Body composition and association with treatment toxicity in patients with advanced renal cell carcinoma receiving targeted agents.

e15608 Background: Treatment toxicity may be influenced by heterogeneity in body composition. Muscle wasting in mRCC patients treated with sorafenib is associated with increased risk of toxicity (Antoun et al, 2010). We used CT analysis to investigate changes in adipose tissue and skeletal muscle in a large cohort of mRCC patients treated with a number of targeted agents and determined whether body composition was associated with treatment toxicity. Methods: A retrospective analysis of between 2-7 sequential CT scans of 112 mRCC patients was conducted. Each patient received between 1-4 courses of therapy. In total 191 treatment episodes within this population were included; 113 courses of VEGF TKIs, 22 courses of mTOR inhibitors, 36 courses of immunotherapy and 20 episodes where no treatment was given. A validated method, using L3 as a lumbar vertebral landmark, was used to measure lumbar skeletal muscle area (cm3) and adipose tissue volume (cm3). Appendicular Skeletal Muscle Index (ASMI) was calculated to determine prevalence of sarcopenia within the cohort; sarcopenia was defined as ASMI <7.26kg/m2 for males and <5.45kg/m2for females. Toxicity was assessed by Common Toxicity Criteria (CTC) scores documented in medical records. The cohort was divided into body mass index (BMI) quartiles. Results: Of the 112 participants, 74.1% of the group had a BMI >25 at their first scan. Mean weight change between first and last scan was -3.89kg (SD: ±9.09). 20.5% of the cohort were sarcopenic at baseline, increasing to 38.4% at final scan. Sarcopenia was independent of weight change and was associated with increased frequency of severe (CTC grade > 2) treatment toxicity (Pearson Chi Square Value: 12.82; p= 0.001). This effect persisted after adjusting for BMI quartile (odds ratio = 5.04; p=0.004). Changes in bone composition and correlation of body composition with clinical outcome will also be reported. Conclusions: Sarcopenia is common in mRCC patients and is associated with a significantly increased risk of severe treatment toxicity when receiving targeted agents. Sarcopenia was seen across all BMI quartiles and was not associated with weight change.

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Impact of body composition on outcomes from anti-PD1 +/− anti-CTLA-4 treatment in melanoma

Journal for ImmunoTherapy of Cancer ◽

10.1136/jitc-2020-000821 ◽

2020 ◽

Vol 8 (2) ◽

pp. e000821

Author(s):

Arissa C Young ◽

Henry T Quach ◽

Haocan Song ◽

Elizabeth J Davis ◽

Javid J Moslehi ◽

...

Keyword(s):

Skeletal Muscle ◽

Body Composition ◽

Adipose Tissue ◽

Checkpoint Inhibitors ◽

Lumbar Vertebrae ◽

Composition Analysis ◽

Muscle Area ◽

Skeletal Muscle Index ◽

Body Composition Analysis ◽

Tissue Area

BackgroundImmune checkpoint inhibitors (ICIs) have transformed treatment for melanoma, but identifying reliable biomarkers of response and effective modifiable lifestyle factors has been challenging. Obesity has been correlated with improved responses to ICI, although the association of body composition measures (muscle, fat, etc) with outcomes remains unknown.MethodsWe performed body composition analysis using Slice-o-matic software on pretreatment CT scans to quantify skeletal muscle index (SMI=skeletal muscle area/height2), skeletal muscle density (SMD), skeletal muscle gauge (SMG=SMI × SMD), and total adipose tissue index (TATI=subcutaneous adipose tissue area + visceral adipose tissue area/height2) of each patient at the third lumbar vertebrae. We then correlated these measures to response, progression-free survival (PFS), overall survival (OS), and toxicity.ResultsAmong 287 patients treated with ICI, body mass index was not associated with clinical benefit or toxicity. In univariable analyses, patients with sarcopenic obesity had inferior PFS (HR 1.4, p=0.04). On multivariable analyses, high TATI was associated with inferior PFS (HR 1.7, p=0.04), which was particularly strong in women (HR 2.1, p=0.03). Patients with intermediate TATI and high SMG had the best outcomes, whereas those with low SMG/high TATI had inferior PFS and OS (p=0.02 for both PFS and OS).ConclusionsBody composition analysis identified several features that correlated with improved clinical outcomes, although the associations were modest. As with other studies, we identified sex-specific associations that warrant further study.

