder M, Kapoor P, Warsame R, Hayman SR, Kourelis T, Hwa YL, Lin Y, Kyle RA, Rajkumar SV, Broski SM, Kumar SK. Muscle and fat composition in patients with newly diagnosed multiple myeloma. Blood Cancer J 2023; 13:185. [PMID: 38086801 PMCID: PMC10716405 DOI: 10.1038/s41408-023-00934-3] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/13/2023] [Accepted: 10/24/2023] [Indexed: 12/18/2023] Open
Abstract
Measures of muscle and adipose tissue mass have been associated with outcomes in several malignancies, but studies in multiple myeloma (MM) are inconsistent. The aim of this study was to evaluate the association between muscle and fat areas and radiodensity, and overall survival (OS) in patients with newly diagnosed MM. We included 341 patients diagnosed with MM from 2010-2019 who had an 18F-fluorodeoxyglucose positron emission tomography/computed tomography at diagnosis. A cross-sectional image at the third lumbar vertebrae was segmented into muscle and fat components. Median follow up was 5.7 years. There was no association between sarcopenia and baseline disease characteristics or OS. Low muscle radiodensity was associated with higher disease stage, anemia, and renal failure. OS was 5.6 vs. 9.0 years in patients with muscle radiodensity in the lower vs. middle/upper tertiles, respectively (P = 0.02). High subcutaneous adipose tissue (SAT) radiodensity was associated with higher stage, anemia, thrombocytopenia, hypercalcemia, renal failure, and high LDH. OS was 5.4 years vs. not reached in patients with SAT radiodensity in the upper vs. middle/lower tertiles, respectively (P = 0.001). In conclusion, sarcopenia was not associated with OS in MM patients. High SAT radiodensity and low muscle radiodensity were associated with advanced disease stage and adverse laboratory characteristics.
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Affiliation(s)
| | | | | | | | - Amie Fonder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Martha Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Miriam Hobbs
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Moritz Binder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Rahma Warsame
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Yi L Hwa
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Robert A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Shaji K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
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Aleixo GFP, Wei W, Chen PH, Gandhi NS, Anwer F, Dean R, Hamilton BK, Hill BT, Jagadeesh D, Khouri J, Pohlman B, Sobecks R, Winter A, Caimi P, Majhail NS. The association of body composition and outcomes following autologous hematopoietic stem cell transplantation in patients with non-Hodgkin lymphoma. Bone Marrow Transplant 2023; 58:1384-1389. [PMID: 37699993 DOI: 10.1038/s41409-023-02104-2] [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: 05/29/2023] [Revised: 07/18/2023] [Accepted: 08/31/2023] [Indexed: 09/14/2023]
Abstract
Recently there has been a growing interest in evaluating body composition as a marker for prognosis in cancer patients. The association of body composition parameters and outcomes has not been deeply investigated in patients with autologous hematopoietic stem cell transplantation (HSCT) recipients with non-Hodgkin lymphoma (NHL). We conducted a retrospective cohort study of 264 NHL patients who received autologous HSCT. PreHSCT abdominal CT scans at the levels of L3 were assessed for body composition measures. We evaluated sarcopenia, myosteatosis, high visceral adipose tissue (VAT) and high visceral adipose tissue density (VATD). Using multivariable Cox proportional regression, we analyzed the association of clinical and transplant-related characteristics with overall survival (OS), relapse-free survival (RFS), and non-relapse mortality (NRM). In a multivariate regression model, patients with higher VATD had worse OS (HR 1.78; 95% confidence intervals CI 1.08-2.95, p = 0.02) and worse NRM (HR 2.31 95% CI 1.08-4.95, p = 0.02) than with lower VATD. Patients with lower levels of VAT also had worse RFS (HR 1.49 95% CI 1.03-2.15, p = 0.03). Sarcopenia and myosteatosis were not associated with outcomes. High pre-transplant VATD was associated with lower OS and higher NRM, and low pre-transplant VAT was associated with worse RFS in patients with NHL undergoing autologous HSCT.
