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Cancer Medicine Feb 2023The body composition of patients has been associated with tolerability and effectiveness of anticancer therapy. This study aimed to assess the influence of the skeletal...
BACKGROUND
The body composition of patients has been associated with tolerability and effectiveness of anticancer therapy. This study aimed to assess the influence of the skeletal muscle index (SMI) on the pharmacokinetics and toxicity of fluorouracil.
METHODS
Patients treated in an oncological practice with fluorouracil-based chemotherapy and undergoing therapeutic drug monitoring were retrospectively investigated. Computed tomography images were analyzed to measure abdominal skeletal muscle areas in Hounsfield units for the psoas major muscle, back and total skeletal muscle to determine the SMI. For the latter, an automated segmentation method was used additionally. SMI measures were tested as covariates on fluorouracil clearance in a population pharmacokinetic model. Furthermore, regression analyses were performed to analyze the influence of SMI measures on the probability of clinically relevant adverse events (CTCAE grades ≥ 2).
RESULTS
Fluorouracil plasma concentrations of 111 patients were available. Covariate analyses showed significant improvements of the model fit by all SMI measures. However, interindividual variability of fluorouracil clearance was only slightly reduced, whereas the SMI of the back muscle showed the largest reduction (-1.1 percentage points). Lower SMI values of the back muscle increased the probability for polyneuropathy and lower SMI of the psoas increased the probability for fatigue.
CONCLUSIONS
Our results suggest that pharmacokinetics and toxicity of fluorouracil may be associated with specific SMI measures which deserve further investigation.
Topics: Humans; Retrospective Studies; Psoas Muscles; Tomography, X-Ray Computed; Fluorouracil; Prognosis
PubMed: 35941837
DOI: 10.1002/cam4.5118 -
Journal of Geriatric Oncology Jan 2021Comprehensive geriatric assessment (CGA) is used for oncological management in older patients. The evaluation of muscle characteristics is currently not included in the...
OBJECTIVE
Comprehensive geriatric assessment (CGA) is used for oncological management in older patients. The evaluation of muscle characteristics is currently not included in the CGA. This study investigates whether muscle mass and the degree of myosteatosis is associated with mortality in older patients with cancer.
METHODS
CGA was performed in a cohort of older patients with cancer. Cross sectional area (CSA) and mean pixel density (Hounsfield units, HU), as measure for respectively muscle mass and myosteatosis, were obtained from CT images of the psoas muscle at the level of mid L3. Mortality was recorded. Correlation was determined between CSA and HU. Paired sample t-test was used to follow changes in muscle mass and density. Logistic regression was performed to define relevant prognostic factors for mortality.
RESULTS
In total, 183 patients were included (86 male and 97 female), 120 patients (66%) died. Mean age was 80 years (range 70-94 years). Mean days of survival was 606 (range 1-2023). There was a significant correlation between CSA and HU (PCC = 0.196) at time of diagnosis and at follow-up (PCC = 0.257). There was a significant decrease in CSA (p = .008) and HU (p = .004) in men at follow-up. No significant changes were observed in women. In multivariate analysis, a higher gender-corrected CSA was linked to a lower mortality rate with an odds ratio of 0.657 (CI = 0.457-0.944, p = .023). No association was found between HU and mortality.
CONCLUSIONS
Muscle mass correlated with the degree of myosteatosis. CSA and HU tended to decrease during follow-up. Having a greater CSA was prognostic for a lower mortality rate.
Topics: Aged; Aged, 80 and over; Female; Humans; Male; Muscle, Skeletal; Neoplasms; Prognosis; Psoas Muscles; Sarcopenia; Tomography, X-Ray Computed
PubMed: 32771287
DOI: 10.1016/j.jgo.2020.06.024 -
The Journal of Surgical Research Jan 2021Emergency laparotomy (EL) is an increasingly common procedure in the elderly. Factors associated with mortality in the subpopulation of frail patients have not been... (Observational Study)
Observational Study
BACKGROUND
Emergency laparotomy (EL) is an increasingly common procedure in the elderly. Factors associated with mortality in the subpopulation of frail patients have not been thoroughly investigated. Sarcopenia has been investigated as a surrogate for frailty and poor prognosis. Our primary aim was to evaluate the association between easily measured sarcopenia parameters and 30-day postoperative mortality in elderly patients undergoing EL. Length of stay (LOS) and admission to an intensive care unit were secondary end points.
