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Skeletal Muscle Depletion Predicts the Prognosis of Patients with Advanced Pancreatic Cancer Undergoing Palliative Chemotherapy, Independent of Body Mass Index.

Choi Y, Oh DY, Kim TY, Lee KH, Han SW, Im SA, Kim TY, Bang YJ - PLoS ONE (2015)

Bottom Line: Among 484 patients, 103 (21.3%) patients were sarcopenic at diagnosis.Decrease in body mass index (BMI) was observed in 149 patients (37.3%), with no gender difference.While the OS of male patients was affected with sarcopenia (P< 0.001) and decreased SMI (P = 0.001), the OS of female patients was influenced with overweight at diagnosis (P = 0.006), decreased BMI (P = 0.032) and decreased SMI (P = 0.014).

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.

ABSTRACT

Introduction: Body composition has emerged as a prognostic factor in cancer patients. We investigated whether sarcopenia at diagnosis and loss of skeletal muscle during palliative chemotherapy were associated with survival in patients with pancreatic cancer.

Methods: We retrospectively reviewed the clinical outcomes of pancreatic cancer patients receiving palliative chemotherapy between 2003 and 2010. The cross-sectional area of skeletal muscle at L3 by computed tomography was analyzed with Rapidia 3D software. We defined sarcopenia as a skeletal muscle index (SMI)< 42.2 cm2/m2 (male) and < 33.9 cm2/m2 (female) using ROC curve.

Results: Among 484 patients, 103 (21.3%) patients were sarcopenic at diagnosis. Decrease in SMI during chemotherapy was observed in 156 (60.9%) male and 65 (40.6%) female patients. Decrease in body mass index (BMI) was observed in 149 patients (37.3%), with no gender difference. By multivariate analysis, sarcopenia (P< 0.001), decreasedBMI and SMI during chemotherapy (P = 0.002, P = 0.004, respectively) were poor prognostic factors for overall survival (OS). While the OS of male patients was affected with sarcopenia (P< 0.001) and decreased SMI (P = 0.001), the OS of female patients was influenced with overweight at diagnosis (P = 0.006), decreased BMI (P = 0.032) and decreased SMI (P = 0.014). Particularly, while the change of BMI during chemotherapy did not have impact on OS within the patients with maintained SMI (P = 0.750), decrease in SMI was associated with poor OS within the patients with maintained BMI (HR 1.502; P = 0.002).

Conclusions: Sarcopenia at diagnosis and depletion of skeletal muscle, independent of BMI change, during chemotherapy were poor prognostic factors in advanced pancreatic cancer.

No MeSH data available.


Related in: MedlinePlus

Computed tomography images of the region of the third lumbar vertebra, with skeletal muscle highlighted in blue (-29 to 150 Hounsfield units).The blue line on the three-dimensionally reconstructed image on the left indicates the level of the third lumbar vertebra, which is shown in the axial view on the right.
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pone.0139749.g001: Computed tomography images of the region of the third lumbar vertebra, with skeletal muscle highlighted in blue (-29 to 150 Hounsfield units).The blue line on the three-dimensionally reconstructed image on the left indicates the level of the third lumbar vertebra, which is shown in the axial view on the right.

Mentions: Cross-sectional imaging of CT scans was used to analyze skeletal muscle mass as in previous studies [3, 4, 12]. CT scans performed at the date of diagnosis wereused to quantify the initial area of L3 skeletal muscle. The CT scans that provided diagnostic evidence of disease progression were used for the final measurement. Two adjacent axial images within the same serieswere used to determine the cross-sectional area of L3 skeletal muscle, and the mean of the 2 measurements was calculated for each patient. Muscles were quantified within a Hounsfield unit (HU) range of -29 to 150 HU [12], and analyzed with Rapidia 3D software (v2.8; INFINITT Healthcare, Seoul, Korea). A single trained staff person corrected the boundary of the entire area of L3 skeletal muscle (Fig 1). Muscle area was normalized for height in meters squared (m2) and reported as the lumbar skeletal muscle index (SMI) (cm2/m2) [4, 5, 9]. We used the area under the receiver operating characteristic (ROC) curve to determine the cutoff values ofsarcopenia for both genders.


