Introduction Sarcopenia is common in men with metastatic castrate-resistant prostate cancer (mCRPC) and has been largely assessed opportunistically through computed-tomography (CT) scans, excluding measures of muscle function. Therefore, the impact of a comprehensive assessment of sarcopenia on clinical outcomes in men with mCRPC is poorly understood. The objectives of this study were to comprehensively assess sarcopenia through CT scans and measures of muscle function and examine its impact on severe treatment toxicity, time to first emergency room (ER) visit, disease progression, and overall mortality in men initiating chemotherapy or androgen receptor-targeted axis (ARAT) therapy for mCRPC. Methods This was a secondary analysis of a prospective observational study of men with mCRPC at the Princess Margaret Cancer Centre between July 2015-May 2021. Participants were classified as sarcopenic if they had CT-based low muscle mass or low muscle density, a grip strength and gait speed score of <35.5kg and <0.8m/s, respectively, prior to treatment initiation. The impact of sarcopenia on severe treatment toxicity was assessed using multivariable logistic regression. Multivariable Cox regression models were used to determine the impact of sarcopenia on risk of visiting the ER, prostate-specific antigen progression, radiographic progression, and overall mortality. Results A total of 110 men (mean age: 74.6) were included in the analysis. At baseline, 30 (27.3%) were classified as sarcopenic. Sarcopenia was a significant predictor of severe toxicity (aOR = 6.26, 95%CI = 1.17–33.58, P = 0.032) and ER visits (aHR = 4.41, 95%CI = 1.26–15.43, p = 0.020) in men initiating ARAT but not in men initiating chemotherapy. Sarcopenia was also a predictor of radiographic progression (aHR = 2.39, 95%CI = 1.06–5.36, p = 0.035) and overall mortality (aHR = 2.44, 95%CI = 1.17–5.08, p = 0.018) regardless of treatment type. Conclusions Baseline sarcopenia predicts radiographic progression and overall mortality in men with mCRPC regardless of the type of treatment and may also predict severe treatment toxicity and ER visits in men initiating ARAT.

Peripheral artery disease is a prevalent illness affecting more than 200 million people worldwide. A commonly used technique to manage the condition has been open endarterectomy. However, in recent times, a shift towards minimally invasive techniques has resulted in endovascular intervention as a popular alternative. This review aims to assess the safety and efficacy of endovascular intervention when compared with endarterectomy. A systematic review of the articles published in PubMed, Ovid, Embase, and Scopus within the last 10 years was conducted. The PRISMA guidelines were adhered to, and the Newcastle-Ottawa and NICE quality assessment scales were used. A meta-analysis of proportions was performed using the RStudio software (RStudio Team (2021). RStudio: Integrated Development Environment for R, PBC, Boston, MA, USA). Twenty-six studies were included, with a total of 7126 patients (endovascular, 2496; endarterectomy, 4630). Technical success was greater for endarterectomy than endovascular intervention with an odds ratio of 0.38; 95% CI [0.27–0.54]. In terms of safety as well endovascular intervention was better than endarterectomy with an odds ratio of 0.22; 95% CI [0.15 to 0.31] for wound infection. Endovascular intervention is a safe and effective procedure; however, it cannot be considered superior to endarterectomy.

12056 Background: Understanding the impact of sarcopenia on clinical outcomes in patients with metastatic cancer will assist clinicians with risk stratification, treatment decision-making, and inform the need for targeted supportive care strategies. Our objective was to comprehensively assess sarcopenia using measures of muscle mass (radiographically) and function (i.e., muscle strength and walking speed) and examine its impact on severe treatment toxicity, time to first emergency room (ER) visit, prostate-specific antigen (PSA) progression, radiographic progression, and overall mortality in men initiating androgen receptor-axis targeted therapy (ARAT) or chemotherapy for mCRPC. Methods: This was a secondary analysis of a prospective observational study of older men with mCRPC at the Princess Margaret Cancer Centre. Sarcopenia was defined as the combination of low muscle strength (grip strength < 35.5kg), slowness (walking speed < 0.8m/s), and low muscle quantity or quality prior to treatment initiation. The skeletal muscle index and skeletal muscle density were assessed through computed tomography scans prior to ARAT or chemotherapy initiation to determine muscle quantity and quality, respectively, using published cut-offs. Severe treatment toxicity, unplanned healthcare use, and disease progression were assessed from treatment initiation until treatment termination or loss to follow up. The associations between sarcopenia and severe treatment toxicity (i.e., grade 3+ toxicity) were assessed using multivariable logistic regression. Survival analyses were used to assess the impact of sarcopenia on the time to first ER visit, PSA progression, radiographic progression, and overall mortality. An interaction term for sarcopenia by treatment was introduced in all multivariable models and when necessary, an analysis by treatment was performed. Results: In total, 110 men participated, of whom 30 (27.3%) had sarcopenia prior to initiating treatment. Sarcopenia was associated with severe treatment toxicity (adjusted odds ratio (aOR) = 6.26, 95%CI = 1.17-33.58, P = 0.032) and time to first ER visit (adjusted hazard ratio (aHR) = 4.41, 95%CI = 1.26-15.43, p = 0.020) in the group that was initiating ARAT but not chemotherapy. Sarcopenia was a significant predictor of radiographic progression (aHR = 2.39, 95%CI = 1.06-5.36, p = 0.035) and overall mortality (aHR = 2.44, 95%CI = 1.17-5.08, p = 0.018) in the entire cohort. Conclusions: Sarcopenia may predict severe treatment toxicity and emergency room visits in men starting ARAT for mCRPC. Additionally, sarcopenia predicts radiographic progression and overall mortality regardless of treatment type in men with mCRPC. Confirmation is needed from large-scale studies. Assessment of sarcopenia can assist clinicians in treatment decision making while identifying high-risk patients that require targeted supportive care strategies.