METHODS
We conducted a retrospective cohort study, over a 5-year period, of patients aged 65 y and older who underwent EL at a tertiary university hospital. Sarcopenia was evaluated on admission computed tomography scan by two methods, first by psoas muscle attenuation and second by the product of perpendicular cross-sectional diameters (PCSDs). The lowest quartile of PCSDs and attenuation were defined as sarcopenic and compared with the rest of the cohort. Attenuation was stratified for the use of contrast enhancement. Multivariant logistic regression was performed to determine independent risk factors.
RESULTS
During the study period, 403 patients, older than 65 y, underwent EL. Of these, 283 fit the inclusion criteria and 65 (23%) patients died within 30 d of surgery. On bivariate analysis, psoas muscle attenuation, but not PCSDs, was found to be associated with 30-day mortality (OR = 2.43, 95% CI = 1.34-4.38, P = 0.003) and longer LOS (35.7 d versus 22.2 d, Δd 13.5, 95% CI = 6.4-20.7, P < 0.001). In a multivariate analysis, psoas muscle attenuation, but not PCSDs, was an independent risk factor for 30-day postoperative mortality (OR = 2.35, 95% CI = 1.16-4.76, P = 0.017) and longer LOS (Δd = 14.4, 95% CI = 7.7-21.0, P < 0.001). Neither of the sarcopenia parameters was associated with increased admission to an intensive care unit.
DISCUSSION
Psoas muscle attenuation is an independent risk factor for 30-day postoperative mortality and LOS after EL in the elderly population. This measurement can inform clinicians about the operative risk and hospital resource utilization.
Topics: Aged; Aged, 80 and over; Cross-Sectional Studies; Emergency Treatment; Feasibility Studies; Female; Frailty; Hospital Mortality; Humans; Laparotomy; Length of Stay; Male; Postoperative Complications; Psoas Muscles; Retrospective Studies; Risk Assessment; Risk Factors; Sarcopenia; Tomography, X-Ray Computed
PubMed: 32862053
DOI: 10.1016/j.jss.2020.07.031 -
Annals of Vascular Surgery Nov 2022Low psoas muscle area (PMA) is associated with worse post-operative outcomes. Our objective was to evaluate the association of PMA and postoperative outcomes in patients...
BACKGROUND
Low psoas muscle area (PMA) is associated with worse post-operative outcomes. Our objective was to evaluate the association of PMA and postoperative outcomes in patients undergoing fenestrated/branched endovascular aneurysm repair (F/BEVAR).
METHODS
Patient characteristics, anatomical and clinical information, and post-operative outcomes were collected from patients undergoing F/BEVAR between 2005-February 2019 who were deemed too high-risk for open repair. PMA was measured using a validated web-based software (coreslicer.com). Post-operative outcomes were compared between patients with low PMA (lowest quartiles) and high PMA (highest quartiles).
RESULTS
We included 129 patients with a mean age of 74.6 ± 8.1, 81.4% male, and a mean follow-up of 29.4 ± 32.2 months. Patients in the low PMA group were more likely to be female (33.8% vs. 3.1%, P < 0.0001), less likely to have hypertension (72.3% vs. 87.5%, P = 0.03), dyslipidemia (63.1% vs. 78.1%, P = 0.06), and a trend towards a greater history of endovascular aneurysm repair (4.6% vs. 0%, P = 0.08). There were no significant differences in aneurysm or device characteristics between groups. In a multivariate model including age, sex, aneurysm type, and presence of prophylactic spinal drain, the low PMA group had a significantly increased risk of spinal cord injury (odds ratio 12.7, 95% CI 1.1-143.6). There were no significant differences in other 30-day outcomes. When compared to the highest quartile, the lowest PMA quartile patients had a hazard ratio of 4.6 (95% CI 1.2-17.6) for mortality during follow-up in a model with age, sex, and aneurysm type. For each 1 cm increase in PMA, the HR was 0.90 (95% CI 0.82-0.99) for mortality during follow-up.
