Low muscle attenuation is a prognostic factor for survival in metastatic breast cancer patients treated with first line palliative chemotherapy

Rier, Hánah N.; Jager, Agnes; Sleijfer, Stefan; Rosmalen, Joost van; Kock, Marc C. J. M.; Levin, Mark‐David

doi:10.1016/j.breast.2016.10.014

Cited by 122 publications

(152 citation statements)

References 42 publications

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“…Several studies have examined the relationship between evaluation of the different components of the diagnosis of sarcopenia diagnosis, yet the relationship and chronology between muscle strength and muscle mass is still poorly known. The analysis of this chronology was not planned to be included in the FIGHTDIGO study because CT examinations were not performed in a systematic way.…”

Section: Discussionmentioning

confidence: 99%

Correlation between muscle mass and handgrip strength in digestive cancer patients undergoing chemotherapy

Moreau

Ordan

Barbe³

et al. 2019

Cancer Medicine

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Background FIGHTDIGO study has shown the feasibility of handgrip strength (HGS) measurements in 201 consecutive digestive cancer patients undergoing chemotherapy. Objective This study focuses on a secondary aim of FIGHTDIGO study: the relationship between muscle mass and HGS. Design Two consecutive bilateral measures of HGS were performed using a Jamar dynamometer before the start of each chemotherapy. The highest value was chosen for final evaluation. Dynapenia (loss of muscle strength) was defined as HGS < 30 kg (men) and < 20 kg (women). Muscle mass was measured at lumbar level (L3) on Computed Tomography (CT) scans performed less than 3 weeks before or after the measurement of HGS. Muscle mass loss was defined by skeletal muscle index (SMI) < 53 cm 2 /m 2 (in men with a body mass index (BMI)> 25 kg/m 2 ), < 43 cm 2 /m 2 (in men with a BMI < 25 kg/m 2 ), and < 41 cm 2 /m 2 (in women regardless of BMI). Sarcopenia was defined by the association of a dynapenia and a loss of muscle mass. Results A total of 150 patients were included in this analysis (mean age: 65.6 ± 10.9 years, 87 males (58%), colorectal cancer (47.3%), metastatic stage (76.7%)). A total of 348 CT scans were evaluated. For the 348 measurements, mean SMI and HGS were 41.8 ± 8.7 cm 2 /m 2 and 32.1 ± 11.0 kg, respectively. Muscle mass loss, dynapenia, or sarcopenia were reported at least once, in 120 (80%), 45 (30%), and 30 (20%) patients, respectively. SMI was significantly correlated with HGS (Pearson coefficient = 0.53, P < 0.0001). At concordance analysis, 188 dyad SMI/HGS (54%) were in agreement (Kappa = 0.14 [95% CI, 0.07‐0.21]). Conclusion Correlation between the measurements of HGS and SMI is strong but the concordance between dynapenia and muscle mass loss is poor. Further studies should be performed to confirm the diagnostic thresholds, and to study the chronology of dynapenia and loss of muscle mass.

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Section: Discussionmentioning

confidence: 99%

Correlation between muscle mass and handgrip strength in digestive cancer patients undergoing chemotherapy

Moreau

Ordan

Barbe³

et al. 2019

Cancer Medicine

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“…Computed tomography (CT) imaging has recently revealed that a reduced level of muscle radiodensity is associated with shorter survival and systemic inflammation in cancer patients . Radiodensity is measured in Hounsfield units (HU), which is a linear transformation of the attenuation coefficient, where the radiodensity of distilled water at standard pressure and temperature is defined as 0 HU and the radiodensity of air at standard temperature and pressure is defined as −1000 HU .…”

Section: Introductionmentioning

confidence: 99%

Lipid is heterogeneously distributed in muscle and associates with low radiodensity in cancer patients

