Prognostic value of sarcopenia in adults with solid tumours: A meta-analysis and systematic review

An awareness of the importance of nutritional status in hospital settings began more than 40 years ago. Much has been learned since and has altered care. For the past 40 years several large studies have shown that cancer patients are amongst the most malnourished of all patient groups. Recently, the use of gold-standard methods of body composition assessment, including computed tomography, has facilitated the understanding of the true prevalence of cancer cachexia (CC). CC remains a devastating syndrome affecting 50-80 % of cancer patients and it is responsible for the death of at least 20 %. The aetiology is multifactorial and complex; driven by pro-inflammatory cytokines and specific tumour-derived factors, which initiate an energy-intensive acute phase protein response and drive the loss of skeletal muscle even in the presence of adequate food intake and insulin. The most clinically relevant phenotypic feature of CC is muscle loss (sarcopenia), as this relates to asthenia, fatigue, impaired physical function, reduced tolerance to treatments, impaired quality of life and reduced survival. Sarcopenia is present in 20-70 % depending on the tumour type. There is mounting evidence that sarcopenia increases the risk of toxicity to many chemotherapy drugs. However, identification of patients with muscle loss has become increasingly difficult as 40-60 % of cancer patients are overweight or obese, even in the setting of metastatic disease. Further challenges exist in trying to reverse CC and sarcopenia. Future clinical trials investigating dose reductions in sarcopenic patients and dose-escalating studies based on pre-treatment body composition assessment have the potential to alter cancer treatment paradigms.

/pdf/cancer-associated-malnutrition-cachexia-and-sarcopenia-the-653hmpvcp4.pdf

Cancer-associated malnutrition, cachexia and sarcopenia: The skeleton in the hospital closet 40 years later

Prevalence and predictive value of pre-therapeutic sarcopenia in cancer patients: A systematic review.

Computed tomography-defined muscle and fat wasting are associated with cancer clinical outcomes

OBJECTIVE The purpose of this article is to review the nomenclature, clinical impact, and diagnostic techniques characterizing sarcopenia CONCLUSION Sarcopenia—defined as significant loss of muscle—is associated with cachexia and frailty Specific diagnostic criteria for sarcopenia continue to evolve, but imaging can play a role in the detection and quantification of muscle depletion Emerging evidence indicates that sarcopenia is a relevant predictor of quality and quantity of life, particularly in patients who are elderly, have cancer, or undergo surgery

https://www.ajronline.org/doi/pdf/10.2214/AJR.15.14635

Sarcopenia: Current Concepts and Imaging Implications

Background Patients with potentially curative oesophago-gastric cancer typically undergo neo-adjuvant chemotherapy prior to surgery. The majority of anti-cancer drugs have a narrow therapeutic index. The aim of this study was to determine if features of body composition, assessed using computed tomography (CT) scans, may be predictive of dose-limiting toxicity (DLT) in patients undergoing neo-adjuvant chemotherapy for oesophago-gastric cancer. The influence of sarcopenia and DLT on overall survival was also evaluated. Methods 89 Patients having potentially curative oesophago-gastric cancer surgery were studied. Patients studied had histologically confirmed oesophago-gastric cancer with no evidence of distant metastasis on pre-operative staging. CT scan was performed in all cases at diagnosis. DLT was defined as toxicity leading to postponement of treatment, a drug dose reduction or definitive interruption of drug administration. Results DLT occurred in 37 out of 89 patients (41.6%) undergoing chemotherapy. Sarcopenia (odds ratio, 2.95; 95% confidence interval, 1.23–7.09; p  = 0.015) was associated with DLT on multivariate analysis. Median overall survival for patients who were sarcopenic was 569 days (IQ range: 357–1230 days) vs. 1013 days (IQ range: 496–1318 days) for patients who were not sarcopenic ( p  = 0.04). There was no significant difference in overall survival in patients who experienced DLT compared with those that did not ( p  = 0.665). Conclusions Sarcopenia is a significant predictor of DLT in oesophago-gastric cancer patients undergoing neo-adjuvant chemotherapy. These results raise the potential for use of assessment of skeletal muscle mass using CT scans to predict toxicity and individualize chemotherapy dosing.

Sarcopenia is associated with toxicity in patients undergoing neo-adjuvant chemotherapy for oesophago-gastric cancer.

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Sarcopenia is associated with toxicity in patients undergoing neo-adjuvant chemotherapy for oesophago-gastric cancer.