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Impact of body composition on outcomes from anti-programmed death-1 (PD-1) treatment.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.9516 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 9516-9516 ◽

Cited By ~ 3

Author(s):

Arissa Young ◽

Henry T. Quach ◽

Elizabeth J. Davis ◽

Javid Moslehi ◽

Grant R. Williams ◽

...

Keyword(s):

Skeletal Muscle ◽

Body Composition ◽

Adipose Tissue ◽

Favorable Effect ◽

High Fat ◽

Muscle Area ◽

Skeletal Muscle Index ◽

Pre Treatment ◽

Skeletal Muscle Area ◽

The Impact

9516 Background: Obesity is associated with improved outcomes in melanoma patients (pts) treated with PD-1, whereas low muscle mass, known as sarcopenia, has been associated with poor outcomes in many cancers. We sought to assess the impact of body composition on PD-1 outcomes. Methods: We analyzed pre-treatment CT scans at the L3 slice using Slice-o-matic software (Tomovision V. 5.0) to determine skeletal muscle, visceral adipose, and subcutaneous adipose tissue parameters for 104 pts with metastatic melanoma who received PD-1 monotherapy. We assessed sarcopenia using skeletal muscle index (SMI=skeletal muscle area/m2). We also quantified total adipose tissue index (TATI), and skeletal muscle gauge (SMG = SMI x skeletal muscle density [SMD]). We stratified pts into high/low groups using previously published cutoffs and assessed toxicity (tox), progression-free and overall survival (PFS/OS), and response rate (RR) by group. Results: Sarcopenia (low SMI) was negatively associated with any tox (39% vs. 60%, p=0.04) but not OS, PFS, or RR. Adiposity (TATI) was not associated with outcomes. By contrast, SMG was significantly associated with OS (median 35.5 vs. 16.0m, p=0.01 for high vs. low SMG). Interestingly, when incorporating TATI with SMG, we found that high SMG/high TATI pts (high muscle/high fat) have superior clinical outcomes (Table). Notably, low SMG/high TATI pts (low muscle/high fat) had seemingly the worst outcomes. Conclusions: We found that high SMG, a measure incorporating muscle area and density, was associated with improved OS in PD1 treated pts. Further, pts with high adiposity and high SMG had superior outcomes, potentially identifying the population responsible for the favorable effect of obesity in these pts. Validation and combination treated cohorts will be presented. [Table: see text]

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Sarcopenia and altered body composition following abiraterone acetate (AA) and corticosteroid (C) treatment in men with castration-refractory prostate cancer (CRPC).

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e15134 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e15134-e15134

Author(s):

Deborah Mukherji ◽

Carmel Jo Pezaro ◽

Diletta Bianchini ◽

Nina Tunariu ◽

Amy Mulick Cassidy ◽

...

Keyword(s):

Skeletal Muscle ◽

Body Composition ◽

Prognostic Factor ◽

Muscle Mass ◽

Median Duration ◽

Visceral Fat ◽

Muscle Area ◽

Skeletal Muscle Index ◽

Advanced Malignancy ◽

Total Fat

e15134 Background: Sarcopenia, or skeletal muscle wasting, is an independent prognostic factor in advanced malignancy (Prado Lancet Onc 2008). Decreased muscle and increased fat are recognized side effects of androgen deprivation therapy. AA is a CYP17 inhibitor administered with corticosteroids (C), approved for treatment of advanced CRPC. AA reduces circulating androgens to ‘super-castrate’ levels; we hypothesized that AA + C would impact body composition. Methods: We retrospectively evaluated 54 CRPC pts treated on a Phase I/II trial. Pts received AA alone followed by combination AA + C on biochemical progression. CT scans at baseline, on AA alone and on AA + C were analyzed. Cross-sectional areas of fat and muscle were measured on 3 consecutive images at L4 using OsiriX 4.0. Muscle area was used to calculate skeletal muscle index (SMI); sarcopenia was defined as SMI <52.4 cm2/m2. Data were analyzed using t-tests and Kaplan-Meier analysis with overall survival (OS) measured from day 1 of AA. Results: Median duration on AA alone was 7.4 months (m; range 1.4-37.5); median duration on concurrent AA + C was 7.4m (range 0.9-46.2). Body composition did not change between two pre-treatment scans (n=29; median 3m apart). On AA alone there was a decrease in total fat (-8.5%, p=0.0001), visceral fat (-9.8%, p=0.0015) and muscle mass (-3.9%, p=0.0023) with a significant decrease in mean body mass index (BMI; -3.4 %, p=0.0118). Conversely AA + C was associated with increased total fat (+15.1%, p<0.0001) and visceral fat (+21.4%, p<0.0001) but no further change in muscle mass. Mean BMI significantly increased on the addition of C, returning to baseline levels (p< 0.0001). Overall, 13 pts (24%) were sarcopenic prior to commencing AA compared to 22 (41%) at the end of treatment. Pts who were sarcopenic at baseline had significantly reduced OS: 26.1m (95%CI 16.6 – 41) vs 46.5m (95%CI 28.6 – 57.5, p=0.0253). Conclusions: Treatment with AA alone resulted in decreased fat and muscle. AA + C increased body fat without further alteration in muscle mass. Changes in BMI did not reflect changes in body composition. Sarcopenia at baseline was a negative prognostic factor in this population.

