Sarcopenia

Elliott, Jessie A; Doyle, Suzanne; Murphy, Conor; King, Sinéad; Guinan, Emer; Beddy, Peter; Ravi, Narayanasamy; Reynolds, John V.

doi:10.1097/sla.0000000000002398

Cited by 227 publications

(41 citation statements)

References 45 publications

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“…Although in our study no significant differences in post‐operative complication incidence and severity between patients with and without sarcopenia were seen, another study showed in a cohort of 207 adenocarcinoma patients that sarcopenia was associated with a five‐fold increased risk of major morbidity and a two‐fold increased risk of pulmonary complications . While the sample sizes and treatment of patients in both studies were similar, patients in the present study have a higher American Society of Anaesthesiologists score, and almost double the number of patients had cardiovascular co‐morbidities and/or type 1 diabetes, which might have contributed to the much higher overall incidence of major complications in the present study.…”

Section: Discussioncontrasting

confidence: 72%

Influence of body composition and muscle strength on outcomes after multimodal oesophageal cancer treatment

Hagens

Feenstra

Egmond

et al. 2020

J cachexia sarcopenia muscle

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Background Influence of sarcopenia in combination with other body composition parameters and muscle strength on outcomes after oesophageal surgery for oesophageal cancer remains unclear. The objectives were (i) to describe the incidence of sarcopenia in relation to adipose tissue quantity and distribution and muscle strength; (ii) to evaluate if neoadjuvant chemoradiation (nCRTx) influences body composition and muscle strength; and (iii) to evaluate the influence of body composition and muscle strength on post‐operative morbidity and long‐term survival. Methods This retrospective study included patients with oesophageal cancer who received nCRTx followed by surgery between January 2011 and 2016. Skeletal muscle, visceral, and subcutaneous adipose tissue cross‐sectional areas were calculated based on computed tomography scans, and muscle strength was measured using hand grip tests, 30 seconds chair stand tests, and maximal inspiratory and expiratory pressure tests prior to nCRTx and after nCRTx. Results A total of 322 patients were included in this study. Sarcopenia was present in 55.6% of the patients prior to nCRTx and in 58.2% after nCRTx (P = 0.082). Patients with sarcopenia had a significantly lower muscle strength and higher fat percentage. The muscle strength and incidence of sarcopenia increased while the mean body mass index and fat percentage decreased during nCRTx. A body mass index above 25 kg/m2 was associated with anastomotic leakage (P = 0.032). Other body composition parameters were not associated with post‐operative morbidity. A lower handgrip strength prior to nCRTx was associated with pulmonary and cardiac complications (P = 0.023 and P = 0.009, respectively). In multivariable analysis, a lower number of stands during the 30 seconds chair stand test prior to nCRTx (hazard ratio 0.93, 95% confidence interval 0.87–0.99, P = 0.017) and visceral adipose tissue of >128 cm2 after nCRTx (hazard ratio 1.81, 95% confidence interval 1.30–2.53, P = 0.001) were associated with worse overall survival. Conclusions Sarcopenia occurs frequently in patients with oesophageal cancer and is associated with less muscle strength and a higher fat percentage. Body composition changes during nCRTx did not influence survival. Impaired muscle strength and a high amount of visceral adipose tissue are associated with worse survival. Therefore, patients with poor fitness might benefit from preoperative nutritional and muscle strengthening guidance, aiming to increase muscle strength and decrease visceral adipose tissue. However, this should be confirmed in a large prospective study.

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Section: Discussioncontrasting

confidence: 72%

Influence of body composition and muscle strength on outcomes after multimodal oesophageal cancer treatment

Hagens

Feenstra

Egmond

et al. 2020

J cachexia sarcopenia muscle

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“…Although the majority of esophageal cancer patients in Korea are men with squamous cell carcinoma [56], further studies that include women and various histologic types of esophageal cancer are needed. Finally, because there is no definite consensus on the cut-off value of SMI for defining sarcopenia, this study adopted the value proposed by a previous population-based study [27], which was used in several recent studies on cancer patients [57][58][59]. However, future studies are needed to determine the exact cut-off value of SMI for defining sarcopenia considering the characteristics of East Asian individuals.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Impact of Sarcopenia and Skeletal Muscle Loss During Neoadjuvant Chemoradiotherapy in Esophageal Cancer

