Total Psoas Muscle Area as a Marker for Sarcopenia Is Related to Outcome in Children With Neuroblastoma

Abstract

Background: Sarcopenia describes a generalized loss of skeletal muscle mass, strength, or function. Determined by measuring the total psoas muscle area (tPMA) on cross-sectional imaging, sarcopenia is an independent marker for poor post-surgical outcomes in adults and children. Children with cancer are at high risk for sarcopenia due to immobility, chemotherapy, and cachexia. We hypothesize that sarcopenic children with neuroblastoma are at higher risk for poor post-operative outcomes.Patients and Methods: Retrospective analysis of children with neuroblastoma ages 1–15 years who were treated at our hospital from 2008 to 2016 with follow-up through March 2021. Psoas muscle area (PMA) was measured from cross-sectional images, using computed tomography (CT) and magnetic resonance imaging (MRI) scans at lumbar disc levels L3-4 and L4-5. tPMA is the sum of the left and right PMA. Z-scores were calculated using age- and gender-specific reference values. Sarcopenia was defined as a tPMA z-score below −2. A correlation of tPMA z-scores and sarcopenia with clinical variables and outcome was performed.Results: One hundred and sixty-four children with workup for neuroblastoma were identified, and 101 children fulfilled inclusion criteria for further analysis, with a mean age of 3.92 years (SD 2.71 years). Mean tPMA z-score at L4-5 was −2.37 (SD 1.02). Correlation of tPMA z-score at L4-5 with weight-for-age z-score was moderate (r = 0.54; 95% CI, 0.38, 0.66). No association between sarcopenia and short-term outcome was observed. Sarcopenia had a sensitivity of 0.82 (95% CI, 0.62–0.93) and a specificity of 0.48 (95% CI 0.36–0.61) in predicting 5-year survival. In a multiple regression analysis, pre-operative sarcopenia, pre-operative chemotherapy in the NB2004 high-risk group, unfavorable tumor histology, and age at diagnosis were associated with 5-year survival after surgery, with hazard ratios of 4.18 (95% CI 1.01–17.26), 2.46 (95% CI 1.02–5.92), 2.39 (95% CI 1.03–5.54), and 1.01 (95% CI 1.00–1.03), respectively.Conclusion: In this study, the majority of children had low tPMA z-scores and sarcopenia was a risk factor for decreased 5-year survival in children with neuroblastoma. Therefore, we suggest measuring the tPMA from pre-surgical cross-sectional imaging as a biomarker for additional risk stratification in children with neuroblastoma.

Reference values for MRI‐derived psoas and paraspinal muscles and macroscopic fat infiltrations in paraspinal muscles in children

“…14,18,19,29 However, this phenomenon has been described more and more recently in paediatric populations. 2,[5][6][7]9 Currently available methods of measuring sarcopenia are often implicated in disease-related conditions and appear to be inadequate to meet the demands of personalized medicine that is easily incorporated into clinical practice. 30 Radiological direct measurements of cross-sectional muscle area at the lumbar level are proven objective and feasible methods to assess sarcopenia.…”

“… 14 , 18 , 19 , 29 However, this phenomenon has been described more and more recently in paediatric populations. 2 , 5 , 6 , 7 , 9 …”

“…This state, called sarcopenia, is associated with adverse health outcomes during treatment and a decrease of life quality, mainly described in the adult population 14,18,19,29 . However, this phenomenon has been described more and more recently in paediatric populations 2,5–7,9 …”

“…In the literature, paediatric sarcopenia is a new term associated with insufficient muscle mass at a given age and is an independent risk factor for surgical complications and neoplasm associated with severe adverse events. 1 , 2 , 5 , 6 , 7 , 8 , 9 …”

Psoas Cross-Sectional Measurements Using Manual CT Segmentation before and after Endovascular Aortic Repair (EVAR)

“…Inter- and intra-reader reproducibility was evaluated using Bland–Altman method. For this purpose, given the lack of significant differences between psoas areas on the two sides [ 21 ], the combined total area of both sides (tPMA) was used to ascertain the exact reproducibility of measurements.…”