Prognostic Significance of Muscle Attenuation in Pancreatic Cancer Patients Treated with Neoadjuvant Chemoradiotherapy

Akahori, Toshikazu; Sho, Masayuki; Kinoshita, Shoichi; Nagai, Minako; Nishiwada, Satoshi; Tanaka, Toshihiro; Tamamoto, Tetsuro; Ohbayashi, Chiho; Hasegawa, Masatoshi; Kichikawa, Kimihiko; Nakajima, Yoshiyuki

doi:10.1007/s00268-015-3205-3

Cited by 50 publications

(73 citation statements)

References 61 publications

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“…For articles that remained after the initial screen, 65 full texts were reviewed for eligibility. Ultimately, 24 studies were selected for inclusion in the systematic review-18 articles [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43]47] and 6 abstracts [33, 44-46, 48, 53]-with a total of 3,607 patients. Table 2 provides an overview of included studies regarding number of study participants, cancer types, inclusion criteria, and stage of care when the BIA assessment was conducted.…”

Section: Resultsmentioning

confidence: 99%

Bioelectrical Impedance Analysis for the Assessment of Sarcopenia in Patients with Cancer: A Systematic Review

et al. 2019

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Background. The loss of muscle mass, known as sarcopenia, is a natural process of aging that is associated with adverse health outcomes regardless of age. Because cancer is a disease of aging, interest in sarcopenia and its potential impact in multiple cancer populations has increased significantly. Bioelectrical impedance analysis (BIA) is a guideline-accepted method for sarcopenia detection. This systematic review assesses the literature pertaining to BIA use in the detection of sarcopenia in adults with cancer. Materials and Methods. In this systematic review, a search of the literature for randomized controlled trials and observational studies was conducted using MEDLINE, Cochrane CENTRAL, and EMBASE, through July 15, 2019. The study is registered at Prospero (CRD 42019130707). For study inclusion, patients had to be aged 18 years or older and diagnosed with solid or hematological neoplasia, and BIA had to be used to detect sarcopenia. Results. Through our search strategy, 5,045 articles were identified, of which 24 studies were selected for inclusion in the review (total number of 3,607 patients). In five studies, BIA was rated comparable to axial computed tomography (CT) scan, calf circumference, or grip strength for sarcopenia screening. In 14 studies, BIAidentified sarcopenia was associated with adverse clinical outcomes. Conclusion. BIA is an accurate method for detecting sarcopenia in adults with cancer prior to treatment and is a viable alternative to CT, dual-energy x-ray absorptiometry, and magnetic resonance imaging in oncology clinical practice. The Oncologist 2020;25:170-182 Implications for Practice: Bioelectrical impedance analysis (BIA) is an attractive method for identifying sarcopenic patients in clinical practice because it provides an affordable, noninvasive test that can be completed within a few minutes during a clinic visit. BIA does not require highly skilled personnel, and results are immediately available. This systematic review summarizes the literature pertaining to BIA assessment of sarcopenia in adults with cancer, with a focus on its use in diverse cancer populations.

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Section: Resultsmentioning

confidence: 99%

Bioelectrical Impedance Analysis for the Assessment of Sarcopenia in Patients with Cancer: A Systematic Review

et al. 2019

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“…This is important as preoperative sarcopenia has been shown to be an important risk factor for postoperative complications following pancreatectomy [21–28] and that some studies have demonstrated either a decrease in SKM [8] or muscle attenuation [11] during preoperative therapy for PDAC. In fact, we previously showed that minor changes in SKM, VAT and SAT occur during preoperative therapy for PDAC but that these changes did not preclude subsequent pancreatectomy nor were they associated with survival [8].…”

Section: Discussionmentioning

confidence: 99%

“…Other studies have reported that clinically significant anthropometric changes occur during neoadjuvant therapy for various malignancies [9–11]. However, the anthropometric and nutritional changes that occur following curative therapy for localized PDAC and throughout the survivorship period have not previously been investigated.…”

Section: Introductionmentioning

confidence: 99%

Anthropometric Changes in Patients with Pancreatic Cancer Undergoing Preoperative Therapy and Pancreatoduodenectomy

