Sarcopenia Does Not Affect Survival or Outcomes in Soft-Tissue Sarcoma

Abstract

Background and Objective. Sarcopenia is associated with decreased survival and increased complications in carcinoma patients. We hypothesized that sarcopenic soft-tissue sarcoma (STS) patients would have decreased survival, increased incidence of wound complications, and increased length of postresection hospital stay (LOS). Methods. A retrospective, single-center review of 137 patients treated surgically for STS was conducted. Sarcopenia was assessed by measuring the cross-sectional area of bilateral psoas muscles (total psoas muscle area, TPA) at the level of the third lumbar vertebrae on a pretreatment axial computed tomography scan. TPA was then adjusted for height (cm2/m2). The association between height-adjusted TPA and survival was assessed using Cox proportional hazard model. A logistical model was used to assess the association between height-adjusted TPA and wound complications. A linear model was used to assess the association between height-adjusted TPA and LOS. Results. Height-adjusted TPA was not an independent predictor of overall survival (p = 0.746). Patient age (p = 0.02) and tumor size (p = 0.009) and grade (p = 0.001) were independent predictors of overall survival. Height-adjusted TPA was not a predictor of increased hospital LOS (p = 0.66), greater incidence of postoperative infection (p = 0.56), or other wound complications (p = 0.14). Conclusions. Sarcopenia does not appear to impact overall survival, LOS, or wound complications in patients with STS.

Sarcopenia is associated with increased mortality but not complications following resection and reconstruction of sarcoma of the extremities

“…To our knowledge, there is only one previous peer‐reviewed publication examining the association between skeletal muscle mass and outcomes in patients with sarcoma: Similar to the current study, Wilson et al 3 reported no association between skeletal muscle mass, as measured by PI, and postoperative complications in patients with soft tissue sarcoma. However, our results differed in the positive relationship between sarcopenia and 1‐year mortality.…”

“…To our knowledge, only one publication has examined the relationship between sarcopenia and clinical outcomes among patients with sarcoma, reporting no relationship between psoas cross‐sectional area and clinical outcomes after oncologic surgery for soft tissue resection 3 . Research assessing the prognostic value of malnutrition and sarcopenia in patients undergoing orthopedic surgery, as well as clinical interventions to mitigate this risk is largely limited to elderly patients with hip fractures 4,5 .…”

Psoas muscle area is not representative of total skeletal muscle area in the assessment of sarcopenia in ovarian cancer

“…Although in some studies a correlation between PA and post‐operative complications was seen, the majority have failed to prove a relationship between PA‐assessed sarcopenia and survival 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23. Only few have actually assessed the agreement between PA and SMA within their population; Jones et al studied 100 patients with colorectal cancer and reported a Spearman correlation of 0.8 for PA and SMA and a Spearman correlation of 0.94 for PA and PLW, which could not be reproduced in our cohort 11.…”

“…This method has been used to predict surgical complications in different cancer types with contrasting results. PA has shown a correlation with post‐operative complications in individual studies on colorectal cancer, colorectal liver metastases, kidney cancer, bladder cancer, cholangiocarcinoma, and hepatocellular cancer,11, 12, 13, 14, 15, 16 while this effect was not seen in other pancreatic cancer, endometrial cancer, biliary cancer, or sarcoma studies 17, 18, 19, 20. Interestingly, only few cancer studies were able to show a correlation between PA and survival 21, 22, 23.…”

“…PA has shown a correlation with post-operative complications in individual studies on colorectal cancer, colorectal liver metastases, kidney cancer, bladder cancer, cholangiocarcinoma, and hepatocellular cancer, [11][12][13][14][15][16] while this effect was not seen in other pancreatic cancer, endometrial cancer, biliary cancer, or sarcoma studies. [17][18][19][20] Interestingly, only few cancer studies were able to show a correlation between PA and survival. [21][22][23] In a small number of non-cancer studies, decreased psoas muscle area has also been correlated with higher rates of morbidity [24][25][26] and mortality 25,[27][28][29] in patients undergoing cardiothoracic, gastro-intestinal, and spinal surgery.…”