Are computed tomography-based measures of specific abdominal muscle groups predictive of adverse outcomes in older cancer patients?

S.M.L.M Looijaard,A.B Maier,A.F Voskuilen,T Van Zanten,D.E Bouman,J.M Klaase,C.G.M Meskers

doi:10.1016/j.heliyon.2020.e05437

Abstract

PurposeIt is unknown whether computed tomography (CT)-based total abdominal muscle measures are representative of specific abdominal muscle groups and whether analysis of specific abdominal muscle groups are predictive of the risk of adverse outcomes in older cancer patients. MethodsRetrospective single-center cohort study in elective colon cancer patients aged ≥65 years. CT-based skeletal muscle (SM) surface area, muscle density and intermuscular adipose tissue (IMAT) surface area were determined for rectus abdominis; external- and internal oblique and transversus abdominis (lateral muscles); psoas; and erector spinae and quadratus lumborum (back muscles). Outcomes were defined as severe postoperative complications (Clavien-Dindo score >2) and long-term survival (median follow-up 5.2 years). Results254 older colon cancer patients were included (median 73.6 years, 62.2% males). Rectus abdominis showed the lowest SM surface area and muscle density and the back muscles showed the highest IMAT surface area. Psoas muscle density, and lateral muscle density and percentage IMAT were associated with severe postoperative complications independent of gender, age and cancer stage. ConclusionsCT-based total abdominal muscle quantity and quality do not represent the heterogeneity that exists between specific muscle groups. The potential added value of analysis of specific muscle groups in predicting adverse outcomes in older (colon) cancer patients should be further addressed in prospective studies.

Highlights

Routine single-slice abdominal computed tomography (CT)-based muscle measures at the abdominal, third lumbar vertebra level such as total cross-sectional skeletal muscle (SM) surface area, muscle density and intermuscular adipose tissue (IMAT) surface area, are increasingly being used to predict adverse outcomes in oncology
CT-based muscle measures differed between specific abdominal muscle groups and showed intra-individual heterogeneity in a cohort of older colon cancer patients, indicating that total cross-sectional measures are not representative of specific abdominal muscle groups
CT-based muscle measures differed between specific abdominal muscle groups and showed large intra-individual heterogeneity in a cohort of older colon cancer patients

Summary

Introduction

Routine single-slice abdominal computed tomography (CT)-based muscle measures at the abdominal, third lumbar vertebra level such as total cross-sectional skeletal muscle (SM) surface area, muscle density and intermuscular adipose tissue (IMAT) surface area, are increasingly being used to predict adverse outcomes in (geriatric) oncology. Studies on the association of CT-based muscle measures and adverse outcomes including postoperative complications, chemotherapy toxicity and survival in older colon cancer patients, show inconsistent results [1, 2, 3, 4]. It is unknown whether total abdominal muscle measures can be assumed representative of specific abdominal muscle groups and whether analysis of specific muscle groups is of clinical value in predicting the risk of adverse outcomes in older cancer patients. The value of analyzing specific muscle groups through CT scan analysis has not been studied in the field of (geriatric) oncology

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Discussion

Conclusion