Sarcopenia is negatively associated with long‐term outcomes in locally advanced rectal cancer

Choi, Moon Hyung; Oh, Soon Nam; Lee, In Kyu; Oh, Seong Taek; Won, Dae

doi:10.1002/jcsm.12234

Cited by 139 publications

(173 citation statements)

References 32 publications

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“…Sarcopenia associates with various clinical complications in aging and cachexia‐associated chronic diseases; therefore, sensitive and reproducible measures of muscle mass are required to assess the evolution of muscle loss and to follow outcomes of therapeutic interventions directed at attenuation of tissue loss in order to improve outcome of patients. Considering availability of diagnostic CT scans in the majority of cachexia‐associated disease such as cancer and cirrhosis, as well as high accuracy and time efficacy of different software programmers for body composition measurements, finding an appropriate indicator of muscle mass, i.e.…”

Section: Discussionmentioning

confidence: 99%

Poor performance of psoas muscle index for identification of patients with higher waitlist mortality risk in cirrhosis

Ebadi

Wang

Lai

et al. 2018

J cachexia sarcopenia muscle

118

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BackgroundSarcopenia, characterized by low muscle mass, associates with mortality in patients with cirrhosis. Skeletal muscle area in a single computed tomography image at the level of the third lumbar vertebrate (L3) is a valid representative of whole body muscle mass. Controversy remains regarding applicability of psoas muscle to identify patients at greater risk of mortality. We aimed to determine psoas muscle index (PMI) association with skeletal muscle index (SMI) and to evaluate the capacity of PMI to predict liver transplant waitlist mortality.MethodsWe evaluated listed adult patients with cirrhosis from 2012 to 2013 at four North American liver transplant centres. From L3 computed tomography images within 3 months of listing, we determined SMI and PMI expressed by cm2/m2. Low SMI was defined as SMI <39 cm2/m2 in women and <50 cm2/m2 in men as published by us earlier. Cut‐offs for PMI to predict mortality were established using a receiver‐operating characteristic analysis. Mortality predictors were determined using competing‐risk analysis with reported results as subdistribution hazard ratios (sHRs).ResultsOf 353 waitlist candidates, 68% were men, mean age 56 ± 9 years, and Model for End‐stage Liver Disease of 16 ± 8 points. Low SMI was present more frequently in men than women (51 vs. 36%, P = 0.02). Moderately strong correlation between SMI and PMI was observed (r > 0.7, P < 0.001). Low PMI (males < 5.1 cm2/m2; females < 4.3 cm2/m2) yielded poor and moderate concordance with low SMI in men and women, respectively (Kappa coefficient 0.31 and 0.63). SMI (39 ± 9 vs. 43 ± 7 cm2/m2; P = 0.009) and PMI (4.4 ± 1.3 vs. 5.2 ± 1.1 cm2/m2; P = 0.001) were lower in women who died and/or were delisted (compared with non‐deceased patients) whereas men who died and/or were delisted had only lower SMI (47 ± 7 vs. 51 ± 9 cm2/m2; P = 0.003), but not PMI compared with non‐deceased patients. In women, both SMI (sHR 0.94, P = 0.048) and PMI (sHR 0.58, P = 0.002) were predictors of mortality, while in men, SMI was significant (sHR 0.95, P = 0.001) and PMI showed a trend to be (sHR 0.85, P = 0.09) associated with mortality. Overall, 104 patients (29%) were misclassified between SMI and PMI categories. Using PMI cut‐offs, 66% and 28% of low SMI men and women, who have a higher risk of mortality, were incorrectly classified as low risk.ConclusionsSkeletal muscle index is a more complete and robust measurement than PMI, especially in men with cirrhosis. Low PMI identifies an incomplete subset of patients at increased risk of mortality indicated by low SMI. Given the poor performance of PMI, SMI should not be substituted by PMI.

