Analytic morphometrics: Assessing the role of sarcopenia and abdominal fat measurements in predicting survival for mRCC patients undergoing cytoreductive nephrectomy.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 603-603
Author(s):  
Nikhil Waingankar ◽  
Robert G. Uzzo ◽  
Elizabeth Handorf ◽  
Mohammed Haseebuddin ◽  
Anthony Corcoran ◽  
...  
Keyword(s):  
Systemic Therapy ◽  
Average Distance ◽  
Subcutaneous Fat ◽  
Psoas Muscle ◽  
Cytoreductive Nephrectomy ◽  
Muscle Area ◽  
Cross Sectional ◽  
Total Body ◽  
Metastatic Sites ◽  
Ecog Ps

603 Background: Analytic morphomics have emerged as promising biomarkers of post-surgical outcomes. Decision-making in patients with mRCC is nuanced, as benefits of cytoreductive nephrectomy (CN) must be balanced against risks of delaying or forgoing systemic therapy. We sought to identify if pre-operative morphometrics predict survival in patients undergoing CN. Methods: We reviewed clinical, histopathologic, and radiographic data for patients who underwent CN at our institution from 2006-2012. Pre-operative cross-sectional images of T12 to L4 were assessed. Subcutaneous fat content (average distance from skin to fascia in midline); visceral fat (average distance from fascia to anterior vertebral body); and total body fat (visceral + subcutaneous fat) were quantitated. Psoas muscle area and density at L4 were indexed. Primary outcomes were OS and DSS. Results: 62 patients had complete data for review. Median age at surgery was 60 years (range 40-77), Charlson score was 1 (0-5), and ECOG PS was 0 (0-2). There were 42 patients with lung , 26 with bone, 8 with liver, and 5 with brain metastases (average metastatic sites per patient = 1.8). 46 patients (75.4%) received adjuvant systemic therapy. At 16 months follow-up, 23 patients (37.1%) died from disease, while 17 (27.4%) died of other causes. Median survival following surgery was 13 months (range 1-75). Morphomic metrics did not correlate with survival (Table). Conclusions: Pre-operative morphometrics did not correlate with survival outcomes in a cohort of patients undergoing cytoreductive nephrectomy. Perhaps acuity of mRCC onset and speed of progression reduce prognostic value of morphometrics in this population. [Table: see text]

scholarly journals Psoas Muscle Volume as an Opportunistic Diagnostic Tool to Assess Sarcopenia in Patients with Hip Fractures: A Retrospective Cohort Study

2021 ◽  
Vol 11 (12) ◽  
pp. 1338
Author(s):  
Sang-Pil So ◽  
Bum-Sik Lee ◽  
Ji-Wan Kim
Keyword(s):  
Skeletal Muscle ◽  
Hip Fractures ◽  
Diagnostic Tool ◽  
Retrospective Cohort ◽  
Psoas Muscle ◽  
Cross Sectional Area ◽  
Muscle Volume ◽  
Sectional Area ◽  
Muscle Area ◽  
Cross Sectional

Purpose: This study aims to determine whether the psoas volume measured from a pelvic computed tomography (CT) could be a potential opportunistic diagnostic tool to measure muscle mass and sarcopenia in patients with hip fractures. Methods: This was a retrospective cohort study. In total; 57 consecutive patients diagnosed with hip fractures who underwent surgery were enrolled. A cross-sectional area of the psoas muscle was measured at the lumbar (L) 3 and L4 vertebrae from a pelvic CT for the diagnosis of hip fractures. The psoas muscle volume was calculated with a three-dimensional modeling software program. The appendicular skeletal muscle mass (ASM) and preoperative handgrip strength (HS) were measured. The correlations between the psoas muscle volume/area and ASM/HS were assessed. Data on patient demographics; postoperative complication; length of hospital stay; and Koval scores were also recorded and analyzed with respect to the psoas muscle area/volume. Results: The psoas muscle volume and adjusted values were significantly correlated with ASM; which showed a stronger correlation than the psoas muscle area did at the L3 or L4 level. HS was correlated with the psoas volume or adjusted values; but not with the cross-sectional area of the psoas muscle. Among the adjusted values; the psoas muscle volume adjusted for the patient’s height (m2) showed a strongest correlation with ASM and HS. The psoas muscle volume was not significantly correlated with postoperative complications or short-term functional outcomes. Conclusions: The psoas muscle volume measured from a pelvic CT for the diagnosis of hip fractures showed a stronger correlation with ASM and HS than the cross-sectional area did. Therefore; the psoas muscle volume could be a potential diagnostic tool to assess the quantity of the skeletal muscle in patients with hip fractures without an additional examination.

