Sarcopenia is poor prognostic factor in older patients with locally advanced rectal cancer who received preoperative or postoperative chemoradiotherapy

Park, Song Ee; Hwang, In Gyu; Choi, Chang Hwan; Kang, Hyun; Kim, Beom Gyu; Park, Byung Kwan; Jae, Seong; Jang, Jae Seong; Choi, Jin Hwa

doi:10.1097/md.0000000000013363

Cited by 36 publications

(47 citation statements)

References 22 publications

(27 reference statements)

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“…Additionally, in a study of 70 older patients (median age: 71 years) who received neoadjuvant or adjuvant chemoradiation for rectal cancer, low skeletal muscle index (muscle depletion) was associated with a higher hazard ratio (HR) for death (6.01; p = 0.001). This HR was higher than that for age, sex, cancer stage and carcinoembryonic antigen (CEA) level [62].…”

Section: Outcomes In Older Adults With Cancer and Wasting Disordersmentioning

confidence: 73%

Cachexia and Sarcopenia in Older Adults with Cancer: A Comprehensive Review

Dunne

Loh

Williams

et al. 2019

Cancers

142

112

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Cancer cachexia is a syndrome characterized by weight loss with accompanying loss of muscle and/or fat mass and leads to impaired patient function and physical performance and is associated with a poor prognosis. It is prevalent in older adults with cancer; age-associated physiologic muscle wasting and weakness, also known as sarcopenia, can compound deficits associated with cancer cachexia in older adults and makes studying this condition more complex in this population. Multiple measurement options are available to assess the older patient with cancer and cachexia and/or sarcopenia including anthropometric measures, imaging modalities such as Dual X-ray absorptiometry (DEXA) and Computed Tomography (CT), muscular strength and physical performance testing, and patient-reported outcomes (PROs). A geriatric assessment (GA) is a useful tool when studying the older patient with cachexia given its comprehensive ability to capture aging-sensitive PROs. Interventions focused on nutrition and increasing physical activity may improve outcomes in older adults with cachexia. Efforts to develop targeted pharmacologic therapies with cachexia have not been successful thus far. Formal treatment guidelines, an updated consensus definition for cancer cachexia and the development of a widely adapted assessment tool, much like the GA utilized in geriatric oncology, could help advance the field of cancer cachexia over the next decade.

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Section: Outcomes In Older Adults With Cancer and Wasting Disordersmentioning

confidence: 73%

Cachexia and Sarcopenia in Older Adults with Cancer: A Comprehensive Review

Dunne

Loh

Williams

et al. 2019

Cancers

142

112

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“…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%

“…These varying results may have been caused by the use of different cutoff points, limiting comparison of studies. Another explanation for the inconsistency in the literature could be the inclusion of all age groups, as only one study specifically included older patients and found a significant association between low muscle mass and overall survival in patients with rectal cancer receiving chemoradiation . The association between CT‐based body composition measures and adverse outcomes is expected to differ between younger and older populations as body composition measures are negatively affected by age but still show inconsistency when only studies with a mean/median age of 65 years and older are considered.…”

Section: Discussionmentioning

confidence: 99%

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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“…Skeletal muscle index (SMI) was calculated as total L3 skeletal muscle divided by height squared. Sex‐specific thresholds of sarcopenia were 52.4 cm 2 /m 2 for men and 38.5 cm 2 /m 2 for women 11,12 …”

Section: Methodsmentioning

confidence: 99%

Sarcopenia is associated with worse overall survival in patients with anal squamous cell cancer

Bingmer

Kondray

Ofshteyn

et al. 2020

Journal of Surgical Oncology

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Background and Objectives: Sarcopenia is associated with poor long-term outcomes in many gastrointestinal cancers, but its role in anal squamous cell carcinoma (ASCC)is not defined. We hypothesized that patients with sarcopenic ASCC experience worse long-term outcomes.Methods: A retrospective review of patients with ASCC treated at an academic medical center from 2006 to 2017 was performed. Of 104 patients with ASCC, 64 underwent PET/computed tomography before chemoradiation and were included in the analysis.The skeletal muscle index was calculated as total L3 skeletal muscle divided by height squared. Sarcopenia thresholds were 52.4 cm 2 /m 2 for men and 38.5 cm 2 /m 2 for women.Cox regression analysis was performed to assess overall and progression-free survival.Results: Twenty-five percent of the patients were sarcopenic (n = 16). Demographics were similar between groups. There was no difference in the clinical stage or comorbidities between groups. On multivariate analysis, factors associated with worse overall survival were male gender (hazard ratio [HR] 3.7, P = .022) and sarcopenia (HR 3.6, P = .019). Male gender was associated with worse progression-free survival (HR 2.6, P = .016).Conclusions: Sarcopenia is associated with worse overall survival in patients with anal cancer. Further studies are indicated to determine if survival can be improved with increased attention to nutritional status in sarcopenic patients. K E Y W O R D Sanal cancer, chemoradiation, sarcopenia

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Sarcopenia is poor prognostic factor in older patients with locally advanced rectal cancer who received preoperative or postoperative chemoradiotherapy

Cited by 36 publications

References 22 publications

Cachexia and Sarcopenia in Older Adults with Cancer: A Comprehensive Review

Cachexia and Sarcopenia in Older Adults with Cancer: A Comprehensive Review

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

Sarcopenia is associated with worse overall survival in patients with anal squamous cell cancer

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