Sarcopenia in Children with Solid Organ Tumors: An Instrumental Era

Abstract

Sarcopenia has recently been studied in both adults and children and was found to be a prognostic marker for adverse outcome in a variety of patient groups. Our research showed that sarcopenia is a relevant marker in predicting outcome in children with solid organ tumors, such as hepatoblastoma and neuroblastoma. This was especially true in very ill, high-risk groups. Children with cancer have a higher likelihood of ongoing loss of skeletal muscle mass due to a mismatch in energy intake and expenditure. Additionally, the effects of cancer therapy, hormonal alterations, chronic inflammation, multi-organ dysfunction, and a hypermetabolic state all contribute to a loss of skeletal muscle mass. Sarcopenia seems to be able to pinpoint this waste to a high degree in a new and objective way, making it an additional tool in predicting and improving outcome in children. This article focuses on the current state of sarcopenia in children with solid organ tumors. It details the pathophysiological mechanisms behind sarcopenia, highlighting the technical features of the available methods for measuring muscle mass, strength, and function, including artificial intelligence (AI)-based techniques. It also reviews the latest research on sarcopenia in children, focusing on children with solid organ tumors.

The impact of sarcopenia and sarcopenic obesity on survival in children with Ewing sarcoma and osteosarcoma

“…The use of specific density limits, however, requires attention to the use of intravenous contrast agent because it affects muscle density [ 13 ]. One critical issue is that reference values may be different in different populations [ 14 ]. Therefore, reference values for each population are needed for accurate diagnosis.…”

“…Puberty might be another confounding factor. Although fat mass and fat-free mass during early childhood are comparable in girls and boys, girls gain more fat mass during puberty, whereas boys acquire more muscle mass [ 14 – 16 ]. These reasons might have contributed to the SMI T12 –paraspinal values being correlated with overall survival in boys but not in girls, given that boys were older than girls in our study.…”

Sarcopenia as a Prognostic Factor in Patients With Hepatoblastoma: Does It Influence Surgical Outcomes and Survival?

“…Nevertheless, this estimation is not very reliable, and its application in clinical practice is useless. tPMA based on cross-sectional imaging at diagnosis has been proven to be a useful, replicable and widely used method to estimate the sarcopenia status 17 .…”

Sarcopenia in Children With Wilms Tumor: A Marker of Undernutrition Which May Impact Adversely on Clinical Outcomes

“…TPMA measurement is easy, fast, reproducible, and amenable to comparison with reference values already established for the pediatric population. Compared with other body composition assessment techniques, using this tool in children with cancer reduces the use of other tests and avoids additional exposure to ionizing radiation 28 . As the study of body composition increases in children with cancer, it will be important to identify the mechanisms underlying the impact of different intensities and regimens of chemotherapy.…”

“…Compared with other body composition assessment techniques, using this tool in children with cancer reduces the use of other tests and avoids additional exposure to ionizing radiation. 28 As the study of body composition increases in children with cancer, it will be important to identify the mechanisms underlying the impact of different intensities and regimens of chemotherapy. Advancing our understanding of TPMA in children with cancer may lead to low-cost clinical interventions, such as optimizing protein and calorie intake following specific guidelines aimed at this population.…”