Resectability, conversion and resections rates, and outcomes in RAS&BRAF wildtype (wt), RAS mutant (mt) and BRAFmt metastatic colorectal cancer (mCRC) subgroups in the prospective Finnish RAXO-study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 3532-3532
Author(s):  
Pia J. Osterlund ◽  
Emerik Osterlund ◽  
Aki Uutela ◽  
Päivi Halonen ◽  
Raija S. Kallio ◽  
...  
Keyword(s):  
Systemic Therapy ◽  
Primary Tumour ◽  
Braf V600e ◽  
Chi Square ◽  
Kaplan Meier ◽  
Conversion Rates ◽  
Tumour Location ◽  
Comorbidity Index ◽  
Metastatic Sites ◽  
Ecog Ps

3532 Background: Outcomes of metastasectomy varies with RAS and BRAF-status, but the effect on resectability, conversion and resection rates has not been extensively studied. Methods: The prospective Finnish RAXO study (NCT01531621) included 1086 patients 2011-2018 (Osterlund et al TLRHE 2021, Isoniemi et al BJS 2021) of which 906 were included in this secondary endpoint analysis. Excluded had missing KRAS/ NRAS/ BRAF-V600E test, were untreatable or had an atypical BRAF mutation. We studied repeated centralized resectability assessment, conversion and resectability rates in mCRC, and overall survival (OS) after resection and/or local ablative therapy (LAT) and systemic therapy. Results: Included were 289 RAS& BRAFwt, 529 RASmt (overrepresented) and 88 BRAFmt, with median age 65.8/66.1/66.9 years. Demographics per RAS& BRAFwt, RASmt and BRAFmt showed significant differences in male proportion (68/61/39%), ECOG PS 2-3 groups (16/14/25%), primary tumour location (right colon 16/30/69%, left colon 47/34/17%, rectum 38/36/14%), but not for Charlson comorbidity index, BMI, resection of primary, synchronous presentation or adjuvant therapy (Bonferroni corrected Chi-square). Metastatic profile was different for liver (78/74/61% per RAS& BRAFwt, RASmt and BRAFmt), lung (24/35/28%) and peritoneal (15/15/32%) metastases, but not for lymph nodes or other sites, nor for number of metastatic sites (1 in 53/54/52%). Upfront resectability rates were different with 32/29/15% for RAS& BRAFwt, RASmt and BRAFmt, respectively, as were conversion rates with 16/13/7%, and resection/LAT rates with 45/37/17%, respectively. Kaplan-Meier median OS estimate in R0/1/2-resected and/or LAT group (n = 342) was 83/69/30 months for RAS& BRAFwt, RASmt and BRAFmt groups, respectively and 5-year OS-rates 67/60/24%, with Cox HR ref/1.53 (95% CI 1.04-2.25)/3.11 (1.49-6.49). In the “systemic therapy only” (n = 564) OS was 29/21/15 months and 5-year OS-rates 11/6/2% respectively, with HR ref/1.43 (1.15-1.76)/2.34 (1.73-3.17). Resection/LAT patients had improved OS over “systemic therapy only” patients in all subgroups, HR 5.74 (3.90-8.44)/5.06 (3.92-6.55)/2.89 (1.43-5.86). Conclusions: There were significant differences in resectability, conversion and resection/LAT rates according to RAS& BRAFwt, RASmt and BRAFmt status. OS was also significantly longer for RAS& BRAFwt versus either mutant. Resected/LAT had better OS than “systemic therapy alone” patients in all subgroups. Clinical trial information: NCT01531621.

Peri-operative morbidity and mortality in a modern series of patients treated with cytoreductive nephrectomy (CN) at five centers.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 268-268
Author(s):  
Ashanda Rosetta Patrice Esdaille ◽  
Jose A. Karam ◽  
Philippe E. Spiess ◽  
Jay D. Raman ◽  
Daniel D. Shapiro ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Systemic Therapy ◽  
Multivariable Analysis ◽  
Perioperative Outcomes ◽  
Cytoreductive Nephrectomy ◽  
Robotic Approach ◽  
Median Length ◽  
Perioperative Mortality ◽  
Major Complications ◽  
Ecog Ps

