The impact of nutritional risk factors and sarcopenia on survival in patients treated with pelvic exenteration for recurrent gynaecological malignancy: a retrospective cohort study

Purpose The aim of the present study is to investigate the prognostic significance of nutritional risk factors and sarcopenia on the outcome of patients with recurrent gynaecological malignancies treated by pelvic exenteration. Methods We retrospectively evaluated muscle body composite measurements based on pre-operative CT scans, nutritional risk factors as assessed by a validated pre-operative questionnaire, and clinical–pathological parameters in 65 consecutive patients with recurrent gynaecological malignancies, excluding ovarian cancer, treated by pelvic exenteration at the Royal Marsden Hospital London. Predictive value for postoperative morbidity was investigated by logistic regression analyses. Relevant parameters were included in uni- and multivariate survival analyses. Results We found only (1) low muscle attenuation (MA)—an established factor for muscle depletion—and (2) moderate risk for malnutrition to be independently associated with shorter overall survival (p = 0.006 and p = 0.008, respectively). MA was significantly lower in overweight and obese patients (p = 0.04). Muscle body composite measurements were not predictive for post-operative morbidity. Conclusion The study suggests that pre-operative low MA and moderate risk for malnutrition are associated with shorter survival in patients with recurrent gynaecological malignancies treated with pelvic exenteration. Further studies are needed to validate these findings in larger cohorts.

Predicting muscle loss during lung cancer treatment (PREDICT): protocol for a mixed methods prospective study

IntroductionLow muscle mass and low muscle attenuation (radiodensity), reflecting increased muscle adiposity, are prevalent muscle abnormalities in people with lung cancer receiving curative intent chemoradiation therapy (CRT) or radiation therapy (RT). Currently, there is a limited understanding of the magnitude, determinants and clinical significance of these muscle abnormalities in the lung cancer CRT/RT population. The primary objective of this study is to identify the predictors of muscle abnormalities (low muscle mass and muscle attenuation) and their depletion over time in people with lung cancer receiving CRT/RT. Secondary objectives are to assess the magnitude of change in these parameters and their association with health-related quality of life, treatment completion, toxicities and survival.Methods and analysisPatients diagnosed with lung cancer and planned for treatment with CRT/RT are invited to participate in this prospective observational study, with a target of 120 participants. The impact and predictors of muscle abnormalities (assessed via CT at the third lumbar vertebra) prior to and 2 months post CRT/RT on the severity of treatment toxicities, treatment completion and survival will be assessed by examining the following variables: demographic and clinical factors, weight loss, malnutrition, muscle strength, physical performance, energy and protein intake, physical activity and sedentary time, risk of sarcopenia (Strength, Assistance in walking, Rise from a chair, Climb stairs, Falls history (SARC-F) score alone and with calf-circumference) and systemic inflammation. A sample of purposively selected participants with muscle abnormalities will be invited to take part in semistructured interviews to understand their ability to cope with treatment and explore preference for treatment strategies focused on nutrition and exercise.Ethics and disseminationThe PREDICT study received ethics approval from the Human Research Ethics Committee at Peter MacCallum Cancer Centre (HREC/53147/PMCC-2019) and Deakin University (2019-320). Findings will be disseminated through peer review publications and conference presentations.

Mean Muscle Attenuation within Paraspinal Muscle as a Determinant of Survival in Patients with Gastric Cancer Undergoing Gastrectomy

Background: This study aimed to evaluate the prognostic potential of skeletal muscle mass and muscle quality at the level of the third lumbar vertebra (L3) using computerized tomography (CT) images in patients with stage I–III gastric cancer (GC) who underwent curative gastric resection.Methods: Patients with stage I–III GC who underwent curative gastric resection between October 2006 and June 2014 were enrolled in this study. Demographic and clinical parameters were collected and analyzed. The muscle-related parameters (MRPs), such as the area of total abdominal wall musculature (SMA), area of paraspinal muscle (PMA), mean muscle attenuation (MA) within the total abdominal wall musculature (SMMA), and MA in the paraspinal muscle (PMMA), were measured at the L3 level using CT images. The Kaplan-Meier curve analyses and Cox proportional hazards model were applied to the MRPs, demographic, and clinical parameters to explore the overall survival (OS) and disease-free survival (DFS).Results: Overall, data from 339 patients (233 men and 116 women) were analyzed in this study. In the multivariate Cox model, the elderly (hazard ratio [HR] 2.08, 95% confidence interval [CI] 1.30–3.32, p=0.002), total gastrectomy (HR 2.14, 95% CI 1.32–3.48, p=0.002), stage (HR 3.41, 95% CI 2.10–5.54, p<0.001), perineural invasion (HR 2.01, 95% CI 1.02–3.93, p=0.042), prognostic nutritional index (PNI) (HR 0.91, 95% CI 0.88–0.95, p<0.001), and PMMA (HR 2.36, 95% CI 1.47–3.78), p<0.001) were prognostic factors for OS. Similarly, the elderly (HR 1.68, 95% CI 1.09–2.59, p=0.018), total gastrectomy (HR 2.16, 95% CI 1.37–3.38, p<0.001, stage (HR 4.16, 95% CI 2.64–6.54, p<0.001), PNI (HR 0.91, 95% CI 0.87–0.94, p<0.001), and PMMA (HR 2.22, 95% CI 1.42–3.47, p<0.001) were prognostic factors for DFS.Conclusions: PMMA is suggested as a determinant of OS and DFS in stage I through III GC patients who underwent gastrectomy. Because PMMA is a newly characterized parameter in GC, external validation before clinical applications is a prerequisite.

