Skeletal Muscle Quality Beyond Average Muscle Attenuation: A Proposal of Skeletal Muscle Phenotypes to Predict Short-Term Survival in Patients With Endometrial Cancer

Rodrigues, Camila Santos; Chaves, Gabriela Villaça

doi:10.6004/jnccn.2017.7028

Cited by 28 publications

(29 citation statements)

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“…CT images can provide objective body composition measures and are widely used in staging, radiotherapy planning, and follow‐up in patients with advanced EC. Rodrigues and Chaves reported that pretreatment sarcopenia and myosteatosis were predictors of poor short‐term survival . We measured pretreatment and post‐treatment body compositions.…”

Section: Discussionmentioning

confidence: 99%

“…61 The body composition measurement using clinically available CT images could be imaging biomarkers of survival outcomes in advanced stage EC. 38,39,47 CT images can provide objective body composition measures and are widely used in staging, radiotherapy planning, and follow-up in patients with advanced EC. Rodrigues and Chaves reported that pretreatment sarcopenia and myosteatosis were predictors of poor short-term survival.…”

Section: Discussionmentioning

confidence: 99%

“…Rodrigues and Chaves reported that pretreatment sarcopenia and myosteatosis were predictors of poor short-term survival. 38 We measured pretreatment and post-treatment body compositions. The deterioration in SMD during treatment was found to be an indicator of poor outcomes; with the increase in fat infiltration to the muscle (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…Sarcopenia and myosteatosis at the time of cancer diagnosis were previously shown to be associated with the outcome in EC . A longitudinal study of changes in body composition during cancer therapy may provide a more comprehensive understanding of the influences of body composition on cancer outcomes; however, the changes in body composition during cancer therapy and its impact on outcomes in stage III EC patients were unclear.…”

Section: Introductionmentioning

confidence: 99%

“…[35][36][37] Sarcopenia and myosteatosis at the time of cancer diagnosis were previously shown to be associated with the outcome in EC. 38,39 A longitudinal study of changes in body composition during cancer therapy may provide a more comprehensive understanding of the influences of body composition on cancer outcomes [40][41][42][43][44][45][46][47][48][49][50][51] ; however, the changes in body composition during cancer therapy and its impact on outcomes in stage III EC patients were unclear. Moreover, current doses of chemotherapy are calculated based on body surface area (BSA), which takes only height and weight into account and not other potentially important body composition parameters.…”

Section: Introductionmentioning

confidence: 99%

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Muscle radiodensity loss during cancer therapy is predictive for poor survival in advanced endometrial cancer

Lee

Lin

et al. 2019

J cachexia sarcopenia muscle

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Background Treatment‐related toxicities and decreased levels of patient performance during cancer therapy might contribute to body composition changes and thereby impact outcomes. However, the effect of longitudinal body composition changes on outcomes in patients with advanced endometrial cancer is unknown. This study investigated the association between body composition changes during staging surgery and adjuvant chemoradiotherapy and outcomes in patients with stage III endometrial cancer. Methods Pretreatment and post‐treatment computed tomography (CT) images of 131 patients with stage III endometrial cancer who were treated between 2008 and 2016 were analysed. All CT images were contrast enhanced and acquired according to the standardized protocol. The skeletal muscle index (SMI), skeletal muscle radiodensity (SMD), and total adipose tissue index were measured from two sets of CT images obtained at the level of the third lumbar vertebra. The skeletal muscle gauge was calculated by multiplying SMI by SMD (SMI × SMD). Predictors of overall survival and progression‐free survival were identified using Cox regression models. Results The median follow‐up was 50.6 (range 12.1–117.0) months. Overall, body mass index (BMI) changes during treatment were 0.4% per 210 days (95% confidence interval: −0.6 to 1.4; P = 0.41), and patients experienced an average SMD loss of 2.1% per 210 days (95% confidence interval: −4.0 to −0.2; P = 0.03). Weight loss and SMD loss ≥5% were observed in 23 (17.6%) and 54 (41.2%) patients, respectively. The changes in SMD did not correlate with those in BMI (Spearman's ρ for SMD, −0.13; P = 0.13). SMD change (per 1 Hounsfield unit/210 days decrease) was independently associated with poorer overall survival (hazard ratio: 1.32, 95% confidence interval: 1.14–1.52; P < 0.001) and progression‐free survival (hazard ratio: 1.28, 95% confidence interval: 1.12–1.43; P < 0.001). Our results did not show association between survival and pretreatment myosteatosis and sarcopenia or changes in SMI and total adipose tissue index during treatment. The pretreatment skeletal muscle gauge was associated with treatment modifications such as delays, dose reductions, and discontinuation of chemotherapy. Conclusions Skeletal muscle radiodensity decreased significantly during treatment and was independently associated with poorer survival in patients with stage III endometrial cancer who underwent staging surgery and adjuvant chemoradiotherapy. SMD loss was occult and occurred independently of BMI change.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Muscle radiodensity loss during cancer therapy is predictive for poor survival in advanced endometrial cancer

