Thresholds and Mortality Associations of Paraspinous Muscle Sarcopenia in Older Trauma Patients

Kaplan, Stephen J.; Zhao, Kun; Koren, Melanie; Bentov, Itay; Reed, May J.; Pham, Tam N.

doi:10.1001/jamasurg.2020.0435

Cited by 19 publications

(16 citation statements)

References 6 publications

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“…Although a number of methods are available for assessment of skeletal muscle mass, the psoas muscle at the L3 level has been used in many studies as the reference for evaluation of sarcopenia by CT 8 . Here, the paraspinous muscle area at the T12 level determined on chest CT was used to classify thoracic sarcopenia, which was also shown to be related to psoas muscle area at the L3 level, 13 and to predict mortality in various populations including NSCLC patients 11–14 . It is recommended to obtain preoperative physical performance measurements for assessment of post‐operative outcome risks in NSCLC patients, 16,27 and the 6MWD is the most common such measurement 17,18,28 .…”

Section: Discussionmentioning

confidence: 99%

“…The sum of cross‐sectional areas of the right and left paraspinous muscles (i.e. the iliocostalis, longissimus, and spinalis) was determined on preoperative chest CT at the T12 level to assess preoperative thoracic sarcopenia 11,13,14 . Briefly, the paraspinous muscle area was defined semi‐automatically using SYNAPSE VINCENT™ software (Fujifilm Medical Co., Ltd., Tokyo, Japan), and the muscle area was quantified based on thresholds of −29 to +150 Hounsfield units.…”

Section: Methodsmentioning

confidence: 99%

“…However, the standard imaging modality in preoperative evaluation of NSCLC, chest CT, does not routinely visualize the L3 level, and supplementary abdominal CT would result in both additional medical costs and radiation exposure to the patient. There is increasing interest in measurement of skeletal muscle mass at the level of the 12th thoracic vertebra (T12) on chest CT, and sarcopenia in the thoracic area was shown to be correlated to poorer survival in various patient populations, including those with NSCLC 11–14 . In addition, measurement of physical performance has been recommended for assessment of the severity of sarcopenia, and severe sarcopenia was shown to be closely related to both frailty and cachexia 7,15 .…”

Section: Introductionmentioning

confidence: 99%

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Preoperative paraspinous muscle sarcopenia and physical performance as prognostic indicators in non‐small‐cell lung cancer

Tanaka

Ozeki

Mizuno

et al. 2021

J cachexia sarcopenia muscle

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Background Despite the associations of both preoperative sarcopenia and physical performance with post‐operative mortality in non‐small‐cell lung cancer (NSCLC), there have been no comprehensive studies of the impact of physical status on prognosis. This study was performed to investigate the prognostic significance of preoperative sarcopenia and physical performance in NSCLC. Methods This retrospective cohort study was performed in NSCLS patients undergoing curative lung resection at a university hospital between January 2014 and December 2017. The patients were divided into four groups according to the skeletal muscle index [sarcopenia (lowest sex‐specific tertile) and non‐sarcopenia] and 6 min walking distance (6MWD) [short distance (<400 m) and long distance (≥400 m)]. Sarcopenia was assessed by preoperative cross‐sectional areas of right and left paraspinous muscles at the level of the 12th thoracic vertebra from computed tomography images, and physical performance was determined by preoperative 6MWD. The primary and secondary endpoints were post‐operative overall survival (OS) and disease‐free survival (DFS). Results The 587 patients [mean age: 68.5 ± 8.8 years, 399 men (68%)] included in the study were divided into the non‐sarcopenia/long‐distance group (58%), sarcopenia/long‐distance group (26%), non‐sarcopenia/short‐distance group (9%), and sarcopenia/short‐distance group (7%). A total of 109 (18.6%) deaths and 209 (35.6%) combined endpoints were observed over a mean follow‐up of 3.1 ± 1.3 years. After adjusting for other covariates, the sarcopenia/short‐distance group showed significant associations with shorter OS (hazard ratio, 3.38; 95% confidence interval, 1.79–6.37; P < 0.001) and DFS (hazard ratio, 2.11; 95% confidence, 1.27–3.51; P = 0.004) compared with the non‐sarcopenia/long‐distance group on multivariate analyses. Although not significant, adding skeletal muscle index and 6MWD to the pre‐existing risk model increased the area under the curve on time‐dependent receiver operating characteristic curve analysis for OS and DFS, except within 2 years of surgery. Conclusions The presence of both preoperative paraspinous muscle sarcopenia and short distance in 6MWD had an adverse effect on post‐operative prognosis in patients with NSCLC, suggesting that preoperative assessment of thoracic sarcopenia and physical performance may be useful for risk stratification of surgical candidates with potential for targeted interventions.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Preoperative paraspinous muscle sarcopenia and physical performance as prognostic indicators in non‐small‐cell lung cancer

Tanaka

Ozeki

Mizuno

et al. 2021

J cachexia sarcopenia muscle

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“…SMA at the 12 th thoracic vertebra level (T12 SMA) has recently been shown to be a novel SMM marker representing whole-body SMM (18). Additionally, the T12 skeletal muscle index (T12 SMI) (i.e., T12 SMA/body height squared) and L3 SMI reportedly have a similar predictive value for 1-year mortality in older patients with trauma (19).…”

Section: Introductionmentioning

confidence: 99%

Factors That Improve Chest Computed Tomography-Defined Sarcopenia Prognosis in Advanced Non-Small Cell Lung Cancer

Yang

Xie

et al. 2021

Front. Oncol.

