Abstract
Background: Sarcopenia describes a generalized loss of skeletal muscle mass, strength, or function. Determined by measuring the total psoas muscle area (tPMA) on cross-sectional imaging, sarcopenia is an independent marker for poor post-surgical outcomes in adults and children. Children with cancer are at high risk for sarcopenia due to immobility, chemotherapy, and cachexia. We hypothesize that sarcopenic children with neuroblastoma are at higher risk for poor post-operative outcomes.Patients and Methods: Retrospective analysis of children with neuroblastoma ages 1–15 years who were treated at our hospital from 2008 to 2016 with follow-up through March 2021. Psoas muscle area (PMA) was measured from cross-sectional images, using computed tomography (CT) and magnetic resonance imaging (MRI) scans at lumbar disc levels L3-4 and L4-5. tPMA is the sum of the left and right PMA. Z-scores were calculated using age- and gender-specific reference values. Sarcopenia was defined as a tPMA z-score below −2. A correlation of tPMA z-scores and sarcopenia with clinical variables and outcome was performed.Results: One hundred and sixty-four children with workup for neuroblastoma were identified, and 101 children fulfilled inclusion criteria for further analysis, with a mean age of 3.92 years (SD 2.71 years). Mean tPMA z-score at L4-5 was −2.37 (SD 1.02). Correlation of tPMA z-score at L4-5 with weight-for-age z-score was moderate (r = 0.54; 95% CI, 0.38, 0.66). No association between sarcopenia and short-term outcome was observed. Sarcopenia had a sensitivity of 0.82 (95% CI, 0.62–0.93) and a specificity of 0.48 (95% CI 0.36–0.61) in predicting 5-year survival. In a multiple regression analysis, pre-operative sarcopenia, pre-operative chemotherapy in the NB2004 high-risk group, unfavorable tumor histology, and age at diagnosis were associated with 5-year survival after surgery, with hazard ratios of 4.18 (95% CI 1.01–17.26), 2.46 (95% CI 1.02–5.92), 2.39 (95% CI 1.03–5.54), and 1.01 (95% CI 1.00–1.03), respectively.Conclusion: In this study, the majority of children had low tPMA z-scores and sarcopenia was a risk factor for decreased 5-year survival in children with neuroblastoma. Therefore, we suggest measuring the tPMA from pre-surgical cross-sectional imaging as a biomarker for additional risk stratification in children with neuroblastoma.
Highlights
Sarcopenia is defined as the progressive and generalized loss of skeletal muscle mass, strength and function with a consequent risk of adverse outcomes [1]
One hundred sixty-four children had a workup for NB at our institute between October 1, 2008 and January 1, 2016, of which 101 fulfilled inclusion criteria
Pre-operatively, 32 patients were treated according to the NB2004 High Risk (NB2004-HR) protocol and 14 patients were treated according to the NB2004 protocol for patients with medium risk as defined by the Society for Pediatric Oncology/Hematology [Gesellschaft für Pädiatrische Onkologie und Hämatologie, GPOH [27, 28]]
Summary
Sarcopenia is defined as the progressive and generalized loss of skeletal muscle mass, strength and function (performance) with a consequent risk of adverse outcomes [1]. Studies have shown that a low total psoas muscle area (tPMA), measured by adding the left and right psoas muscle between intervertebral lumbar disc level L3-L5 on MRI or CT imaging, is an independent risk factor for adverse outcomes in adults undergoing surgery or with chronic illnesses [11,12,13,14,15,16,17,18]. Determined by measuring the total psoas muscle area (tPMA) on cross-sectional imaging, sarcopenia is an independent marker for poor post-surgical outcomes in adults and children. We hypothesize that sarcopenic children with neuroblastoma are at higher risk for poor post-operative outcomes
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