268 Background: For metastatic renal cell cancer (mRCC) patients considering cytoreductive nephrectomy (CN), perioperative morbidity is important to discuss but few contemporary multi-institutional data are available. The objective of this study is to describe factors associated with perioperative outcomes in a modern multi-institutional cohort of patients treated with cytoreductive nephrectomy. Methods: Data for perioperative complications was recorded for patients treated with CN at 5 centers from 2005-2019. Postoperative complications within 90 days were categorized using Clavien- Dindo system. Univariate and multivariable analysis was used to evaluate for associations with complications and 90-day mortality. Factors evaluated included receipt of pre-surgical systemic therapy, ECOG performance status (PS), Charlson comorbidity index (CCI), concurrent IVC thrombectomy, age, and surgical approach (open vs. laparoscopic/robotic). Results: Perioperative outcomes were evaluated in 937 consecutive patients treated with CN at 5 institutions from 2005-2019. Median age at surgery was 61 years (IQR 53-68) and median tumor diameter was 9.8cm (IQR 7-12).Venous thrombus was present in 406/937 (43.3%) patients overall including 65/406 (16%) patients for whom IVC thrombus extended above the hepatic veins. Open and laparoscopic/robotic approach was used in 715 (76.3%) and 290 (23.4%) patients. The median ECOG PS was 1 (IQR 0-1) and median CCI was 1 (IQR 0-2). Pre-surgical systemic therapy was given to 243 (25.9%) patients prior to CN. The median length of hospital stay was 5 days (IQR 4-7) and 429 (34.6%) received blood transfusion. Median length of stay was 3.0 (IQR 2-4) for laparoscopic/robotic approach and 6 days (IQR 4-8) for patients with IVC thrombectomy. Hospital readmission within 30 days was identified in 112 (9.0%) patients. A total of 93/937 (9.9%) patients had major (≥Clavien 3) complications identified within 90 days postoperatively. On multivariable analysis, IVC thrombectomy was associated with higher risk of major complications OR 1.95 (95% CI 1.2-3.1), p = 0.006. Pre-surgical systemic therapy, ECOG PS, CCI, age and surgical approach were not associated with major complications (p = 0.09-0.85). Perioperative mortality was 12/937 (1.3%) at 30 days and 51/937 (6.7%) at 90 days. After multivariable analysis, pre-surgical systemic therapy, ECOG PS, CCI, age, and IVC thrombectomy were not associated with perioperative mortality (p = 0.1-0.85). Conclusions: Cytoreductive nephrectomy is associated with major complications for 10% of patients and 1% mortality at 30 days. Pre-surgical systemic therapy was not associated with increased risk of complications or mortality.

Interaction of Maternal and Neonatal Obesity

PEDIATRICS ◽  
1978 ◽  
Vol 62 (1) ◽  
pp. 17-21
Author(s):  
John N. Udall ◽  
Gail G. Harrison ◽  
Yvonne Vaucher ◽  
Philip D. Walson ◽  
Grant Morrow
Keyword(s):  
Weight Gain ◽  
Birth Weight ◽  
Gestational Age ◽  
Subcutaneous Fat ◽  
Large For Gestational Age ◽  
Maternal Weight ◽  
Muscle Area ◽  
Cross Sectional ◽  
Skin Fold ◽  
Weight Gain During Pregnancy

Maternal weight and height before pregnancy and weight gain during pregnancy were recorded for each of 109 mothers who were delivered of normal infants after gestations of 37 to 43 weeks. Infant parameters obtained included gestational age, birth weight, bilateral mid-arm circumference, and eight skin fold thickness measurements. The eight skin fold thicknesses were summed (SSFT) for each infant. Infants with SSFTs greater than 40 mm (N = 8) for the group were classified as "fatter" infants. All of the fatter infants were large for gestational age (LGA), but accounted for only one third of the LGA infants in the study. Birth weight, length, and cross-sectional mid-arm fat area were significantly increased in the fatter LGA group when compared to other LGA infants. Cross-sectional mid-arm muscle area was not significantly different for the fatter LGA infants compared to the other LGA group. Mothers were defined as obese or nonobese according to pregnant weight for height. Obese mothers had infants with significantly increased SSFTs when compared with infants of nonobese mothers. Multiple regression analysis showed that both prepregnant weight for height and weight gain during pregnancy were associated with increased subcutaneous fat in the neonate. Weight gain during pregnancy was associated with increased neonatal fatness and length, while prepregnant weight for height was associated with neonatal fatness independent of neonatal length.

