Diagnosis of pre-sarcopenia from a single selectional cross at C3 region, using CT scans before radiotherapy

Muresan, Bianca Tabita; Juan, Carlos Sánchez; Artero, Ana; Machancoses, Ana Hernández; Almendros-Blanco, Piedad; Montoro, Alegría; Jordá, Gonzalo Sánchez; Marco-Alacid, Cristian; Ríos, Jaime Ríos; Castillo, José Miguel Soriano del; Guillén, Laura Sánchez; López-Torrecilla, J.

doi:10.20960/nh.02422

Cited by 8 publications

(12 citation statements)

References 26 publications

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“…Several foundational studies demonstrated a strong correlation of L3 and C3 skeletal muscle area in patients with HNC consistent with our findings herein 12,15,24,25 . Abdominal skeletal muscle cross-sectional area is linearly related to total body muscle mass, so we normalized C3 muscle cross sectional area for stature to determine sex-specific thresholds for sarcopenia as previously described 5 .…”

Section: Discussionsupporting

confidence: 92%

Establishment and validation of pre-therapy cervical vertebrae muscle quantification as a prognostic marker of sarcopenia in head and neck patients receiving definitive cancer surgery

Olson

Edwards

Degnin

et al. 2021

Preprint

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Importance: Sarcopenia, or diminished skeletal muscle mass, is prognostic for survival in patients with head and neck cancer (HNC). However, identification of this high-risk feature remains challenging for patients without computed tomography (CT) images that capture the abdomen or lower thorax. Objectives: To (1) define sarcopenia thresholds at the C3 vertebral level using previously established thresholds derived from abdominal CT imaging and (2) determine if C3-defined sarcopenia is associated with survival in patients with HNC. Design, setting, and participants: This retrospective cohort study was conducted in consecutive patients with a squamous cell carcinoma of the head and neck with cross-sectional abdominal or neck imaging within 60 days prior to treatment and treated between January 2005 and December 2017. Data analysis was completed from December 2018 to April 2021. Exposures: Measurement of the cross-sectional muscle area at the third lumbar and cervical vertebral levels using CT imaging. Main outcomes and measures: Primary study outcome was overall survival. Results: In a cohort of 253 HNC patients with CT imaging that captures both L3 and C3 vertebral levels, skeletal muscle cross-sectional area at C3 was strongly correlated with the L3 level in both men (n = 188; r = 0.77; p < 0.001) and women (n = 65; r = 0.80; p < 0.001), and C3-defined sarcopenia thresholds of 14.0 cm2/m2 (men) and 11.1 cm2/m2 (women) were best predictive of previously established L3-defined sarcopenia thresholds. Applying these defined C3 sarcopenia thresholds in a cohort of 536 HNC patients with neck imaging alone revealed that C3-defined sarcopenia was independently associated with reduced overall survival in men (HR = 2.63; 95% CI, 1.79, 3.85) but not women (HR = 1.18, 95% CI, 0.76, 1.85) with HNC. Conclusions and relevance: This study identifies sarcopenia thresholds at the C3 level that best predict L3-defined sarcopenia in both men and women. In HNC, C3-defined sarcopenia is associated with poor survival outcomes in men, but not women, suggesting sarcopenia may differentially affect men and women with HNC.

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Section: Discussionsupporting

confidence: 92%

Establishment and validation of pre-therapy cervical vertebrae muscle quantification as a prognostic marker of sarcopenia in head and neck patients receiving definitive cancer surgery

Olson

Edwards

Degnin

et al. 2021

Preprint

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“…The number of patient scans used in each study varied, with the majority 24/32 (75 %) having sample sizes <250, with only three studies having much larger cohorts of >800 (51)(52)(53) . The majority (52 %) of papers focused on muscle mass assessment in patients with head and neck cancer (HNC) (seventeen studies (51,52,(54)(55)(56)(57)(58)(59)(60)(61)(62)(63)(64)(65)(66)(67)(68) ), with ten (32 %) investigating lung cancer (69)(70)(71)(72)(73)(74)(75)(76)(77)(78) and the remaining papers focusing on a mixed tumour cohort of head and neck, lung, breast and colorectal (53,(79)(80)(81)(82) . More detailed characteristics of the studies are shown in Table 1.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…software packages. Fifteen papers used a cervical vertebral slice (C3) (54)(55)(56)(57)(59)(60)(61)(62)(63)(64)(65)(66)68,80) with most using the study by Swartz et al as the reference for the use of C3, and applying the prediction formula described to the CSA at C3 to predict CSA at L3 (56) . Seven of these studies were conducted at the same institution in the Netherlands where the use of C3 in muscle mass estimation was first investigated (54)(55)(56)(57)59,(66)(67)(68) .…”

Section: C3mentioning

confidence: 99%

“…Five studies referenced the sarcopenia cut-off value determined by Wendrich et al (57) of SMI < 43•2 cm 2 /m 2 which was found to be predictive of chemotherapy dose-limiting toxicity, however provided no sex-specific values (55,59,61,66,67) . Others used the sex-specific cut-offs applied for CSA at L3 by Martin et al (10) which also provides cut-off values for obese males (60,80,82) . Twelve studies provided their own cut-off values based on mortality or morbidity prediction, or using receiver operating characteristic curves in their population analysis, with or without sex-specific cut-offs, at the alternate vertebral slice levels (51,58,62,63,65,68,70,(73)(74)(75)78,79) .…”

