Body composition is associated with operative and oncologic outcomes in the management of retroperitoneal and trunk soft tissue sarcoma

Boyle, Ellen A.; Elliott, Jessie A; McIntyre, Tom; Barnes, Melissa E.; Donlon, Noel E; Umair, Muhammad; Gillis, Amy; Ridgway, Paul F.

doi:10.1016/j.amjsurg.2021.08.005

Cited by 9 publications

(14 citation statements)

References 37 publications

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“…All measurements were performed by experienced researcher, accredited for complex image analysis and segmentation techniques. Additionally, we used previously reported and validated equations to calculate appendicular skeletal muscle index (ASMI), lean body mass (LBM) and fat mass (FM) 26 , 29 , 43 , 47 : ASMI (kg/m 2 ) = 0.11 × SMI (cm 2 /m 2 ) + 1.17 LBM (kg) = 0.030 × Lean Tissue Area (cm 2 ) + 6.06 FM (kg) = 0.042 × Total Fat Area (cm 2 ) + 11.2 …”

Section: Methodsmentioning

confidence: 99%

“… 39 Previously reported diagnostic criteria for visceral obesity were applied: VAT > 163.8 cm 2 for men and VAT > 80.1 cm 2 for women. 29 , 39 , 47 …”

Section: Methodsmentioning

confidence: 99%

“… 28 Number of recent studies reported that VO is more reliable clinical marker for predicting outcome than traditional view on obesity defined by BMI. 29 , 30 , 31 , 32 , 33 The useful predictor of VO is visceral-to-subcutaneous adipose tissue area ratio (VSR), and high VSR is associated with poor oncologic outcome. 34 , 35 , 36 , 37 Also, another body composition abnormality, the new concept of sarcopenic obesity (SO), a combination of excess adiposity and sarcopenia, seems to have powerful negative prognostic impact in oncology treatment and is gaining increased attention in cancer research.…”

Section: Introductionmentioning

confidence: 99%

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Influence of nutritional status and body composition on postoperative events and outcome in patients treated for primary localized retroperitoneal sarcoma

Ramanovic,

Novak,

Perhavec

et al. 2024

Radiology and Oncology

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Background Retroperitoneal sarcomas (RPS) are rare tumours of mesenchymal origin, commonly presented as a large tumour mass at time of diagnosis. We investigated the impact of body composition on outcome in patients operated on for primary localized RPS. Patients and methods We retrospectively analysed data for all patients operated on for primary RPS at our institution between 1999 and 2020. Preoperative skeletal muscle area (SMA), visceral and subcutaneous adipose tissue area (VAT and SAT) and muscle radiation attenuation (MRA) were calculated using computed tomography scans at the level of third lumbar vertebra. European Working Group on Sarcopenia in Older People (EWGSOP2) criteria were applied to define myopenia. Using maximum log-rank statistic method we determined the optimal cut-off values of body composition parameters. Myosteatosis was defined based on determined MRA cut-offs. Results In total 58 patient were eligible for the study. With a median follow-up of 116 months, the estimated 5-year overall survival (OS) and local-recurrence free survival (LRFS) were 66.8% and 77.6%, respectively. Patients with myopenia had significantly lower 5-year OS compared to non-myopenic (p = 0.009). Skeletal muscle index and subcutaneous adipose tissue index predicted LRFS on univariate analysis (p = 0.052 and p = 0.039, respectively). In multivariate analysis high visceral-to-subcutaneous adipose tissue area ratio (VSR) independently predicted higher postoperative complication rate (89.2% vs. 10.8%, p = 0.008). Myosteatosis was associated with higher postoperative morbidity. Conclusions Myopenia affected survival, but not postoperative outcome in RPS. Visceral obesity, VSR (> 0.26) and myosteatosis were associated with higher postoperative morbidity. VSR was better prognostic factor than VAT in RPS.

