Preoperative sarcopenia and post‐operative accelerated muscle loss negatively impact survival after resection of pancreatic cancer

Choi, Moon Hyung; Yoon, Seung Bae; Lee, Kyungjin; Song, Minju; Lee, In Seok; Lee, Myung Ah; Hong, Tae Ho; Choi, Myung‐Gyu

doi:10.1002/jcsm.12274

Cited by 118 publications

(158 citation statements)

References 41 publications

Supporting

Mentioning

150

Contrasting

Unclassified

Order By: Relevance

“…Evaluating muscle at a single specific time point may not help in predicting survival and could not evaluate muscle loss . These findings suggested that a longitudinal study of changes in body composition may provide a more comprehensive understanding of the impacts of body composition on outcomes …”

Section: Discussionmentioning

confidence: 99%

“…In this study, SMD at baseline was negatively correlated with BMI and TATI and weakly correlated with SMI ( Figure S3). We defined our own cut‐off values for our cohort based on previous studies with similar population sizes . Using the present cut‐off value of SMD, the myosteatosis group had significantly higher adipose tissue indexes and non‐significantly higher BMI.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Muscle radiodensity loss during cancer therapy is predictive for poor survival in advanced endometrial cancer

Lee

Lin

et al. 2019

J cachexia sarcopenia muscle

View full text Add to dashboard Cite

Background Treatment‐related toxicities and decreased levels of patient performance during cancer therapy might contribute to body composition changes and thereby impact outcomes. However, the effect of longitudinal body composition changes on outcomes in patients with advanced endometrial cancer is unknown. This study investigated the association between body composition changes during staging surgery and adjuvant chemoradiotherapy and outcomes in patients with stage III endometrial cancer. Methods Pretreatment and post‐treatment computed tomography (CT) images of 131 patients with stage III endometrial cancer who were treated between 2008 and 2016 were analysed. All CT images were contrast enhanced and acquired according to the standardized protocol. The skeletal muscle index (SMI), skeletal muscle radiodensity (SMD), and total adipose tissue index were measured from two sets of CT images obtained at the level of the third lumbar vertebra. The skeletal muscle gauge was calculated by multiplying SMI by SMD (SMI × SMD). Predictors of overall survival and progression‐free survival were identified using Cox regression models. Results The median follow‐up was 50.6 (range 12.1–117.0) months. Overall, body mass index (BMI) changes during treatment were 0.4% per 210 days (95% confidence interval: −0.6 to 1.4; P = 0.41), and patients experienced an average SMD loss of 2.1% per 210 days (95% confidence interval: −4.0 to −0.2; P = 0.03). Weight loss and SMD loss ≥5% were observed in 23 (17.6%) and 54 (41.2%) patients, respectively. The changes in SMD did not correlate with those in BMI (Spearman's ρ for SMD, −0.13; P = 0.13). SMD change (per 1 Hounsfield unit/210 days decrease) was independently associated with poorer overall survival (hazard ratio: 1.32, 95% confidence interval: 1.14–1.52; P < 0.001) and progression‐free survival (hazard ratio: 1.28, 95% confidence interval: 1.12–1.43; P < 0.001). Our results did not show association between survival and pretreatment myosteatosis and sarcopenia or changes in SMI and total adipose tissue index during treatment. The pretreatment skeletal muscle gauge was associated with treatment modifications such as delays, dose reductions, and discontinuation of chemotherapy. Conclusions Skeletal muscle radiodensity decreased significantly during treatment and was independently associated with poorer survival in patients with stage III endometrial cancer who underwent staging surgery and adjuvant chemoradiotherapy. SMD loss was occult and occurred independently of BMI change.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Muscle radiodensity loss during cancer therapy is predictive for poor survival in advanced endometrial cancer

Lee

Lin

et al. 2019

J cachexia sarcopenia muscle

View full text Add to dashboard Cite

show abstract

“…In patients with end-stage liver disease and awaiting transplantation, a model including sarcopenia could even surpass the MELD score in predicting waiting list mortality [54]. A variety of studies [19,30,32] have also explored the role of sarcopenia in the occurrence of complications in patients undergoing hepatopancreatobiliary surgery. In these studies, sarcopenia was defined by various indexes; however, the conclusions drawn from different studies and various indexes have remained controversial.…”

Section: Discussionmentioning

confidence: 99%

“…Fifteen studies [11,13,[20][21][22][23] [32], and 1 in China [26]. Among the included studies, 13 studies were directed at liver [11,13,[19][20][21][22][23][24][25][26][27][28][29] malignancy, 2 bile duct [30,31], 6 pancreas [12,14,[32][33][34][35], 2 periampullary [36,37], 4 periampullary and pancreas [38][39][40][41], and 1 hepatopancreatobiliary [42]. The sample size ranged from 67 to 763.…”