Abstract MP047: Abdominal Skeletal Muscle Density is Significantly Associated With Selected Measures of Adiposity Associated Inflammation: the Multi-Ethnic Study of Atherosclerosis

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Rachel Van Hollebeke ◽  
Mary Cushman ◽  
Matthew A Allison
Keyword(s):  
Skeletal Muscle ◽  
Interleukin 6 ◽  
Subcutaneous Fat ◽  
Psoas Muscle ◽  
Abdominal Muscle ◽  
Muscle Area ◽  
Muscle Density ◽  
Ethnic Study ◽  
The Mean ◽  
Muscle Groups

Background: Excess adiposity is associated with higher levels of certain inflammatory markers that have been linked to cardiometabolic disease. Lean skeletal muscle is the largest regulator of glucose metabolism but few population-based studies have examined the associations between muscle and inflammation. Therefore, we studied the relationships between abdominal muscle mass [area] and density with selected measures of adiposity-associated inflammation. Methods: Nearly 2,000 subjects enrolled in the Multi-Ethnic Study of Atherosclerosis underwent computed tomography (CT) of the abdomen and had venous fasting blood drawn concomitantly. The CT scans were interrogated for visceral and subcutaneous fat, as well as lean muscle areas and densities in the rectus abdominus, obliques, paraspinus and psoas muscle groups. We then categorized the muscle in locomotion (psoas) and stabilization groups (rectus, obliques and paraspinus). The blood samples were assayed for interleukin-6, resistin, C-reactive protein, and tumor necrosis factor - alpha. Multivariable linear regression was used to determine the independent associations between muscle area and density with each of the aforementioned adipokines. Results: The mean age was 64.7 years and 49% were female. Forty percent were non-Hispanic White, 26% were Hispanic/ Latino American, 21% were African American, 13% were Chinese American. The mean BMI was 28.0 kg/m 2 and 30% were obese (BMI > 30 kg/m 2 ). With adjustment for age, gender, race, dyslipidemia, diabetes, hypertension, eGFR, coronary artery calcium, physical activity, sedentary behavior, selected adipokines and both subcutaneous and visceral fat, a 1-SD increment in the mean densities for total abdominal muscle, total stabilization muscle and total locomotive muscle were each significantly associated with lower levels of interleukin-6 (-15%, -15% and -9%, p < 0.01 for all) and resistin (-0.11, -0.11 and -0.07 ng/mL, p < 0.02 for all), but not CRP or TNF-alpha. These associations remained significant after additional adjustment for muscle area in the corresponding muscle group. Conversely, the areas of the muscle variables were not independently associated with any of the adipokines, especially after adjustment for muscle density. There were no significant interactions between ethnicity and both muscle area and density for any of the adipokines. Conclusions: Higher densities of several muscle groups in the abdomen are significantly associated with lower interleukin-6 and resistin levels, independent of the muscle area in these groups. Techniques that either enhance or maintain muscle density levels may reduce the risk of cardiometabolic diseases linked to adverse levels of inflammation.

Body weight and composition changes, primary tumor side, and resection as survival predictors in metastatic colorectal cancer.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 850-850
Author(s):  
Jan Franko ◽  
Tara Michelle Graff ◽  
Christian McClairen
Keyword(s):  
Colorectal Cancer ◽  
Weight Loss ◽  
Metastatic Colorectal Cancer ◽  
Primary Tumor ◽  
Subcutaneous Fat ◽  
Tumor Resection ◽  
Psoas Muscle ◽  
Primary Tumor Resection ◽  
Muscle Area ◽  
Anthropometric Measures

850 Background: Common symptoms of metastatic colorectal cancer (mCRC) are sarcopenia and weight loss. We investigated whether weight loss, sarcopenia and primary tumor resection can predict overall survival among patients (pts) with mCRC Methods: Consecutive pts newly diagnosed with mCRC in a community hospital between 2012-2014 we reviewed. We gathered initial and 6-month follow up data on weight, standardized muscle mass measure (estimated psoas muscle area/m2 height, sEPA) and subcutaneous fat (SQ). Results: There were 109 pts (age 66.9±14.5, range 37-93 years). Chemotherapy recipients were younger (n = 59, 61.2±13.3 years) and survived longer (22.3 versus 5.3 months, p < 0.001) as compared to best supportive care patients (n = 50, 73.6±13.0 years, p < 0.001). There were no baseline and 6-month differences between pts with resected versus in situ primary tumor in age (p = 0.074), baseline weight (p = 0.728) or percent weight loss (p = 0.404), albumin (p = 0.322), hemoglobin (p = 0.301), creatinine (p = 0.791), initial standardized EPA (p = 0.866), percent of sEPA loss (p = 0.952), and percent subcutaneous thickness loss (p = 0.477). Cohort was further dichotomized by median anthropometric changes at 6 months: -7.1% for weight loss, -6.2% sEPA, -3.3% SQ fat. Cox proportional hazard models demonstrated that anthropometric measures and receipt of systemic chemotherapy were the strongest predictors of survival with their predictive strength surpassing traditional predictors as age, tumor sidedness, primary tumor resection, initial BMI and serum albumin level. Conclusions: Weight loss and anthropometric changes are strongly associated with shorter survival. Prognostic characteristics of loss of weight, muscle and fat should be investigated further using more robust datasets. [Table: see text]

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