Changes in skeletal muscle mass during palliative chemotherapy in patients with advanced lung cancer

Stene, Guro Birgitte; Helbostad, Jorunn L.; Amundsen, Tore; Sørhaug, Sveinung; Hjelde, Harald; Kaasa, Stein; Grønberg, Bjørn Henning

doi:10.3109/0284186x.2014.953259

Cited by 183 publications

(194 citation statements)

References 24 publications

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“…The importance of sarcopenia has scarcely been studied in ovarian cancer, and these results have yet to be confirmed in international prospective trials. However, similar results have been found for other cancer types; stable or increasing muscle mass has been reported to relate to a prolonged survival in non‐small cell lung cancer, pancreatic cancer, and colorectal cancer, while a low muscle mass at baseline showed no prognostic significance 6, 7, 8…”

Section: Introductionsupporting

confidence: 65%

“…External validation of these findings in patients with other gynaecological malignancies and ovarian cancer specifically is imperative. Comparable results have been reported for patients with lung cancer, pancreatic cancer, and colorectal cancer, but these populations were primarily comprised of male patients and translation of these results to female patients—with lower muscle mass in general—should be applied carefully 6, 7, 8…”

Section: Discussionmentioning

confidence: 97%

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Psoas muscle area is not representative of total skeletal muscle area in the assessment of sarcopenia in ovarian cancer

Rutten

Ubachs

Kruitwagen

et al. 2017

J cachexia sarcopenia muscle

163

133

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BackgroundComputed tomography measurements of total skeletal muscle area can detect changes and predict overall survival (OS) in patients with advanced ovarian cancer. This study investigates whether assessment of psoas muscle area reflects total muscle area and can be used to assess sarcopenia in ovarian cancer patients.MethodsOvarian cancer patients (n = 150) treated with induction chemotherapy and interval debulking were enrolled retrospectively in this longitudinal study. Muscle was measured cross sectionally with computed tomography in three ways: (i) software quantification of total skeletal muscle area (SMA); (ii) software quantification of psoas muscle area (PA); and (iii) manual measurement of length and width of the psoas muscle to derive the psoas surface area (PLW). Pearson correlation between the different methods was studied. Patients were divided into two groups based on the extent of change in muscle area, and agreement was measured with kappa coefficients. Cox‐regression was used to test predictors for OS.ResultsCorrelation between SMA and both psoas muscle area measurements was poor (r = 0.52 and 0.39 for PA and PLW, respectively). After categorizing patients into muscle loss or gain, kappa agreement was also poor for all comparisons (all κ < 0.40). In regression analysis, SMA loss was predictive of poor OS (hazard ratio 1.698 (95%CI 1.038–2.778), P = 0.035). No relationship with OS was seen for PA or PLW loss.ConclusionsChange in psoas muscle area is not representative of total muscle area change and should not be used to substitute total skeletal muscle to predict survival in patients with ovarian cancer.

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Section: Introductionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 97%

Psoas muscle area is not representative of total skeletal muscle area in the assessment of sarcopenia in ovarian cancer

Rutten

Ubachs

Kruitwagen

et al. 2017

J cachexia sarcopenia muscle

163

133

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“…Sarcopenia and myosteatosis have been significantly associated with a range of adverse outcomes including increased rate of post‐operative complications,10, 11, 40, 41, 42 longer length of hospital stay,41, 43 30‐day post‐operative mortality and in‐hospital mortality,44 and dose‐limiting toxicities 5, 6, 7, 8, 45, 46, 47, 48, 49, 50. In addition, the conditions have been demonstrated as independent predictors of reduced overall survival 18, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64. The situation is further complicated by the obesity epidemic that has been progressively worsening in recent times.…”

Section: Discussionmentioning

confidence: 99%

Computed tomography diagnosed cachexia and sarcopenia in 725 oncology patients: is nutritional screening capturing hidden malnutrition?

