Decreased psoas muscle area is a prognosticator for 90-day and 1-year survival in patients undergoing surgical treatment for spinal metastasis

Hu, Ming-Hsiao; Yen, Hung-Kuan; Chen, I-Hsin; Wu, Cho‐Kai; Chen, Chih-Wei; Yang, Jyh‐Chin; Wang, Zhongyu; Yen, Mao-Hsu; Yang, Shu Hua; Lin, Wei-Hsin

doi:10.1016/j.clnu.2022.01.011

Cited by 14 publications

(9 citation statements)

References 51 publications

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“…Our findings align with trends observed in previous studies exploring the survival outcomes of patients undergoing surgical treatment for metastases affecting the spine or viscera. [17][18][19][20][21][22][23]25 These observations were consistent with a recent study by Groot et al that found decreased PMA on CT was associated with a higher likelihood of mortality at 1 year (Hazard ratio, HR, 1.68; 95% CI, 1.08-2.61; p = 0.02) in 212 patients undergoing surgery for extremity metastases. 28 Although the authors concluded body composition measurements could be used as a novel imaging biomarker to supplement current survival prediction tools for patients with long-bone metastases, they did not further analyze if predictions made by these tools could actually be improved when morphometric factors were considered.…”

Section: Unadjustedsupporting

confidence: 91%

“…Psoas muscle area at the L3 vertebra measured on CT images has been shown to be a predictor of mortality in patients with cancer. [16][17][18][19][20][21][22][23] If body measurements such as PMA provide additional predictive value independent of the existing SPAs, incorporating morphometric factors into these tools could potentially improve their performance and help patients and clinicians make better-informed decisions. In this study, we would like to ask (1) whether decreased PMA on CT is associated with worse 90-day, 1-year, and overall survival in patients with extremity metastases?…”

Section: Introductionmentioning

confidence: 99%

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Psoas muscle area is an independent survival prognosticator in patients undergoing surgery for long‐bone metastases

Lee,

Tseng,

Chang

et al. 2024

Cancer Medicine

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BackgroundPredictive analytics is gaining popularity as an aid to treatment planning for patients with bone metastases, whose expected survival should be considered. Decreased psoas muscle area (PMA), a morphometric indicator of suboptimal nutritional status, has been associated with mortality in various cancers, but never been integrated into current survival prediction algorithms (SPA) for patients with skeletal metastases. This study investigates whether decreased PMA predicts worse survival in patients with extremity metastases and whether incorporating PMA into three modern SPAs (PATHFx, SORG‐NG, and SORG‐MLA) improves their performance.MethodsOne hundred eighty‐five patients surgically treated for long‐bone metastases between 2014 and 2019 were divided into three PMA tertiles (small, medium, and large) based on their psoas size on CT. Kaplan–Meier, multivariable regression, and Cox proportional hazards analyses were employed to compare survival between tertiles and examine factors associated with mortality. Logistic regression analysis was used to assess whether incorporating adjusted PMA values enhanced the three SPAs' discriminatory abilities. The clinical utility of incorporating PMA into these SPAs was evaluated by decision curve analysis (DCA).ResultsPatients with small PMA had worse 90‐day and 1‐year survival after surgery (log‐rank test p < 0.001). Patients in the large PMA group had a higher chance of surviving 90 days (odds ratio, OR, 3.72, p = 0.02) and 1 year than those in the small PMA group (OR 3.28, p = 0.004). All three SPAs had increased AUC after incorporation of adjusted PMA. DCA indicated increased net benefits at threshold probabilities >0.5 after the addition of adjusted PMA to these SPAs.ConclusionsDecreased PMA on CT is associated with worse survival in surgically treated patients with extremity metastases, even after controlling for three contemporary SPAs. Physicians should consider the additional prognostic value of PMA on survival in patients undergoing consideration for operative management due to extremity metastases.

