Cancer Cachexia in the Age of Obesity: Skeletal Muscle Depletion Is a Powerful Prognostic Factor, Independent of Body Mass Index

Martin, Lisa W.; Birdsell, Laura; MacDonald, Neil; Reiman, Tony; Clandinin, Michael T.; McCargar, Linda J.; Murphy, Rachel A.; Ghosh, Sunita; Sawyer, Michael B.; Baracos, Vickie E.

doi:10.1200/jco.2012.45.2722

Cited by 2,170 publications

(2,563 citation statements)

References 28 publications

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“…In addition, we found that the changes in SMM are not reflected by the observed changes in body weight. This is in agreement with previous studies that state that body weight and BMI are not appropriate tools to understand the effect of systemic treatment on body composition 4, 6…”

Section: Discussionsupporting

confidence: 93%

“…BMI, body mass index; CAPOX‐B, capecitabine + oxaliplatin + bevacizumab; SD, standard deviation; WHO, World Health Organization.aSarcopenia for males was defined as skeletal muscle index of <43 cm 2 /m 2 if BMI <25 kg/m 2 or <53 cm 2 /m 2 for males if BMI ≥25 kg/m 2 , and sarcopenia for females was skeletal muscle index <41 cm 2 /m 2 for any BMI 6b

Sarcopenic obesity was defined as being sarcopenic and BMI >30 kg/m 2 .

…”

Section: Resultsmentioning

confidence: 99%

“…aSarcopenia for males was defined as skeletal muscle index of <43 cm 2 /m 2 if BMI <25 kg/m 2 or <53 cm 2 /m 2 for males if BMI ≥25 kg/m 2 , and sarcopenia for females was skeletal muscle index <41 cm 2 /m 2 for any BMI 6…”

Section: Resultsmentioning

confidence: 99%

“…( Table 2). 6 Sarcopenic obesity, in which obesity and sarcopenia occur simultaneously, representing a patient group with poor prognosis because it combines the health risks of obesity and muscle loss,7 was defined by being sarcopenic and BMI ≥ 30.…”

Section: Methodsmentioning

confidence: 99%

“…Cancer cachexia results from reduced food intake caused by a range of symptoms like anorexia, gastro‐intestinal symptoms, pain, and fatigue, occurring in combination with systemic inflammation and abnormal metabolism 4. The most relevant phenotypic feature of cancer cachexia is low SMM (sarcopenia), as this relates to lower quality of life, increased dose limiting toxicities, and reduced overall survival 4, 6, 7. The presence of sarcopenia and cachexia can be masked by excess body weight, leading to a diagnosis of cachexia at a late stage.…”

Section: Introductionmentioning

confidence: 99%

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Impact of different palliative systemic treatments on skeletal muscle mass in metastatic colorectal cancer patients

