Impact Total Psoas Volume on Short- and Long-Term Outcomes in Patients Undergoing Curative Resection for Pancreatic Adenocarcinoma: a New Tool to Assess Sarcopenia

Amini, Neda; Spolverato, Gaya; Gupta, Rohan; Margonis, Georgios Antonios; Kim, Yuhree; Wagner, Doris; Rezaee, Neda; Weiss, Matthew J.; Wolfgang, Christopher L.; Makary, Martin; Kamel, Ihab R.; Pawlik, Timothy M.

doi:10.1007/s11605-015-2835-y

Cited by 205 publications

(191 citation statements)

References 60 publications

(64 reference statements)

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“…HGS would have a great advantage to select patients with good performance status but high risk for morbidity. Previous studies for other upper abdominal surgery such as hepatocellular carcinoma, pancreas cancer, and metastatic liver tumor demonstrated that sarcopenia was a risk factor for postoperative complication [12,35,36]. However, no report showed a correlation of sarcopenia and respiratory complications, which is different from the present study.…”

Section: Discussioncontrasting

confidence: 99%

Impact of preoperative hand grip strength on morbidity following gastric cancer surgery

et al. 2015

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Background Sarcopenia is a decrease in both muscle mass and strength. It remains unclear whether sarcopenia is associated with morbidity after gastric cancer surgery. This study evaluated the impact of sarcopenia on the morbidity of gastric cancer surgery. Methods A total of 293 gastric cancer patients who underwent curative surgery between May 2011 and June 2013 were retrospectively examined. Patients with performance status 3 or 4 were excluded. Preoperative lean body mass (LBM) was evaluated by bioelectrical impedance analysis and expressed as LBM index. Preoperative muscle function was measured by hand grip strength (HGS). The cutoff values were the gender-specific lowest 20 %. Grade 2 or higher morbidities, as retrospectively evaluated by the Clavien-Dindo classification, were obtained from the patient record. The risk factors for morbidity were examined by univariate and multivariate analyses. Results Morbidity was observed in 39 patients (13.3 %), including 7 with pancreatic leakage, 12 with anastomotic leakage, and 4 with intraabdominal abscesses, but no mortality was observed. The univariate analysis showed that male gender, total gastrectomy, splenectomy, and a low HGS were significant risk factors for morbidity. A low LBM was not a significant risk factor. A low HGS, male gender, and total gastrectomy remained significant in the multivariate analysis. Conclusions A low hand grip strength was a significant risk factor for morbidity after gastric cancer surgery. The importance of the hand grip strength as a risk factor should be examined in future prospective studies.

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Section: Discussioncontrasting

confidence: 99%

Impact of preoperative hand grip strength on morbidity following gastric cancer surgery

et al. 2015

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“…Although in some studies a correlation between PA and post‐operative complications was seen, the majority have failed to prove a relationship between PA‐assessed sarcopenia and survival 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23. Only few have actually assessed the agreement between PA and SMA within their population; Jones et al studied 100 patients with colorectal cancer and reported a Spearman correlation of 0.8 for PA and SMA and a Spearman correlation of 0.94 for PA and PLW, which could not be reproduced in our cohort 11.…”

Section: Discussionmentioning

confidence: 99%

“…This method has been used to predict surgical complications in different cancer types with contrasting results. PA has shown a correlation with post‐operative complications in individual studies on colorectal cancer, colorectal liver metastases, kidney cancer, bladder cancer, cholangiocarcinoma, and hepatocellular cancer,11, 12, 13, 14, 15, 16 while this effect was not seen in other pancreatic cancer, endometrial cancer, biliary cancer, or sarcoma studies 17, 18, 19, 20. Interestingly, only few cancer studies were able to show a correlation between PA and survival 21, 22, 23.…”

Section: Introductionmentioning

confidence: 99%

Psoas muscle area is not representative of total skeletal muscle area in the assessment of sarcopenia in ovarian cancer

Rutten

Ubachs

Kruitwagen

et al. 2017

J cachexia sarcopenia muscle

148

128

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BackgroundComputed tomography measurements of total skeletal muscle area can detect changes and predict overall survival (OS) in patients with advanced ovarian cancer. This study investigates whether assessment of psoas muscle area reflects total muscle area and can be used to assess sarcopenia in ovarian cancer patients.MethodsOvarian cancer patients (n = 150) treated with induction chemotherapy and interval debulking were enrolled retrospectively in this longitudinal study. Muscle was measured cross sectionally with computed tomography in three ways: (i) software quantification of total skeletal muscle area (SMA); (ii) software quantification of psoas muscle area (PA); and (iii) manual measurement of length and width of the psoas muscle to derive the psoas surface area (PLW). Pearson correlation between the different methods was studied. Patients were divided into two groups based on the extent of change in muscle area, and agreement was measured with kappa coefficients. Cox‐regression was used to test predictors for OS.ResultsCorrelation between SMA and both psoas muscle area measurements was poor (r = 0.52 and 0.39 for PA and PLW, respectively). After categorizing patients into muscle loss or gain, kappa agreement was also poor for all comparisons (all κ < 0.40). In regression analysis, SMA loss was predictive of poor OS (hazard ratio 1.698 (95%CI 1.038–2.778), P = 0.035). No relationship with OS was seen for PA or PLW loss.ConclusionsChange in psoas muscle area is not representative of total muscle area change and should not be used to substitute total skeletal muscle to predict survival in patients with ovarian cancer.

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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%

“…Previous studies investigated the association between pre-operative and post-operative TPA with outcomes in patients with pancreatic cancer (19)(20)(21)(22)(23)(24)(25). However, none have examined TPA prior to neoadjuvant therapy.…”

Section: Introductionmentioning

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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Impact Total Psoas Volume on Short- and Long-Term Outcomes in Patients Undergoing Curative Resection for Pancreatic Adenocarcinoma: a New Tool to Assess Sarcopenia

Cited by 205 publications

References 60 publications

Impact of preoperative hand grip strength on morbidity following gastric cancer surgery

Impact of preoperative hand grip strength on morbidity following gastric cancer surgery

Psoas muscle area is not representative of total skeletal muscle area in the assessment of sarcopenia in ovarian cancer

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

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