CONCLUSIONS
In high-risk patients undergoing F/BEVAR low PMA is associated with spinal cord injury and mortality during follow-up. We found no association between PMA and 30-day mortality. PMA measurement is a simple method to assess for sarcopenia and frailty and may be useful for risk stratification pre-operatively.
Topics: Humans; Male; Female; Aortic Aneurysm, Abdominal; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Psoas Muscles; Retrospective Studies; Risk Factors; Treatment Outcome; Spinal Cord Injuries; Aortic Aneurysm, Thoracic
PubMed: 35772667
DOI: 10.1016/j.avsg.2022.05.037 -
Surgery Today Sep 2020An association between the prognoses of trauma and sarcopenia has not been well documented. The purpose of this study was to compare the outcomes of elderly Japanese...
PURPOSE
An association between the prognoses of trauma and sarcopenia has not been well documented. The purpose of this study was to compare the outcomes of elderly Japanese trauma patients with sarcopenia and those without sarcopenia.
METHODS
The medical records of patients aged ≧ 65 years old and Injury Severity Scores above 15 treated for trauma between 2010 and 2017 were reviewed, retrospectively. We measured the psoas muscle index (PMI), defined as the psoas muscle area at the third lumbar vertebra level divided by the body surface area. Patients of each gender with a PMI less than the lower interquartile range were included in the sarcopenia group. A questionnaire was mailed to the patients or their families to collect data on 1-year mortality and activities of daily living.
RESULTS
There were 405 patients included in this study: 304 in the non-sarcopenia group (Group NS) and 101 in the sarcopenia group (Group S). Mortality was significantly higher in Group S than in Group NS (NS; 7.9% vs. S; 15.8%, OR, 2.20; 95% CI, 1.12-4.32; p = 0.027). Only 175 of the questionnaires were completed and the responses did not reveal any significant differences between the groups.
CONCLUSIONS
Sarcopenia as defined by the PMI may be used as an indicator for mortality risk for geriatric trauma patients.
Topics: Age Factors; Aged; Aged, 80 and over; Comorbidity; Female; Forecasting; Humans; Japan; Male; Prognosis; Psoas Muscles; Retrospective Studies; Risk; Sarcopenia; Surveys and Questionnaires; Tomography, X-Ray Computed; Trauma Centers; Trauma Severity Indices; Wounds and Injuries
PubMed: 32124084
DOI: 10.1007/s00595-020-01980-1 -
European Journal of Gastroenterology &... May 2023The psoas muscle index (PMI) and neutrophil-to-lymphocyte ratio (NLR) have been reported as useful noninvasive prognostic markers in patients with hepatocellular...
Combination of psoas muscle mass index and neutrophil-to-lymphocyte ratio as a noninvasive prognostic marker in hepatocellular carcinoma patients undergoing radiofrequency ablation.
AIM
The psoas muscle index (PMI) and neutrophil-to-lymphocyte ratio (NLR) have been reported as useful noninvasive prognostic markers in patients with hepatocellular carcinoma (HCC). The usefulness of the combination of the PMI and NLR as a prognostic marker in HCC patients undergoing radiofrequency ablation (RFA) is unclear.
METHODS
We retrospectively analyzed the PMI and NLR in 112 patients undergoing RFA, including 40 patients aged 75 years and older (36%). The influence of the PMI and NLR on disease-free survival and overall survival (OS) was analyzed.
RESULTS
There were 66 patients with high PMI and low NLR values (58%), 36 patients with a low PMI or high NLR value (32%), and 10 patients with low PMI and high NLR values (9%). The combination of the PMI and NLR did not show a significant association with the disease-free survival rate. For patients aged ≥75 years, those with both low PMI and high NLR values showed significantly shorter OS periods (log-rank: P < 0.001). In the multivariate analysis, the combination of a low PMI value and high NLR value was significantly associated with shorter survival periods (hazard ratio: 19.72; 95% confidence interval, 4.933-78.8; P < 0.001).
CONCLUSION
In this study, the combination of PMI and NLR was associated with prognosis in patients with early HCC and preserved liver function. The combination of the PMI and NLR may be a useful and noninvasive prognostic marker in HCC patients aged 75 years and older, as well as in younger patients.