Effect of exercise on myosteatosis in adults: a systematic review and meta-analysis

Muscle tissue typically contains only small amounts of adipose tissue, and the excess deposition of adiposity is considered a pathological phenomenon termed myosteatosis. Several studies have assessed the effects of exercise alone on the severity of myosteatosis, and some studies have reported promising results. We performed a systematic review and meta-analysis to investigate the effects of exercise interventions on myosteatosis (i.e., lipid infiltration and muscle attenuation). Studies were identified through a systematic search of three databases and limited to randomized controlled trials (RCTs) focused on evaluating the effect of exercise interventions on lipid infiltration and/or muscle attenuation in adults. Thirteen studies met the inclusion criteria and twelve were included in the meta-analysis (n = 465, 84.7% women). The volume of lipid infiltration was decreased in the exercise group compared to the control group (Hedges'g = -0.45 95% confidence interval [CI] -0.74 to -0.16, p = 0.008, I2= 0%), and the degree of muscle attenuation was increased (Hedges'g = 0.67 95% CI 0.22 to 1.13, p = 0.009, I2= 59.3%). Based on meta-regression analyses, there were no significant effects of mean age at baseline (lipid infiltration, β=-0.008 95% CI, -0.035 to 0.019; p=0.495; muscle attenuation, β=-0.013 95% CI, -0.036 to 0.011; p=0.248) and intervention duration (lipid infiltration, β=-0.008 95% CI, -0.028 to 0.010; p=0.311; muscle attenuation, β=-0.018 95% CI, -0.050 to 0.014; p=0.230) on the effect sizes estimates. Overall, our findings indicate that exercise can significantly improve muscle quality in populations at risk of developing obesity - and sarcopenia-related disability.

Muscle Characteristics Obtained Using Computed Tomography as Prognosticators in Patients with Castration-Resistant Prostate Cancer

Limited studies have investigated the correlation between body composition and prostate cancer outcomes. We analyzed the effect of muscle mass and quality on castration-resistant prostate cancer (CRPC) outcomes. Skeletal muscle index (SMI) and skeletal muscle attenuation (SMA) were measured for 411 patients at the L3 vertebral level using computed tomography at CRPC diagnosis and were dived to low and high groups at the value of median. Analysis of the skeletal phenotypes and age (<70 and >70 years) was performed to evaluate the effect of SMI and SMA. The median survival rates for patients with low and high SMI were 19 and 24 months (p = 0.015), and those with low and high SMAs were 15 and 26 months (p < 0.001), respectively. In the subgroup analysis by age, SMA was a significant prognosticator in both groups, while SMI was a significant prognosticator only in patients aged >70 years. Patients with low SMA + low SMI had the worst prognosis. Muscle characteristics seems to be a prognosticator in survival of CRPC patients and may be considered in treatment planning.

Skeletal muscle adiposity and outcomes in candidates for lung transplantation: a lung transplant body composition cohort study

CT measurement of body composition may improve lung transplant candidate selection. We assessed whether skeletal muscle adipose deposition on abdominal and thigh CT scans was associated with 6 min walk distance (6MWD) and wait-list survival in lung transplant candidates. Each ½-SD decrease in abdominal muscle attenuation (indicating greater lipid content) was associated with 14 m decrease in 6MWD (95% CI −20 to −8) and 20% increased risk of death or delisting (95% CI 10% to 40%). Each ½-standard deviation decrease in thigh muscle attenuation was associated with 15 m decrease in 6MWD (95% CI −21 to −10). CT imaging may improve candidate risk stratification.