Factors Associated with Sarcopenia in Patients with Colorectal Cancer

Souza, Bianca Umbelino de; Souza, Naiara Maria de; Martucci, Renata Brum; Rodrigues, V.D.; Pinho, Nivaldo Barroso de; Gonzalez, Maria Cristina; Avesani, Carla María

doi:10.1080/01635581.2018.1412480

Cited by 38 publications

(54 citation statements)

References 69 publications

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“…This is contradictory to evidence surrounding the study of sarcopenia as it relates to other malignancies, particularly those of the gastrointestinal tract, whereby patients who meet criteria for sarcopenia seem to be exceedingly malnourished, underweight, and physiologically frail. 33,34 We believe that breast cancer may represent a different set of physiologic challenges and treatments, which may affect patients differently. Given that abdominally based microvascular breast reconstruction requires more physiologic reserve, has a longer operative time, and a longer hospital stay than other forms of reconstruction, the surgeon may not offer more complex methods of reconstruction to patients who appear frail or deconditioned.…”

Section: Discussionmentioning

confidence: 99%

The effect of sarcopenia on perioperative complications in abdominally based free‐flap breast reconstruction

Broyles

Smith

Phillips

et al. 2020

Journal of Surgical Oncology

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Purpose: The identification of patient-specific risk factors, which predict morbidity following abdominally based microvascular breast reconstruction is difficult. Sarcopenia is a proxy for patient frailty and is an independent predictor of complications in a myriad of surgical disciplines. We predict that sarcopenic patients will be at higher risk for surgical complications following abdominally based microvascular breast reconstruction. Methods: A retrospective study of all patients who underwent delayed abdominally based autologous breast reconstruction following postmastectomy radiation therapy from 2007 to 2013 at a single institution was conducted. Univariate and multiple logistic regression models were used to assess the effect of sarcopenia on postoperative outcomes. Results: Two hundred and eight patients met the inclusion criteria, of which 30 met criteria for sarcopenia (14.1%). There were no significant differences in demographics between groups. There were no significant differences in minor (36.7% vs 44.4%; P = .43) or major (16.7% vs 25.3%; P = .36) complications between groups as well as hospital length of stay. Multivariable logistic regression demonstrated that a staged reconstruction with the use of a tissue expander was the only consistent variable, which predicted major complications (OR, 2.24; 95% CI, 1.18-4.64; P = .015). Conclusions: Sarcopenia does not predispose to minor or major surgical complications in patients who undergo abdominally based microsurgical breast reconstruction.

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Section: Discussionmentioning

confidence: 99%

The effect of sarcopenia on perioperative complications in abdominally based free‐flap breast reconstruction

Broyles

Smith

Phillips

et al. 2020

Journal of Surgical Oncology

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“…(34) As for albumin, previous studies have investigated that albumin is an independent prognostic factor in CRC and hypoalbuminemia was associated with poor survival with CRC. (8,35,36) Nomogram is considered a reliable tool to quantify cancer risk than TNM staging system classi cation. (37) Previous studies have developed nomograms to predict the clinical outcomes of CRC patients.…”

Section: Discussionmentioning

confidence: 99%

“…(13,39) CRC is more likely to cause malnutrition due to its unique characteristics, such as intestinal obstruction. (7,8) The PG-SGA criteria are used as a gold standard for diagnosing cancer malnutrition, which has been widely validated, while the GLIM criteria still need to be further validated. Yin et al showed 24%…”

Section: Discussionmentioning

confidence: 99%

“…(6) This is due to the combined effects of cancer progression, host response to tumors, anti-cancer therapies, and direct effects of intestinal obstruction and malabsorption. (7,8) Malnutrition can also adversely affect some clinical outcomes of cancer patients, such as overall survival (OS) and tolerance to chemotherapy. (9,10) Varadhan et al reported that cancer could affect the patients' physiology and psychology, particularly in terms of nutritional status.…”

Section: Introductionmentioning

confidence: 99%

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A Prospective and Nutrition-Related Nomogram Model for Prognosis in Colorectal Cancer Survival: A Multicenter Cohort Study in China

