Urinary titin N-terminal fragment concentration is an indicator of preoperative sarcopenia and nutritional status in patients with gastrointestinal tract and hepatobiliary pancreatic malignancies.

Abstract

Recent reports indicate that preoperative patients with gastrointestinal malignancies often have sarcopenia. The diagnosis of sarcopenia is generally done by evaluation of walking speed, grip strength, and skeletal muscle volume of the limbs on computed tomography (CT). However, these parameters are objective indices, and new indicators for diagnosis, such as molecular biomarkers, have been anticipated. The aim of this study was to investigate whether titin, a muscular contractile protein present in sarcomeres, is an indicator of sarcopenia. We analyzed 39 patients with gastrointestinal tract and hepatobiliary pancreatic malignancies who underwent surgery. We compared urinary titin n-terminal fragment concentration (UTF) with clinical factors, subcutaneous fat volume, and skeletal muscle volume index, and also compared UTF levels between patients with and without sarcopenia. The patients comprised 24 men and 15 women, with a mean age of 72 y (range: 35-85 y). Cancer locations were the pancreas (n=17), liver (n=9), stomach (n=5), colorectum (n=5), and esophagus (n=3). UTF was significantly higher in patients with sarcopenia (P=0.04), and showed statistically significant negative correlations with albumin (r=-2.61, P=0.001), pre-albumin (r=-2.14, P=0.02), body mass index (r=-0.49, P=0.007), cholinesterase (r=-0.02, P=0.01, skeletal muscle volume index (r=-0.16, P=0.04), and subcutaneous fat volume (r=-0.03, P=0.007). UTF may be a new index for preoperative nutritional assessment in patients with gastrointestinal malignancies.