Bhuachalla

Daly

Power

et al. 2017

J cachexia sarcopenia muscle

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BackgroundNutrition screening on admission to hospital is mandated in many countries, but to date, there is no consensus on which tool is optimal in the oncology setting. Wasting conditions such as cancer cachexia (CC) and sarcopenia are common in cancer patients and negatively impact on outcomes; however, they are often masked by excessive adiposity. This study aimed to inform the application of screening in cancer populations by investigating whether commonly used nutritional screening tools are adequately capturing nutritionally vulnerable patients, including those with abnormal body composition phenotypes (CC, sarcopenia, and myosteatosis).MethodsA prospective study of ambulatory oncology outpatients presenting for chemotherapy was performed. A detailed survey incorporating clinical, nutritional, biochemical, and quality of life data was administered. Participants were screened for malnutrition using the Malnutrition Universal Screening Tool (MUST), Malnutrition Screening Tool (MST), and the Nutritional Risk Index (NRI). Computed tomography (CT) assessment of body composition was performed to diagnose CC, sarcopenia, and myosteatosis according to consensus criteria.ResultsA total of 725 patients (60% male, median age 64 years) with solid tumours participated (45% metastatic disease). The majority were overweight/obese (57%). However, 67% were losing weight, and CT analysis revealed CC in 42%, sarcopenia in 41%, and myosteatosis in 46%. Among patients with CT‐identified CC, the MUST, MST, and NRI tools categorized 27%, 35%, and 7% of them as ‘low nutritional risk’, respectively. The percentage of patients with CT‐identified sarcopenia and myosteatosis that were categorised as ‘low nutritional risk’ by MUST, MST and NRI were 55%, 61%, and 14% and 52%, 50%, and 11%, respectively. Among these tools, the NRI was most sensitive, with scores <97.5 detecting 85.8%, 88.6%, and 92.9% of sarcopenia, myosteatosis, and CC cases, respectively. Using multivariate Cox proportional hazards models, NRI score < 97.5 predicted greater mortality risk (hazard ratio 1.8, confidence interval: 1.2–2.8, P = 0.007).ConclusionsHigh numbers of nutritionally vulnerable patients, with demonstrated abnormal body composition phenotypes on CT analysis, were misclassified by MUST and MST. Caution should be exercised when categorizing the nutritional risk of oncology patients using these tools. NRI detected the majority of abnormal body composition phenotypes and independently predicted survival. Of the tools examined, the NRI yielded the most valuable information from screening and demonstrated usefulness as an initial nutritional risk grading system in ambulatory oncology patients.

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“…Stene et al have also suggested that achieving tumor control might reverse the catabolic processes involved in cancer cachexia (18). Although their study was small, they observed that 16 of 35 stage IV NSCLC patients maintained or gained cross sectional muscle mass at the level of the third lumbar vertebra while receiving chemotherapy, and it's interesting that almost all of these patients (14 mof 16) had tumor remission as defined by RECIST v 1.1 criteria (18). If tumor regression/control reverse cancer cachexia, it's conceivable that treatments which target cachexia might inhibit a tumor's growth by reducing its energy sources and precursors of macromolecules (19).…”

mentioning

confidence: 99%

Practical and theoretical implications of weight gain in advanced non-small cell lung cancer patients

et al. 2017

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Changes in skeletal muscle mass during palliative chemotherapy in patients with advanced lung cancer

Abstract: Almost half of the patients had stable or increased muscle mass during chemotherapy without receiving any cachexia treatment. Nearly all of these patients responded to the chemotherapy. Increase in muscle mass, but not sarcopenia at baseline, was a significant prognostic factor.

Cited by 183 publications

References 24 publications

Psoas muscle area is not representative of total skeletal muscle area in the assessment of sarcopenia in ovarian cancer

Psoas muscle area is not representative of total skeletal muscle area in the assessment of sarcopenia in ovarian cancer

Computed tomography diagnosed cachexia and sarcopenia in 725 oncology patients: is nutritional screening capturing hidden malnutrition?

Practical and theoretical implications of weight gain in advanced non-small cell lung cancer patients

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