Temporal Muscle Thickness as a Prognostic Marker in Patients with Newly Diagnosed Glioblastoma: Translational Imaging Analysis of the CENTRIC EORTC 26071–22072 and CORE Trials

Abstract

Purpose: To investigate the prognostic relevance of temporal muscle thickness (TMT) as a surrogate parameter of skeletal muscle status in patients with newly diagnosed glioblastoma. Experimental Design: We assessed TMT in cranial MRI of 755 patients enrolled in the CENTRIC EORTC 26071–22072 study (n = 508) and CORE study (n = 247). We used predefined sex-specific TMT cut-off values to categorize “patients at risk of sarcopenia” and “patients with normal muscle status” at baseline. Furthermore, we categorized patients according to the extent of TMT loss over time. Associations with progression-free survival (PFS) and overall survival (OS) were evaluated using the Cox model adjusted for other exploratory variables. Results: Patients at risk of sarcopenia (CENTRIC; n = 158/508, 31.1%; CORE; n = 87/247, 35.2%) at baseline had significantly higher risk of progression and death than patients with normal muscle status in both study cohorts [CENTRIC: PFS = HR 0.16; 95% confidence interval (CI), 0.12–0.21; P < 0.001; OS = HR 0.341; 95% CI, 0.27–0.44; P < 0.001; CORE: PFS = HR 0.29; 95% CI, 0.21–0.39; P < 0.001; OS = HR, 0.365; 95% CI, 0.27–0.49; P < 0.001]. Similar results were obtained in multivariate Cox models adjusted for other important prognostic parameters. The extent of TMT loss over time showed a significant inverse correlation with median OS times in patients at risk for sarcopenia (CENTRIC: P < 0.001; CORE: P = 0.005), but not in patients with normal baseline muscle mass (CENTRIC: P = 0.538; CORE: P = 0.28). Conclusions: TMT identifies ambulatory patients with newly diagnosed glioblastoma at risk for progressive sarcopenia and adverse outcomes. Early intervention may prevent skeletal muscle loss and improve patient outcome.

Temporal Muscle and Stroke—A Narrative Review on Current Meaning and Clinical Applications of Temporal Muscle Thickness, Area, and Volume

“…Then, Furtner et al established TMT measurement using T1-weighted MR images. They measured TMT perpendicular to the long axis of the temporal muscle at the level of the orbital roof [ 14 , 17 , 18 , 37 , 38 ]. This method is widely used, but low accessibility to MRI in routine work is a problem.…”

“…Measuring skeletal muscle mass and function is an evolving parameter for the clinical evaluation of physiological conditions [ 14 ]. The gold standard to evaluate sarcopenia are muscle function tests such as the gait speed test and the grip strength test, according to the European Working Group on Sarcopenia in Older People (EWGSOP), EWGSOP2, and the Asian Working Group for Sarcopenia (AGWS) [ 15 , 16 ].…”

Temporal Muscle and Stroke—A Narrative Review on Current Meaning and Clinical Applications of Temporal Muscle Thickness, Area, and Volume

“…Then, Furtner et al established TMT measurement using T1weighted MR images. They measured TMT perpendicular to the long axis of the temporal muscle at the level of the orbital roof [14,17,18,37,38]. This method is widely used, but low accessibility to MRI in routine work is a problem.…”

Temporal muscle thickness as an independent prognostic imaging marker in newly diagnosed glioblastoma patients: A validation study

“… 20 In a large sample of 755 newly diagnosed glioblastoma patients enrolled in two clinical trials they found that patients at risk of sarcopenia at baseline, defined as TMT below the sex-specific cutoff, had a significantly higher risk of progression and death than patients with normal muscle status. 18 In addition, the extent of TMT loss over time showed a significant inverse correlation with median OS time in patients at risk of sarcopenia. However, solely patients with an ECOG score of 0-1 (fully active or only restricted in physically strenuous activity) were included and often clinical trial participants significantly differ from real-world patients which could limit external validity.…”

“…Studies have solely shown that there is a negative association between reduced TMT and survival, but with lack of established cutoff values, varying study sample size, high percentages of missing molecular tumor data, and low percentages of bilateral measurements due to previous tumor surgery. 11–17 In a powerful attempt to facilitate implementation of TMT measurement in the clinical setting, a very recent hallmark study of Furtner et al on behalf of the EORTC Brain tumor group, 18 proposed and used sex-specific TMT cutoff values 2.5 standard deviation below a normative reference population. 19 This is in line with a recommendation of the European Working Group on Sarcopenia in Older People (EWGSOP).…”