Prognostic value of adipose tissue and muscle mass in advanced colorectal cancer: a post hoc analysis of two non-randomized phase II trials

Charette, Nicolas; Vandeputte, Caroline; Ameye, Lieveke; Bogaert, Camille Van; Krygier, J.; Guiot, Thomas; Deleporte, Amélie; Delaunoit, Thierry; Geboes, Karen; Laethem, Jean‐Luc Van; Peeters, Marc; Demolin, Gauthier; Holbrechts, Stéphane; Flamen, Patrick; Paesmans, Marianne; Hendlisz, Alain

doi:10.1186/s12885-019-5319-8

Cited by 76 publications

(115 citation statements)

References 34 publications

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“…However, although several studies have revealed an association between SM and severe or infectious postoperative complications , a lack of association with severe postoperative complications was found in other studies . Muscle density was found to be associated with long‐term overall survival , in contrast to other studies . For VAT, the association with prolonged LOS showed both positive and negative results .…”

Section: Introductionmentioning

confidence: 67%

“…This inconsistency is in line with available literature. Low muscle density has been associated with postoperative complications and long‐term survival , although other studies have found no associations with overall or severe postoperative complications and long‐term survival . The same counts for VAT or visceral obesity, which was found to be associated with postoperative complications , LOS , readmission , and 2‐year survival in some studies.…”

Section: Discussionmentioning

confidence: 94%

“…The current body of evidence shows inconsistent associations between body composition measures and adverse outcomes in patients with CRC. Low SM has been shown to be associated with severe postoperative complications , LOS , dose‐limiting toxicity , and long‐term survival . However, other studies did not show associations between low SM and overall or severe postoperative complications , readmission , and long‐term survival .…”

Section: Discussionmentioning

confidence: 97%

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Computed Tomography-Based Body Composition Is Not Consistently Associated with Outcome in Older Patients with Colorectal Cancer

Looijaard¹,

Meskers²,

Slee-Valentijn³

et al. 2019

The Oncologist

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Background Current literature is inconsistent in the associations between computed tomography (CT)‐based body composition measures and adverse outcomes in older patients with colorectal cancer (CRC). Moreover, the associations with consecutive treatment modalities have not been studied. This study compared the associations of CT‐based body composition measures with surgery‐ and chemotherapy‐related complications and survival in older patients with CRC. Materials and Methods A retrospective single‐center cohort study was conducted in patients with CRC aged ≥65 years who underwent elective surgery between 2010 and 2014. Gender‐specific standardized scores of preoperative CT‐based skeletal muscle (SM), muscle density, intermuscular adipose tissue (IMAT), visceral adipose tissue (VAT), subcutaneous adipose tissue, IMAT percentage, SM/VAT, and body mass index (BMI) were tested for their associations with severe postoperative complications, prolonged length of stay (LOS), readmission, and dose‐limiting toxicity using logistic regression and 1‐year and long‐term survival (range 3.7–6.6 years) using Cox regression. Bonferroni correction was applied to account for multiple testing. Results The study population consisted of 378 patients with CRC with a median age of 73.4 (interquartile range 69.5–78.4) years. Severe postoperative complications occurred in 13.0%, and 39.4% of patients died during follow‐up. Dose‐limiting toxicity occurred in 77.4% of patients receiving chemotherapy (n = 53). SM, muscle density, VAT, SM/VAT, and BMI were associated with surgery‐related complications, and muscle density, IMAT, IMAT percentage, and SM/VAT were associated with long‐term survival. After Bonferroni correction, no CT‐based body composition measure was significantly associated with adverse outcomes. Higher BMI was associated with prolonged LOS. Conclusion The associations between CT‐based body composition measures and adverse outcomes of consecutive treatment modalities in older patients with CRC were not consistent or statistically significant. Implications for Practice Computed tomography (CT)‐based body composition, including muscle mass, muscle density, and intermuscular, visceral, and subcutaneous adipose tissue, showed inconsistent and nonsignificant associations with surgery‐related complications, dose‐limiting toxicity, and overall survival in older adults with colorectal cancer. This study underscores the need to verify whether CT‐based body composition measures are worth implementing in clinical practice.

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Section: Introductionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 97%

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Computed Tomography-Based Body Composition Is Not Consistently Associated with Outcome in Older Patients with Colorectal Cancer

Looijaard¹,

Meskers²,

Slee-Valentijn³

et al. 2019

The Oncologist

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“…However, depending on the moment the patient is evaluated, PG-SGA will not be effective to correlate with survival (17,35) . It is observed that changes in body composition (36) , such as body fat in FIGURE 1B, can be related to the survival of the patient with CRC.…”

Section: Discussionmentioning

confidence: 99%

Adiponectin, Vitamin D and Nutritional Status in Patients With Advanced Colorectal Cancer or During Follow-Up

Cavagnari

Vidigal

Silva

et al. 2019

Arq. Gastroenterol.