Topics: Humans; Carcinoma, Hepatocellular; Neutrophils; Liver Neoplasms; Prognosis; Retrospective Studies; Psoas Muscles; Lymphocytes; Radiofrequency Ablation
PubMed: 37115983
DOI: 10.1097/MEG.0000000000002532 -
Scientific Reports Oct 2022Sarcopenia is characterised by chronically reduced skeletal muscle volume and function, and is determined radiologically by psoas and skeletal muscle measurement. The... (Meta-Analysis)
Meta-Analysis
Sarcopenia is characterised by chronically reduced skeletal muscle volume and function, and is determined radiologically by psoas and skeletal muscle measurement. The present systematic review and meta-analysis aims to examine the relationship between pre-operative CT-derived psoas and skeletal muscle parameters and outcomes in patients undergoing EVAR and F/B-EVAR for aortic aneurysm. The MEDLINE database was interrogated for studies investigating the effect of pre-operative CT-diagnosed sarcopenia on outcomes following EVAR and F/B-EVAR. The systematic review was carried out in accordance with PRISMA guidelines. The primary outcome was overall mortality. RevMan 5.4.1 was used to perform meta-analysis. PROSPERO Database Registration Number: CRD42021273085. Ten relevant studies were identified, one reporting skeletal muscle parameters, and the remaining nine reporting psoas muscle parameters, which were used for meta-analysis. There were a total of 2563 patients included (2062 EVAR, 501 F/B-EVAR), with mean follow-up ranging from 25 to 101 months. 836 patients (33%) were defined as radiologically sarcopenic. In all studies, the combined HR for all-cause mortality in sarcopenic versus non-sarcopenic patients was 2.61 (1.67-4.08), p < .001. Two studies reported outcomes on patients undergoing F/B-EVAR; the combined HR for all-cause mortality in sarcopenic versus non-sarcopenic patients was 3.08 (1.66-5.71), p = .004. Radiological sarcopenia defined by psoas or skeletal muscle parameters was associated with inferior survival in patients undergoing both EVAR and F/B-EVAR. Current evidence is limited by heterogeneity in assessment of body composition and lack of a consensus definition of radiological sarcopenia.
Topics: Aortic Aneurysm, Abdominal; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Humans; Psoas Muscles; Risk Factors; Sarcopenia; Treatment Outcome
PubMed: 36198699
DOI: 10.1038/s41598-022-20490-3 -
The Journal of Experimental Biology Nov 2022The steady-state isometric force produced by skeletal muscle after active shortening and stretching is depressed and enhanced, respectively, compared with purely...
The steady-state isometric force produced by skeletal muscle after active shortening and stretching is depressed and enhanced, respectively, compared with purely isometric force produced at corresponding final lengths and at the same level of activation. One hypothesis proposed to account for these force depression (FD) and force enhancement (FE) properties is a change in cross-bridge cycling kinetics. The rate of cross-bridge attachment (f) and/or cross-bridge detachment (g) may be altered following active shortening and active stretching, leading to FD and FE, respectively. Experiments elucidating cross-bridge kinetics in actively shortened and stretched muscle preparations and their corresponding purely isometric contractions have yet to be performed. The aim of this study was to investigate cross-bridge cycling kinetics of muscle fibres at steady-state following active shortening and stretching. This was done by determining muscle fibre stiffness and rate of active force redevelopment following a quick release-re-stretch protocol (kTR). Applying these measures to equations previously used in the literature for a two-state cross-bridge cycling model (attached/detached cross-bridges) allowed us to determine apparent f and g, the proportion of attached cross-bridges, and the force produced per cross-bridge. kTR, apparent f and g, the proportion of attached cross-bridges and the force produced per cross-bridge were significantly decreased following active shortening compared with corresponding purely isometric contractions, indicating a change in cross-bridge cycling kinetics. Additionally, we showed no change in cross-bridge cycling kinetics following active stretch compared with corresponding purely isometric contractions. These findings suggest that FD is associated with changes in cross-bridge kinetics, whereas FE is not.
