Prognostic value of radiologically determined sarcopenia prior to treatment in urologic tumors

Li, Jialin; Deng, Yihui; Zhang, Menghui; Cheng, Yusheng; Zhao, Xin; Ji, Zhigang

doi:10.1097/md.0000000000017213

“…The subgroup analyses in our meta-analysis according to cancer type yielded results largely consistent results with previous meta-analyses. Previous literature have identified significant associations in patients with lung cancer [ 10 ], head and neck cancer [ 11 , 18 ], GI cancer [ 9 , 19 , 20 ], liver cancer [ 9 , 21 , 22 ], pancreatic cancer [ 23 ], and urinary tract cancer [ 24 ], with largely consistent effect sized identified in the current meta-analysis. However, other recently published meta-analyses by Zhang et al [ 25 ], Ubachs et al [ 26 ], and Jia et al [ 27 ] have identified a significant association between sarcopenia and survival in breast cancer, ovarian cancer, and hematological malignancies, respectively, contrary to insignificant association identified in the current meta-analysis.…”

Section: Discussionsupporting

confidence: 80%

Sarcopenia and mortality in cancer: A meta-analysis

Au¹,

Li

²

,

Lee³

et al. 2021

Osteoporosis and Sarcopenia

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Objectives The aim of this meta-analysis is to comprehensively evaluate the effects of lean mass on all-cause mortality across different cancer types. Methods This is a meta-analysis. Cohort studies on lean mass and mortality published before December 20, 2017 were obtained by systematic search on PubMed, Cochrane Library, and Embase. Inclusion criteria were cohort studies reporting lean mass measurements by dual-energy X-ray absorptiometry, bioimpedance analysis or computed tomography, and with all-cause mortality as the study outcome. Exclusion criteria were studies using muscle mass surrogates, anthropometric measurement of muscle, rate of change in muscle mass, and sarcopenia defined by composite criteria. Hazard ratios (HRs) and 95% confidence intervals (CIs) of low/reduced lean mass on cancer mortality were pooled with a random-effects model. Subgroup analysis stratifying studies according to cancer type and measurement index was performed. Results Altogether 100 studies evaluated the association between lean mass and cancer mortality. The overall pooled HR on cancer mortality was 1.41 (95% CI, 1.24 to 1.59) for every standard deviation decrease in lean mass and 1.69 (95% CI, 1.56 to 1.83) for patients with sarcopenia (binary cutoffs). Overall mortality was also significantly associated with sarcopenia in across various cancer types, except for hematopoietic, breast, ovarian and endometrial, and prostate cancer. Conclusions The robust association of decreased lean mass with increased mortality further justified the importance of developing clinical guidelines for managing sarcopenia in cancer patients. Public health initiatives aiming at promoting awareness of muscle health in susceptible individuals are urgently needed.

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“…In patients with gastric cancer, sarcopenia was associated with mortality, postoperative complications, hospital costs, and postoperative hospital stay [ 26 ]. In renal cell carcinoma and urogenital tumors, patients with sarcopenia showed reduced overall survival and cancer-specific survival compared to patients without sarcopenia [ 27 28 ]. Sarcopenia is associated with a reduction in overall and recurrence-free survival in head and neck cancer [ 29 ].…”