Ruan

Zhang

et al. 2020

Preprint

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BackgroundColorectal cancer (CRC) is a common malignancy with high incidence of malnutrition. Increasing evidence showed that nutritional status could be a prognostic indicator of cancer survival. However, there were few prognostic models involving nutrition-related indicators in CRC. This study aimed to develop a nutrition-related prognostic model for CRC survival.MethodsThis multicenter retrospectively primary cohort data included 1,373 CRC patients, and the external validation cohort enrolled other 108 CRC patients. LASSO and multivariate regression analyses were used to select prognostic indicators and develop the nomogram. We performed C-index, calibration curves, and DCA to assess the discrimination, calibration, and applicability. Finally, the indicators of the nomogram model were used as adjustment factors. Multivariate Cox survival analyses were performed to investigate the benefit of the Patient-Generated Subjective Global Assessment (PG-SGA) and Global Leadership Initiative on Malnutrition (GLIM) malnutrition criteria to CRC prognosis.ResultsFive prognostic indicators (TNM stage, radical resection, reduced food intake, activities and function decline, and low albumin) were chosen to develop the nomogram. C-index of the nomogram was 0.74 (95% CI 0.72-0.77) and 0.72 (95% CI 0.62-0.81) in the primary cohort and validation cohort, which were higher than other models. Calibration plots and DCA showed that the nomogram model has a good consistency and clinical benefit in predicting CRC survival. Multivariate Cox survival analysis suggested moderate (P<0.05, HR 1.32, 95% CI 1.002-1.75) and severe malnutrition (P<0.001, HR 1.69, 95% CI 1.27-2.25) were associated with worse overall survival (OS) in CRC using the PG-SGA criteria. However, there was no prognostic significance in GLIM criteria (all P>0.05). Finally, stratified analysis suggested that malnourished CRC patients with low albumin synergistically increased the death risk of CRC OS both in PG-SGA and GLIM. (P for interaction = 0.007 and 0.004, respectively)ConclusionThis study established a prospective model to predict the OS in CRC patients using nutrition-related indicators. Moreover, we also found that PG-SGA had a better prognostic and predictive efficiency in CRC than GLIM. These findings grant further verification.

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“…In addition, BIVA appears to be an accurate procedure to evaluate the body composition, since it is independent of the hydration status . Several studies have shown that PhA and standardized PhA (SPA) can predict prognosis in different cancer populations and that PhA is a reliable marker for the detection of sarcopenia in cancer patients …”

Section: Introductionmentioning

confidence: 99%

Whey protein isolate supplementation improves body composition, muscle strength, and treatment tolerance in malnourished advanced cancer patients undergoing chemotherapy

et al. 2019

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In recent years, whey proteins (WP) have attracted increasing attention in health and disease for their bioactive functions. The aim of this study was to evaluate the benefit of WP isolate (WPI) supplementation in addition to nutritional counseling in malnourished advanced cancer patients undergoing chemotherapy (CT). In a single‐center, randomized, pragmatic, and parallel‐group controlled trial (http://www.ClinicalTrials.gov: NCT02065726), 166 malnourished advanced cancer patients with mixed tumor entities candidate to or undergoing CT were randomly assigned to receive nutritional counseling with (N = 82) or without (N = 84) WPI supplementation (20 g/d) for 3 months. The primary endpoint was the change in phase angle (PhA). Secondary endpoints included changes in standardized PhA (SPA), fat‐free mass index (FFMI), body weight, muscle strength, and CT toxicity (CTCAE 4.0 events). In patients with the primary endpoint assessed (modified intention‐to‐treat population), counseling plus WPI (N = 66) resulted in improved PhA compared to nutritional counseling alone (N = 69): mean difference, 0.48° (95% CI, 0.05 to 0.90) (P = .027). WPI supplementation also resulted in improved SPA (P = .021), FFMI (P = .041), body weight (P = .023), muscle strength (P < .001), and in a reduced risk of CT toxicity (risk difference, −9.8% [95% CI, −16.9 to −2.6]; P = .009), particularly of severe (grade ≥ 3) events (risk difference, −30.4% [95% CI, −44.4 to −16.5]; P = .001). In malnourished advanced cancer patients undergoing CT, receiving nutritional counseling, a 3‐month supplementation with WPI resulted in improved body composition, muscle strength, body weight, and reduced CT toxicity. Further trials, aimed at verifying the efficacy of this nutritional intervention on mid‐ and long‐term primary clinical endpoints in newly diagnosed specific cancer types, are warranted.

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Factors Associated with Sarcopenia in Patients with Colorectal Cancer

Cited by 38 publications

References 69 publications

The effect of sarcopenia on perioperative complications in abdominally based free‐flap breast reconstruction

The effect of sarcopenia on perioperative complications in abdominally based free‐flap breast reconstruction

A Prospective and Nutrition-Related Nomogram Model for Prognosis in Colorectal Cancer Survival: A Multicenter Cohort Study in China

Whey protein isolate supplementation improves body composition, muscle strength, and treatment tolerance in malnourished advanced cancer patients undergoing chemotherapy

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