Adipose tissue and muscle attenuation as novel biomarkers predicting mortality in patients with extremity sarcomas

Veld, Joyce V.; Vossen, Josephina A.; Bernstein, Karen De Amorim; Halpern, Elkan F.; Torriani, Martin; Bredella, Miriam A.

doi:10.1007/s00330-016-4306-6

Cited by 48 publications

(84 citation statements)

References 40 publications

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“…In a previous study having patients with colon cancer, only the VAT parameters had significant clinical values . In other previous studies with non‐small cell lung cancer, extremity sarcoma, and prostate cancer, only the SAT parameters were significantly associated with clinical outcomes . Considering these results of the previous studies, VAT and SAT could have different characteristics and could be related to tumor cells with different mechanisms according to the type of cancer.…”

Section: Discussionmentioning

confidence: 71%

“…Furthermore, cancer cells can inversely affect adipocytes by dedifferentiating adipocytes into fibroblast‐like cells, which increase the secretion of pro‐inflammatory cytokines and induce tumor cells to acquire more aggressiveness . In a previous study on nonhuman primates, increased attenuation of adipose tissue on noncontrast CT images corresponded to the inflammatory and fibrotic changes in adipose tissue, suggesting that the CT‐attenuation of adipose tissue can be used as an indicator of the qualitative changes of adipose tissue . Several studies have demonstrated the significant positive association between the CT‐attenuation of adipose tissue and prognosis in diverse diseases, including cardiovascular disease, extremity sarcoma, and prostate cancer .…”

Section: Discussionmentioning

confidence: 99%

“…Subsequently, adipose tissue parameters including volume, Hounsfield units (HU), and the mean SUV of SAT and VAT were measured using a DICOM viewer approved by the U.S. Food and Drug Administration (OsiriX MD 9.0 software, Pixmeo, Geneva, Switzerland). Three consecutive slices of CT images at the midportion of the fourth lumbar spine were selected for adipose tissue parameters measurement . Using a threshold set for −50 to −200 HU, the SAT and VAT areas on the CT images were automatically identified, and the volume and mean HU of both SAT and VAT on three CT slices were computed.…”

Section: Methodsmentioning

confidence: 99%

“…In addition to the amount of adipose tissue, the relationship between the qualitative characteristics of adipose tissue and clinical outcome has recently been investigated, because lipolytic, fibrotic, and inflammatory changes in adipose tissue have been shown to be related to cancer aggressiveness and progression . In most previous studies, two imaging parameters have been used from CT and positron emission tomography (PET) images for assessing the qualitative characteristics of adipose tissue of patients: CT‐attenuation of adipose tissue measured on noncontrast‐enhanced CT and 18 F‐fluorodeoxyglucose (FDG) uptake of adipose tissue measured on PET images . The CT‐attenuation of adipose tissue is known to be related to inflammatory and fibrotic changes of adipose tissue .…”

Section: Introductionmentioning

confidence: 99%

“…The FDG uptake of adipose tissue reflects both the glucose metabolism for lipogenesis process in adipocytes and inflammatory condition in adipose tissue . Recent studies have demonstrated that these two imaging parameters are associated with tumor characteristics and prognosis in various types of malignancies, including lung cancer, extremity sarcoma, and colorectal cancer . Given that obesity has significant association with survival in HNSCC, the qualitative characteristics of adipose tissue might have a relationship with clinical outcomes in HNSCC.…”

Section: Introductionmentioning

confidence: 99%

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Visceral adipose tissue volume and CT‐attenuation as prognostic factors in patients with head and neck cancer

et al. 2019

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Background The aim of this study was to evaluate the relationship of the characteristics of subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) to the disease progression‐free survival and distant failure‐free survival of head and neck squamous cell carcinoma (HNSCC). Methods We enrolled 152 HNSCC patients who underwent staging 18F‐fluorodeoxyglucose (FDG) positron emission tomography/CT (PET/CT). Maximum FDG uptake (standardized uptake value [SUV]) and total lesion glycolysis (TLG) of the primary tumor and volume, CT‐attenuation (Hounsfield units [HU]), and FDG uptake of SAT and VAT were measured. Survival analysis using Cox proportional hazard modeling was performed to assess the relationship between the adipose tissue parameters of PET/CT and survival. Results Patients with low VAT volume and high VAT HU had significantly worse progression‐free survival and distant failure‐free survival than those with high VAT volume and low VAT HU. On multivariate analysis, the volume and HU of VAT were significantly correlated with disease progression‐free survival and distant failure‐free survival after adjusting for age, sex, body mass index, TNM stage, serum C‐reactive protein, maximum SUV, and TLG. Conclusion The volume and CT‐attenuation of VAT were significantly correlated with disease progression‐free survival and distant failure‐free survival in patients with HNSCC.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Visceral adipose tissue volume and CT‐attenuation as prognostic factors in patients with head and neck cancer