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Section: Methodsmentioning

confidence: 99%

“… 39 Previously reported diagnostic criteria for visceral obesity were applied: VAT > 163.8 cm 2 for men and VAT > 80.1 cm 2 for women. 29 , 39 , 47 …”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Influence of nutritional status and body composition on postoperative events and outcome in patients treated for primary localized retroperitoneal sarcoma

Ramanovic,

Novak,

Perhavec

et al. 2024

Radiology and Oncology

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“…Patients often attribute increased abdominal girth and tumor mass to weight gain and will attempt weight loss prior to presentation. In addition, visceral obesity is common among patients with RPS [ 37 ], and may contribute to a recognition delay [ 38 ]. Uncommonly, patients present with obstructive symptoms of the gastrointestinal or genitourinary tract, venous return, or hemorrhage.…”

Section: Clinical Presentationmentioning

confidence: 99%

Retroperitoneal Sarcoma Care in 2021

Schmitz

Nessim

2022

Cancers

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Soft-tissue sarcomas are biologically heterogenous tumors arising from connective tissues with over 100 subtypes. Although sarcomas account for <1% of all adult malignancies, retroperitoneal sarcomas are a distinct subgroup accounting for <10% of all sarcomatous tumors. There have been considerable advancements in the understanding and treatment of retroperitoneal sarcoma in the last decade, with standard treatment consisting of upfront primary surgical resection. The evidence surrounding the addition of radiation therapy remains controversial. There remains no standard with regards to systemic therapy, including immunotherapy. Adjunctive therapy remains largely dictated by expert consensus and preferences at individual centers or participation in clinical trials. In this 2021 review, we detail the anatomical boundaries of the retroperitoneum, clinical characteristics, contemporary standard of care and well as recent advancements in retroperitoneal sarcoma care. Ongoing international collaborations are encouraged to advance our understanding of this complex disease.

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“…Furthermore, in Findlay et al study on the impact of SP and MS in patients undergoing curative RT for head and neck cancer, post-treatment SP and pre-treatment MS were independent predictors of reduced overall survival at multivariable analysis [ 60 ]. Moreover, MS was independently associated with postoperative morbidity and adverse oncologic outcomes in patients with retroperitoneal and trunk sarcoma treated with preoperative RT and surgery [ 72 ]. On the contrary, Findlay et al, in their study on patients with head and neck cancer treated with RT, reported that malnutrition (evaluated using the Scored Patient-Generated Subjective Global Assessment) but not SP and MS was independently associated with reduced overall survival at multivariable analysis [ 61 ].…”

Section: Impact Of Sarcopeniamentioning

confidence: 99%

Everything You Always Wanted to Know about Sarcopenia but Were Afraid to Ask: A Quick Guide for Radiation Oncologists (impAct oF saRcopeniA In raDiotherapy: The AFRAID Project)

et al. 2022

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Sarcopenia (SP) is a syndrome characterized by age-associated loss of skeletal muscle mass and function. SP worsens both acute and late radiation-induced toxicity, prognosis, and quality of life. Myosteatosis is a pathological infiltration of muscle tissue by adipose tissue which often precedes SP and has a proven correlation with prognosis in cancer patients. Sarcopenic obesity is considered a “hidden form” of SP (due to large fat mass) and is independently related to higher mortality and worse complications after surgery and systemic treatments with worse prognostic impact compared to SP alone. The evaluation of SP is commonly based on CT images at the level of the middle of the third lumbar vertebra. On this scan, all muscle structures are contoured and then the outlined surface area is calculated. Several studies reported a negative impact of SP on overall survival in patients undergoing RT for tumors of the head and neck, esophagus, rectum, pancreas, cervix, and lung. Furthermore, several appetite-reducing side effects of RT, along with more complex radiation-induced mechanisms, can lead to SP through, but not limited to, reduced nutrition. In particular, in pediatric patients, total body irradiation was associated with the onset of SP and other changes in body composition leading to an increased risk of cardiometabolic morbidity in surviving adults. Finally, some preliminary studies showed the possibility of effectively treating SP and preventing the worsening of SP during RT. Future studies should be able to provide information on how to prevent and manage SP before, during, or after RT, in both adult and pediatric patients.

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Body composition is associated with operative and oncologic outcomes in the management of retroperitoneal and trunk soft tissue sarcoma

Cited by 9 publications

References 37 publications

Influence of nutritional status and body composition on postoperative events and outcome in patients treated for primary localized retroperitoneal sarcoma

Influence of nutritional status and body composition on postoperative events and outcome in patients treated for primary localized retroperitoneal sarcoma

Retroperitoneal Sarcoma Care in 2021

Everything You Always Wanted to Know about Sarcopenia but Were Afraid to Ask: A Quick Guide for Radiation Oncologists (impAct oF saRcopeniA In raDiotherapy: The AFRAID Project)

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