Impact of sarcopenia in patients with advanced or recurrent colorectal cancer treated with regorafenib

Murachi, Yasushi; Sakai, Daisuke; Koseki, Junichi; Inagaki, Chiaki; Nishida, Naohiro; Yamaguchi, Toshifumi; Satoh, Taroh

doi:10.1007/s10147-020-01805-8

Cited by 11 publications

(12 citation statements)

References 30 publications

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“…Sarcopenia assessed by psoas muscle index is a simple and practical method that should be helpful to estimate patient frailty and to predict surgical outcome not only for oncological patients. It’s utility was demonstrated in liver transplantation [ 26 ], complication prediction in resected non-small-cell-lung-carcinoma [ 27 ], a prognostic value in primary operable colorectal cancer [ 28 ] and advanced or recurrent colorectal cancer treated with regorafenib [ 29 ], ICU (Instesive Care Unit) stay predictor in trauma patients [ 30 ], gynecological malignant diseases [ 31 ] as in liver cirrhosis, when PMI is a predictive tool for long term mortality [ 32 ]. In a study conducted by Y. Zager et al the radiological measurement of psoas area proved to be important as in Crohn’s disease among patients with bowel resection.…”

Section: Discussionmentioning

confidence: 99%

Psoas Muscle Index Defined by Computer Tomography Predicts the Presence of Postoperative Complications in Colorectal Cancer Surgery

et al. 2021

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Background and Objectives: Sarcopenia is a recognized prognostic factor for both complications and survival in cancer patients. This study aims to analyze the relationship between sarcopenia measured by psoas muscle index on computer tomography scans and the presence of postoperative complications in colorectal cancer surgery. Materials and Methods: In a prospective study we recorded data from 51 patients who underwent colorectal cancer surgery in the Mures County Clinical Hospital, Romania. Total psoas muscle area and psoas density were measured at the level of the third lumbal vertebra (L3) for further index calculation. We also evaluated the general characteristics and laboratory analyses to obtain more information about status of the patients. Short-term postoperative complications were scored according to the Clavien-Dindo classification. Results: The majority of the 51 patients were male (61%) and the median age was 65 years. More than half of the cancer was located in the rectum (56.9%), a quarter in the right colon (25.5%), the rest in the sigmoid (11.8%), and the left colon (5.9%). Twenty-one patients (41.2%) developed a complication, five (9.8%) of these were Clavien-Dindo grade 3, 4 or 5 (high grade) and sixteen (31.3%) grade 1 or 2 (low grade). The low- and high-grade groups showed a significantly lower right psoas muscle area, left psoas muscle area, total psoas muscle area, and psoas muscle index (p < 0.001 in all cases). Among laboratory analyses, a significantly lower perioperative hematocrit, hemoglobin, and albumin level were found in patients who developed complications. Furthermore we observed that an elevated serum C-reactive protein level was associated with a higher grade of complication (p < 0.043). Conclusions: The psoas muscle index (PMI) influence on the postoperative outcome is an important factor in our single center prospective study and it appears to be a good overall predictor in colorectal surgery. A lower PMI is directly associated with a low or high grade complication by Clavien-Dindo classification. Perioperative inflammatory and nutritional status evidenced by serum C-reactive protein (CRP) and albumin level influences the presence of postoperative complications.

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Section: Discussionmentioning

confidence: 99%

Psoas Muscle Index Defined by Computer Tomography Predicts the Presence of Postoperative Complications in Colorectal Cancer Surgery

et al. 2021

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“…Increasing evidence suggests that body composition may be an essential biomarker in patients with CRC [22]. Murachi et al demonstrated an association between sarcopenia and DLT in patients with metastatic colorectal cancer receiving regorafenibtherapy [23]. Other studies show that sarcopenia is associated with worse postoperative outcome and shorter overall survival in patients with metastatic colorectal cancer [24,25].…”

Section: Discussionmentioning

confidence: 99%

Sarcopenia does not limit overall survival in patients with colorectal liver metastases undergoing interstitial brachytherapy

