Trajectory of body mass and skeletal muscle indices and disease progression in metastatic colorectal cancer patients

Abstract

Background Knowledge of the evolution of BMI and skeletal muscle index (SMI) measurements during advanced cancer and their relationships with disease progression (PD) is relevant to improve the timing of interventions that may improve cachexia-associated outcomes. Objectives We investigated BMI and SMI trajectories and their associations with PD in metastatic colorectal cancer (mCRC) patients during consecutive palliative systemic regimens. Methods In a secondary analysis of the primary CAIRO3 trial, we included 533 mCRC patients with BMI measurements repeated every 3 wk and 95 randomly selected patients with SMI measurements repeated every 9 wk. We studied 2 periods: p1, during first-line maintenance capecitabine + bevacizumab or observation until the first progression of disease (PD1); and p2, during capecitabine + oxaliplatin + bevacizumab or another reintroduction treatment from PD1 until the second progression of disease (PD2). BMI and SMI trajectories were modeled separately throughout both periods, and joint longitudinal-survival modeling was used to investigate the relationships between slopes in BMI and SMI with PD at 9 and 3 wk pre-PD. A multivariate longitudinal joint model was used to investigate the association between the BMI trajectory and PD at time of PD, independent of SMI. Results During p1, the slopes in BMI and SMI were associated with early PD1 [HRs for 9-wk BMI: 1.54 (95% CI: 1.33, 1.76); 9-wk SMI: 1.38 (95% CI: 0.87, 1.89), NS; 3-wk BMI: 1.74 (95% CI: 1.48, 1.99); 3-wk SMI: 2.65 (95% CI: 1.97, 3.32)]. During p2, only the slope in SMI was related to PD2 [9-wk BMI: 1.09 (95%: CI: 0.73, 1.45), NS; 9-wk SMI: 1.64 (95% CI: 1.25, 2.04); 3-wk BMI: 1.17 (95% CI: 0.77, 1.57); 3-wk SMI: 1.11 (95% CI: 0.70, 1.53)]. In models mutually adjusting for BMI and SMI, SMI was associated with PD in p1 [p1 ( n = 95), HR BMI: 1.32 (95% CI: 0.74, 2.39), NS; p1, HR SMI: 1.50 (95% CI: 1.04, 2.14); p2 ( n = 50), BMI: 0.98 (95% CI: 0.55, 1.75), NS; p2, HR SMI: 1.11 (95% CI: 0.61, 2.05), NS]. Conclusions In mCRC patients during palliative systemic treatment, SMI losses, irrespective of BMI losses, may be a marker for the early initiation of cachexia interventions.

Longitudinal changes in skeletal muscle mass in patients with advanced squamous cell lung cancer

“…2 Furthermore, a recent study on patients with metastatic colorectal cancer indicated that the acceleration of skeletal muscle loss precedes disease progression. 27 It is important to diagnose sarcopenia and evaluate the changes in skeletal muscle. However, the measurement is not routinely implemented at clinical practice because of limited time and human source to measure SMM.…”

Association between CT-Quantified Body Composition and Recurrence, Survival in Nonmetastasis Colorectal Cancer Patients Underwent Regular Chemotherapy after Surgery

“…Thus, targeted and preventive intervention strategies such as nutritional intervention and physical exercise should be given for CRC T2-3 stage patients, avoiding developing sarcopenia, thereupon then decreasing the recrudescence and overall survival rate [ 19 , 20 ]. However, due to skeletal muscle did not effectively reflect muscle function, CT-based body components combined with functional measures assessed by handgrip strength and stair-climbing power would be more precise [ 21 ].…”

Skeletal muscle metastases of hepatocellular carcinoma: A case report and literature review

“…Four cases died among the reported cases, with a median survival time range 6–18 mo. Only one patient, who underwent chemoradiotherapy for multiple skeletal metastases, remained alive at 24 mo after recurrence[ 25 ]; however, the underlying mechanisms remain poorly understood[ 26 - 29 ]. Skeletal muscle mass in the body accounts for a large percentage of overall body weight, and there is a significant amount of blood supply to the entire skeletal musculature of the body.…”