Temporal Muscle Thickness is an Independent Prognostic Biomarker in Patients with Glioma: Analysis of 261 Cases

Abstract

Purpose: Temporal muscle thickness (TMT) has been proposed as a novel surrogate marker for skeletal muscle mass in head and neck malignancies. This study investigated the TMT prognostic relevance with gliomas and evaluated the influence of TMT values on survival in patients with gliomas of different grades and IDH subtypes. Methods: The patients' TMT was measured on contrast-enhanced T1-weighted magnetic resonance images before surgical treatment. Patients were divided into two cohorts based on their median TMT values. The Kaplan-Meier curve was used to compute the overall survival (OS) of different categories and all gliomas. Univariate and multivariate Cox regression analyses were conducted to assess the association between OS and TMT, hematological markers, and other clinical factors in glioma patients. Moreover, the clinical diagnostic efficiency of single and combination biomarkers was evaluated using receiver operating characteristic curve analysis. Results: We retrospectively analyzed 261 patients with newly diagnosed glioma between November 2016 and May 2020 at Hunan Cancer Hospital. Cox analysis indicated that higher TMT (HR 0.286, P< 0.001) and higher KPS score (HR 0.629, P= 0.012) were protective prognostic factors and IDH wildtype status (HR 2.946, P< 0.001), RDW > 12.6 (HR 1.513, P= 0.036), and NLR > 4 (HR 1.560, P= 0.042) were poor prognostic factors for gliomas. Subsequently, patients with thicker TMT were found to have significantly better overall survival (P<0.001) than patients with thinner TMT among WHO III and WHO IV grade and patients with or without IDH mutation. TMT was considered a better single biomarker than recently prevalent hematological biomarkers for predicting high-grade [0.856 (0.797-0.916)] and IDH-wild-type [0.864 (0.786-0.941)] gliomas. Conclusion:This study suggests that TMT is a positive biomarker for clinical prognosis in gliomas and that patients with thicker TMT have greater overall survival for gliomas of different grades and IDH subtypes.

The prognostic utility of temporalis muscle thickness measured on magnetic resonance scans in patients with intra-axial malignant brain tumours: A systematic review and meta-analysis

“…Following the abstract/title screening, 20 articles were found to meet our selection criteria. On full-text screening, three studies were excluded for measuring TMT on CT scans with inconsistent markings 12 ; measuring the temporalis muscle cross-sectional area rather than the TMT thickness 22 ; and including benign intracranial conditions in the analysis. 23 The summary of findings of these excluded articles is presented in the Supplementary Material .…”

“…Neurosurgeons, neuro-oncologists, or neuroradiologists could perform TMT measurements, and this measurement could be incorporated in the radiology reports of patients with intra-axial malignant tumours. 12 , 30 The ease of acquisition and the conferred survival benefit would make personalised treatment plans based on TMT readily available. Several mechanisms have been postulated as to why sarcopenia, secondary to malignancy and/or other causes, has such a profound effect on patient outcomes.…”

“…Sarcopenia serves as a surrogate marker of performance status and is strongly associated with long term outcomes in solid cancers such as hepatocellular carcinoma, pancreaticobiliary cancer, and oesophageal cancer. 8 , 9 , 10 , 11 , 12 Sarcopenia has typically been determined by sex-adjusted skeletal muscle mass index values derived from computed tomography (CT) images at the level of L3. 8 , 9 , 10 , 13 However, recent studies have demonstrated a correlation between skeletal muscle mass and temporalis muscle thickness (TMT).…”

“… 8 , 14 TMT is typically measured on T1-weighted magnetic resonance (MR) images perpendicular to the long axis of the temporal muscle using the orbital roof (cranio-caudal) and the Sylvian fissure (anterior-posterior) as landmarks. 4 , 8 , 12 Furthermore, as TMT is readily quantifiable on MR scans, 8 it would be easily translatable and advantageous in patients with intracranial neoplastic lesions who are routinely assessed using this imaging modality. Consequently, this systematic review aims to analyse existing evidence and evaluate the relationship between TMT measured on MR scans and outcome measures in patients with malignant intra-axial neoplasms, with a view to improving risk-benefit considerations and shared decision making in the management of these patients.…”

Significance of Temporal Muscle Thickness in Chronic Subdural Hematoma

“…However, measuring muscle function with the abovementioned techniques often cannot be performed in CSDH patients because of the frequently present disturbances of consciousness and/or hemiparesis. However, an alternative evaluation of muscle mass and function was recently shown through the association of radiologically measured temporal muscle thickness (TMT) and outcome in brain tumor patients [ 7 , 8 , 9 ]. Further, CT scans (computed tomography) are routinely performed on CSDH patients, and TMT measurement is easy and rapid to implement.…”