Thormann

Heitmann

Wrobel

et al. 2022

Rofo

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Purpose Several studies report an association of sarcopenia with survival in oncologic patients. The aim of this study is to assess the influence of sarcopenia on overall survival (OS) in patients with colorectal liver metastases undergoing interstitial brachytherapy (iBT) Methods We identified 144 patients with colorectal liver metastases from our database from 2014–2017. Computed tomography (CT) chest scans at the L3 level were retrospectively analyzed. Psoas muscle area (PMA), psoas muscle index (PMI), and skeletal muscle gauge (SMG) were measured on the CT scan before treatment. Parameters were associated with overall survival. Results 116 patients were included. Median overall survival was 27 months. Median PMA was 13.79 cm2, median PMI 4.51 cm2/m2. Neither PMA (HR 1.036, 95 % CI 0.996–1.078, p = 0.080), PMI (HR 1.068, 95 % CI 0.922–1.238, p = 0.382), nor SMG (HR 1.00, 95 % CI 0.998–1.003, p = 0.955) were significantly associated with overall survival. Conclusion Sarcopenic patients undergoing iBT for colorectal liver metastases did not show decreased overall survival. If confirmed by comparative studies, sarcopenia may serve as a biomarker for treatment decision in patients with CRLM. Key points: Sarcopenia is not a risk factor for survival in patients with CLRM undergoing iBT. Citation Format

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“…Different lines of evidence are available for a role of the body composition as a predictive and/or prognostic marker in patients with gastrointestinal cancers [ 15 , 16 ]. Both experimental and clinical analyses have demonstrated an impaired response to treatment and an impaired overall survival in patients with a reduced muscle mass and/or an impaired muscle quality [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, we used baseline CT scans to quantify the area of skeletal muscle as well as the skeletal muscle attenuation as a surrogate for sarcopenia. CT imaging is available for almost all CCA patients before chemotherapy, allowing cost-effective analyses of multiple surrogates for the body composition, as it was recently demonstrated in different clinical contexts [ 16 , 19 ]. Therefore, in contrast to most of the previous studies on biliary tract cancer that relied on measurements of the psoas muscle area only [ 20 , 21 , 22 ], we are able to provide a more complete picture of the individual body composition by simultaneously measuring muscle mass (L3SMI and L3PMI) and myosteatosis (MMA).…”

Section: Discussionmentioning

confidence: 99%

Sarcopenia and Myosteatosis as Prognostic Markers in Patients with Advanced Cholangiocarcinoma Undergoing Palliative Treatment

Jördens

Wittig

Heinrichs

et al. 2021

JCM

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Background: Cholangiocarcinoma (CCA) represents the second most common primary liver cancer and is characterized by a very poor outcome, but reliable prognostic markers are largely missing. Sarcopenia, the progressive loss of muscle mass and strength, as well as myosteatosis have been associated with an unfavorable outcome in several clinical conditions, including cancer. Here, we evaluated the prognostic relevance of sarcopenia and myosteatosis using routine abdominal CT (computed tomography) scans in advanced stage CCA patients undergoing palliative treatment. Methods: Routine abdominal CT scans were used to assess the skeletal muscle and the psoas muscle index (L3SMI/L3PMI) at the level of the third lumbar vertebra as radiological indices for sarcopenia as well as the mean skeletal muscle attenuation (MMA) as a surrogate for myosteatosis. Results were correlated with clinical data and outcomes. Results: Using a calculated optimal cut-off value of 71.95 mm2/cm, CCA patients with an L3SMI value below this cut-off showed a significantly reduced median overall survival (OS) of only 250 days compared to 450 days in patients with a higher L3SMI. Moreover, the median OS of CCA patients with an L3PMI above 6345 mm2/cm was 552 days compared to 252 days in patients with a lower L3PMI. Finally, CCA patients with an MMA above 30.51 Hounsfield Units survived significantly longer (median OS: 430 days) compared to patients with an MMA value below this ideal cut-off (median OS: 215 days). The prognostic relevance of L3SMI, L3PMI, and MMA was confirmed in uni- and multivariate Cox regression analyses. Conclusion: Routine abdominal CT scans represent a unique opportunity to evaluate sarcopenia as well as myosteatosis in advanced CCA patients. We identified the L3SMI/L3PMI as well as the MMA as negative prognostic factors in CCA patients undergoing palliative therapy, arguing that the “opportunistic” evaluation of these parameters might yield important clinical information in daily routine.

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Impact of sarcopenia in patients with advanced or recurrent colorectal cancer treated with regorafenib

Cited by 11 publications

References 30 publications

Psoas Muscle Index Defined by Computer Tomography Predicts the Presence of Postoperative Complications in Colorectal Cancer Surgery

Psoas Muscle Index Defined by Computer Tomography Predicts the Presence of Postoperative Complications in Colorectal Cancer Surgery

Sarcopenia does not limit overall survival in patients with colorectal liver metastases undergoing interstitial brachytherapy

Sarcopenia and Myosteatosis as Prognostic Markers in Patients with Advanced Cholangiocarcinoma Undergoing Palliative Treatment

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