Section: Study Characteristicsmentioning

confidence: 99%

Computed Tomography-Assessed Sarcopenia Indexes Predict Major Complications following Surgery for Hepatopancreatobiliary Malignancy: A Meta-Analysis

et al. 2018

View full text Add to dashboard Cite

Background: Computed tomography (CT)-assessed sarcopenia indexes have been reported to predict postoperative morbidity and mortality; however conclusions drawn from different indexes and studies remain controversial. Aim: The purpose of this meta-analysis was to evaluate various CT-assessed sarcopenia indexes as predictors of risk for major complications in patients undergoing hepatopancreatobiliary surgery for malignancy. Methods: Medline/PubMed, Web of Science, and Embase databases were systematically searched to identify relevant studies published before June 2018. PRISMA guidelines for systematic reviews were followed. The pooled risk ratio (RR) for major postoperative complications (Clavien-Dindo ≥III) was estimated in patients with sarcopenia versus patients without sarcopenia. Data extracted were meta-analyzed using Review Manager (version 5.3). Results: Twenty-eight studies comprising 6,656 patients were included in this study. CT-assessed sarcopenia indexes, such as skeletal muscle index (SMI, RR 1.36; 95% CI 1.14–1.63; p = 0.0008; I² = 24%), psoas muscle index (PMI, RR 1.35; 95% CI 1.15–1.58; p = 0.0002; I² = 0%), muscle attenuation (MA, RR 1.40; 95% CI 1.14–1.73; p = 0.002; I² = 4%), and intramuscular adipose tissue content (IMAC, RR 1.63; 95% CI 1.28–2.09; p < 0.0001; I² = 0%) were all predictors of postoperative major complications, although moderate heterogeneity existed and cutoffs for these indexes to define sarcopenia varied. Conclusions: All commonly used CT-assessed sarcopenia indexes, such as SMI, PMI, MA, and IMAC can predict the risk of major postoperative complications; however, a consensus on the cutoffs for these indexes to define sarcopenia is still lacking.

show abstract

“…15 The effects of body compositions on post-operative longterm outcomes have been reported in patients with pancreatic cancer and hepatocellular carcinoma. 16,17 In case of biliary tract cancer, there have been a few studies analysing the relationship between prognosis and body composition, limited to a specific location of bile duct cancer (i.e. distal, perihilar, or intrahepatic bile ducts).…”

Section: Introductionmentioning

confidence: 99%

Impact of preoperative body compositions on survival following resection of biliary tract cancer

Yoon

Choi

Song

et al. 2019

J cachexia sarcopenia muscle

Self Cite

View full text Add to dashboard Cite

Background Although surgical resection is the only potentially curative treatment for biliary tract cancer, the prognosis remains poor after a major operation such as pancreatoduodenectomy or hepatectomy. We aimed to investigate the impact of preoperative body compositions on long‐term survival of patients undergoing resection of biliary tract cancer. Methods We analysed data of patients diagnosed with biliary tract cancer who underwent surgery from 2009 to 2015. Skeletal muscle area, skeletal muscle radiation attenuation, and visceral and subcutaneous adipose tissue areas were measured from the computed tomography images at L3 vertebral levels obtained before resection of cancer. Patients were divided into two groups based on the sex‐specific median values for each parameter, and long‐term survival was compared between the groups. Results A total of 371 patients (women, 39.6%; mean age, 66.2 ± 9.6 years) were finally included in the analysis. Patients with low skeletal muscle index (SMI) had significantly shorter median survival than those with high SMI (29 vs. 39 months; P = 0.026). Patients with low skeletal muscle attenuation (SMA) also showed reduced survival compared with those with high SMA (median survival 25 vs. 60 months; P = 0.002). Combining these two factors, survival was highest in the high SMI/high SMA group (reference) and lowest in the low SMI/low SMA group (hazard ratio, 2.18; 95% confidence interval, 1.44–3.30). Visceral and subcutaneous adipose tissue areas were not associated with long‐term survival. Conclusions Low SMI and low SMA on computed tomography scan have a negative impact on survival after resection of biliary tract cancer. They can be used in preoperative risk assessment to assist in treatment decision making.

show abstract

Preoperative sarcopenia and post‐operative accelerated muscle loss negatively impact survival after resection of pancreatic cancer

Cited by 118 publications

References 41 publications

Muscle radiodensity loss during cancer therapy is predictive for poor survival in advanced endometrial cancer

Muscle radiodensity loss during cancer therapy is predictive for poor survival in advanced endometrial cancer

Computed Tomography-Assessed Sarcopenia Indexes Predict Major Complications following Surgery for Hepatopancreatobiliary Malignancy: A Meta-Analysis

Impact of preoperative body compositions on survival following resection of biliary tract cancer

Contact Info

Product

Resources

About