Prognostic Significance of Sarcopenia in Patients with Metastatic Renal Cell Carcinoma

Fukushima, Hiroshi; Nakanishi, Yasukazu; Kataoka, Masao; Tobisu, Ken‐ichi; Koga, Fumitaka

doi:10.1016/j.juro.2015.08.071

Cited by 107 publications

(92 citation statements)

References 25 publications

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“…These results indicated that sarcopenia may be a significant predictor of prognosis in patients with HCC who underwent sorafenib therapy, and potentially in patients with other types of malignancies. Individualized nutritional assessment and interventional strategies may be recommended for patients with HCC and sarcopenia treated with sorafenib (18,24,25). By contrast, it should be noted that sarcopenia was identified in 151 (65.1%) patients in the present analysis.…”

Section: Discussioncontrasting

confidence: 54%

“…Recently, sarcopenia has attracted a high level of attention in the fields of several types of malignancies due to its impact on clinical outcomes (18,24,25). However, to the best of our knowledge, reliable data regarding the impact of sarcopenia on the clinical outcomes of patients with HCC receiving sorafenib therapy have yet to be obtained.…”

Section: Discussionmentioning

confidence: 99%

“…Although commonly observed, malnutrition is frequently underdiagnosed or overlooked, and it is poorly characterized in patients with HCC and LC complications (21)(22)(23). In addition, to the best of our knowledge, although sarcopenia has been reported to be an adverse predictor in patients with HCC who may have a potential for curative therapy such as surgical resection, as well as in patients with several malignancies other than HCC, there have been no studies regarding the impact of sarcopenia on clinical outcomes in patients with HCC undergoing sorafenib therapy (18,(24)(25)(26)(27). Therefore, it is imperative to address these issues.…”

Section: Introductionmentioning

confidence: 99%

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Prognostic significance of sarcopenia in patients with hepatocellular carcinoma undergoing sorafenib therapy

et al. 2017

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Abstract. The present study aimed to examine the impact of sarcopenia, defined as low muscle mass on computed tomography (CT), prior to sorafenib therapy on the clinical outcomes of patients with hepatocellular carcinoma (HCC) receiving sorafenib therapy. In total, 232 patients with unresectable HCC (median age, 72 years) were analyzed, and the extent of sarcopenia was assessed using CT. Cross-sectional areas (cm 2 ) of the skeletal muscles at the third lumbar vertebra level were determined by manual outlining on the CT images. The cross-sectional areas were normalized for height [skeletal rates, progression-free survival (PFS) rates and best treatment response of the sarcopenia group were retrospectively compared with those of the non-sarcopenia group, and the factors associated with OS and PFS were examined. Sarcopenia was observed in 151 patients (65.1%). There were 165 patients with Child-Pugh A and 67 with Child-Pugh B cirrhosis. In the sarcopenia group, the median treatment duration was 66 days, whereas in the non-sarcopenia group it was 103 days (P=0.001). The median OS time was 174 days in the sarcopenia group and 454 days in the non-sarcopenia group (P<0.0001). The median PFS was 77 days in the sarcopenia group and 106 days in the non-sarcopenia group (P=0.0131). Multivariate analysis identified sarcopenia to be an independent predictor of OS (hazard ratio, 0.365; P<0.0001). The objective response rate and disease control rate in the sarcopenia group were significantly lower, compared with those in the non-sarcopenia group (P=0.0146 and P=0.0151, respectively). In conclusion, sarcopenia may be an indicator of poor clinical course in patients with HCC receiving sorafenib. IntroductionHepatocellular carcinoma (HCC) is one of the major causes of cancer-associated mortality worldwide, accounting for 5.7% of all newly diagnosed malignancies (1-5). The annual incidence rates of HCC are the highest in East Asia and Sub-Saharan Africa, where >80% of all known cases develop (1-5). Advances in treatments for HCC during the last few decades markedly improved the prognosis of the disease (1,2,4,5). However, a curative therapy such as surgical resection may be applied to a limited number (<20%) of patients with HCC (5,6). Sorafenib is a multi-kinase inhibitor that suppresses cancer growth and cell proliferation (7,8). Two pivotal randomized phase III studies, namely the Sorafenib HCC Assessment Randomized Protocol study (7)

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Section: Discussioncontrasting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prognostic significance of sarcopenia in patients with hepatocellular carcinoma undergoing sorafenib therapy

et al. 2017

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“…Sarcopenia is a commonly observed disorder in aged populations and is associated with disability, functional decline and frailty (13,14). Age-associated sarcopenia is defined as primary sarcopenia, whilst advanced malignancies, as well as chronic inflammatory diseases including renal, heart and liver diseases, can be the causes of secondary sarcopenia (12)(13)(14)(15)(16). Severe underlying diseases can lead to sarcopenia and cachexia, which involves body weight loss and muscle wasting.…”