Skeletal Muscle Depletion Predicts the Prognosis of Patients with Advanced Pancreatic Cancer Undergoing Palliative Chemotherapy, Independent of Body Mass Index.

Choi Y, Oh DY, Kim TY, Lee KH, Han SW, Im SA, Kim TY, Bang YJ - PLoS ONE (2015)

Computed tomography images of the region of the third lumbar vertebra, with skeletal muscle highlighted in blue (-29 to 150 Hounsfield units).The blue line on the three-dimensionally reconstructed image on the left indicates the level of the third lumbar vertebra, which is shown in the axial view on the right.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4593598&req=5

pone.0139749.g001: Computed tomography images of the region of the third lumbar vertebra, with skeletal muscle highlighted in blue (-29 to 150 Hounsfield units).The blue line on the three-dimensionally reconstructed image on the left indicates the level of the third lumbar vertebra, which is shown in the axial view on the right.
Mentions: Cross-sectional imaging of CT scans was used to analyze skeletal muscle mass as in previous studies [3, 4, 12]. CT scans performed at the date of diagnosis wereused to quantify the initial area of L3 skeletal muscle. The CT scans that provided diagnostic evidence of disease progression were used for the final measurement. Two adjacent axial images within the same serieswere used to determine the cross-sectional area of L3 skeletal muscle, and the mean of the 2 measurements was calculated for each patient. Muscles were quantified within a Hounsfield unit (HU) range of -29 to 150 HU [12], and analyzed with Rapidia 3D software (v2.8; INFINITT Healthcare, Seoul, Korea). A single trained staff person corrected the boundary of the entire area of L3 skeletal muscle (Fig 1). Muscle area was normalized for height in meters squared (m2) and reported as the lumbar skeletal muscle index (SMI) (cm2/m2) [4, 5, 9]. We used the area under the receiver operating characteristic (ROC) curve to determine the cutoff values ofsarcopenia for both genders.

Bottom Line: Among 484 patients, 103 (21.3%) patients were sarcopenic at diagnosis.Decrease in body mass index (BMI) was observed in 149 patients (37.3%), with no gender difference.While the OS of male patients was affected with sarcopenia (P< 0.001) and decreased SMI (P = 0.001), the OS of female patients was influenced with overweight at diagnosis (P = 0.006), decreased BMI (P = 0.032) and decreased SMI (P = 0.014).

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.

ABSTRACT

Introduction: Body composition has emerged as a prognostic factor in cancer patients. We investigated whether sarcopenia at diagnosis and loss of skeletal muscle during palliative chemotherapy were associated with survival in patients with pancreatic cancer.

Methods: We retrospectively reviewed the clinical outcomes of pancreatic cancer patients receiving palliative chemotherapy between 2003 and 2010. The cross-sectional area of skeletal muscle at L3 by computed tomography was analyzed with Rapidia 3D software. We defined sarcopenia as a skeletal muscle index (SMI)< 42.2 cm2/m2 (male) and < 33.9 cm2/m2 (female) using ROC curve.

Results: Among 484 patients, 103 (21.3%) patients were sarcopenic at diagnosis. Decrease in SMI during chemotherapy was observed in 156 (60.9%) male and 65 (40.6%) female patients. Decrease in body mass index (BMI) was observed in 149 patients (37.3%), with no gender difference. By multivariate analysis, sarcopenia (P< 0.001), decreasedBMI and SMI during chemotherapy (P = 0.002, P = 0.004, respectively) were poor prognostic factors for overall survival (OS). While the OS of male patients was affected with sarcopenia (P< 0.001) and decreased SMI (P = 0.001), the OS of female patients was influenced with overweight at diagnosis (P = 0.006), decreased BMI (P = 0.032) and decreased SMI (P = 0.014). Particularly, while the change of BMI during chemotherapy did not have impact on OS within the patients with maintained SMI (P = 0.750), decrease in SMI was associated with poor OS within the patients with maintained BMI (HR 1.502; P = 0.002).

Conclusions: Sarcopenia at diagnosis and depletion of skeletal muscle, independent of BMI change, during chemotherapy were poor prognostic factors in advanced pancreatic cancer.

No MeSH data available.


Related in: MedlinePlus