Skeletal muscle depletion is an independent prognostic factor for hepatocellular carcinoma

Iritani, Soichi; Imai, Kenji; Koji, Takehiko; Hanai, Taizo; Ideta, Takayasu; Miyazaki, Tsuneyuki; Suetsugu, Atsushi; Shiraki, Makoto; Shimizu, Masahito; Moriwaki, Hisataka

doi:10.1007/s00535-014-0964-9

Cited by 218 publications

(223 citation statements)

References 36 publications

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“…Sarcopenia and myosteatosis have been significantly associated with a range of adverse outcomes including increased rate of post‐operative complications,10, 11, 40, 41, 42 longer length of hospital stay,41, 43 30‐day post‐operative mortality and in‐hospital mortality,44 and dose‐limiting toxicities 5, 6, 7, 8, 45, 46, 47, 48, 49, 50. In addition, the conditions have been demonstrated as independent predictors of reduced overall survival 18, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64. The situation is further complicated by the obesity epidemic that has been progressively worsening in recent times.…”

Section: Discussionmentioning

confidence: 99%

Computed tomography diagnosed cachexia and sarcopenia in 725 oncology patients: is nutritional screening capturing hidden malnutrition?

Bhuachalla

Daly

Power

et al. 2017

J cachexia sarcopenia muscle

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BackgroundNutrition screening on admission to hospital is mandated in many countries, but to date, there is no consensus on which tool is optimal in the oncology setting. Wasting conditions such as cancer cachexia (CC) and sarcopenia are common in cancer patients and negatively impact on outcomes; however, they are often masked by excessive adiposity. This study aimed to inform the application of screening in cancer populations by investigating whether commonly used nutritional screening tools are adequately capturing nutritionally vulnerable patients, including those with abnormal body composition phenotypes (CC, sarcopenia, and myosteatosis).MethodsA prospective study of ambulatory oncology outpatients presenting for chemotherapy was performed. A detailed survey incorporating clinical, nutritional, biochemical, and quality of life data was administered. Participants were screened for malnutrition using the Malnutrition Universal Screening Tool (MUST), Malnutrition Screening Tool (MST), and the Nutritional Risk Index (NRI). Computed tomography (CT) assessment of body composition was performed to diagnose CC, sarcopenia, and myosteatosis according to consensus criteria.ResultsA total of 725 patients (60% male, median age 64 years) with solid tumours participated (45% metastatic disease). The majority were overweight/obese (57%). However, 67% were losing weight, and CT analysis revealed CC in 42%, sarcopenia in 41%, and myosteatosis in 46%. Among patients with CT‐identified CC, the MUST, MST, and NRI tools categorized 27%, 35%, and 7% of them as ‘low nutritional risk’, respectively. The percentage of patients with CT‐identified sarcopenia and myosteatosis that were categorised as ‘low nutritional risk’ by MUST, MST and NRI were 55%, 61%, and 14% and 52%, 50%, and 11%, respectively. Among these tools, the NRI was most sensitive, with scores <97.5 detecting 85.8%, 88.6%, and 92.9% of sarcopenia, myosteatosis, and CC cases, respectively. Using multivariate Cox proportional hazards models, NRI score < 97.5 predicted greater mortality risk (hazard ratio 1.8, confidence interval: 1.2–2.8, P = 0.007).ConclusionsHigh numbers of nutritionally vulnerable patients, with demonstrated abnormal body composition phenotypes on CT analysis, were misclassified by MUST and MST. Caution should be exercised when categorizing the nutritional risk of oncology patients using these tools. NRI detected the majority of abnormal body composition phenotypes and independently predicted survival. Of the tools examined, the NRI yielded the most valuable information from screening and demonstrated usefulness as an initial nutritional risk grading system in ambulatory oncology patients.

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Section: Discussionmentioning

confidence: 99%

Computed tomography diagnosed cachexia and sarcopenia in 725 oncology patients: is nutritional screening capturing hidden malnutrition?

Bhuachalla

Daly

Power

et al. 2017

J cachexia sarcopenia muscle

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“…The measurement of the CT-CSA at L3 is reliable for the assessment of sarcopenia [11, 17]. Hepatocellular carcinoma patients with sarcopenia defined by the CT-CSA measurement have a significantly higher mortality than those without sarcopenia [18]. Among patients treated with capecitabine for metastatic breast cancer, those with sarcopenia defined by the CT-CSA have a higher grade of chemotherapy toxicity and a shorter time to disease progression than those without sarcopenia [19].…”

