The predictive and prognostic value of skeletal muscle mass in cancer patients with distant metastases
Öz
Aim:Skeletal muscle loss is an indicator of cachexia and a strong prognostic factor for some types of cancer. After strict standardization, we aim to evaluate both the predictive and prognostic value of low muscle mass (LMM) in common cancer types for first-line chemotherapy.
Methods: This retrospective single-center study was conducted in a regional hospital between 2015 and 2020. Patients diagnosed with distant metastatic cancer were screened and included in the study if they had abdominal computed tomography 45 days prior to first-line chemotherapy. The relationship between LMM and progression-free survival (PFS), overall survival (OS), and objective response rate (ORR) was evaluated.
Results: Initially, 289 patients with metastatic cancer were included. The median duration of follow-up was 17 months, with a mean age of 61.09±13.03 years (range 25 to 95), and 45.9% of patients were female. In total, 50.5% of patients had LMM, which was adjusted for gender. LMM was associated with worse OS and PFS in univariate analysis (HR:1.598;1.216-2.100; p=0.001 for OS and HR:1.583;1.216-2.059; p=0.001 for PFS), and this positive association was maintained after adjusted for diagnosis and age. Better ORRs were obtained in respiratory and gastrointestinal tract cancers, breast, prostate and gynecological cancer in non-LMM groups.
Conclusion:LMM has not only prognostic value but also predictive value for many types of cancer. Therefore, the assessment of muscle loss should be incorporated as part of the initial routine clinical evaluation.
Anahtar Kelimeler
Proje Numarası
yok
Kaynakça
- 1. Evans WJ, Morley JE, Argilés J, Bales C, Baracos V, Guttridge D, et al. Cachexia: a new definition. Clin Nutr. 2008;27(6):793-9. doi:10.1016/j.clnu.2008.06.013.
- 2. Fearon KC. Cancer cachexia: developing multimodal therapy for a multidimensional problem. Eur J Cancer. 2008 May;44(8):1124-32. doi: 10.1016/j.ejca.2008.02.033.
- 3. Argilés JM, López-Soriano FJ. The role of cytokines in cancer cachexia. Med Res Rev. 1999;19(3):223-48. doi: 10.1002/(sici)1098-1128(199905)19:3<223::aid-med3>3.0.co;2-n.
- 4. Shen W, Punyanitya M, Wang Z, Gallagher D, St-Onge MP, Albu J, et al. Total body skeletal muscle and adipose tissue volumes: estimation from a single abdominal cross-sectional image. J Appl Physiol (1985). 2004;97(6):2333-8. doi: 10.1152/japplphysiol.00744.2004.
- 5. Kazemi-Bajestani SMR, Mazurak VC, Baracos V. Computed tomography-defined muscle and fat wasting are associated with cancer clinical outcomes. Semin Cell Dev Biol. 2016;54:2-10. doi: 10.1016/j.semcdb.2015.09.001.
- 6. Joglekar S, Nau PN, Mezhir JJ. The impact of sarcopenia on survival and complications in surgical oncology: A review of the current literature. J Surg Oncol. 2015;112(5):503-9. doi: 10.1002/jso.24025.
- 7. Shachar SS, Deal AM, Weinberg M, Nyrop KA, Williams GR, Nishijima TF, et al. Skeletal Muscle Measures as Predictors of Toxicity, Hospitalization, and Survival in Patients with Metastatic Breast Cancer Receiving Taxane-Based Chemotherapy. Clin Cancer Res. 2017;23(3):658–65. doi:10.1158/1078-0432.CCR-16-0940.
- 8. Rier HN, Jager A, Sleijfer S, Rosmalen JV, Kock MCJM, Levin MD. Low muscle attenuation is a prognostic factor for survival in metastatic breast cancer patients treated with first line palliative chemotherapy. Breast. 2017;31:9-15. doi: 10.1016/j.breast.2016.10.014.
- 9. Zhang XM, Dou QL, Zeng Y, Yang Y, Cheng ASK, Zhang WW. Sarcopenia as a predictor of mortality in women with breast cancer: a meta-analysis and systematic review. BMC Cancer. 2020;20(1):172. doi: 10.1186/s12885-020-6645-6.
- 10. Dieli-Conwright CM, Courneya KS, Demark-Wahnefried W, Sami N, Lee K, Buchanan TA, et al. Effects of Aerobic and Resistance Exercise on Metabolic Syndrome, Sarcopenic Obesity, and Circulating Biomarkers in Overweight or Obese Survivors of Breast Cancer: A Randomized Controlled Trial. J Clin Oncol. 2018;36(9):875-83. doi: 10.1200/JCO.2017.75.7526.
- 11. Kung T, Springer J, Doehner W, Anker SD, von Haehling S. Novel treatment approaches to cachexia and sarcopenia: highlights from the 5th Cachexia conference. Expert Opin Investig Drugs. 2010;19(4):579–85. doi: 10.1517/13543781003724690.