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Affiliation(s)
- Gabriel F P Aleixo
- Internal Medicine Residency Program, Cleveland Clinic, Cleveland, OH, USA
| | - Wei Wei
- Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Po-Hao Chen
- Department of Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Namita S Gandhi
- Department of Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Faiz Anwer
- Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Robert Dean
- Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Betty K Hamilton
- Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brian T Hill
- Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Deepa Jagadeesh
- Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jack Khouri
- Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brad Pohlman
- Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ronald Sobecks
- Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Allison Winter
- Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Paolo Caimi
- Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
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Xiong J, Chen K, Huang W, Huang M, Cao F, Wang Y, Chen Q. Prevalence and effect on survival of pre-treatment sarcopenia in patients with hematological malignancies: a meta-analysis. Front Oncol 2023; 13:1249353. [PMID: 37869092 PMCID: PMC10587577 DOI: 10.3389/fonc.2023.1249353] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/11/2023] [Indexed: 10/24/2023] Open
Abstract
Background & aims Evidence regarding the prevalence of pre-treatment sarcopenia and its impact on survival in patients with hematological malignancies (HM) varies across studies. We conducted a systematic review and meta-analysis to summarize this discrepancy. Methods PubMed, Embase and Cochrane library were systematically searched for relevant studies. Outcomes assessed were: prevalence of pre-treatment sarcopenia, overall survival (OS), progression-free survival (PFS) and complete response (CR). Weighted mean proportion, odds ratios (ORs) and hazard ratios (HRs) were estimated using a fixed-effects and a random-effects model. Results A total of 27 retrospective cohort studies involving 4,991 patients were included in this study. The prevalence of pre-treatment sarcopenia was 37.0% (95% CI: 32.0%-42.0%) in HM patients <60 years and 51.0% (95% CI: 45.0%-57.0%) in≥60 years. Patients with leukemia had the lowest prevalence, compared with those with other HM (38.0%; 95% CI: 33.0%-43.0%; P = 0.010). The presence of sarcopenia was independently associated with poor OS (HR = 1.57, 95% CI = 1.41-1.75) and PFS (HR = 1.50, 95% CI = 1.22-1.83) throughout treatment period, which may be partially attributed to decreased CR (OR = 0.54, 95% CI = 0.41-0.72), particularly for BMI ≥ 25 (P = 0.020) and males (P = 0.020). Conclusion Sarcopenia is highly prevalent in patients with HM and an adverse prognostic factor for both survival and treatment efficacy. HM and sarcopenia can aggravate each other. We suggest that in future clinical work, incorporating sarcopenia into risk scores will contribute to guide patient stratification and therapeutic strategy, particularly for the elderly. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier (CRD42023392550).
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Affiliation(s)
- Jianzhu Xiong
- Department of Public Health, Shaoxing Seventh People's Hospital, Shaoxing, China
| | - Kangkang Chen
- Department of Non-communicable Diseases Control and Prevention, Shaoxing Center for Disease Control and Prevention, Shaoxing, China
| | - Wen Huang
- Department of Non-communicable Diseases Control and Prevention, Shaoxing Center for Disease Control and Prevention, Shaoxing, China
| | - Mingang Huang
- Department of Non-communicable Diseases Control and Prevention, Shaoxing Center for Disease Control and Prevention, Shaoxing, China
| | - Feiyan Cao
- Dispatch Division of Shaoxing Emergency Medical Services, Shaoxing Center for Emergency, Shaoxing, China
| | - Yiwen Wang
- Department of Non-communicable Diseases Control and Prevention, Shaoxing Center for Disease Control and Prevention, Shaoxing, China
| | - Qifeng Chen
- Department of Non-communicable Diseases Control and Prevention, Shaoxing Center for Disease Control and Prevention, Shaoxing, China
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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.
