Myosteatosis predicts higher complications and reduced overall survival following radical oesophageal and gastric cancer surgery

Murnane, Lisa; Forsyth, Adrienne; Koukounaras, Jim; Pilgrim, Charles; Shaw, Kalai; Brown, Wendy A.; Mourtzakis, Marina; Tierney, Audrey C.; Burton, Paul R.

doi:10.1016/j.ejso.2021.02.008

Cited by 30 publications

(44 citation statements)

References 41 publications

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“…Myosteatosis in CC is associated with worse DFS and OS even after adjustments for age, CCI, alcoholism, and CS. In opposite, we did not detect that myosteatosis affected the survival Myosteatosis is a factor that negatively affects survival (14,(34)(35)(36), and it is associated with increased chemotherapy toxicity (36)(37)(38) as well as with increased hospital readmissions due to postoperative complications (13,22). Our findings extend these data by showing that myosteatosis prevented patients with CC from receiving the entire preplanned adjuvant chemotherapy regimen.…”

Section: Discussionsupporting

confidence: 53%

“…Myosteatosis is a factor that negatively affects survival ( 14 , 34 – 36 ), and it is associated with increased chemotherapy toxicity ( 36 – 38 ) as well as with increased hospital readmissions due to postoperative complications ( 13 , 22 ). Our findings extend these data by showing that myosteatosis prevented patients with CC from receiving the entire preplanned adjuvant chemotherapy regimen.…”

Section: Discussionmentioning

confidence: 99%

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Myosteatosis Differentially Affects the Prognosis of Non-Metastatic Colon and Rectal Cancer Patients: An Exploratory Study

et al. 2021

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Body composition performed by computed tomography (CT) impacts on cancer patients’ prognoses and responses to treatment. Myosteatosis has been related to overall survival (OS) and disease-specific survival in colorectal cancer (CRC); however, the independent impact of the association of myosteatosis with prognosis in colon cancer (CC) and rectal cancer (RC) is still unclear. CT was performed at the L3 level to assess body composition features in 227 patients with CRC. Clinical parameters were collected. Overall survival (OS) was the primary outcome, and the secondary outcome was disease-free survival (DFS). Skeletal muscle attenuation and intramuscular adipose tissue area were associated with DFS (p = 0.003 and p = 0.011, respectively) and OS (p < 0.001 and p < 0.001, respectively) in CC patients but not in RC patients. Only the skeletal muscle area was associated with better prognosis related to OS in RC patients (p = 0.009). When CC and RC were analyzed separately, myosteatosis influenced survival negatively in CC patients, worsening DFS survival (hazard ratio [HR], 2.70; 95% confidence interval [CI], 1.07–6.82; p = 0.035) and OS (HR, 5.76; 95% CI, 1.31–25.40; p = 0.021). By contrast, the presence of myosteatosis did not influence DFS (HR, 1.02; 95% CI, 0.52–2.03; p = 0.944) or OS (HR, 0.76; 95% CI, 0.33–1.77; p = 0.529) in RC patients. Our study revealed the interference of myosteatosis in the therapy and survival of patients with CC but not in those with RC, strengthening the value of grouping the two types of cancer in body composition analyses.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Myosteatosis Differentially Affects the Prognosis of Non-Metastatic Colon and Rectal Cancer Patients: An Exploratory Study

et al. 2021

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“…The association between myosteatosis and OS on adjusted analysis (HR 1.28; 95% CI 0.57-2.84), P = 0.500) differs from our previous study (n = 79) (HR 8.86; 95% CI 1.12-69.88, P = 0.038) 18 which is likely attributable to the smaller cohort in the earlier study. Myosteatosis is a demonstrated poor prognostic factor in other tumour groups 32,33 ; however, there remains a paucity of studies in patients with HNC. Most research on CT-defined body composition in patients with HNC has to date reported findings regarding sarcopenia alone; however, our study explores whether skeletal muscle depletion features occur in isolation or concurrently appears to also influence outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…The association between myosteatosis and OS on adjusted analysis (HR 1.28; 95% CI 0.57–2.84), P = 0.500) differs from our previous study ( n = 79) (HR 8.86; 95% CI 1.12–69.88, P = 0.038) 18 which is likely attributable to the smaller cohort in the earlier study. Myosteatosis is a demonstrated poor prognostic factor in other tumour groups 32 , 33 ; however, there remains a paucity of studies in patients with HNC.…”

Section: Discussionmentioning

confidence: 99%

Nutritional status and skeletal muscle status in patients with head and neck cancer: Impact on outcomes

