Imaging body composition in cancer patients: visceral obesity, sarcopenia and sarcopenic obesity may impact on clinical outcome

Abstract

In recent years, there has been increasing interest in the influence of body composition on oncological patient outcomes. Visceral obesity, sarcopenia and sarcopenic obesity have been identified as adverse factors in cancer patients. Imaging quantification of body composition such as lean muscle mass and fat distribution is a potentially valuable tool. This review describes the following imaging techniques that may be used to assess body composition: dual-energy X-ray absorptiometry (DXA), computed tomography (CT) and magnetic resonance imaging (MRI). CT and MRI are acquired as part of oncological patient care, thus providing an opportunity to integrate body composition assessment into the standard clinical pathway and allowing supportive care to be commenced as appropriate to improve outcome.Main Messages• Sarcopenia, sarcopenic obesity and visceral obesity are adverse prognostic factors in cancer patients.• CT and MRI are the current gold standard in body composition evaluation.• Body composition may affect chemotherapy tolerance and toxicities.

Weight Fluctuation and Cancer Risk in Postmenopausal Women: The Women's Health Initiative

“…If fat mass replaces fat free mass as a consequence of weight cycling, then weight cycling may lend to a more sarcopenic obese phenotype(8,32,38). Sarcopenia alone is associated with cardiovascular disease markers, such as insulin resistance(39), and when accompanied by obesity, evidence suggests that worse cardio-metabolic(40,41) and cancer survival(42) outcomes exist. However, it is unknown if sarcopenic obesity leads to increased cancer incidence.…”

Lower Pectoralis Muscle Area Is Associated with a Worse Overall Survival in Non–Small Cell Lung Cancer

“…mid-upper arm), dual energy x-ray absorbance (DXA), bioimpedance studies, or abdominal computed tomography (CT) scan. (6,10) However, these measurements all have limitations, particularly when applied to patients with lung cancers. Anthropometric measurements of skin fold thickness and body circumference overestimate muscularity by 15-25% compared to abdominal CT and are associated with high within-subject error.…”

A pilot study of radiologic measures of abdominal adiposity: weighty contributors to early pancreatic carcinogenesis worth evaluating?

“…Measures of total abdominal fat (TAF) area, VFA, and subcutaneous fat area (SFA) were obtained using the volume segmentation and thresholding tools in AW server version 2.0 software (General Electric, Waukesha, WI, USA). The axial L2-L3 intervertebral disc level was used for analysis because adipose tissue at this level corresponds to whole body quantities 45 and is well distinguished from skeletal muscle and other structures 40,46,47 . CT attenuation thresholds to define adipose tissue were set between –249 and –49 Hounsfield Units 44 .…”

“…SFA was calculated by subtracting VFA from TAF. The VFA to SFA ratio (V/S) was calculated with V/S>0.4 cm 2 defined as viscerally obese 46,49,50 . Manual tracing of the visceral fascial plane allowed the radiologist to exclude any fat density regions within bowel or fatty lesions within organs.…”