Section: Effect Of Pretreatment Psoas Muscle Mass On Survival For Patmentioning

confidence: 99%

Effect of pretreatment psoas muscle mass on survival for patients with unresectable pancreatic cancer undergoing systemic chemotherapy

et al. 2017

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Abstract. To the best of our knowledge, there are few previous studies that have investigated the effect of decreased skeletal muscle mass (DSMM) on survival in patients with unresectable advanced pancreatic cancer (APC) who are undergoing systemic chemotherapy. Thus, the present study aimed to investigate the impact of DSMM, as determined by the psoas muscle index (PMI) following computed tomography and prior to systemic chemotherapy, on the outcomes of patients with unresectable APC (n=61). The primary endpoint used was the overall survival (OS) rate. The OS rates in the PMI-High group (exceeds the median PMI value in each gender) were retrospectively compared with those in the PMI-Low group (below the median PMI value in each gender), and factors associated with OS were investigated using univariate and multivariate analyses. The study cohort included 31 male and 30 female patients with a median age of 72 years, 13 of whom were stage IVA, and 48 were stage IVB. ). The proportion of patients with performance status 0 in the PMI-High group was significantly high, compared with that in the PMI-Low group [83.3% (25/30) vs. 58.1% (18/31); P=0.0486]. Body mass index in the PMI-High group was significantly higher compared with that in the PMI-Low group (P=0.0154). The 1-year cumulative survival rate was 43.3% in the PMI-High group and 12.9% in the PMI-Low group (P=0.0027). Following multivariate analysis, PMI (P=0.0036), prothrombin time (P=0.0044) and carbohydrate antigen 19-9 (P= 0.0451) were identified to be significant predictors of OS. In conclusion, DSMM, as determined by the PMI, could be a significant predictor of prognosis in patients with unresectable APC who are receiving systemic chemotherapy.

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“…10 In RCC, sarcopenia has been recently studied, in patients with localized 11 , and metastatic disease. 12, 13 …”

Section: Introductionmentioning

confidence: 99%

The Effects of Neoadjuvant Axitinib on Anthropometric Parameters in Patients With Locally Advanced Non-metastatic Renal Cell Carcinoma

Chéry

Borregales

Fellman

et al. 2017

Urology

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Objective To examine the effect that neoadjuvant axitinib for the treatment of localized renal cell carcinoma has on body compartment composition. Patients and Methods The study was based on a single-institution, single-arm clinical trial that enrolled 24 patients with locally advanced non-metastatic biopsy-proven clear cell renal cell carcinoma. Patients received axitinib orally for up to 12 weeks. Computed tomography scans were completed before the start of treatment, after 7 weeks of treatment and at the completion of 12 weeks of treatment. Patients underwent nephrectomy after axitinib treatment. The primary outcome of the current study was change in body compartment composition. Secondary outcomes included development of new-onset sarcopenia and changes in body weight. Results A total of 23 patients had a complete set of imaging for evaluation, of which 19 (82.6%) lost weight. Median weight loss was 4.5 kg (p < 0.001). Seven patients (30.4%) had sarcopenia prior to treatment, with an additional 5 (21.7%) developing sarcopenia during treatment. Median decrease in skeletal muscle was 2.9 cm2/m2 (p < 0.001), visceral adipose tissue was 4.9 cm2/m2 (p = 0.132), and subcutaneous adipose tissue was 1.0 cm2/m2 (p = 0.043). Ten(62.5%) of the 16 patients without baseline sarcopenia achieved a partial response, while only one(14.3%) of the 7 patients with baseline pretreatment sarcopenia achieved a partial response (p=0.069). Conclusions Neoadjuvant axitinib resulted in a decrease in skeletal muscle and subcutaneous adipose tissue, as well as weight loss. Patients with baseline sarcopenia tended to have a lower response rate to neoadjuvant axitinib.

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Prognostic Significance of Sarcopenia in Patients with Metastatic Renal Cell Carcinoma

Abstract: Sarcopenia is a significant prognostic factor in metastatic renal cell carcinoma.

Cited by 107 publications

References 25 publications

Prognostic significance of sarcopenia in patients with hepatocellular carcinoma undergoing sorafenib therapy

Prognostic significance of sarcopenia in patients with hepatocellular carcinoma undergoing sorafenib therapy

Effect of pretreatment psoas muscle mass on survival for patients with unresectable pancreatic cancer undergoing systemic chemotherapy

The Effects of Neoadjuvant Axitinib on Anthropometric Parameters in Patients With Locally Advanced Non-metastatic Renal Cell Carcinoma

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