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BackgroundWhether muscle strength and physical performance should be components of sarcopenia remains controversial. This study evaluated the skeletal muscle index derived from computed tomography images at the 12th thoracic vertebra level (T12 SMI), handgrip strength, performance status, and their combination for predicting overall survival in patients with advanced non-small cell lung cancer.MethodsChest computed tomography, handgrip strength measurement, and bioelectrical impedance analysis were performed. Sarcopenia was defined based on the T12 SMI alone or the T12 SMI, handgrip, and/or physical performance (i.e. Asian Working Group for Sarcopenia [AWGS]-defined sarcopenia or severe sarcopenia).ResultsOverall, 639 participants were included; 488 (76.4%) died. At baseline, 160 (25.0%), 141 (22.1%), and 42 (6.6%) patients had computed tomography-defined sarcopenia, AWGS-defined sarcopenia, and AWGS-defined severe sarcopenia, respectively. Chest computed tomography-defined sarcopenia (hazard ratio [HR], 2.00; 95% confidence interval [CI], 1.65-2.43), AWGS-defined sarcopenia (HR, 2.00; 95% CI, 1.59-2.49), and AWGS-defined severe sarcopenia (HR, 3.01; 95% CI, 2.21-4.09) were more strongly associated with poor prognosis than a performance status score ≥2 (HR, 1.37; 95% CI, 1.10-1.73).ConclusionsAdding handgrip strength and the performance status score to chest computed tomography-defined sarcopenia improved its prognostic ability. Oncological sarcopenia research should focus on muscle mass, strength, and function.

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“…Current skeletal muscle index (SMI) values for defining sarcopenia are specific to abdominal or lower thoracic musculature 5,11 . As abdominal and lower thoracic imaging is not always performed as part of the HNC workup, only a subset of patients that have imaging studies capturing these regions are included in the majority of previous reports, introducing potential selection bias.…”

Section: Introductionmentioning

confidence: 99%

Establishment and validation of pre-therapy cervical vertebrae muscle quantification as a prognostic marker of sarcopenia in head and neck patients receiving definitive cancer surgery

Olson

Edwards

Degnin

et al. 2021

Preprint

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Importance: Sarcopenia, or diminished skeletal muscle mass, is prognostic for survival in patients with head and neck cancer (HNC). However, identification of this high-risk feature remains challenging for patients without computed tomography (CT) images that capture the abdomen or lower thorax. Objectives: To (1) define sarcopenia thresholds at the C3 vertebral level using previously established thresholds derived from abdominal CT imaging and (2) determine if C3-defined sarcopenia is associated with survival in patients with HNC. Design, setting, and participants: This retrospective cohort study was conducted in consecutive patients with a squamous cell carcinoma of the head and neck with cross-sectional abdominal or neck imaging within 60 days prior to treatment and treated between January 2005 and December 2017. Data analysis was completed from December 2018 to April 2021. Exposures: Measurement of the cross-sectional muscle area at the third lumbar and cervical vertebral levels using CT imaging. Main outcomes and measures: Primary study outcome was overall survival. Results: In a cohort of 253 HNC patients with CT imaging that captures both L3 and C3 vertebral levels, skeletal muscle cross-sectional area at C3 was strongly correlated with the L3 level in both men (n = 188; r = 0.77; p < 0.001) and women (n = 65; r = 0.80; p < 0.001), and C3-defined sarcopenia thresholds of 14.0 cm2/m2 (men) and 11.1 cm2/m2 (women) were best predictive of previously established L3-defined sarcopenia thresholds. Applying these defined C3 sarcopenia thresholds in a cohort of 536 HNC patients with neck imaging alone revealed that C3-defined sarcopenia was independently associated with reduced overall survival in men (HR = 2.63; 95% CI, 1.79, 3.85) but not women (HR = 1.18, 95% CI, 0.76, 1.85) with HNC. Conclusions and relevance: This study identifies sarcopenia thresholds at the C3 level that best predict L3-defined sarcopenia in both men and women. In HNC, C3-defined sarcopenia is associated with poor survival outcomes in men, but not women, suggesting sarcopenia may differentially affect men and women with HNC.

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Thresholds and Mortality Associations of Paraspinous Muscle Sarcopenia in Older Trauma Patients

Abstract: Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs.

Cited by 19 publications

References 6 publications

Preoperative paraspinous muscle sarcopenia and physical performance as prognostic indicators in non‐small‐cell lung cancer

Preoperative paraspinous muscle sarcopenia and physical performance as prognostic indicators in non‐small‐cell lung cancer

Factors That Improve Chest Computed Tomography-Defined Sarcopenia Prognosis in Advanced Non-Small Cell Lung Cancer

Establishment and validation of pre-therapy cervical vertebrae muscle quantification as a prognostic marker of sarcopenia in head and neck patients receiving definitive cancer surgery

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