Clinical Impact of Nutritional Status and Sarcopenia in Pediatric Patients with Bone and Soft Tissue Sarcomas: A Pilot Retrospective Study (SarcoPed)

Abstract

Background: We evaluated nutritional and sarcopenia status and their clinical impact in pediatric patients affected by bone and soft tissue sarcomas. Methods: Body mass index (BMI), prognostic nutritional index (PNI), and total psoas muscle area (tPMA) at diagnosis and after 12 months were analyzed. tPMA was measured from single cross-sectional computed tomography (CT) images at L4–L5. Age-specific and sex-specific tPMA Z-scores were retrieved from an online calculator. Results: A total of 21 patients were identified between February 2013 and December 2018. Twelve patients (57.1%) experienced sarcopenia at diagnosis, although not statistically associated with overall survival (OS) (p = 0.09). BMI Z-score, PNI, and tPMA Z-score significantly decreased between diagnosis and after 12 months of treatment (p < 0.05). Univariate analysis showed significant associations between poor OS and the presence of metastasis (p = 0.008), the absence of surgery (p = 0.005), PNI decrease (p = 0.027), and the reduction in tPMA > 25% (p = 0.042) over the 12 months. Conclusions: Sarcopenia affects more than half of the patients at diagnosis. Decreased PNI during 12 months of treatment has significant predictive value for OS. The role of tPMA derived from CT scan among pediatric patients with sarcoma should be investigated in further prospective and larger studies.

Nutritional Status at Diagnosis as Predictor of Survival from Childhood Cancer: A Review of the Literature

“…Though malnutrition was a significant complication in this population, with a prevalence of 30% at diagnosis increased to 38% three months later, there was no impact of malnutrition on survival outcomes [ 35 ]. Likewise, a study on 139 children with Ewing sarcoma and osteosarcoma reported high proportions of malnutrition 2 years after treatment initiation (43% of osteosarcoma and 25% of Ewing sarcoma) [ 36 ]; again, malnutrition had non-significant effects on survival outcomes. A more recent study assessed the prognostic effect of sarcopenia, defined by the BMI-z score, the prognostic nutritional index (PNI), and the total psoas muscle area (tPMA), on the survival of children with bone and soft tissue sarcomas [ 37 ].…”

Sarcopenia is associated with worse surgical complications but not relapse-free survival and overall survival in patients with retroperitoneal liposarcoma

“…Many reports have shown that sarcopenia is closely related to the prognosis of patients with various malignant tumors. 3,[6][7][8][9][10][11]13,[19][20][21] However, different pathological types of sarcomas are not identical in treatment and prognosis, so we conducted a study on the exact pathological type of sarcomas and drew relevant conclusions. Meanwhile, the effect of sarcopenia on the post-surgical outcomes of patients with liposarcoma undergoing en bloc compartment resection has not been reported.…”

Sarcopenia is associated with worse surgical complications but not relapse-free survival and overall survival in patients with retroperitoneal liposarcoma

“…Many reports have shown that sarcopenia is closely related to the prognosis of patients with various malignant tumors. [ 3 , 6 – 11 , 13 , 19 – 21 ] However, different pathological types of sarcomas are not identical in treatment and prognosis, so we conducted a study on the exact pathological type of sarcomas and drew relevant conclusions. Meanwhile, the effect of sarcopenia on the post-surgical outcomes of patients with liposarcoma undergoing en bloc compartment resection has not been reported.…”

“…However, some publications explored the relationship between sarcopenia and clinical outcomes among patients with sarcoma; one reported that there was no relationship between psoas cross-sectional area and clinical outcomes after soft tissue resection [6]. The others demonstrated that sarcopenia was independently associated with poorer long-term prognosis in sarcoma [3,[7][8][9][10][11], and lower psoas muscle attenuation was associated with higher mortality [8,12]. The advanced studies showed that sarcopenia is associated with prognostic parameters in advanced or metastatic STS and first-line therapy response [13].…”