Prognostic Value of Computed Tomography: Measured Parameters of Body Composition in Primary Operable Gastrointestinal Cancers

Black, Douglas; Mackay, Craig; Ramsay, George; Hamoodi, Zaid; Nanthakumaran, Shayanthan; Park, Kenneth G. M.; Loudon, Malcolm; Richards, Colin H.

doi:10.1245/s10434-017-5829-z

Cited by 86 publications

(77 citation statements)

References 33 publications

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“…Some of the previous studies, all recruiting patients from Asian populations, suggested an increased risk of death among patients with sarcopenia and GC with hazard ratio (HR) of 1.6‐2.7 . Detailed data from Western countries are not available, but in a mixed population of patients with various gastrointestinal malignancies, including 65 GCs, SMI of sarcopenia did not influence survival . However, results from our well‐defined clinical cohort demonstrated that sarcopenia was an independent prognostic factor (HR, 1.94; 95% CI, 1.08‐3.48) irrespective of tumor stage and radicality of resection.…”

Section: Discussionmentioning

confidence: 63%

“…29,33,37 Detailed data from Western countries are not available, but in a mixed population of patients with various gastrointestinal malignancies, including 65 GCs, SMI of sarcopenia did not influence survival. 12 However, results from our well-defined clinical cohort demonstrated that sarcopenia was an independent prognostic factor (HR, 1.94; 95% CI, 1.08-3.48) irrespective of tumor stage and radicality of resection. Nevertheless, the exact mechanism possibly linking sarcopenia with impaired survival is still unclear.…”

Section: Sarcopenia and Long-term Survivalmentioning

confidence: 67%

“…However, until recently, there were few reports on the role of sarcopenia in patients with GC and those published were derived almost exclusively from countries outside Europe and America . Surprisingly, the limited evidence from Western populations suggested that contrary to observations made in Asian patients, sarcopenia was not associated with prognosis or postoperative complications …”

Section: Introductionmentioning

confidence: 93%

“…11 Surprisingly, the limited evidence from Western populations suggested that contrary to observations made in Asian patients, sarcopenia was not associated with prognosis or postoperative complications. 12,13 Considering the distinct differences in general muscularity among Western and Asian ethnic groups, as well as the potential implications of sarcopenia for short-and long-term oncological outcomes, there is an urgent need for clinical validation of CT-based measurements of body composition in gastric carcinoma. Therefore, the aim of this study was to evaluate the prognostic impact of sarcopenia on patients' overall survival and the predictive impact on the risk of postoperative complications in a group of Caucasian patients subject to stomach resections due to gastric adenocarcinoma.…”

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confidence: 99%

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Prognostic and predictive implications of sarcopenia in Western patients undergoing gastric resections for carcinoma of the stomach

Sierżęga

Chrzan

Wiktorowicz

et al. 2019

Journal of Surgical Oncology

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Introduction Sarcopenia is highly prevalent in patients with gastrointestinal malignancies, including gastric cancer, but there is a lack of adequate data from Western populations. Methods Computed tomography scans of 138 Caucasian patients subject to stomach resections due to gastric adenocarcinoma between 2012 and 2015 were reviewed to evaluate the impact of sarcopenia. The definition of sarcopenia was based on the lumbar skeletal muscle index (SMI) using cut‐off values formulated by the international consensus definitions of sarcopenia (SMI <52.4 cm2/m2 for men and <38.5 cm2/m2 for women). Results Sixty (43%) of 138 patients were sarcopenic. Sarcopenia was associated with postoperative morbidity (43% vs 23%; P = .011), major postoperative complications (Clavien‐Dindo ≥3a; 36% vs 21%; P = .035), and reoperations (23% vs 9%; P = .020). Patients with sarcopenia also had prolonged postoperative hospital stay (8.0 vs 6.5 days; P = .010). The overall median survival of patients with sarcopenia was significantly lower than those with normal skeletal muscles (11.0 vs 36.7 months; P = .005) and sarcopenia remained an independent prognostic factor with an odds ratio of 1.94 (95% confidence interval, 1.08 to 3.48; P = .026). Conclusion Sarcopenia, defined by SMI, is associated with an increased risk of postoperative morbidity and impaired long‐term survival.