Section: Sarcopeniamentioning

confidence: 99%

Rehabilitation Nutrition and Exercise Therapy for Sarcopenia

Kakehi

¹

,

Wakabayashi

²

,

Inuma

³

et al. 2022

World J Mens Health

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Sarcopenia is an age-related loss of skeletal muscle associated with adverse outcomes such as falls, fractures, disability, and increased mortality in older people and hospitalized patients. About half of older male nursing home residents have sarcopenia. The diagnostic criteria by the European Working Group on Sarcopenia in Older People (EWGSOP) and the Asian Working Group for Sarcopenia (AWGS) have led to increased interest in sarcopenia. Exercise and nutritional management are crucial for the prevention and treatment of sarcopenia. Nutritional therapy for sarcopenia that includes 20 g of whey protein and 800 IU of vitamin D twice a day improves lower limb strength. Exercise therapy for sarcopenia, such as resistance training and 6 months of home exercises, improves muscle strength and physical function. Combination therapy that includes both nutritional and exercise therapy improves gait speed and knee extension strength more than either exercise alone or nutrition therapy alone. Excessive bedrest and mismanagement of nutrition in medical facilities can lead to iatrogenic sarcopenia. Iatrogenic sarcopenia is sarcopenia caused by the activities of health care workers in health care facilities. Appropriate nutritional management and exercise programs through rehabilitation nutrition are important for prevention and treatment of iatrogenic sarcopenia. Nutritional and exercise therapy should be started very early after admission and adjusted to the level of inflammation and disease status. Repeated assessment, diagnosis, goal setting, interventions, and monitoring using the rehabilitation nutrition care process is important to maximize treatment effectiveness and improve patients' functional recovery and quality of life.

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“…It is generally developed in aged patients or malnourished individuals with risk factors, such as chronic inflammation, oxidative stress, and hormonal changes [12][13][14][15]. Many studies have linked sarcopenia with poor postoperative outcomes in patients with colorectal cancer [16], pancreatic cancer [17], urological cancer [18], and hepatocellular carcinoma [19]. According to a systematic review, the incidence of sarcopenia is as high as 52% in patients with CD when anatomical criteria are considered without functional strength assessment [13,20,21].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Sarcopenia and Its Effect on Postoperative Complications in Patients with Crohn’s Disease

Zhang

¹

,

Yu

²

,

Hong

³

et al. 2021

Gastroenterology Research and Practice

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Background and Aims. Sarcopenia is a prognostic factor of outcomes for various diseases, but reports on sarcopenia in patients with Crohn’s disease (CD) are few. We aim to determine the prevalence of sarcopenia and assess the role of sarcopenia in postoperative complications in patients with CD at a tertiary referral center. Methods. Patients who underwent intestinal surgery for CD from January 2013 to October 2019 were retrospectively enrolled. The L3 skeletal muscle mass index (SMI) was used to identify sarcopenia. Demographic data, preoperative laboratory data, surgical details, and hospital outcomes were recorded. The factors associated with postoperative complications were evaluated through univariate and multivariate analyses. Results. One hundred and twenty-four patients were enrolled. Thirty-four of them (27.4%), including 11 males, were diagnosed with sarcopenia. Compared with patients without sarcopenia, sarcopenic patients had a significantly lower BMI ( P < 0.001 ); lower preoperative serum albumin ( P = 0.006 ), prealbumin ( P = 0.030 ), and hemoglobin levels ( P < 0.001 ); longer hospital stay ( 34.4 ± 26.8 days vs. 22.8 ± 15.6 days, P = 0.003 ); and more occurrences of complications (41.2% vs. 23.3%, P = 0.049 ). The overall incidence of postoperative complications was 28.2%. Infection (51.4%) and intestinal fistula (22.9%) were the most common among such complications. Through the multivariate analysis, sarcopenia was identified as an independent risk factor for major postoperative complications ( odds ratio = 3.974 , 95 % CI = 1.171 –13.489, P = 0.027 ). Conclusion. Sarcopenia is common in patients with CD requiring bowel resection, and it significantly increases the risk of major postoperative complications.

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Prognostic value of radiologically determined sarcopenia prior to treatment in urologic tumors

Cited by 9 publications

References 57 publications

Sarcopenia and mortality in cancer: A meta-analysis

Sarcopenia and mortality in cancer: A meta-analysis

Rehabilitation Nutrition and Exercise Therapy for Sarcopenia

Prevalence of Sarcopenia and Its Effect on Postoperative Complications in Patients with Crohn’s Disease

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