Cloyd

Nogueras‐González

Prakash

et al. 2018

Journal of Gastrointestinal Surgery

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Background The changes in body composition that occur in response to therapy for localized PDAC and during the early survivorship period, as well as their clinical significance, are poorly understood. Methods 127 consecutive patients with PDAC who received preoperative therapy followed by pancreatoduodenectomy at a single institution between 2009–2012 were longitudinally evaluated. Changes in skeletal muscle (SKM), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) were measured on serial computed tomography images obtained upon presentation, prior to pancreatectomy, and approximately 3 and 12 months after surgery. Results Prior to therapy, patients’ mean baseline BMI was 26.5±4.7 Kg/m2 and 63.0% met radiographic criteria for sarcopenia. During a mean 5.4±2.3 months of preoperative therapy, minimal changes in SKM (−0.5±7.8%, p>0.05), VAT (−1.8±62.6%, p<0.001), and SAT (−4.8±27.7%, p<0.001) were observed. In contrast, clinically significant changes were observed on post-operative CT compared to baseline anthropometry: SKM −4.1±10.7%, VAT −38.7±30.2%, and SAT −24.1±22.6% (all p<0.001) and these changes persisted at one year following PD. While anthropometric changes during preoperative therapy were not independently associated with survival, SKM gain between the postoperative period and one year follow-up was associated with improved overall survival (OR 0.50, 95% CI 0.29–0.87). Conclusions In contrast to the minor changes that occur during preoperative therapy for PDAC, significant losses in key anthropometric parameters tend to occur over the first year following PD. Ongoing SKM loss in the postoperative period may represent an early marker for worse outcomes.

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“…Most studies that measure body composition with CT analysis attempt to identify the prognostic ability of skeletal muscle cross‐sectional area, or changes in skeletal muscle attenuation values (ie, HUs) at a single time point 10 , 12 – 21 , 32 – 35 . In general, skeletal muscle cross‐sectional area and muscle attenuation are often demonstrated to have strong prognostic values—with lower cross‐sectional area or reduced attenuation values being associated with worse outcomes.…”

Section: Ctmentioning

confidence: 99%

“…Some investigators have attempted to use average CT HUs as a way to evaluate muscle quality , but the validity of this practice is not clear 10 , 11 , 33 , 34 , 37 . This will need to be validated through studies that include muscle biopsies.…”

Section: Ctmentioning

confidence: 99%

The Use of Technology for Estimating Body Composition

et al. 2016

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Assessment of body composition, both at single time points and longitudinally, is particularly important in clinical nutrition practice. It provides a means for the clinician to characterize nutrition status at a single time point, aiding in the identification and diagnosis of malnutrition, and to monitor changes over time by providing real-time information on the adequacy of nutrition interventions. Objective body composition measurement tools are available clinically but are often underused in nutrition care, particularly in the United States. This is, in part, due to a number of factors concerning their use in a clinical context: cost and accessibility of equipment, as well as interpretability of the results. This article focuses on the factors influencing interpretation of results in a clinical setting. Body composition assessment, regardless of the method, is inherently limited by its indirect nature. Therefore, an understanding of the strengths and limitations of any method is essential for meaningful interpretation of its results. This review provides an overview of body composition technologies available clinically (computed tomography, dual-energy x-ray absorptiometry, bioimpedance, ultrasound) and discusses the strengths and limitations of each device.

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Prognostic Significance of Muscle Attenuation in Pancreatic Cancer Patients Treated with Neoadjuvant Chemoradiotherapy

Abstract: Muscle attenuation may have a significant impact in pancreatic cancer patients treated with multimodal therapy. Therefore, our data may provide new insights into perioperative patient care to improve the prognosis of resectable pancreatic cancer.

Cited by 50 publications

References 61 publications

Bioelectrical Impedance Analysis for the Assessment of Sarcopenia in Patients with Cancer: A Systematic Review

Bioelectrical Impedance Analysis for the Assessment of Sarcopenia in Patients with Cancer: A Systematic Review

Anthropometric Changes in Patients with Pancreatic Cancer Undergoing Preoperative Therapy and Pancreatoduodenectomy

The Use of Technology for Estimating Body Composition

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