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Section: Discussionmentioning

confidence: 63%

Section: Sarcopenia and Long-term Survivalmentioning

confidence: 67%

Section: Introductionmentioning

confidence: 93%

mentioning

confidence: 99%

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Prognostic and predictive implications of sarcopenia in Western patients undergoing gastric resections for carcinoma of the stomach

Sierżęga

Chrzan

Wiktorowicz

et al. 2019

Journal of Surgical Oncology

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“…13 The importance of the systemic inflammatory response as a unifying mechanism for weight loss and loss of lean tissue in patients with cancer is increasingly recognized. 3,14,15 Therefore, it is of interest that SMI and SMD have been repeatedly reported to be inversely associated with measures of the systemic inflammatory response, such as the neutrophil lymphocyte ratio (NLR) and modified Glasgow prognostic score (mGPS), [16][17][18][19][20][21][22] that are recognized to have prognostic value in their own right. 23,24 However, this relationship is not clear.…”

Section: Introductionmentioning

confidence: 99%

The relationship between computed tomography‐derived body composition, systemic inflammatory response, and survival in patients undergoing surgery for colorectal cancer

Dolan

Almasaudi

Dieu

et al. 2018

J cachexia sarcopenia muscle

140

142

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Introduction Colorectal cancer is the fourth leading cause of cancer mortality in developed countries. There is evidence supporting a disproportionate loss of skeletal muscle as an independent prognostic factor. The importance of the systemic inflammatory response as a unifying mechanism for specific loss of skeletal muscle mass in patients with cancer is increasingly recognized. The aim of the present study was to delineate the relationship between the systemic inflammatory response, skeletal muscle index (SMI), skeletal muscle density (SMD), and overall survival in patients with colorectal cancer. Materials and methods The study included 650 patients with primary operable colorectal cancer. Computed tomography scans were used to define the presence of visceral obesity, sarcopenia (low SMI), and myosteatosis (low SMD). Tumour and patient characteristics were recorded. Survival analysis was carried out using univariate and multivariate Cox regression. Results A total of 650 patients (354 men and 296 women) were included. The majority of patients were over 65 years of age (64%) and overweight or obese (68%). On univariate survival analysis, age, ASA, TNM stage, modified Glasgow Prognostic Score (mGPS), body mass index, subcutaneous fat index, visceral obesity, SMI, and SMD were significantly associated with overall survival (all P < 0.05). A low SMI and SMD were significantly associated with an elevated mGPS (<0.05). On multivariate analysis, SMI (Martin) [hazard ratio (HR) 1.50, 95% confidence interval (CI) 1.04–2.18, P = 0.031], SMD (Xiao) (HR 1.42, 95% CI 0.98–2.05, P = 0.061), and mGPS (HR 1.44, 95% CI 1.15–1.79, P = 0.001) were independently associated with overall survival. SMD but not SMI was significantly associated with ASA ( P < 0.001). Conclusions This study delineates the relationship between the loss of quantity and quality of skeletal muscle mass, the systemic inflammatory response, and survival in patients with operable colorectal cancer.

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Body Composition, Inflammation, and 5-Year Outcomes in Colon Cancer

et al. 2021

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IMPORTANCE Obesity, particularly visceral obesity and sarcopenia, are poor prognostic indicators in colon cancer. OBJECTIVES To explore the association between body composition profiles and 5-year colon cancer outcomes and delineate the associated underlying inflammatory processes. DESIGN, SETTING, AND PARTICIPANTS This multicenter translational cohort study included patients with nonmetastatic colon cancer who did not have underlying chronic inflammatory disorders and were not receiving anti-inflammatory drugs referred to tertiary cancer centers from 2009 to 2015. Preoperative acute phase proteins (white cell count, C-reactive protein, and albumin), cytokines (interleukin [IL]-1b, IL-2, IL-6, IL-10, interferon γ, and tumor necrosis factor α), vascular endothelial growth factor (VEGF), and cell surface receptor expression levels (CD11b and CD14) were measured. All patients underwent follow-up for at least 5 years. Data were analyzed in December 2020. EXPOSURE Nonmetastatic colon cancer. MAIN OUTCOMES AND MEASURES The associations of body composition profiles with 5-year cancer recurrence and disease-specific mortality were analyzed using Mantel Cox log-rank test and Kaplan-Meier curves. RESULTS A total of 28 patients were included (median [interquartile range] age, 67 [58-72] years;22 [78.6%] men). Low skeletal muscle area (SMA) and high visceral to total fat ratio were associated with poor clinical and oncological outcomes, including increased 5-year recurrence (low SMA: hazard ratio [HR], 2.30 [95% CI, 1.41-2.89]; P = .04; high visceral to total fat ratio: HR, 5.78 [95% CI, 3.66-7.95]; P = .02). High visceral to total fat ratio was associated with increased 5-year disease-specific mortality (HR,5.

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Prognostic Value of Computed Tomography: Measured Parameters of Body Composition in Primary Operable Gastrointestinal Cancers

Cited by 86 publications

References 33 publications

Prognostic and predictive implications of sarcopenia in Western patients undergoing gastric resections for carcinoma of the stomach

Prognostic and predictive implications of sarcopenia in Western patients undergoing gastric resections for carcinoma of the stomach

The relationship between computed tomography‐derived body composition, systemic inflammatory response, and survival in patients undergoing surgery for colorectal cancer

Body Composition, Inflammation, and 5-Year Outcomes in Colon Cancer

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