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Section: Discussionmentioning

confidence: 99%

Poor performance of psoas muscle index for identification of patients with higher waitlist mortality risk in cirrhosis

Ebadi

Wang

Lai

et al. 2018

J cachexia sarcopenia muscle

118

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“…Sarcopenia is considered to be a primarily age‐dependent syndrome and was initially defined as the age‐related loss of skeletal muscle of the limbs 2 SD below the mean of a healthy young reference group, and has been associated with a range of adverse outcomes . In contrast to cachexia, sarcopenia and muscle wasting cannot be diagnosed by simply weighing the patients longitudinally to detect unintentional weight loss …”

Section: Sarcopenia In Heart Failurementioning

confidence: 99%

Muscle wasting and sarcopenia in heart failure and beyond: update 2017

2017

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Sarcopenia (loss of muscle mass and muscle function) is a strong predictor of frailty, disability and mortality in older persons and may also occur in obese subjects. The prevalence of sarcopenia is increased in patients suffering from chronic heart failure. However, there are currently few therapy options. The main intervention is resistance exercise, either alone or in combination with nutritional support, which seems to enhance the beneficial effects of training. Also, testosterone has been shown to increased muscle power and function; however, a possible limitation is the side effects of testosterone. Other investigational drugs include selective androgen receptor modulators, growth hormone, IGF‐1, compounds targeting myostatin signaling, which have their own set of side effects. There are abundant prospective targets for improving muscle function in the elderly with or without chronic heart failure, and the continuing development of new treatment strategies and compounds for sarcopenia and cardiac cachexia makes this field an exciting one.

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“…25,33 In contrast to cachexia, sarcopenia and muscle wasting cannot be identified by simply longitudinally determining the patients' body weight to detect involuntary weight loss. 25,33 In contrast to cachexia, sarcopenia and muscle wasting cannot be identified by simply longitudinally determining the patients' body weight to detect involuntary weight loss.…”

Section: Chronic Heart Failure and Muscle Maintenancementioning

confidence: 99%

Skeletal muscle wasting in chronic heart failure

2018

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Patients suffering from chronic heart failure (CHF) show an increased prevalence (~20% in elderly CHF patients) of loss of muscle mass and muscle function (i.e. sarcopenia) compared with healthy elderly people. Sarcopenia, which can also occur in obese patients, is considered a strong predictor of frailty, disability, and mortality in older persons and is present in 5–13% of elderly persons aged 60–70 years and up to 50% of all octogenarians. In a CHF study, sarcopenia was associated with lower strength, reduced peak oxygen consumption (peak VO2, 1173 ± 433 vs. 1622 ± 456 mL/min), and lower exercise time (7.7 ± 3.8 vs. 10.22 ± 3.0 min, both P < 0.001). Unfortunately, there are only very limited therapy options. Currently, the main intervention remains resistance exercise. Specialized nutritional support may aid the effects of resistance training. Testosterone has significant positive effects on muscle mass and function, and low endogenous testosterone has been described as an independent risk factor in CHF in a study with 618 men (hazard ratio 0.929, P = 0.042). However, the use of testosterone is controversial because of possible side effects. Selective androgen receptor modulators have been developed to overcome these side effects but are not yet available on the market. Further investigational drugs include growth hormone, insulin‐like growth factor 1, and several compounds that target the myostatin pathway. The continuing development of new treatment strategies and compounds for sarcopenia, muscle wasting regardless of CHF, and cardiac cachexia makes this a stimulating research area.

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Sarcopenia is negatively associated with long‐term outcomes in locally advanced rectal cancer

Cited by 139 publications

References 32 publications

Poor performance of psoas muscle index for identification of patients with higher waitlist mortality risk in cirrhosis

Poor performance of psoas muscle index for identification of patients with higher waitlist mortality risk in cirrhosis

Muscle wasting and sarcopenia in heart failure and beyond: update 2017

Skeletal muscle wasting in chronic heart failure

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