Section: Sarcopenia Analysis and Cut-off Valuesmentioning

confidence: 99%

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The use of alternate vertebral levels to L3 in computed tomography scans for skeletal muscle mass evaluation and sarcopenia assessment in patients with cancer: a systematic review

et al. 2021

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Body composition measurement using diagnostic computed tomography (CT) scans has emerged as a method to assess sarcopenia (low muscle mass) in oncology patients. Assessment of skeletal muscle mass (SMM) using the cross-sectional area (CSA) of a single vertebral slice (at lumbar L3) in a CT scan is correlated to whole body skeletal muscle volume. This method is used to assess CT-defined sarcopenia in patients with cancer, with low SMM effecting outcomes. However, as diagnostic scans are based on tumour location, not all include L3. We evaluated the evidence for the use of alternate vertebral CT slices for SMM evaluation when L3 is not available. Five electronic databases were searched from Jan 1996-April 2020 for studies using CT scan vertebral slices above L3 for SM measurement in adults with cancer (solid tumours). Validation with whole body SMM, rationale for the chosen slice, and sarcopenia cut-off values were investigated. Thirty-two studies were included, all retrospective and cross-sectional in design. Cervical, thoracic, and lumbar slices were used (from C3-L1), with no validation of whole body SMM using CT scans. Alternate slices were used in lung, and head and neck cancer patients. Sarcopenia cut-off values were reported in 75% of studies, with differing methods, with or without sex-specific values, and a lack of consensus. Current evidence is inadequate to provide definitive recommendations for alternate vertebral slice use for SMM evaluation in cancer patients. Variation in sarcopenia cut-offs warrants more robust investigation, in order for risk stratification to be applied to all patients with cancer.

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“…Un nuevo estudio llevado a cabo en 2019 ha analizado la MM en pacientes con cáncer mediante una TC de radioterapia extensa que englobaba el nivel C3 y L3. Estos hallazgos también han determinado una correlación positiva entre la MM e índice musculoesquelético (IME) a nivel de C3 y L3 (R 2 =0,876 y R 2 =0,805 respectivamente), por lo que permiten diagnosticar la presarcopenia mediante TC a nivel cervical, sin necesidad de realizar una medición a nivel lumbar 15 .…”

Section: Cita Introducciónunclassified

Tomografía computarizada a nivel de C3 y dinamometría como técnicas de diagnóstico de sarcopenia en pacientes con cáncer de cabeza y cuello

Muresan¹,

Juan

Artero³

et al. 2020

Rev Esp Nutr Hum Diet

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Introducción: Estudio piloto que determina el diagnóstico de sarcopenia mediante tomografía computarizada (TC) a nivel de la tercera vértebra cervical (C3) y dinamometría en pacientes con cáncer de cabeza y cuello. Comparación de la masa magra (MM) determinada mediante TC con técnicas clásicas de antropometría y dinamometría.Material y métodos: Se analizó la MM y el tejido adiposo mediante TC a nivel de C3 en 37 pacientes oncológicos mediante Unidades Hounsfield (UH). Posteriormente, se calculó el índice musculoesquelético (IME) y se determinó la fuerza prensora de mano para la determinación de sarcopenia. Por último, se comparó el IME mediante técnicas de valoración antropométrica clásica y dinamometría. Resultados: El 59,46% de los pacientes presentaron un IME (cm2/m2) disminuido, el 64,86% dinapenia, el 54,05% sarcopenia, el 32,43% sarcopenia dentro del sobrepeso y obesidad. Por otro lado, la media de la masa grasa intermuscular fue 6,69 (3,8) cm2, y la masa grasa intramuscular 2,06 (1,11) cm2. Además, se encontró una asociación estadísticamente significativa entre la fuerza tanto en la mano fuerte (estimado = 0,412, IC95% [0,219; 0,605], p-valor <0,001) como en la mano débil (estimado =0,289, IC95% [0,123; 0,454], p-valor <0,001) y el IME cm2/m2. Respecto a la circunferencia muscular braquial), no alcanzamos a mostrar correlación positiva.Conclusiones: Nuestro estudio muestra que en el paciente con cáncer de cabeza y cuello la prevalencia de sarcopenia es elevada. Además, la depleción muscular evaluada mediante TC a nivel de C3 y dinamometría presenta cierta correlación, por lo que, aquellos pacientes con mayor depleción muscular a nivel de C3 presentan menor funcionalidad.

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Diagnosis of pre-sarcopenia from a single selectional cross at C3 region, using CT scans before radiotherapy

Cited by 8 publications

References 26 publications

Establishment and validation of pre-therapy cervical vertebrae muscle quantification as a prognostic marker of sarcopenia in head and neck patients receiving definitive cancer surgery

Establishment and validation of pre-therapy cervical vertebrae muscle quantification as a prognostic marker of sarcopenia in head and neck patients receiving definitive cancer surgery

The use of alternate vertebral levels to L3 in computed tomography scans for skeletal muscle mass evaluation and sarcopenia assessment in patients with cancer: a systematic review

Tomografía computarizada a nivel de C3 y dinamometría como técnicas de diagnóstico de sarcopenia en pacientes con cáncer de cabeza y cuello

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