Sarcopenia Predicts Overall Survival in Patients with Lung, Breast, Prostate, or Myeloma Spine Metastases Undergoing Stereotactic Body Radiation Therapy (SBRT), Independent of Histology

Abstract

BACKGROUND Predicting survival of patients with spinal metastases would help stratify treatments from aggressive to palliation. OBJECTIVE To evaluate whether sarcopenia predicts survival in patients with lung, breast, prostate, or multiple myeloma spinal metastases. METHODS Psoas muscle measurements in patients with spinal metastasis were taken from computed tomography scans at 2 time points: at first episode of stereotactic body radiation therapy (SBRT) and from the most recent scan available. Overall survival and hazard ratios were calculated with multivariate cox proportional hazards regression analyses. RESULTS In 417 patients with spinal metastases, 40% had lung cancer, 27% breast, 21% prostate, and 11% myeloma. Overall survival was not associated with age, sex, ethnicity, levels treated, or SBRT volume. Multivariate analysis showed patients in the lowest psoas tertile had shorter survival (222 d, 95% CI = 185-323 d) as compared to the largest tertile (579 d, 95% CI = 405-815 d), (HR1.54, P = .005). Median psoas size as a cutoff value was also strongly predictive for survival (HR1.48, P = .002). Survival was independent of tumor histology. The psoas/vertebral body ratio was also successful in predicting overall survival independent of tumor histology and gender (HR1.52, P < .01). Kaplan–Meier survival curves visually represent survival (P = .0005). CONCLUSION In patients with spine metastases, psoas muscle size as a hallmark of frailty/sarcopenia is an objective, simple, and effective way to identify patients who are at risk for shorter survival, regardless of tumor histology. This information can be used to help with surgical decision making in patients with advanced cancer, as patients with small psoas sizes are at higher risk of death.

Associations of fat and muscle mass with overall survival in men with prostate cancer: a systematic review with meta-analysis

“…A total of 16 cohort studies undertaking retrospective analyses [16,24,25,[33][34][35][36][37][38][39][40][41][42][43][44][45] were included in the primary analysis. During the eligibility assessment, six additional studies [46][47][48][49][50][51] were initially selected and authors contacted given the lack of specific information on the results for prostate cancer patients. Responses were not obtained and, as a result, these studies were not included in our review.…”

Defining the vulnerable patient with myeloma—a frailty position paper of the European Myeloma Network

“…Muscle mass can be measure by several techniques though none are ideal with major limitations. The most effective to date seems to be the dual-energy X-ray absorptiometry (DXA) but CT (especially Lumbar 3 rd vertebra by CT imaging in cancer patients including MM [63]) and more recently MRI scanning have been advocated, the latter being able to pose a calibration of muscle quality as well as mass [62,64,65]. One promising approach is the d3 creatinine A isotope dilution test, which has generated more correlative results with sarcopenia than DXA [66].…”

Sarcopenia in Patients With Spinal Metastasis: A Systematic Review and Meta-Analysis of Retrospective Cohort Studies

“…Eight studies reported overall survival ( 6 , 30 – 36 ). Seven of these showed a significantly increased overall mortality related to sarcopenia.…”