CT-based compartmental quantification of adipose tissue versus body metrics in colorectal cancer patients

Nattenmueller, Johanna; Hoegenauer, Hanna; Boehm, Juergen; Scherer, Dominique; Paskow, Michael; Gigic, Biljana; Schrotz‐King, Petra; Grenacher, Lars; Ulrich, Cornelia M.; Kauczor, Hans Ulrich

doi:10.1007/s00330-016-4231-8

Cited by 38 publications

(48 citation statements)

References 40 publications

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“…The next best option is to use data from multiple studies using percentile based summative values. The literature currently uses a plethora of cohort-specific values, including using the lowest median, tertile, quartile, quintile, or standard deviation (19)(20)(21)23,24,27,28,(33)(34)(35)(36)(37)(38) in the study cohort. We validated our cohort's cutoff, by performing ROC curve analysis with regards to acute radiotoxicities which correlates to approximately a TPA of 500.…”

Section: Discussionmentioning

confidence: 99%

Impact of sarcopenia in borderline resectable and locally advanced pancreatic cancer patients receiving stereotactic body radiation therapy

Jin¹,

Mellon²,

Frakes³

et al. 2018

J. Gastrointest. Oncol.

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Background: Total psoas area (TPA), a marker of sarcopenia, has been used as an independent predictor of clinical outcomes in gastrointestinal (GI) cancers as a proxy for frailty and nutritional status. Our study aimed to evaluate whether TPA, in contrast to traditional measurements of nutrition like body mass index (BMI) and body surface area (BSA), was predictive of outcomes in borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC) patients receiving stereotactic body radiation therapy (SBRT). Methods: Retrospective analysis of an institutional review board approved database of 222 BRPC and LAPC treated with SBRT from 2009-2016 yielded 183 patients that met our selection criteria of pre-SBRT computed tomography (CT) imaging with an identifiable L4 vertebra. Once the L4 vertebral level was identified, the bilateral psoas muscles were manually contoured. This area was normalized by patient height, with units described in mm 2 /m 2 . Receiver operating characteristic (ROC) curves were generated for TPA, BMI, and BSA to elicit clinically relevant cutoffs. Regression and Kaplan-Meier analyses were used to correlate toxicity with survival functions.Results: Low TPA (OR =1.903, P=0.036) was predictive of acute toxicities, and only TPA was predictive of Grade 3 or higher acute toxicities (OR =10.24, P=0.007). Both findings were independent of tumor resectability. Pain (P=0.003), fatigue (P=0.040), and nausea (P=0.039) were significantly associated with low TPA. No association was identified between any measurement of nutritional status and the development of late toxicities, overall survival, local progression or local recurrence. However, BRPC patients survived longer (median =21.98 months) than their LAPC (median =16.2 months) counterparts (P=0.002), independent of nutritional status. Conclusions: TPA measurement is readily available and more specific than BMI or BSA as a predictor of acute radiotoxic complications following SBRT in BRPC/LAPC patients. A TPA of <500 mm 2 /m 2 is a clinically relevant cutoff that can direct physicians to address expected complications of pain, fatigue, and nausea. However, tumor resectability remains as the only predictor of overall survival in this cohort.

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Section: Discussionmentioning

confidence: 99%

Impact of sarcopenia in borderline resectable and locally advanced pancreatic cancer patients receiving stereotactic body radiation therapy

Jin¹,

Mellon²,

Frakes³

et al. 2018

J. Gastrointest. Oncol.

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“…Limits of measurements for selecting specifically adipose tissue were –190 to –30 HU [22, 23]. SAT was calculated by subtracting VAT from TAT [21]. The visceral-to-subcutaneous fat ratio was calculated as VAT/SAT at level L3/4.…”

Section: Methodsmentioning

confidence: 99%

“…First, area-based quantification of adipose tissue compartments was performed on the L3/4 spinal level (volumetric quantification of selected slice, divided by slice thickness, unit: cm 2 ) [19-21] (Fig. 1).…”

Section: Methodsmentioning

confidence: 99%

CT-Quantified Adipose Tissue Distribution: Risk or Protective Factor for Complications after Rectal Cancer Surgery?