Findlay

White

Brown

et al. 2021

J cachexia sarcopenia muscle

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Background Computed tomography (CT)-defined skeletal muscle depletion and malnutrition are demonstrated as poor prognostic factors in patients with head and neck cancer (HNC), however to date, have only been explored in isolation. We aimed to describe body composition profile and examine the impact of nutritional status as well as independently and concurrently occurring body composition features on overall survival, treatment completion, unplanned admissions and length of stay (LOS) in patients undergoing radiotherapy (RT) or chemoradiotherapy (CRT) of curative intent for HNC. Methods This work is a retrospective, observational study of patients who had completed treatment of curative intent for HNC. Scored Patient-Generated Subjective Global Assessment (PG-SGA) was used to determine nutritional status. Tissue-density data were derived at the third lumbar vertebra (L3) with sarcopenia and myosteatosis defined by published, sex-specific threshold values stratified by body mass index for skeletal muscle index (cm 2 /m 2 ) and skeletal muscle radiodensity (SMR, Hounsfield Unit). Results Pre-treatment data (n = 277: 78% male, mean (SD) age 60 (13) years) revealed the prevalence of malnutrition (24.9%), sarcopenia (52.3%), myosteatosis (82.3%), and concurrently occurring sarcopenia and myosteatosis (39.7%). Malnutrition was independently associated with reduced OS for patients with moderate [hazard ratio (HR) 2.57; 95% confidence interval (CI) 1.45-4.55, P = 0.001] and severe (HR 3.19; 95% CI 1.44-7.07, P = 0.004) malnutrition on multivariable analysis but not sarcopenia (HR 1.09; 95% CI 0.70-1.71), P = 0.700 or myosteatosis (HR 1.28; 95% CI 0.57-2.84), P = 0.500). Malnutrition was associated with treatment discontinuation (P < 0.001), not completing RT as planned (P < 0.001), unplanned hospital admission (P = 0.021), and greater LOS (P < 0.001). Skeletal muscle status features were associated with unplanned hospital admissions for those with no features (32%), with sarcopenia only (50%), myosteatosis only (25%), and concurrent sarcopenia and myosteatosis (50%), P < 0.001. Similarly, a clinically relevant greater median (Q1, Q3) LOS was observed for those with sarcopenia only [5 (3, 32)], myosteatosis only [10 (5, 30)], concurrent sarcopenia, and myosteatosis [14 (4, 33)] days vs. those with no features [3 (2, 11)] days, P = 0.2. Conclusions Malnutrition was a more powerful prognostic indicator than CT-defined skeletal muscle depletion and was independently associated with reduced OS in patients undergoing RT or CRT of curative intent for HNC. CT-defined skeletal muscle depletion studies should recognize the multifaceted nature of human body composition and also measure nutritional status using validated methods in order to move towards developing a typology of high risk criteria for this complex patient group.

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“…A relationship exists between low muscle density, low muscle mass and systemic inflammation; however, it remains unclear whether altered muscle mass and muscle density lead to chronic systemic inflammation or if inflammatory changes cause muscle alterations 8,22,24–26 . However, the pro‐inflammatory state related to myopenia and myosteatosis might disturb the physiological inflammatory responses to withstand perioperative stressors, impairing wound and anastomotic healing and increasing the risk for postoperative infections 27,28 . This might explain why low muscle density is predominantly associated with the risk for major complications, rather than minor complications, 29,30 and why patients with low muscle mass who developed complications were more likely to develop major than minor complications.…”

Section: Discussionmentioning

confidence: 99%

Aerobic fitness and muscle density play a vital role in postoperative complications in colorectal cancer surgery

Cuijpers

Bongers

Heldens

et al. 2022

Journal of Surgical Oncology

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Background and Objectives To assess the association of preoperative aerobic fitness and body composition variables with a patient's resilience to the development and impact of postoperative complications after elective colorectal cancer (CRC) surgery. Methods Preoperative aerobic fitness was assessed by steep ramp test performance. Preoperative body composition was assessed by muscle mass and density determined from preoperative computed tomography scan analysis at the L3‐level. Complication development and severity was graded according to Clavien‐Dindo. Complication impact was assessed by the time to recovery of physical functioning after complications. Multivariable logistic regression analyses adjusted for age, sex, comorbidities and tumour location was performed. Results Of 238 included patients, 96 (40.3%) developed postoperative complications. Better preoperative aerobic fitness decreased the likelihood to develop complications, independent of muscle mass (odds ratio [OR]: 0.55, 95% confidence interval [CI]: 0.35−0.85) or muscle density (OR: 0.57, 95% CI: 0.36−0.89). A prolonged time to recovery following complications was associated with lower preoperative muscle density (OR: 4.14, 95% CI: 1.28−13.41), independent of aerobic fitness. Conclusions Lower aerobic fitness increases the risk of complication development, while low muscle density seems associated with a prolonged recovery from complications. Aerobic fitness and muscle density could be valuable additives to preoperative risk assessment.

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Myosteatosis predicts higher complications and reduced overall survival following radical oesophageal and gastric cancer surgery

Cited by 30 publications

References 41 publications

Myosteatosis Differentially Affects the Prognosis of Non-Metastatic Colon and Rectal Cancer Patients: An Exploratory Study

Myosteatosis Differentially Affects the Prognosis of Non-Metastatic Colon and Rectal Cancer Patients: An Exploratory Study

Nutritional status and skeletal muscle status in patients with head and neck cancer: Impact on outcomes

Aerobic fitness and muscle density play a vital role in postoperative complications in colorectal cancer surgery

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