Yoon

Ahn

et al. 2020

Cancers

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Backgrounds: The relationship between sarcopenia, characterized by loss of muscle mass and strength, and survival outcomes of esophageal cancer is controversial. This study aimed to assess the effect of sarcopenia and skeletal muscle loss on overall survival (OS) and recurrence-free survival (RFS) of esophageal cancer patients. Methods: We retrospectively collected the medical records of 248 male patients diagnosed with squamous cell esophageal cancer and who underwent neoadjuvant chemoradiotherapy (NACRT) followed by surgery. We measured the cross-sectional area of the skeletal muscle at the L3 vertebra level using computed tomography images and calculated the skeletal muscle index (SMI). Sarcopenia was defined as SMI <52.4 cm2/m2, and excessive muscle loss was defined as SMI change <−10.0%/50 days during NACRT. Moreover, laboratory test results, such as albumin, prognostic nutritional index (PNI), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) before and after NACRT, were collected. Results: In the univariable Cox analysis, pre- (p = 0.689) and post-radiotherapy (RT) sarcopenia (p = 0.669) were not associated with OS. However, excessive muscle loss had a significant association with OS in both the univariable and multivariable analyses (all p = 0.001). Excessive muscle loss was also related to RFS in both the univariable (p = 0.011) and multivariable (p = 0.022) Cox analysis. Patients with excessive muscle loss had significantly lower levels of post-RT albumin (p < 0.001) and PNI (p < 0.001), higher levels of post-RT NLR (p = 0.031) and PLR (p = 0.071), larger decrease in albumin (p < 0.001) and PNI (p < 0.001) after NACRT, and larger increase in NLR (p = 0.051) and PLR (p = 0.088) after NACRT than in those with non-excessive muscle loss. Conclusion: Excessive muscle loss rather than pre- and post-RT sarcopenia was a significant prognostic factor for OS and RFS, and it was also related to nutritional and inflammatory markers.

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“…There is an abundance of data, however, on archived CT scans readily available in oncology clinics globally, which allow retrospective evaluation of quantitative muscle mass, muscle quality, and fat mass. This tactic has spawned a host of studies in all age groups that have demonstrated correlations between skeletal muscle depletion and various outcomes, including increased complications from surgery [54,55], toxicity from chemotherapy [56,57], and, most notably, poorer overall survival [58][59][60]. In older adults with cancer, however, correlations between skeletal muscle depletion alone and adverse outcomes are less clear.…”

Section: Outcomes In Older Adults With Cancer and Wasting Disordersmentioning

confidence: 99%

Cachexia and Sarcopenia in Older Adults with Cancer: A Comprehensive Review

Dunne

Loh

Williams

et al. 2019

Cancers

142

112

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Cancer cachexia is a syndrome characterized by weight loss with accompanying loss of muscle and/or fat mass and leads to impaired patient function and physical performance and is associated with a poor prognosis. It is prevalent in older adults with cancer; age-associated physiologic muscle wasting and weakness, also known as sarcopenia, can compound deficits associated with cancer cachexia in older adults and makes studying this condition more complex in this population. Multiple measurement options are available to assess the older patient with cancer and cachexia and/or sarcopenia including anthropometric measures, imaging modalities such as Dual X-ray absorptiometry (DEXA) and Computed Tomography (CT), muscular strength and physical performance testing, and patient-reported outcomes (PROs). A geriatric assessment (GA) is a useful tool when studying the older patient with cachexia given its comprehensive ability to capture aging-sensitive PROs. Interventions focused on nutrition and increasing physical activity may improve outcomes in older adults with cachexia. Efforts to develop targeted pharmacologic therapies with cachexia have not been successful thus far. Formal treatment guidelines, an updated consensus definition for cancer cachexia and the development of a widely adapted assessment tool, much like the GA utilized in geriatric oncology, could help advance the field of cancer cachexia over the next decade.

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Sarcopenia

Cited by 227 publications

References 45 publications

Influence of body composition and muscle strength on outcomes after multimodal oesophageal cancer treatment

Influence of body composition and muscle strength on outcomes after multimodal oesophageal cancer treatment

Prognostic Impact of Sarcopenia and Skeletal Muscle Loss During Neoadjuvant Chemoradiotherapy in Esophageal Cancer

Cachexia and Sarcopenia in Older Adults with Cancer: A Comprehensive Review

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