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The impact of sarcopenia on toxicity and pharmacokinetics of 5-fluorouracil (5FU) in colorectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.633 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 633-633 ◽

Cited By ~ 2

Author(s):

Grant Richard Williams ◽

Allison Mary Deal ◽

Shlomit S. Shachar ◽

Christine Marie Walko ◽

Jai Narendra Patel ◽

...

Keyword(s):

Colorectal Cancer ◽

Skeletal Muscle ◽

Body Composition ◽

Secondary Analysis ◽

Cytotoxic Agents ◽

Composition Analysis ◽

Muscle Area ◽

Skeletal Muscle Index ◽

Grade 3 ◽

The Impact

633 Background: Great heterogeneity exists in the ability of adults with cancer to tolerate treatment. Variability in body composition may affect rates of metabolism of cytotoxic agents and contribute to the variable chemotherapy toxicity observed. The goal of this study was to explore the impact of body composition, in particular sarcopenia, on the pharmacokinetics of 5-fluorouracil (5FU) in a cohort of patients receiving FOLFOX +/- bevacizumab for colorectal cancer. Methods: We performed a secondary analysis of a completed multicenter trial that investigated pharmacokinetic-guided 5FU in patients receiving mFOLFOX6 +/- bevacizumab [Patel et al. The Oncologist 2014]. Computed Tomography (CT) images that were performed as part of routine care were used to for body composition analysis. Skeletal muscle area (SMA) and density (SMD) were analyzed from CT scan L3 lumbar segments using radiological software. SMA and height (m2) were used to calculate skeletal muscle index (SMI = SMA/m2). Skeletal Muscle Gauge (SMG) was created by multiplying SMI x SMD. Differences were compared using two group t-tests and fisher’s exact tests. Results: Of the 70 patients from the original study, 25 had available CT imaging. The mean age was 59, 52% female, 80% Caucasian, and 92% with either stage III or IV disease. Eleven patients (44%) had grade 3/4 toxicity, and 12 patients were identified as sarcopenic (48%) [per Martin et al. JCO 2013]. Sarcopenic patients had numerically higher first cycle 5FU AUCs compared to non-sarcopenic patients (19.3 vs. 17.3 AUC, p= 0.43) and higher grade 3/4 toxicities (50 vs 38.5%, p= 0.70). Patients with low SMG ( < 1475 AU) had higher grade 3/4 toxicities (62 vs 25%, p= 0.11) and higher hematologic toxicities (46 v 8%, p= 0.07). Conclusions: CRC patients with sarcopenia had numerically higher first cycle AUCs of 5FU and a higher incidence of severe toxicities; however, this was not statistically significant, possibly due to limited sample size. SMG, an integrated muscle measure, was more highly correlated with toxicity outcomes than either SMI or SMD alone. Further research exploring the role of body composition in pharmacokinetics is needed with a focus on alternative dosing strategies in sarcopenic patients.

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Preoperative muscle strength as a predictor of complications after esophagectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.454 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 454-454

Author(s):

Madison Colcord ◽

Michael D Watson ◽

Nicole Lee Gower ◽

Jennifer H Benbow ◽

Sally Jeanne Trufan ◽

...