Lee

Lin

et al. 2019

J cachexia sarcopenia muscle

View full text Add to dashboard Cite

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The prognostic impact of myosteatosis on overall survival in gynecological cancer patients: A meta‐analysis and trial sequential analysis

Cao

Yang

Wang

2022

Intl Journal of Cancer

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Myosteatosis is a novel imaging biomarker for survival in gynecological cancer patients; however, the evidence is inconsistent. This meta‐analysis aims to investigate the impact of myosteatosis on overall survival in the gynecological oncology setting. Three databases (PubMed, EMBASE and Web of Science) were systematically searched for relevant literature up to October 30, 2021. A random‐effects model was used to evaluate the predictive effect of myosteatosis on overall survival in the gynecological cancer population. The Newcastle‐Ottawa Scale was used to assess the methodological quality of the included studies. Trial sequential analysis was used to control the risk of random errors. Twelve studies with a total of 2519 patients were included. Myosteatosis was associated with a 50% increased mortality risk (HR 1.50, 95% CI 1.24‐1.82, P < .001) in gynecological cancer patients. Subgroup analyses stratified by study design, statistical model, treatment, sample size and stage confirmed the predictive value of myosteatosis on survival. However, the prognostic ability of myosteatosis only was held in the American and European populations but lost in Asians. Additionally, myosteatosis was not associated with the increased mortality in endometrial and cervical cancers, except for ovarian cancers. Overall, myosteatosis is a powerful predictor of reduced overall survival in gynecological cancer patients.

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Influence of Methods Used to Establish Sarcopenia Cutoff Values for Skeletal Muscle Measures Using Unenhanced and Contrast‐Enhanced Computed Tomography Images

Feng

Rong

Luo

et al. 2019

J Parenter Enteral Nutr

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Background:Multiple cutoff values of computed tomography (CT)-based skeletal muscle measures have been proposed, but there is currently no consensus used to identify sarcopenia. We aimed to evaluate the influence of statistical methods used to establish sarcopenia cutoff values and to examine the impact of contrast enhancement on the skeletal muscle measures. Methods: The skeletal muscle area (SMA) and muscle radiation attenuation (MRA) of 316 healthy individuals were measured on unenhanced CT images at the third lumbar vertebra level, and the skeletal muscle index (SMI) was SMA divided by height squared. Possible cutoff values were established using 2 methods: 5 th percentile of individuals aged 20-60 years or mean − 2 × SD of individuals aged 20-50 years. The concordance was assessed using Cohen's κ coefficients and McNemar test. The skeletal muscle parameters on 3 phases from 30 CT examinations were compared. Results: The concordance between the 2 methods was almost perfect (κ coefficients: 0.830-0.849) for low MRA but slight to moderate (κ coefficients: 0.189-0.591) for low SMI, especially in the men (P < 0.01). Compared with the unenhanced images, the mean SMA, SMI, and MRA on the contrast-enhanced images increased by 0.8%-1.7%, 0.8%-1.8%, and 14.8%-21.6% (all P < 0.001), respectively, and only the changes in MRA were clinically significant. Conclusions: The methods for establishing cutoff values and contrast enhancement influence the identification of low SMI and low MRA, respectively. Thus, the definition of sarcopenia should include the standardized method for establishing cutoff values and the phase of CT for analysis. (JPEN J Parenter Enteral Nutr. In this study, we comprehensively evaluated the influence of statistical methods used to establish sarcopenia cutoff values in a healthy population and examined the impact of contrast enhancement on the skeletal muscle measures. Our study highlights the standardized method for establishing cutoff values and the phase of computed tomography for analysis in the definition of sarcopenia. Future research should further validate the proposed sex-specific cutoff values in different patient populations.From the

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Skeletal Muscle Quality Beyond Average Muscle Attenuation: A Proposal of Skeletal Muscle Phenotypes to Predict Short-Term Survival in Patients With Endometrial Cancer

Cited by 28 publications

References 3 publications

Muscle radiodensity loss during cancer therapy is predictive for poor survival in advanced endometrial cancer

Muscle radiodensity loss during cancer therapy is predictive for poor survival in advanced endometrial cancer

The prognostic impact of myosteatosis on overall survival in gynecological cancer patients: A meta‐analysis and trial sequential analysis

Influence of Methods Used to Establish Sarcopenia Cutoff Values for Skeletal Muscle Measures Using Unenhanced and Contrast‐Enhanced Computed Tomography Images

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