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Section: Unadjustedsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Psoas muscle area is an independent survival prognosticator in patients undergoing surgery for long‐bone metastases

Lee,

Tseng,

Chang

et al. 2024

Cancer Medicine

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“…This being said, we found in the literature only PSSs for survival estimation. No PSSs have been developed to predict other postoperative outcomes such as complications, length of hospital stay, non‐home discharge, reoperations, or quality of life 57–61 . We believe all these aspects should also be discussed with patients with limited survival, who might consider quality of life as the most important goal of treatment.…”

Section: Discussionmentioning

confidence: 99%

Comparison of eight modern preoperative scoring systems for survival prediction in patients with extremity metastasis

et al. 2023

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Background: Survival is an important factor to consider when clinicians make treatment decisions for patients with skeletal metastasis. Several preoperative scoring systems (PSSs) have been developed to aid in survival prediction. Although we previously validated the Skeletal Oncology Research Group Machine-learning Algorithm (SORG-MLA) in Taiwanese patients of Han Chinese descent, the performance of other existing PSSs remains largely unknown outside their respective development cohorts. We aim to determine which PSS performs best in this unique population and provide a direct comparison between these models. Methods:We retrospectively included 356 patients undergoing surgical treatment for extremity metastasis at a tertiary center in Taiwan to validate and compare eight PSSs. Discrimination (c-index), decision curve (DCA), calibration (ratio of observed:expected survivors), and overall performance (Brier score) analyses were conducted to evaluate these models' performance in our cohort. Results:The discriminatory ability of all PSSs declined in our Taiwanese cohort compared with their Western validations. SORG-MLA is the only PSS that still demonstrated excellent discrimination (c-indexes>0.8) in our patients. SORG-MLA also brought the most net benefit across a wide range of risk probabilities on DCA with its 3-month and 12-month survival predictions.Conclusions: Clinicians should consider potential ethnogeographic variations of a PSS's performance when applying it onto their specific patient populations.Further international validation studies are needed to ensure that existing PSSs are generalizable and can be integrated into the shared treatment decision-making | 14265 LEE et al.

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“…Recently, preoperative sarcopenia has become a prognostic indicator for various types of surgery (31)(32)(33)(34), whereas few studies investigated the impact of preoperative skeletal muscle loss on survival in patients receiving CABG. In our previous study, preoperative sarcopenia was proved to be an independent risk factor for postoperative complications and OS of CABG (10).…”

Section: Discussionmentioning

confidence: 99%

Prognostic significance of postoperative loss of skeletal muscle mass in patients underwent coronary artery bypass grafting

et al. 2022

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BackgroundIncreasing life expectancy of coronary artery bypass grafting (CABG) remains to be the major concern of cardiac surgeons. However, few studies have investigated the effect of postoperative skeletal muscle index (SMI) loss on prognosis. This study aims to evaluate the prognostic role of postoperative SMI loss ≥ 5% after CABG, in order to develop a novel nomogram to predict overall survival (OS).MethodsPatients underwent CABG via midline sternotomy from December 2015 to March 2021 were recruited in this study. Preoperative and postoperative 3 months chest computed tomography (CT) images were compared to assess changes in SMI at T12 level. Based on this, patients were classified into the presence or absence of SMI loss ≥ 5%. The association between postoperative SMI loss ≥ 5% and OS was then analyzed by the Kaplan-Meier curves and Cox model. A novel nomogram incorporating independent clinical prognostic variables was also developed.ResultsThe study enrolled 506 patients receiving CABG, of whom 98 patients experienced T12 SMI loss ≥ 5% and had a significantly worse OS (P < 0.0001). Multivariate regression analysis showed that T12 SMI per cent change (%T12 SMI-change) was an independent prognostic factor for OS (HR = 0.809, 95% CI = 0.749–0.874). The nomogram incorporating %T12 SMI-change with other variables was accurate for predicting OS. Besides, we also found that postoperative oral nutritional supplement (ONS) can rescue T12 SMI loss.ConclusionPostoperative SMI loss can predict survival outcome after CABG. The nomogram incorporating changes in SMI provides a superior performance than existing systems.

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Decreased psoas muscle area is a prognosticator for 90-day and 1-year survival in patients undergoing surgical treatment for spinal metastasis

Cited by 14 publications

References 51 publications

Psoas muscle area is an independent survival prognosticator in patients undergoing surgery for long‐bone metastases

Psoas muscle area is an independent survival prognosticator in patients undergoing surgery for long‐bone metastases

Comparison of eight modern preoperative scoring systems for survival prediction in patients with extremity metastasis

Prognostic significance of postoperative loss of skeletal muscle mass in patients underwent coronary artery bypass grafting

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