Impact of sarcopenia in advanced and metastatic soft tissue sarcoma

Abstract

Introduction Advanced or metastatic soft tissue sarcoma (a/mSTS) is associated with a dismal prognosis. Patient counseling on treatment aggressiveness is pivotal to avoid over- or undertreatment. Recently, evaluation of body composition markers like the skeletal muscle index (SMI) became focus of interest in a variety of cancers. This study focuses on the prognostic impact of SMI in a/mSTS, retrospectively. Methods 181 a/mSTS patients were identified, 89 were eligible due to prespecified criteria for SMI assessment. Baseline CT-Scans were analyzed using an institutional software solution. Sarcopenia defining cut-off values for the SMI were established by optimal fitting method. Primary end point was overall survival (OS) and secondary endpoints were progression free survival (PFS), disease control rate (DCR), overall response rate (ORR). Descriptive statistics as well as Kaplan Meier- and Cox regression analyses were administered. Results 28/89 a/mSTS patients showed sarcopenia. Sarcopenic patients were significantly older, generally tended to receive less multimodal therapies (62 vs. 57 years, P = 0.025; respectively median 2.5 vs. 4, P = 0.132) and showed a significantly lower median OS (4 months [95%CI 1.9–6.0] vs. 16 months [95%CI 8.8–23.2], Log-rank P = 0.002). Sarcopenia was identified as independent prognostic parameter of impaired OS (HR 2.40 [95%-CI 1.4–4.0], P < 0.001). Moreover, DCR of first palliative medical treatment was superior in non-sarcopenic patients (49.2% vs. 25%, P = 0.032). Conclusion This study identifies sarcopenia as a prognostic parameter in a/mSTS. Further on, the data suggest that sarcopenia shows a trend of being associated with first line therapy response. SMI is a promising prognostic parameter, which needs further validation.

Sarcopenia is associated with worse surgical complications but not relapse-free survival and overall survival in patients with retroperitoneal liposarcoma

“…Many reports have shown that sarcopenia is closely related to the prognosis of patients with various malignant tumors. 3,[6][7][8][9][10][11]13,[19][20][21] However, different pathological types of sarcomas are not identical in treatment and prognosis, so we conducted a study on the exact pathological type of sarcomas and drew relevant conclusions. Meanwhile, the effect of sarcopenia on the post-surgical outcomes of patients with liposarcoma undergoing en bloc compartment resection has not been reported.…”

“…8,12 The advanced studies showed that sarcopenia is associated with prognostic parameters in advanced or metastatic STS and rst-line therapy response. 13 Therefore, body composition parameters should be deeply investigated to evaluate the next step of treatment, which needs forward prognostication systems to avoid over-or undertreatment as soon as possible.…”

Sarcopenia is associated with worse surgical complications but not relapse-free survival and overall survival in patients with retroperitoneal liposarcoma

“…Many reports have shown that sarcopenia is closely related to the prognosis of patients with various malignant tumors. [ 3 , 6 – 11 , 13 , 19 – 21 ] However, different pathological types of sarcomas are not identical in treatment and prognosis, so we conducted a study on the exact pathological type of sarcomas and drew relevant conclusions. Meanwhile, the effect of sarcopenia on the post-surgical outcomes of patients with liposarcoma undergoing en bloc compartment resection has not been reported.…”

Sarcopenia: Etiology, Nutritional Approaches, and miRNAs

“…In this sense, sarcopenia is linked to the prognostic state of some pathologies, e.g., in those that affect the intestinal function and, as aforementioned, the absorption of nutrients as reported in abdominal hernias [13] and inflammatory bowel disease (IBD) [14]. Furthermore, sarcopenia has been recently related to the prognosis of various tumors [15][16][17][18], which leads to a monitoring status at the initial stage, as well as during and after chemotherapy. This narrative review aims to summarize the key molecular mechanisms of sarcopenia, the recent and future directions of the microRNAs for diagnosis and prognosis, and several strategies with an emphasis on nutrition to counteract the progression of this condition.…”