- 12. Martin L, Birdsell L, Macdonald N, Reiman T, Clandinin MT, McCargar LJ, et al. Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol. 2013;31(12):1539-47. doi: 10.1200/JCO.2012.45.2722.
- 13. Taguchi S, Akamatsu N, Nakagawa T, Gonoi W, Kanatani A, Miyazaki H, et al. Sarcopenia Evaluated Using the Skeletal Muscle Index Is a Significant Prognostic Factor for Metastatic Urothelial Carcinoma. Clin Genitourin Cancer. 2016;14(3):237-43. doi: 10.1016/j.clgc.2015.07.015.
- 14. Ohtaka A, Aoki H, Nagata M, Kanayama M, Shimizu F, Ide H, et al. Sarcopenia is a poor prognostic factor of castration-resistant prostate cancer treated with docetaxel therapy. Prostate Int. 2019;7(1):9-14. doi: 10.1016/j.prnil.2018.04.002
- 15. Ikeda T, Ishihara H, Iizuka J, Hashimoto Y, Yoshida K, Kakuta Y, et al. Prognostic impact of sarcopenia in patients with metastatic hormone-sensitive prostate cancer. Jpn J Clin Oncol. 2020;50(8):933-9. doi: 10.1093/jjco/hyaa045.
- 16. Gadducci A, Cosio S. The Prognostic Relevance of Computed Tomography-assessed Skeletal Muscle Index and Skeletal Muscle Radiation Attenuation in Patients With Gynecological Cancer. Anticancer Res. 2021;41(1):9-20. doi: 10.21873/anticanres.14747.
- 17. Sehouli J, Mueller K, Richter R, Anker M, Woopen H, Rasch J, et al. Effects of sarcopenia and malnutrition on morbidity and mortality in gynecologic cancer surgery: results of a prospective study. Cachexia Sarcopenia Muscle. 2021;12(2):393-402. doi: 10.1002/jcsm.12676.
Öz
Amaç: İskelet kası kaybı, kaşeksinin bir göstergesi ve bazı kanser türleri için güçlü bir prognostik faktördür. Bu çalışmada sıkı standardizasyon sonrası, birinci basamak kemoterapi için yaygın kanser türlerinde düşük kas kütlesinin (LMM) hem prognostik hem de prediktif değerini değerlendirmeyi amaçlıyoruz.
Yöntem: Bu retrospektif tek merkezli çalışma 2015-2020 yılları arasında bir bölge hastanesinde yapılmıştır. Uzak metastatik kanser tanısı alan hastalar tarandı ve birinci basamak kemoterapiden 45 gün önce abdomen bilgisayarlı tomografisi olan hastalar çalışmaya dahil edildi. LMM ile genel sağkalım (OS), progresyonsuz sağkalım (PFS) ve objektif yanıt oranı (ORR) arasındaki ilişki değerlendirildi.
Bulgular: Çalışmaya metastatik kanserli 289 hasta dahil edildi. Hastaların %45,9'u kadın olup medyan takip süresi 17 ay ve ortalama yaşı 61,09±13,03 yıldır (min-max: 25-95). Cinsiyete göre düzeltme sonrası, toplamda hastaların %50,5'inde LMM vardı. LMM, univariate analizde daha kötü OS ve PFS ile ilişkilendirildi (OS için HR:1,598;1,216-2,100;p=0,001 ve PFS için HR:1,583;1,216-2,059;p=0,001) ve bu pozitif ilişki tanı ve yaşa göre düzeltme yapıldığında da devam etti. LMM olmayan gruplarda solunum sistemi, gastrointestinal sistem, meme, prostat ve jinekolojik kanserlerde daha iyi ORR'ler elde edildi.
Sonuç: LMM sadece prognostik değere sahip değildir, aynı zamanda birçok kanser türü için prediktif değere de sahiptir. Bu nedenle kas kaybının değerlendirilmesi, ilk muayenede rutin klinik değerlendirmede yer almalıdır.
Anahtar Kelimeler
Prediktif değer kas kütlesi prognostik değer kanser kas indeksi
Destekleyen Kurum
yok
Proje Numarası
yok
Teşekkür
yok
Kaynakça
- 1. Evans WJ, Morley JE, Argilés J, Bales C, Baracos V, Guttridge D, et al. Cachexia: a new definition. Clin Nutr. 2008;27(6):793-9. doi:10.1016/j.clnu.2008.06.013.
- 2. Fearon KC. Cancer cachexia: developing multimodal therapy for a multidimensional problem. Eur J Cancer. 2008 May;44(8):1124-32. doi: 10.1016/j.ejca.2008.02.033.
- 3. Argilés JM, López-Soriano FJ. The role of cytokines in cancer cachexia. Med Res Rev. 1999;19(3):223-48. doi: 10.1002/(sici)1098-1128(199905)19:3<223::aid-med3>3.0.co;2-n.