et al. 2019

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Opportunistic muscle measurements on staging chest CT for extremity and truncal soft tissue sarcoma are associated with survival

Phan

Thorpe

Wong

et al. 2020

Journal of Surgical Oncology

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Background and Objectives Computed tomography (CT) measurements of sarcopenia have been proposed as biomarkers associated with outcomes in various cancers and have typically been evaluated at the L3 vertebral level. However, staging imaging for patients with extremity and truncal soft tissue sarcoma (STS) often only includes chest CT imaging which precludes evaluation at L3. Therefore, we sought to evaluate muscle metrics at T12 on standard staging chest CT scans and evaluate for correlation with overall and event‐free survival in patients with STS. Methods CT chest imaging for 89 patients with intermediate and high‐grade STS (53 male, 36 female; 58.5 ± 19.0 years old, follow‐up 37.4 ± 27.1 months) was reviewed on PACS at T12 for skeletal muscle density (SMD) and skeletal muscle index (SMI). Results Overall survival increased with increased SMD on univariate (hazard ratio [HR] = 0.61 [0.43, 0.86]) and age‐adjusted analysis (HR = 0.65 [0.42, 0.89]. Event‐free survival also increased with increased SMD in univariate analyses (HR = 0.68 [0.49, 0.95]) but did not maintain significance after adjusting for age (HR = 0.68 [0.43, 1.07]). SMI was not a predictor of overall or event‐free survival. Conclusions Higher SMD measured on routinely obtained staging chest CTs in STS patients is associated with improved survival.

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Body composition predictors of mortality in patients undergoing surgery for long bone metastases

Groot

Bongers

Buckless

et al. 2022

Journal of Surgical Oncology

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Background and Objectives Body composition measurements using computed tomography (CT) may serve as imaging biomarkers of survival in patients with and without cancer. This study assesses whether body composition measurements obtained on abdominal CTs are independently associated with 90‐day and 1‐year mortality in patients with long‐bone metastases undergoing surgery. Methods This single institutional retrospective study included 212 patients who had undergone surgery for long‐bone metastases and had a CT of the abdomen within 90 days before surgery. Quantification of cross‐sectional areas (CSA) and CT attenuation of abdominal subcutaneous adipose tissue, visceral adipose tissue, and paraspinous and abdominal muscles were performed at L4. Multivariate Cox proportional‐hazards analyses were performed. Results Sarcopenia was independently associated with 90‐day mortality (hazard ratio [HR] = 1.87; 95% confidence interval [CI] = 1.11–3.16; p = 0.019) and 1‐year mortality (HR = 1.50; 95% CI = 1.02–2.19; p = 0.038) in multivariate analysis while controlling for clinical variables such as primary tumors, comorbidities, and chemotherapy. Abdominal fat CSAs and muscle attenuation were not associated with mortality. Conclusions The presence of sarcopenia assessed by CT is predictive of 90‐day and 1‐year mortality in patients undergoing surgery for long‐bone metastases. This body composition measurement can be used as novel imaging biomarker supplementing existing prognostic tools to optimize patient selection for surgery and improve shared decision making.

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Adipose tissue and muscle attenuation as novel biomarkers predicting mortality in patients with extremity sarcomas

Cited by 48 publications

References 40 publications

Visceral adipose tissue volume and CT‐attenuation as prognostic factors in patients with head and neck cancer

Visceral adipose tissue volume and CT‐attenuation as prognostic factors in patients with head and neck cancer

Opportunistic muscle measurements on staging chest CT for extremity and truncal soft tissue sarcoma are associated with survival

Body composition predictors of mortality in patients undergoing surgery for long bone metastases

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