Keyword(s):

Skeletal Muscle ◽

Adipose Tissue ◽

Muscle Mass ◽

Clinical Care ◽

Cost Effective ◽

Skeletal Muscle Index ◽

Intramuscular Adipose Tissue ◽

Operative Outcomes ◽

Increased Risk ◽

One Year

454 Background: Sarcopenia has been associated with post-operative complications and length of stay (LOS) in patients undergoing esophagectomy. A variety of methods exist to measure muscle mass and strength, with few comparisons between methods. We compared hand-grip strength (HGS), muscle mass and intramuscular adipose tissue as predictors of post-operative outcomes. Methods: Patients with esophageal cancer undergoing esophagectomy were identified between January 2015 – June 2019 at Levine Cancer Institute. Skeletal muscle index (SMI) and skeletal muscle density (SMD), a measure of intramuscular adipose tissue, were derived from CT. HGS was measured using a dynamometer. Uni- and multivariable GLM analyses were performed. Results: 115 patients (100 male, 15 female) underwent esophagectomy with an average age of 64.3 +/- 9.8. The analysis was stratified by sex due to significant differences in HGS, SMI, and SMD. Among men, univariable analysis revealed a significant association between pre-operative HGS <25 kg and increased risk of post-operative pneumonia ( p=0.02), ventilation >48hrs ( p=0.02), LOS ( p=0.002), discharge to home ( p=0.001), and one-year mortality ( p=0.005). All associations except discharge home remained significant in multivariable analyses (Table). Among women, no factors analyzed were significantly associated with postoperative outcomes. Conclusions: HGS is a more powerful predictor of postoperative complications and LOS than either muscle mass or intramuscular adipose tissue among men undergoing esophagectomy. HGS is cost-effective and easily incorporated into routine clinical care, allowing for preoperative intervention to optimize patients for esophagectomy. To better understand the implications in women, additional research with a larger cohort is needed. [Table: see text]

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A critical evaluation of body composition modalities used to assess adipose and skeletal muscle tissue in cancer

Applied Physiology Nutrition and Metabolism ◽

10.1139/h2012-079 ◽

2012 ◽

Vol 37 (5) ◽

pp. 811-821 ◽

Cited By ~ 48

Author(s):

Katie M. Di Sebastiano ◽

Marina Mourtzakis

Keyword(s):

Skeletal Muscle ◽

Body Composition ◽

Adipose Tissue ◽

Cancer Patients ◽

Tissue Loss ◽

Metabolic Complications ◽

Increased Risk ◽

Body Composition Change ◽

Patients Experience ◽

Risk Of Cancer

The majority of cancer patients experience some form of body composition change during the disease trajectory. For example, breast cancer patients undergoing chemotherapy and prostate cancer patients undergoing androgen deprivation therapy gain fat and lose skeletal muscle, which are associated with increased risk of cancer recurrence and clinical comorbidities. In contrast, advanced cancer patients, such as lung and colorectal cancer patients, experience symptoms of cancer cachexia (accelerated loss of skeletal muscle with or without adipose tissue loss), which are associated with decreased treatment response and poorer survival rates in advanced cancers. The heterogeneity of body composition features and their diverse implications across different cancer populations supports the need for accurate quantification of muscle and adipose tissue. Use of appropriate body composition modalities will facilitate an understanding of the complex relationship between body composition characteristics and clinical outcomes. This will ultimately support the development and evaluation of future therapeutic interventions that aim to counter muscle loss and fat gain in cancer populations. Despite the various metabolic complications that may confound the accurate body composition measurement in cancer patients (i.e., dehydration may confound lean tissue measurement), there are no guidelines for selecting the most appropriate modalities to make these measurements. In this review we outline specific considerations for choosing the most optimal approaches of lean and adipose tissue measurements among different cancer populations. Anthropometric measures, bioelectrical impedance analysis, air displacement plethysmography, dual-energy X-ray absorptiometry, computed tomography, and magnetic resonance imaging will be discussed.

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Impact of Body Composition on the Risk of Hepatocellular Carcinoma Recurrence After Liver Transplantation

Journal of Clinical Medicine ◽

10.3390/jcm8101672 ◽

2019 ◽

Vol 8 (10) ◽

pp. 1672

Author(s):

Karolina Grąt ◽

Ryszard Pacho ◽

Michał Grąt ◽

Marek Krawczyk ◽

Krzysztof Zieniewicz ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Skeletal Muscle ◽