Kurk

Peeters

Dorresteijn

et al. 2018

J cachexia sarcopenia muscle

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BackgroundObservational studies suggest that loss of skeletal muscle mass (SMM) is associated with chemotherapy‐related toxicity, poor quality of life, and poor survival in metastatic colorectal cancer (mCRC) patients. Little is known about the evolution of SMM during palliative systemic therapy. We investigated changes in SMM during various consecutive palliative systemic treatment regimens using repeated abdominal computed tomography scans of mCRC patients who participated in the randomized phase 3 CAIRO3 study.MethodsIn the CAIRO3 study, mCRC patients with stable disease or better after 6 cycles of first‐line treatment with capecitabine + oxaliplatin + bevacizumab (CAPOX‐B) were randomized between maintenance treatment with capecitabine + bevacizumab (CAP‐B) or observation. Upon first disease progression, in both groups, CAPOX‐B or other treatment was reintroduced until the second disease progression, which was the primary study endpoint. We analysed 1355 computed tomography scans of 450 (81%) CAIRO3 patients (64 ± 9.0 years, CAP‐B n = 223; observation n = 227) for SMM at four time points (i.e. prior to the start of pre‐randomization initial treatment, at randomization, and at first and at second disease progression) using the Slice‐o‐matic software and single slice evaluation at the lumbar 3 level. By using accepted and widely used formulas, whole body SMM was calculated. A linear mixed effects model, adjusted for relevant confounders, was used to assess SMM changes for the total group and within and between study arms.ResultsDuring 6 cycles of initial treatment with CAPOX‐B prior to randomization, SMM decreased significantly in all patients [CAP‐B arm: −0.53 kg (95% CI −1.12; −0.07) and observation arm: −0.85 kg (−1.45; −0.25)]. After randomization, SMM recovered during CAP‐B treatment by 1.32 kg (0.73; 1.90) and observation by 1.20 kg (0.63; 1.78) (median time from randomization to first disease progression 8.6 and 4.1 months for CAP‐B arm and observation arm, respectively). After first progression and during reintroduction treatment with CAPOX‐B or other treatment, SMM again decreased significantly and comparable in both arms, CAP‐B: −2.71 kg (−3.37; −2.03), and observation: −2.01 kg (−2.64; −1.41) (median time from first progression until second progression CAP‐B arm: 4.7 months and observation arm: 6.6 months).ConclusionsThis longitudinal study provides a unique insight in SMM changes in mCRC patients during palliative systemic treatment regimens, including observation. Our data show that muscle loss is reversible and may be influenced by the intensity of systemic regimens. Although studies have shown prognostic capacity for SMM, the effects of subsequent changes in SMM are unknown and may be clues for new future therapeutic interventions.

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Section: Discussionsupporting

confidence: 93%

Sarcopenic obesity was defined as being sarcopenic and BMI >30 kg/m 2 .

…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Impact of different palliative systemic treatments on skeletal muscle mass in metastatic colorectal cancer patients

Kurk

Peeters

Dorresteijn

et al. 2018

J cachexia sarcopenia muscle

View full text Add to dashboard Cite

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Development and Validation of a Nomogram for Assessing Survival in Patients With Metastatic Lung Cancer Referred for Radiotherapy for Bone Metastases

et al. 2018

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Key Points Question What are the optimal factors to use for constructing a nomogram to assess the probability of survival in patients with bone metastases arising from lung cancer? Findings This prognostic study of 477 patients with metastatic lung cancer found that age, histological type, smoking status, epidermal growth factor receptor mutation status, body mass index, and neutrophil to lymphocyte ratio were ideal parameters to construct a nomogram for potentially indicating 3-, 6-, and 12-month survival. This nomogram was successfully validated in a separate cohort of 235 patients at another institution. Meaning The study’s nomogram can guide radiation oncologists in making treatment decisions and determining the proper timing for end-of-life discussions and/or hospice referrals.

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Nutritional Support Should Target the Cause of Malnutrition in Hospitalized Patients

Evans

2021

JAMA Netw Open

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Kaegi-Braun and colleagues 1 have presented a retrospective analysis of the outcomes of nutritional support on hospitalized patients who are malnourished. This study found that nutritional support is associated with small but statistically significant decrease in patient mortality (7.2% vs 8.8%; incidence rate ratio, 0.79 [95% CI, 0.75-0.84]; P < .001) and reduced hospital readmission. There are a number of important strengths to this study, principally the very large number and heterogeneity

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Cancer Cachexia in the Age of Obesity: Skeletal Muscle Depletion Is a Powerful Prognostic Factor, Independent of Body Mass Index

Abstract: CT images reveal otherwise occult muscle depletion. Patients with cancer who are cachexic by the conventional criterion (involuntary weight loss) and by two additional criteria (muscle depletion and low muscle attenuation) share a poor prognosis, regardless of overall body weight.

Cited by 2,170 publications

References 28 publications

Impact of different palliative systemic treatments on skeletal muscle mass in metastatic colorectal cancer patients

Impact of different palliative systemic treatments on skeletal muscle mass in metastatic colorectal cancer patients

Development and Validation of a Nomogram for Assessing Survival in Patients With Metastatic Lung Cancer Referred for Radiotherapy for Bone Metastases

Nutritional Support Should Target the Cause of Malnutrition in Hospitalized Patients

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