Comparative Analysis Between Computed Tomography and Surrogate Methods to Detect Low Muscle Mass Among Colorectal Cancer Patients

Abstract

Background We aimed to evaluate the agreement between computed tomography (CT) and surrogate methods applied in clinical practice for the assessment of low muscle mass. In addition, we assessed the association between different muscle‐assessment methods and nutrition status, as well as the prognostic value of low muscle mass on survival in patients with colorectal cancer (CRC). Methods This is a cohort including 188 CRC patients with 17 months’ follow‐up (interquartile range: 12–23 months) for mortality. Low muscle mass was evaluated by corrected mid‐upper arm muscle area (AMAc) and calf circumference, skeletal muscle mass by bioelectrical impedance analysis (BIA), muscle deficit by physical examination with the Patient‐Generated Subjective Global Assessment (PG‐SGA), and lumbar muscle cross‐sectional area by CT (reference method). Results The prevalence of low muscle mass ranged from 9.6% to 54.3% according to the method used. The physical examination had the highest κ coefficient compared with CT. Low muscularity was associated with the presence of malnutrition, lower body fat, and low phase angle. The Cox regression models—adjusted for age, sex, and treatment 3 months before study inclusion—showed that severe muscle loss measured by BIA and CT and low muscle mass measured by PG‐SGA predicted higher mortality rates. Conclusions Compared with CT, the physical examination had the best agreement to assess low muscle mass. Low muscle mass assessed by PG‐SGA, BIA, and CT showed similar prognostic values for survival.

Linguistic and content validation of the translated and culturally adapted PG-SGA, as perceived by Norwegian cancer patients and healthcare professionals

“…An earlier study has tested criterion-validity on the question of food intake, and found a good association with energy-and protein intake measured with 24 h recall [23]. The physical examination part showed good agreement with low muscle mass assessed by CT, in an out-patient clinic for colorectal cancer patients in Brazil [24]. In contrast, low agreement between PG-SGA and muscle mass assessed by BIA, was found among colorectal patients in Norway, especially among overweight persons [25].…”

Malnutrition Prevalence according to the GLIM Criteria in Head and Neck Cancer Patients Undergoing Cancer Treatment

“…Additionally, we subjectively assessed a minimum of four of a possible seven muscle sites to determine a reduction in muscle stores rather than an objective measure such as bioelectrical impedance analysis (BIA) which all may have led to malnutrition under-reporting. However the physical assessment from the PG-SGA has demonstrated the best agreement with the gold standard computed tomography (CT) determined muscularity compared to other surrogate tools used in the clinical setting [ 30 , 31 ], and therefore is a clinically relevant measure. Importantly, the PG-SGA is commonly used in clinical practice in the oncology setting, whilst resources and tools to obtain objective measures, such as CT scans and BIA scales are less available and therefore less likely to be utilised.…”

Presence of dynapenia and association with anthropometric variables in cancer patients

“…Cancer cachexia is a multifactorial syndrome known for involuntary weight loss concomitant with reduced skeletal muscle mass, with or without loss of adipose tissue, being associated with decreased function, physical performance and a negative prognosis [8,9]. It happens as a result of a negative energy-protein balance, reduced food intake and an increased catabolic process, being aggravated by the systemic inflammation syndrome that often takes place in cancer patients [8][9][10][11][12]. The worsening of the cachectic condition leads to a progressive impairment of muscle function, which may explain its association with dynapenia in these patients [13].…”