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Pellegrini M, Besutti G, Ottone M, Canovi S, Bonelli E, Venturelli F, Farì R, Damato A, Bonelli C, Pinto C, Ligabue G, Pattacini P, Giorgi Rossi P, El Ghoch M. Abdominal Fat Characteristics and Mortality in Rectal Cancer: A Retrospective Study. Nutrients 2023; 15:nu15020374. [PMID: 36678245 PMCID: PMC9864407 DOI: 10.3390/nu15020374] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 01/14/2023] Open
Abstract
The aim of this study was to evaluate the association of adipose tissue characteristics with survival in rectal cancer patients. All consecutive patients, diagnosed with stage II-IV rectal cancer between 2010-2016 using baseline unenhanced Computed Tomography (CT), were included. Baseline total, subcutaneous and visceral adipose tissue areas (TAT, SAT, VAT) and densities (TATd, SATd, VATd) at third lumbar vertebra (L3) were retrospectively measured. The association of these tissues with cancer-specific and progression-free survival (CCS, PFS) was assessed by using competitive risk models adjusted by age, sex and stage. Among the 274 included patients (median age 70 years, 41.2% females), the protective effect of increasing adipose tissue area on survival could be due to random fluctuations (e.g., sub-distribution hazard ratio-SHR for one cm2 increase in SAT = 0.997; 95%confidence interval-CI = 0.994-1.000; p = 0.057, for CSS), while increasing density was associated with poorer survival (e.g., SHR for one Hounsfield Unit-HU increase in SATd = 1.03, 95% CI = 1.01-1.05, p = 0.002, for CSS). In models considering each adipose tissue area and respective density, the association with CSS tended to disappear for areas, while it did not change for TATd and SATd. No association was found with PFS. In conclusion, adipose tissue density influenced survival in rectal cancer patients, raising awareness on a routinely measurable variable that requires more research efforts.
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Affiliation(s)
- Massimo Pellegrini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Giulia Besutti
- Radiology Unit, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy
- Correspondence: ; Tel.: +39-0522296369
| | - Marta Ottone
- Epidemiology Unit, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Simone Canovi
- Clinical Chemistry and Endocrinology Laboratory, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Efrem Bonelli
- Radiology Unit, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
- Clinical Chemistry and Endocrinology Laboratory, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Francesco Venturelli
- Epidemiology Unit, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Roberto Farì
- Radiology Unit, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Angela Damato
- Oncology Department, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Candida Bonelli
- Oncology Department, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Carmine Pinto
- Oncology Department, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Guido Ligabue
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Pierpaolo Pattacini
- Radiology Unit, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Marwan El Ghoch
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, Riad El Solh, Beirut 11072809, Lebanon
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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.
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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.
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Aleixo GF, Sheu M, Mirzai S, Majhail NS. Prognostic Impact of Adiposity in Hematological Malignancies: A Systematic Review and Meta-analysis. Clinical Lymphoma Myeloma and Leukemia 2022; 22:726-734. [DOI: 10.1016/j.clml.2022.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/19/2022] [Accepted: 05/25/2022] [Indexed: 04/08/2023]
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Ebadi M, Dunichand-Hoedl AR, Rider E, Kneteman NM, Shapiro J, Bigam D, Dajani K, Mazurak VC, Baracos VE, Montano-Loza AJ. Higher subcutaneous adipose tissue radiodensity is associated with increased mortality in patients with cirrhosis. JHEP Rep 2022; 4:100495. [PMID: 35600667 PMCID: PMC9117882 DOI: 10.1016/j.jhepr.2022.100495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/24/2022] [Accepted: 03/30/2022] [Indexed: 11/21/2022] Open
Abstract