- 4. Shen W, Punyanitya M, Wang Z, Gallagher D, St-Onge MP, Albu J, et al. Total body skeletal muscle and adipose tissue volumes: estimation from a single abdominal cross-sectional image. J Appl Physiol (1985). 2004;97(6):2333-8. doi: 10.1152/japplphysiol.00744.2004.
- 5. Kazemi-Bajestani SMR, Mazurak VC, Baracos V. Computed tomography-defined muscle and fat wasting are associated with cancer clinical outcomes. Semin Cell Dev Biol. 2016;54:2-10. doi: 10.1016/j.semcdb.2015.09.001.
- 6. Joglekar S, Nau PN, Mezhir JJ. The impact of sarcopenia on survival and complications in surgical oncology: A review of the current literature. J Surg Oncol. 2015;112(5):503-9. doi: 10.1002/jso.24025.
- 7. Shachar SS, Deal AM, Weinberg M, Nyrop KA, Williams GR, Nishijima TF, et al. Skeletal Muscle Measures as Predictors of Toxicity, Hospitalization, and Survival in Patients with Metastatic Breast Cancer Receiving Taxane-Based Chemotherapy. Clin Cancer Res. 2017;23(3):658–65. doi:10.1158/1078-0432.CCR-16-0940.
- 8. Rier HN, Jager A, Sleijfer S, Rosmalen JV, Kock MCJM, Levin MD. Low muscle attenuation is a prognostic factor for survival in metastatic breast cancer patients treated with first line palliative chemotherapy. Breast. 2017;31:9-15. doi: 10.1016/j.breast.2016.10.014.
- 9. Zhang XM, Dou QL, Zeng Y, Yang Y, Cheng ASK, Zhang WW. Sarcopenia as a predictor of mortality in women with breast cancer: a meta-analysis and systematic review. BMC Cancer. 2020;20(1):172. doi: 10.1186/s12885-020-6645-6.
- 10. Dieli-Conwright CM, Courneya KS, Demark-Wahnefried W, Sami N, Lee K, Buchanan TA, et al. Effects of Aerobic and Resistance Exercise on Metabolic Syndrome, Sarcopenic Obesity, and Circulating Biomarkers in Overweight or Obese Survivors of Breast Cancer: A Randomized Controlled Trial. J Clin Oncol. 2018;36(9):875-83. doi: 10.1200/JCO.2017.75.7526.
- 11. Kung T, Springer J, Doehner W, Anker SD, von Haehling S. Novel treatment approaches to cachexia and sarcopenia: highlights from the 5th Cachexia conference. Expert Opin Investig Drugs. 2010;19(4):579–85. doi: 10.1517/13543781003724690.
- 12. Martin L, Birdsell L, Macdonald N, Reiman T, Clandinin MT, McCargar LJ, et al. Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol. 2013;31(12):1539-47. doi: 10.1200/JCO.2012.45.2722.
- 13. Taguchi S, Akamatsu N, Nakagawa T, Gonoi W, Kanatani A, Miyazaki H, et al. Sarcopenia Evaluated Using the Skeletal Muscle Index Is a Significant Prognostic Factor for Metastatic Urothelial Carcinoma. Clin Genitourin Cancer. 2016;14(3):237-43. doi: 10.1016/j.clgc.2015.07.015.
- 14. Ohtaka A, Aoki H, Nagata M, Kanayama M, Shimizu F, Ide H, et al. Sarcopenia is a poor prognostic factor of castration-resistant prostate cancer treated with docetaxel therapy. Prostate Int. 2019;7(1):9-14. doi: 10.1016/j.prnil.2018.04.002
- 15. Ikeda T, Ishihara H, Iizuka J, Hashimoto Y, Yoshida K, Kakuta Y, et al. Prognostic impact of sarcopenia in patients with metastatic hormone-sensitive prostate cancer. Jpn J Clin Oncol. 2020;50(8):933-9. doi: 10.1093/jjco/hyaa045.
- 16. Gadducci A, Cosio S. The Prognostic Relevance of Computed Tomography-assessed Skeletal Muscle Index and Skeletal Muscle Radiation Attenuation in Patients With Gynecological Cancer. Anticancer Res. 2021;41(1):9-20. doi: 10.21873/anticanres.14747.
- 17. Sehouli J, Mueller K, Richter R, Anker M, Woopen H, Rasch J, et al. Effects of sarcopenia and malnutrition on morbidity and mortality in gynecologic cancer surgery: results of a prospective study. Cachexia Sarcopenia Muscle. 2021;12(2):393-402. doi: 10.1002/jcsm.12676.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Klinik Onkoloji |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Proje Numarası | yok |
| Erken Görünüm Tarihi | 20 Ekim 2023 |
| Yayımlanma Tarihi | 29 Ekim 2023 |
| Gönderilme Tarihi | 29 Ağustos 2022 |
| Kabul Tarihi | 6 Eylül 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 7 Sayı: 2 |
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