Liver Transplantation ◽

Body Composition ◽

Adipose Tissue ◽

Visceral Fat ◽

Recurrence Free Survival ◽

Muscle Area ◽

Free Survival ◽

Hcc Recurrence

Background: Body composition parameters are reported to influence the risk of hepatocellular carcinoma (HCC) recurrence after liver resection, yet data on patients undergoing liver transplantation are scarce. The aim of this study was to evaluate the impact of the amount of abdominal adipose tissue and skeletal muscles on the risk of HCC recurrence after liver transplantation. Methods: This was a retrospective observational study performed on 77 HCC patients after liver transplantation. Subcutaneous fat area (SFA), visceral fat area, psoas muscle area and total skeletal muscle area were assessed on computed tomography on the level of L3 vertebra and divided by square meters of patient height. The primary outcome measure was five-year recurrence-free survival. Results: Recurrence-free survival in the entire cohort was 95.7%, 90.8%, and 86.5% after one, three, and five years post-transplantation, respectively. SFA was significantly associated with the risk of HCC recurrence (p = 0.013), whereas no significant effects were found for visceral fat and skeletal muscle indices. The optimal cut-off for SFA for prediction of recurrence was 71.5 cm2/m2. Patients with SFA < 71.5 cm2/m2 and ≥71.5 cm2/m2 exhibited five-year recurrence-free survival of 96.0% and 55.4%, respectively (p = 0.001). Conclusions: Excessive amount of subcutaneous adipose tissue is a risk factor for HCC recurrence after liver transplantation and may be considered in patient selection process.

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Volumetric body composition parameters in predicting survival outcomes of metastatic renal cell carcinoma patients treated with targeted therapy

10.22541/au.161987971.18594998/v1 ◽

2021 ◽

Author(s):

Oktay Aktepe ◽

Ahmet Gürkan Erdemir ◽

Gurkan Guner ◽

Deniz Can Güven ◽

Suayib Yalcin ◽

...

Keyword(s):

Skeletal Muscle ◽

Renal Cell Carcinoma ◽

Body Composition ◽

Adipose Tissue ◽

Targeted Therapy ◽

Cell Carcinoma ◽

Risk Score ◽

Renal Cell ◽

Survival Outcomes ◽

Skeletal Muscle Index

Background: To explore the clinical significance of baseline volumetric body composition parameters evaluated with computerized tomography (CT) and their changes after 3-4 months from treatment initiation of targeted therapy in patients with metastatic renal cell carcinoma (mRCC). Method: This study included 108 Caucasian mRCC patients (Male/Female: 77/31) treated with targeted therapy. Volumetric body composition parameters including total adipose tissue index (TATI), subcutaneous adipose tissue index (SATI), visceral adipose tissue index (VATI) and skeletal muscle index (SMI) values were depicted from CT images at third lumbar vertebra level through volumetric measurement software. Kaplan-Meier method and the long test were used for estimation of progression free survival (PFS) and overall survival (OS). Univariate and multivariate analyses were done to determine the associations between clinic-pathologic variables including VBC and survival outcomes. Results: The median PFS and OS of all patients were 11 months and 46 months in patients respectively. After adjustment for the variables including international mRCC database consortium (IMDC) risk score, only a high skeletal muscle index (SMI) was associated with better PFS (HR: 0.975, P=0.015). The independent predictors for OS were VATI (HR 1.005, P=0.024), SATI (HR: 0.976, P=0.019) and TATI (HR: 0.982, P=0.035) in addition to IMDC risk score. Conclusion: Our findings revealed that while SMI was the only significant determinant parameter for PFS among VBC parameters, TATI, VATI, and SATI were determined as independent predictors for OS in addition to IMDC risk score.

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Body composition and treatment-related toxicity in pediatric lymphoma.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e22503 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e22503-e22503

Author(s):

Aman Wadhwa ◽

Kandice Barnett ◽

Chen Dai ◽

Joshua Richman ◽

Andrew Michael McDonald ◽

...

Keyword(s):

