Sarcopenia as a Prognostic Factor among Patients with Stage III Melanoma

Sabel, Michael S.; Lee, Jay; Cai, Shijie; Englesbe, Michael J.; Holcombe, Stephen; Wang, Stewart

doi:10.1245/s10434-011-1976-9

Cited by 248 publications

(223 citation statements)

References 30 publications

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“…Importantly, low muscle radiodensity is emerging as an important and in some cases stronger predictor of clinical outcomes (compared with muscle mass alone). In Sabel et al (60) low (psoas) muscle radiodensity was associated with disease-free and distant disease-free survival (P = 0·04 and P = 0·0002, respectively). These results were supported by a Martin et al (20) study, where low muscle attenuation was a powerful predictor of survival (HR 1·36, 95 % CI 1·2, 1·6), and more recently by Okumura et al (50) , who showed low muscle quality associated with poor overall (HR 2·5, P < 0·001) and recurrence free (HR 1·6; P = 0·004) survival.…”

Section: Impact Of Muscle Radiodensitymentioning

confidence: 88%

Sarcopenia and cachexia in the era of obesity: clinical and nutritional impact

et al. 2016

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Our understanding of body composition (BC) variability in contemporary populations has significantly increased with the use of imaging techniques. Abnormal BC such as sarcopenia (low muscle mass) and obesity (excess adipose tissue) are predictors of poorer prognosis in a variety of conditions or clinical situations. As a catabolic illness, a defining feature of cancer is muscle loss. Although the conceptual model of wasting in cancer is typically conceived as involuntary weight loss leading to low body weight, recent studies have shown that both sarcopenia and cachexia can be present with obesity. The combination of low muscle and high adipose tissue (sarcopenic obesity) is an emerging abnormal BC phenotype prevalent across the body weight, and hence BMI spectra. Sarcopenia and sarcopenic obesity in cancer are in most instances occult conditions, which have been independently associated with higher incidence of chemotherapy toxicity, shorter time to tumour progression, poorer outcomes of surgery, physical impairment and shorter survival. Although the mechanisms are yet to be fully understood, the associations with poorer clinical outcomes emphasise the value of nutritional assessment as well as the need to develop appropriate interventions to countermeasure abnormal BC. Sarcopenia and sarcopenic obesity create diverse nutritional requirements, highlighting the compelling need for a more comprehensive and differentiated understanding of energy and protein requirements in this heterogeneous population.

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Section: Impact Of Muscle Radiodensitymentioning

confidence: 88%

Sarcopenia and cachexia in the era of obesity: clinical and nutritional impact

et al. 2016

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“…Higher skeletal muscle density has been associated with improved survival in renal cell carcinoma (38) , melanoma (68) and in a number of others solid tumours (42) . Skeletal muscle density could potentially be a more accurate measure of muscle function and therefore precede the development of sarcopenia.…”

Section: Impact Of Sarcopenia On Tolerance To Cytotoxic Chemotherapymentioning

confidence: 99%

Cancer-associated malnutrition, cachexia and sarcopenia: the skeleton in the hospital closet 40 years later

et al. 2016

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An awareness of the importance of nutritional status in hospital settings began more than 40 years ago. Much has been learned since and has altered care. For the past 40 years several large studies have shown that cancer patients are amongst the most malnourished of all patient groups. Recently, the use of gold-standard methods of body composition assessment, including computed tomography, has facilitated the understanding of the true prevalence of cancer cachexia (CC). CC remains a devastating syndrome affecting 50-80 % of cancer patients and it is responsible for the death of at least 20 %. The aetiology is multifactorial and complex; driven by pro-inflammatory cytokines and specific tumour-derived factors, which initiate an energy-intensive acute phase protein response and drive the loss of skeletal muscle even in the presence of adequate food intake and insulin. The most clinically relevant phenotypic feature of CC is muscle loss (sarcopenia), as this relates to asthenia, fatigue, impaired physical function, reduced tolerance to treatments, impaired quality of life and reduced survival. Sarcopenia is present in 20-70 % depending on the tumour type. There is mounting evidence that sarcopenia increases the risk of toxicity to many chemotherapy drugs. However, identification of patients with muscle loss has become increasingly difficult as 40-60 % of cancer patients are overweight or obese, even in the setting of metastatic disease. Further challenges exist in trying to reverse CC and sarcopenia. Future clinical trials investigating dose reductions in sarcopenic patients and dose-escalating studies based on pre-treatment body composition assessment have the potential to alter cancer treatment paradigms.

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“…[3,4] There is also evidence to suggest a significant correlation with long-term outcomes after cancer resection. [5,6] Importantly, sarcopenia increases with advanced age, where the propensity for poor surgical outcomes is well-established. Nonetheless, there is evidence to suggest that sarcopenia may be at least partially independent from age and comorbid disease burden as a domain of surgical risk.…”

Section: Introductionmentioning

confidence: 99%