Background & Aims Association between sarcopenia and mortality in cirrhosis is well recognised; however, little is known about the clinical implications of adipose tissue radiodensity, indicative of biological features. This study aimed to determine an association between high subcutaneous adipose tissue (SAT) radiodensity and survival, compare the prevalence of high SAT radiodensity between healthy population and patients with cirrhosis, and identify an association between computed tomography (CT)-measured SAT radiodensity and histological characteristics. Methods Adult patients with cirrhosis (n = 786) and healthy donors (n = 129) with CT images taken as part of the liver transplant (LT) assessment were included. Abdominal SAT biopsies (1–2 g) were harvested from the incision site at the time of LT from 12 patients with cirrhosis. Results The majority of patients were male (67%) with a mean model for end-stage liver disease (MELD) score of 15 ± 8. SAT radiodensity above -83 HU in females (sub-distribution hazard ratio [sHR] 1.84, 95% CI 1.20–2.85, p = 0.006) and higher than -74 HU in males (sHR 1.51, 95% CI 1.05–1.18, p = 0.02) was associated with the highest mortality risk after adjusting for confounders in competing risk analysis. The frequency of high SAT radiodensity was 26% for those with cirrhosis, compared with 2% in healthy donors (p <0.001). An inverse correlation was found between SAT radiodensity and the mean cross-sectional area of SAT adipocytes (r = -0.67, p = 0.02). Shrunken, smaller adipocytes with expanded interstitial space were predominant in patients with high SAT radiodensity, whereas larger adipocytes with a thin rim of cytoplasm were observed in patients with low SAT radiodensity (744 ± 400 vs. 1,521 ± 1,035 μm2, p <0.001). Conclusion High SAT radiodensity frequently presents and is associated with a higher mortality in cirrhosis. SAT morphological rearrangement in patients with high SAT radiodensity might indicate diminished lipid stores and alterations in tissue characteristics. Lay summary Poor quality of subcutaneous adipose tissue (fat under the skin) is associated with higher mortality in patients with end-stage liver disease. Fat cells are smaller in patients with poor adipose tissue quality. Subcutaneous adipose tissue (SAT) radiodensity can be objectively measured by CT in Hounsfield units (HU). SAT radiodensity constitutes an indirect surrogate marker of adipose tissue quality. High SAT radiodensity in cirrhosis was defined as >-83 HU in females and >-74 HU in males. High SAT radiodensity presents in more than a quarter of patients with cirrhosis and is associated with higher mortality. High SAT radiodensity might indicate adipose tissue remodelling with morphological features of atrophy.
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Takahashi MES, Lorand-Metze I, de Souza CA, Mesquita CT, Fernandes FA, Carvalheira JBC, Ramos CD. Metabolic Volume Measurements in Multiple Myeloma. Metabolites 2021; 11:875. [PMID: 34940633 PMCID: PMC8703741 DOI: 10.3390/metabo11120875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/26/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 02/07/2023] Open
Abstract
Multiple myeloma (MM) accounts for 10-15% of all hematologic malignancies, as well as 20% of deaths related to hematologic malignant tumors, predominantly affecting bone and bone marrow. Positron emission tomography/computed tomography with 18F-fluorodeoxyglucose (FDG-PET/CT) is an important method to assess the tumor burden of these patients. It is often challenging to classify the extent of disease involvement in the PET scans for many of these patients because both focal and diffuse bone lesions may coexist, with varying degrees of FDG uptake. Different metrics involving volumetric parameters and texture features have been proposed to objectively assess these images. Here, we review some metabolic parameters that can be extracted from FDG-PET/CT images of MM patients, including technical aspects and predicting MM outcome impact. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) are volumetric parameters known to be independent predictors of MM outcome. However, they have not been adopted in clinical practice due to the lack of measuring standards. CT-based segmentation allows automated, and therefore reproducible, calculation of bone metabolic metrics in patients with MM, such as maximum, mean and standard deviation of the standardized uptake values (SUV) for the entire skeleton. Intensity of bone involvement (IBI) is a new parameter that also takes advantage of this approach with promising results. Other indirect parameters obtained from FDG-PET/CT images, such as visceral adipose tissue glucose uptake and subcutaneous adipose tissue radiodensity, may also be useful to evaluate the prognosis of MM patients. Furthermore, the use and quantification of new radiotracers can address different metabolic aspects of MM and may have important prognostic implications.
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Affiliation(s)
| | - Irene Lorand-Metze
- Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-888, Brazil;
| | - Carmino Antonio de Souza
- Center of Hematology and Hemotherapy, University of Campinas (UNICAMP), Campinas 13083-878, Brazil;
| | - Claudio Tinoco Mesquita
- Departamento de Radiologia, Faculdade Medicina, Universidade Federal Fluminense (UFF), Niterói 24033-900, Brazil;
- Hospital Universitário Antônio Pedro/EBSERH, Universidade Federal Fluminense (UFF), Niterói 24033-900, Brazil;
| | - Fernando Amorim Fernandes
- Hospital Universitário Antônio Pedro/EBSERH, Universidade Federal Fluminense (UFF), Niterói 24033-900, Brazil;
| | | | - Celso Dario Ramos
- Division of Nuclear Medicine, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-888, Brazil
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