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BACKGROUND: Considering the high incidence of colorectal cancer (CRC) related deaths, many studies have investigated variables that can affect survival, with the aim of prolonging survival. The nutritional status can also be predict survival in patients with CRC. OBJECTIVE: The aim of the present study was to evaluate if BMI, %FAT, PhA, PG-SGA, adiponectin levels, and vitamin D levels are relevant to the characterization and differentiation of patients with advanced CRC and patients with a history of CRC. METHODS: The study was carried out by patients with advanced colorectal cancer (Group 1) and patients in follow-up after colorectal cancer treatment (Group 2). Nutritional status was assessed using the body mass index, body fat percentage, phase angle from bioelectrical impedance, Patient-Generated Subjective Global Assessment score. Adiponectin concentrations were determined using an enzyme-linked immunosorbent assay, and vitamin D levels were measured using high performance liquid chromatography. RESULTS: Groups 1 and 2 consisted of 23 and 27 patients, respectively. The body mass index, body fat percentage, phase angle, vitamin D and adiponectin levels were not significantly different between the groups. The mean Patient-Generated Subjective Global Assessment score was significantly higher in group 1 compared with group 2, and was significantly correlated with the long-term mortality risk. CONCLUSION: Among the nutritional status parameters, only the Patient-Generated Subjective Global Assessment score was significantly different between the groups and was an important predictor of survival in patients with advanced colorectal cancer.

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“…Přítomnost sarkopenie ještě před dia gnózou CRC (tedy v době screeningové kolonoskopie) pozitivně koreluje s přítomností pokročilého onemocnění, které se najde dalším vyšetřováním [20][21][22]. Podle výsledků četných studií koreluje přítomnost sarkopenie u nemetastatického CRC v předoperačním období s výskytem operačních komplikací a horší prognózou [23][24][25][26]. Sarkopenie je také spojena s horší prognózou u starších pacientů léčených neoadjuvantní nebo adjuvantní chemoradioterapií pro karcinom rekta [27,28].…”

Section: Sarkopenie a Systémová Léčba Mcrcunclassified

Sarcopenia in Metastatic Colorectal Carcinoma

Büchler¹,

Hornová²

2019

Klin Onkol

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SouhrnSarkopenie je ztráta svalové hmoty (skeletal muscle mass -SMM) spojená se snížením svalové síly a/ nebo fyzické výkonnosti. U pacientů s malignitami jde o multifaktoriální problém, na jehož vzniku se podílí jak chronický zánět spojený se zhoubnými nádory, tak stárnutí, nutriční deficience, inaktivita a onkologická léčba. Metastatický kolorektální karcinom (metastatic colorectal cancer -mCRC) je podobně jako jiné nádory zažívacího traktu provázen vysokou prevalencí sarkopenie (přibližně 30-60 % v době zahájení léčby 1. linie). Sarkopenie je u mCRC objektivně měřitelným nezávislým prognostickým faktorem a prediktorem toxicity systémové léčby. Detekce a kvantifikace sarkopenie v běžné klinické praxi nevyžaduje žádná vyšetření kromě u mCRC běžně využívaných zobrazovacích metod. První výsledky ukazují na různý vliv režimů používaných v léčbě mCRC na svalovou hmotu. SMM má tendenci se zmenšovat během podávání intenzivních režimů. Naopak během udržovací léčby s nízkou intenzitou nebo při observaci u pacientů se stabilizovanou nádorovou chorobou dochází k nárůstu SMM. Longitudinálně se výrazně uplatňuje vliv základní nemoci -při progresi nádoru dochází k redukci SMM. Terapie 3. linie regorafenibem, tyrozinkinázovým inhibitorem receptoru pro vaskulární endoteliální růstový faktor, ve srovnání s chemoterapií trifluridinem/ tipiracilem snižuje objem skeletální muskulatury, což může mít vliv na přežití či kvalitu života pacientů. Pro objasnění významu změn objemu skeletálních svalů během léčby mCRC však budou nutné větší prospektivní studie. Klíčová slovakolorektální karcinom -sarkopenie -chemoterapie -cílená molekulární terapie SummarySarcopenia is the loss of skeletal muscle mass (SMM) and is associated with decreased muscle strength and/ or decreased physical performance. Sarcopenia in patients with malignancies is a multifactorial problem, caused by chronic inflammation associated with malignancies, aging, nutritional deficiency, inactivity, and antineoplastic treatment. Sarcopenia is present in approximately 30-60% of patients with metastatic colorectal cancer (mCRC). It is an objective, measurable predictor of survival and systemic toxicity. The detection and quantification of sarcopenia in routine clinical practice does not require any particular test beyond routine imaging. Initial results show that regimens used to treat mCRC can have differential effect on skeletal mass. SMM tends to decrease during intensive regimens. Conversely, SMM tends to increase during low-intensity maintenance therapy or in patients with stable disease. The status of the underlying disease is another determinant of muscle mass changes, and SMM decreases during disease progression. Third-line therapy with regorafenib, a tyrosine kinase inhibitor of the vascular endothelial growth factor receptor, results in more skeletal muscle loss than trifluridine/ tipiracil chemotherapy, which may have consequences for the survival or quality of life of patients. Larger prospective studies are needed to elucidate the importance of SMM changes durin...

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Prognostic value of adipose tissue and muscle mass in advanced colorectal cancer: a post hoc analysis of two non-randomized phase II trials

Cited by 76 publications

References 34 publications

Computed Tomography-Based Body Composition Is Not Consistently Associated with Outcome in Older Patients with Colorectal Cancer

Computed Tomography-Based Body Composition Is Not Consistently Associated with Outcome in Older Patients with Colorectal Cancer

Adiponectin, Vitamin D and Nutritional Status in Patients With Advanced Colorectal Cancer or During Follow-Up

Sarcopenia in Metastatic Colorectal Carcinoma

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