Skeletal Muscle ◽

Body Composition ◽

Adipose Tissue ◽

Age At Diagnosis ◽

Muscle Quality ◽

Ct Scans ◽

Hematologic Toxicity ◽

Cancer Type ◽

Skeletal Muscle Index ◽

Grade 3

e22503 Background: Body composition is an emerging predictor of toxicity and survival in older adults with cancer ( Shachar, Eur J Can, 2016); however, its role in pediatric cancer is not known. We examined body composition (using computed-tomography [CT] scans at the 3rd lumbar level) in children with lymphoma (Hodgkin [HL] and non-Hodgkin [NHL]) at cancer diagnosis and examined its association with treatment-related toxicities. Methods: We constructed a retrospective cohort of 87 consecutive children (HL: n = 45; NHL: n = 42) diagnosed between 2000 and 2015 (2-21y at diagnosis) with pretreatment abdominal CT scans. Body composition was assessed using sliceOmatic (TomoVision) and included skeletal muscle index (SMI, cm2/m2), skeletal muscle density (SMD: Hounsfield units [HU]), and height-adjusted total adipose tissue (hTAT: sum of visceral, intramuscular and subcutaneous adipose tissue, cm2/m2). For the analysis, we used skeletal muscle gauge (SMG = SMI x SMD, expressed per 1000 in arbitrary units [AU]) and hTAT. Sociodemographics, disease and treatment details, as well as toxicities (CTCAE v5) were abstracted from medical records. Proportion of chemotherapy cycles with grade 4 hematologic or grade 3-4 non-hematologic toxicities were calculated (percent toxicity). Generalized linear regression models were constructed to examine associations between body composition metrics and toxicities, adjusting for age at diagnosis, gender, race/ethnicity and lymphoma subtype. Results: Median age at diagnosis was 12.9y (range, 2-18.5y); 60.9% males; 60.4% non-Hispanic white. Median BMI%ile was 62 (0-99), median SMG was 2.2AU (0.9-3.7) and median hTAT was 20.1 cm2/m2 (0.04-226.7). Overall, the mean percent toxicity for grade 4 hematologic and grade 3-4 non-hematologic toxicity was 38.9% (±32.6) and 31.4% (±32.6) respectively. Correlation was poor between SMG and BMI%ile ( R2= 0.04), SMG and hTAT ( R2= -0.01) and moderate between hTAT and BMI%ile ( R2= 0.4). SMG was significantly associated with grade 4 hematologic percent toxicity ( β= -18, P= 0.007) after adjusting for hTAT and cancer type. BMI%ile was not associated with grade 4 hematologic percent toxicity ( β= -0.09, P= 0.5). Non-hematologic percent toxicity was not associated with BMI%ile, hTAT or SMG. Conclusions: In this first study of its kind, we find that children with poorer muscle quality are more likely to experience grade 4 hematologic toxicities. These findings form the basis for larger studies to incorporate body composition when developing prediction models for chemotherapy-related toxicity and disease outcomes.

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Body composition and its association with fatigue in the first 2 years after colorectal cancer diagnosis

Journal of Cancer Survivorship ◽

10.1007/s11764-020-00953-0 ◽

2020 ◽

Author(s):

H. van Baar ◽

M. J. L. Bours ◽

S. Beijer ◽

M. van Zutphen ◽

F. J. B. van Duijnhoven ◽

...

Keyword(s):

Colorectal Cancer ◽

Skeletal Muscle ◽

Body Composition ◽

Adipose Tissue ◽

The Body ◽

Life Questionnaire ◽

European Organization ◽

Skeletal Muscle Index ◽

Computed Tomography Images ◽

Pre Treatment

Abstract Purpose Persistent fatigue among colorectal cancer (CRC) patients might be associated with unfavorable body composition, but data are sparse and inconsistent. We studied how skeletal muscle index (SMI), skeletal muscle radiodensity (SMR), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) at diagnosis are associated with fatigue up to 24 months post-diagnosis in stage I–III CRC patients. Methods SMI, SMR, VAT, and SAT were assessed among 646 CRC patients using pre-treatment computed tomography images. Fatigue at diagnosis, at 6, and 24 months post-diagnosis was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. The association of SMI, SMR, VAT, and SAT with fatigue (yes/no) was assessed using confounder-adjusted restricted cubic spline analyses. Results Prevalence of fatigue at diagnosis was 18%, at 6 months 25%, and at 24 months 12%. At diagnosis, a significant (p = 0.01) non-linear association of higher levels of SAT with higher prevalence of fatigue was observed. Lower levels of SMR were linearly associated with higher prevalence of fatigue at 6 months post-diagnosis (overall association p = 0.02). None of the body composition parameters were significantly associated with fatigue at 24 months. Conclusion Having more SAT was associated with more fatigue at diagnosis, while low levels of SMR were associated with more fatigue at 6 months post-diagnosis. Implications for Cancer Survivors Our results suggest that it may be interesting to investigate whether interventions that aim to increase SMR around the time of diagnosis may help to lower fatigue. However, more knowledge is needed to understand the mechanisms behind the association of SMR with fatigue.

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