Bhullar

Anoveros‐Barrera

Dunichand‐Hoedl

et al. 2020

J cachexia sarcopenia muscle

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Background Low muscle radiodensity is associated with mortality in a variety of cancer types. Biochemical and morphological correlates are unknown. We aimed to evaluate triglyceride (TG) content and location as a function of computed tomography (CT)‐derived measures of skeletal muscle radiodensity in cancer patients. Methods Rectus abdominis (RA) biopsies were collected during cancer surgery from 75 patients diagnosed with cancer. Thin‐layer chromatography and gas chromatography were used for quantification of TG content of the muscle. Axial CT images of lumbar vertebra were used to measure muscle radiodensity. Oil Red O staining was used to determine the location of neutral lipids in frozen muscle sections. Results There was wide variation in RA radiodensity in repeated measures (CV% ranged from 3 to 55% based on 10 serial images) as well as within one slice (CV% ranged from 6 to 61% based on 10 subregions). RA radiodensity and total lumbar muscle radiodensity were inversely associated with TG content of RA (r = −0.396, P < 0.001, and r = −0.355, P = 0.002, respectively). Of the total percentage area of muscle staining positive for neutral lipid, 54 ± 17% was present as extramyocellular lipids (range 23.5–77.8%) and 46 ± 17% (range 22.2–76.5%) present as intramyocellular lipid droplets. Conclusions Repeated measures revealed wide variation in radiodensity of RA muscle, both vertically and horizontally. Low muscle radiodensity reflects high level of TG in patients with cancer. Non‐uniform distribution of intramyocellular and extramyocellular lipids was evident using light microscopy. These results warrant investigation of mechanisms resulting in lipid deposition in muscles of cancer patients.

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“…This metric, similar to skeletal muscle mass, can confer prognostic value for cancer outcomes . One study of metastatic breast cancer showed that low CT‐derived muscle radiodensity associated with reduced overall survival and time to next treatment . Adipose tissue content, including subcutaneous (SAT) and visceral adipose tissue (VAT), can also be determined from CT imaging, and has also been associated with treatment outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…[7][8][9][10] One study of metastatic breast cancer showed that low CT-derived muscle radiodensity associated with reduced overall survival and time to next treatment. 11 Adipose tissue content, including subcutaneous (SAT) and visceral adipose tissue (VAT), can also be determined from CT imaging, and has also been associated with treatment outcomes. For instance, CT-derived visceral adiposity has been linked to doxorubicin toxicity in a curable breast cancer population.…”

Section: Introductionmentioning

confidence: 99%

Beyond sarcopenia: Characterization and integration of skeletal muscle quantity and radiodensity in a curable breast cancer population

et al. 2017

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Skeletal muscle loss, commonly known as sarcopenia, is highly prevalent and prognostic of adverse outcomes in oncology. However, there is limited information on adults with early breast cancer and examination of other skeletal muscle indices, despite the potential prognostic importance. This study characterizes and examines age-related changes in body composition of adults with early breast cancer and describes the creation of a novel integrated muscle measure. Female patients diagnosed with stage I-III breast cancer with abdominal computerized tomography (CT) scans within 12 weeks from diagnosis were identified from local tumor registry (N = 241). Skeletal muscle index (muscle area per height [cm /m ]), skeletal muscle density, and subcutaneous and visceral adipose tissue areas, were determined from CT L3 lumbar segments. We calculated a novel integrated skeletal measure, skeletal muscle gauge, which combines skeletal muscle index and density (SMI × SMD). 241 patients were identified with available CT imaging. Median age 52 years and range of 23-87. Skeletal muscle index and density significantly decreased with age. Using literature based cut-points, older adults (≥65 years) had significantly higher proportions of sarcopenia (63 vs 28%) and myosteatosis (90 vs 11%) compared to younger adults (<50 years). Body mass index was positively correlated with skeletal muscle index and negatively correlated with muscle density. Skeletal muscle gauge correlated better with increasing age (ρ = 0.52) than with either skeletal muscle index (ρ = 0.20) or density (ρ = 0.46). Wide variations and age-related changes in body composition metrics were found using routinely obtained abdominal CT imaging. Skeletal muscle index and density provide independent, complementary information, and the product of the two metrics, skeletal muscle gauge, requires further research to explore its impact on outcomes in women with curable breast cancer.

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Low muscle attenuation is a prognostic factor for survival in metastatic breast cancer patients treated with first line palliative chemotherapy

Cited by 122 publications

References 42 publications

Correlation between muscle mass and handgrip strength in digestive cancer patients undergoing chemotherapy

Correlation between muscle mass and handgrip strength in digestive cancer patients undergoing chemotherapy

Lipid is heterogeneously distributed in muscle and associates with low radiodensity in cancer patients

Beyond sarcopenia: Characterization and integration of skeletal muscle quantity and radiodensity in a curable breast cancer population

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