Section: Discussionmentioning

confidence: 99%

The Impact of Skeletal Muscle Depletion on Head and Neck Squamous Cell Carcinoma

Nishikawa

Hanai

Suzuki

et al. 2018

ORL

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Background: Skeletal muscle depletion and sarcopenia have been reported as poor prognostic factors for several types of cancer. The aim of this study was to investigate the prognostic impact of skeletal muscle depletion and sarcopenia on the outcomes in head and neck cancer patients. Methods: Patients with head and neck squamous cell carcinoma (HNSCC) treated from January 2013 to June 2014 were included in this study. The pretreatment cross-sectional area of skeletal muscle at the third lumbar vertebra (L3) was measured by computed tomography image analysis using the ImageJ software. L3 skeletal muscle index (SMI) and fat-free mass (FFM) were calculated. Results: Eighty-five patients with HNSCC were included. The cut-off value of sarcopenia was set at SMI <46.7 cm²/m² (males) and 30.3 cm²/m² (females). The cut-off value of FFM was set at 42.3 kg (males) and 30.6 kg (females). Patients with a low SMI (sarcopenia) and low FFM had a significantly poorer prognosis than others, especially those who received definitive radiotherapy. Sarcopenia and low FFM are independent factors for poor prognosis in patients with HNSCC. Conclusion: The skeletal muscle area at L3 should be calculated when considering treatment options for head and neck cancer.

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“…The crude pooled HR of skeletal muscle mass loss for recurrence-free survival from 6 studies was calculated to be 1.85 (95% CI: 1.44-2.37) [21,22,24,[26][27][28], while the adjusted summary HR from 4 selected trials was 1.76 (95% CI: 1.27-2.45) (Fig. 5) [22,23,26,27].…”

Section: Recurrence-free Survivalmentioning

confidence: 99%

“…In terms of patient demographic characteristics, female patients accounted for 28.4% of the investigated population and the mean (or median) age of the enrolled patients in each study (or its subgroup) ranged between 57 and 73.9 years. Regarding the pattern of underlying malignancy, 7 studies included patients with resectable HCC [21][22][23][24][25][26][27], 3 included patients with any clinical stage of HCC [20,28,29], 1 included patients with primary liver tumors (69.8% had HCC) [30], 1 included patients with hepatic cancers (50.5% had HCC) undergoing intraarterial therapy [31], and 1 included patients with HCC following sorafenib treatment [32]. The muscle volume was estimated on the transverse CT image at the third lumbar vertebra level in all the selected studies, although the intensity window -(shown by using the Hounsfield scale) for recognizing skeletal muscles and cut-off points for sarcopenia -varied across trials ( Table 1).…”

Section: Study Characteristicsmentioning

confidence: 99%

Association between Loss of Skeletal Muscle Mass and Mortality and Tumor Recurrence in Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

Chang¹,

Chen

Wu³

et al. 2017

Liver Cancer

155

140

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Background: Hepatocellular carcinoma (HCC) has multiple prognostic factors, and there is an increase in knowledge about the body composition and physical status of patients with HCC. The present meta-analysis aimed to explore whether loss of skeletal muscle mass is associated with mortality and tumor recurrence in patients with HCC. Method: A systematic search was conducted for published literature using PubMed, Embase, and Scopus. We included cohort or case-control studies investigating patients with HCC. The primary and secondary outcomes were the associations of loss of skeletal muscle mass with overall survival and tumor recurrence, respectively, expressed by a summary hazard ratio (HR) and 95% confidence interval (CI). Result: A total of 13 studies comprising 3,111 patients were included. The summary HRs calculated by either univariate or multivariate analysis both suggested a significant association between sarcopenia and all-cause mortality (crude HR = 2.04, 95% CI: 1.74-2.38; adjusted HR = 1.95, 95% CI: 1.60-2.37). Similarly, loss of skeletal muscle mass was associated with tumor recurrence (crude HR = 1.85, 95% CI: 1.44-2.37; adjusted HR = 1.76, 95% CI: 1.27-2.45). The stratified analysis showed that treatment types and inclusion of body mass index or body weight in the Cox regression model did not modify both clinical outcomes. With an increase in cut-off values of muscle mass on computed tomography images (especially for male patients), there was an insignificant trend of stronger associations between loss of skeletal muscle mass and all-cause mortality. Conclusion: Loss of skeletal muscle mass is associated with increased all-cause mortality and tumor recurrence in patients with HCC. Further prospective studies incorporating measurements of muscle strength and physical function are warranted to see whether inclusion of both parameters better predicts the outcome than use of muscle mass only.

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Skeletal muscle depletion is an independent prognostic factor for hepatocellular carcinoma

Abstract: Skeletal muscle depletion is an independent prognostic factor. Intervention to prevent muscle wasting might be an effective strategy for improving the outcome of HCC.

Cited by 218 publications

References 36 publications

Computed tomography diagnosed cachexia and sarcopenia in 725 oncology patients: is nutritional screening capturing hidden malnutrition?

Computed tomography diagnosed cachexia and sarcopenia in 725 oncology patients: is nutritional screening capturing hidden malnutrition?

The Impact of Skeletal Muscle Depletion on Head and Neck Squamous Cell Carcinoma

Association between Loss of Skeletal Muscle Mass and Mortality and Tumor Recurrence in Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

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