Nattenmüller¹,

Böhm²,

Bagdassarjan³

et al. 2019

Obes Facts

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Purpose: Obesity is associated with increased incidence and mortality in rectal cancer (RC). However, an obesity paradox in the sense of a protective effect of obesity is discussed controversially. We evaluated whether adipose tissue distribution has an impact on medical (MC) and surgical complications (SC) after RC surgery. Methods: A total of 296 RC patients underwent oncological surgery and multidetector CT with quantification of total (TAT), visceral (VAT), and subcutaneous adipose tissue (SAT). Logistic regressions on SC (anastomotic leakage [n = 26], wound infection [n = 58], bleeding [n = 12], abscess [n = 32], bladder dysfunction [n = 24], burst abdomen [n = 10]), and MC (pulmonary [n = 22], cardiac [n = 18], urinary tract infection [n = 9], sepsis [n = 5]) were performed. Results: High pelvicVAT was associated with reduced risk for overall SC (OR = 0.915, p = 0.012) and anastomotic leakage (OR = 0.587, p = 0.024, CI: 0.369/0.934). In contrast, CT-quantified obesity was associated with increased risk for wound infection, bladder dysfunction, burst abdomen, overall MC, and cardiac complications (ORs up to 1.423). BMI was not associated with any SC or MC. Conclusion: An obesity paradox with a protective effect of CT-quantified adipose tissue was confirmed for anastomotic leakage and overall SC. In contrast, high adipose tissue was associated with higher risk for other SC and MC. These results show a more complex influence of body composition on MC and SC. CT-quantified obesity is able to provide deeper insights to explain the obesity paradox beyond BMI.

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“…(Nattenmueller et al 2016) CTs from pre- and post-surgery were similar and thus, combined for statistical analyses. 28 …”

Section: Methodsmentioning

confidence: 99%

“…(Nattenmueller et al 2016) The measurements limits for aforementioned selected ROIs were at a minimum attenuation of 40 Hounsfield Units (HU) to maximum 100 HU to avoid measuring errors including muscles’ lipid content and application of contrast media. (Goodpaster et al 2000)…”

Section: Methodsmentioning

confidence: 99%

Associations of branched-chain amino acids with parameters of energy balance and survival in colorectal cancer patients: results from the ColoCare study

et al. 2018

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Background Branched-chain amino acids (BCAA) have been previously linked to survival in colorectal cancer (CRC) patients. It is unclear whether BCAAs are prognostic biomarkers or surrogate markers for energy balance. Objectives We aimed to determine correlations of BCAAs with markers of energy balance over time and to investigate prognostic significance of BCAAs in CRC. Methods We used urinary samples from newly diagnosed CRC patients [n=163; (stage I – IV)] from the ColoCare study in Heidelberg, Germany, collected at surgery (n=163), 6 (n=83) and 12 months follow-up (n=54). Isoleucine, leucine, valine, (2Z)-3-methylglutaconic acid (3HM), 2-ethylhydracrylic acid (2EA), 2-methyl-3-hydroxybutyrate (2M3H) were detected using gas-chromatography mass-spectrometry and proton-nuclear-magnetic-resonance spectroscopy. Partial correlation coefficients between BCAAs with body mass index (BMI), physical activity (metabolic equivalent [MET]) and muscle area were computed and adjusted for sex and age at diagnosis. We used Cox proportional hazard models to investigate overall survival (OS) after 24 months of follow-up. Results We did not observe significant correlations between BCAAs and parameters of energy balance at all time points (correlation ranges: BMI: r= −0.13 to −0.01; METs: r=−0.14 to 0.02; dorsal muscle: r=−0.03 to 0.10). BCAAs were not associated with risk of death in stage I-III (e.g., valine: HRlog2=1.62, p=0.25) or in stage IV tumors. Elevated concentrations of 2EA and 2M3H were significantly associated with OS, independent of stage (2EA: stage I-III: HRlog2=0.42, p=0.04; stage IV: HRlog2=0.51, p=0.01). Conclusion Our study suggests that BCAAs in colorectal cancer patients do not reflect parameters of energy balance and may be independently associated with overall survival.

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CT-based compartmental quantification of adipose tissue versus body metrics in colorectal cancer patients

Cited by 38 publications

References 40 publications

Impact of sarcopenia in borderline resectable and locally advanced pancreatic cancer patients receiving stereotactic body radiation therapy

Impact of sarcopenia in borderline resectable and locally advanced pancreatic cancer patients receiving stereotactic body radiation therapy

CT-Quantified Adipose Tissue Distribution: Risk or Protective Factor for Complications after Rectal Cancer Surgery?

Associations of branched-chain amino acids with parameters of energy balance and survival in colorectal cancer patients: results from the ColoCare study

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