Topics: Animals; Rabbits; Isometric Contraction; Muscle Fibers, Skeletal; Mechanical Phenomena; Psoas Muscles; Muscle, Skeletal; Kinetics; Muscle Contraction
PubMed: 36268629
DOI: 10.1242/jeb.244703 -
Internal and Emergency Medicine Mar 2022Both quality and quantity of skeletal muscle are considered important for prognostic factors and clinical outcomes in solid cancers. However, few studies have examined...
Both quality and quantity of skeletal muscle are considered important for prognostic factors and clinical outcomes in solid cancers. However, few studies have examined both quality and quantity of skeletal muscle in patients with hematological malignancies. The aim of the present study was to clarify the prevalence of low skeletal muscle quantity and quality and their associated factors in patients before allogeneic hematopoietic stem cell transplantation (allo-HSCT). Pretransplant plain CT imaging at the third lumber vertebra level was used to measure the psoas muscle mass index (PMI) and the intramuscular adipose tissue content (IMAC) in 113 adult patients (age 47.1 ± 14.6 years) before HSCT. We analyzed the factors associated with PMI and IMAC, respectively. Although 62.8% of all patients had low skeletal muscle mass, only 8% had poor skeletal muscle quality. Multivariable logistic analysis showed that older age [odds ratio (OR) = 2.45, confidence interval (CI) = 1.04-5.76, P = 0.04], male (OR = 4.35, CI = 0.05-0.97, P = 0.04), and low BMI (OR = 0.83, CI = 0.71-0.97, P = 0.02) were independent risk factors for low PMI before HSCT. Only age (≤ 50 years) was significantly associated with muscle quality (modified OR = 0.07, CI = 0.00-0.43, P < 0.01) in univariate analysis. Most patients already showed low skeletal muscle mass before allo-HSCT although skeletal muscle quality was relatively preserved. These results may be indicative of pre-cachexia and may be useful for its long-term management in allo-HSCT patients.
Topics: Adult; Cachexia; Hematopoietic Stem Cell Transplantation; Humans; Male; Middle Aged; Prevalence; Psoas Muscles; Retrospective Studies; Risk Factors
PubMed: 34387840
DOI: 10.1007/s11739-021-02828-3 -
The Journal of Nutrition, Health & Aging 2022A growing body of evidence has demonstrated the prognostic value of skeletal muscle area and quality measured by computed tomography (CT) as biomarkers of sarcopenia and...
BACKGROUND
A growing body of evidence has demonstrated the prognostic value of skeletal muscle area and quality measured by computed tomography (CT) as biomarkers of sarcopenia and frailty. However, there exists little data in normal healthy subjects to inform reference values and determine the effects of advancing age and sex on CT muscle parameters.
METHODS
Abdominal CT images of patients (20-80 years of age) presenting to the emergency department with benign abdominal symptoms and no significant medical comorbidities were retrospectively collected from 2014 to 2017. Psoas and abdominal wall muscle area (PMA, WMA) and density (PMD, WMD) at the level of the L4 vertebrae were measured with the CoreSlicer.com web app. The normal reference range was computed by non-parameteric 2.5th and 97.5th percentiles stratified by sex and restricted by age to the younger subgroup (20-39 years of age).
RESULTS
The cohort consisted of 390 otherwise healthy patients (162 males, 228 females). The lower reference range for PMA was <22.0 cm2 in males and <11.1 cm2 in females, and for WMA was <112.2 cm2 in males and <75.6 cm2 in females. There was a graded decline observed in PMA and WMA among older compared to younger adults (especially ≥60 years of age) (P<0.001) and among females compared to males (P<0.001). There was also a graded decline observed in PMD and WMD among older compared to younger adults (P<0.001), irrespective of sex.
CONCLUSION
This study has defined the normal reference values and age-associated down-trend for CT muscle parameters at L4 in a healthy population using an accessible web-based software, which help contextualize and interpret these imaging biomarkers of sarcopenia in clinical care.
Topics: Aging; Female; Humans; Male; Muscle, Skeletal; Psoas Muscles; Reference Values; Retrospective Studies; Sarcopenia; Tomography, X-Ray Computed
PubMed: 35297466
DOI: 10.1007/s12603-022-1746-3