Skeletal Muscle Index Cutoff Research Articles

Role of sarcopenia in complex abdominal wall surgery: does it increase postoperative complications and mortality?

Sarcopenia is defined as the loss of skeletal muscle mass and is associated with an increased risk or morbidity and mortality in complex surgical patient populations. Its role in complex abdominal wall surgery (AWS) is yet to be determined. The aim of this study is to establish if sarcopenia has an impact on postoperative complications, mortality and hernia recurrence. Retrospective study of patients undergoing elective surgery for complex incisional hernias > 10cm (W3 of European Hernia Society classification) between 2014-2023. Sarcopenia was stablished as the skeletal muscle index (SMI), measured at L3 transversal section of a preoperative CT-scan. Previously defined literature-based SMI cutoff values were used: men ≤ 52.4cm2/m2, women ≤ 38.5cm2/m2. 135 patients undergoing complex AWS were included. Of them, 38 were sarcopenic (28.1%). The median follow-up time was 13months (IQR 12-25). In total, 11 patients died (8.1%). We found that sarcopenia was associated with a higher risk of mortality [HR 7.494 (95% CI 1.985-28.289); p 0.003]. There were no statistically significant differences in postoperative complications or hernia recurrence between both groups. Although sarcopenia does not seem to have an influence on hernia recurrence or the development of postoperative complications, whether local or systemic, in our study sarcopenia is associated with a higher risk of mortality after complex abdominal wall surgery. Nonetheless, with the results obtained in our study, we think that prehabilitation programs before complex AWS is advisable.

Association of sarcopenia with severe chemotherapy toxicities and survival in patients with advanced gastric cancer.

Sarcopenia or skeletal muscle depletion is a poor prognostic factor for gastric cancer (GC). However, existing cutoff values of skeletal muscle index (SMI) for defining sarcopenia have been found to have limitations when clinically applied. This study aimed to determine the optimal cutoff for SMI to predict severe toxicities of chemotherapy and overall survival (OS) in patients with advanced GC. Patients with metastatic gastric adenocarcinoma who received first-line palliative chemotherapy between January 2014 and December 2021 at Queen Mary Hospital, Hong Kong, were included in this study. The SMI was determined via a pre-chemotherapy computed tomography scan. Optimal cutoff points of SMI were identified by recursive partitioning analysis. Univariate and multivariate analyses evaluating risk factors of severe chemotherapy toxicities and OS were also performed. A total of 158 patients (male: 108 (68.4%), median age: 65.3) were included. The SMI cutoff to define low SMI was ≤33 cm2/m2 for males and ≤28 cm2/m2 for females; 30 patients (19.0%) had low SMI. Patients with low SMI had a higher incidence of hematological toxicities (63.3% vs 32.0%, P = .001) and non-hematological toxicities (66.7% vs 36.7%, P = .003). Multivariable analysis indicated that low SMI and low serum albumin (≤28 g/L) were independent predictive factors of hematological toxicity, while low SMI and neutrophil-lymphocyte ratio ≥5 were predictive factors of non-hematological toxicity. Moreover, patients with low SMI had a significantly shorter OS (P = .011), lower response rate to chemotherapy (P = .045), and lower utilization of subsequent lines of treatment (P < .001). Using pre-chemotherapy SMI cutoff (≤33 cm2/m2 for males and 28 cm2/m2 for females) one can identify individuals with a higher risk of severe chemotherapy toxicities and worse prognosis.

AI-Assisted Body Composition Assessment Using CT Imaging in Colorectal Cancer Patients: Predictive Capacity for Sarcopenia and Malnutrition Diagnosis.

(1) Background: The assessment of muscle mass is crucial in the nutritional evaluation of patients with colorectal cancer (CRC), as decreased muscle mass is linked to increased complications and poorer prognosis. This study aims to evaluate the utility of AI-assisted L3 CT for assessing body composition and determining low muscle mass using both the Global Leadership Initiative on Malnutrition (GLIM) criteria for malnutrition and the European Working Group on Sarcopenia in Older People (EWGSOP2) criteria for sarcopenia in CRC patients prior to surgery. Additionally, we aim to establish cutoff points for muscle mass in men and women and propose their application in these diagnostic frameworks. (2) Methods: This retrospective observational study included CRC patients assessed by the Endocrinology and Nutrition services of the Regional University Hospitals of Malaga, Virgen de la Victoria of Malaga, and Vall d'Hebrón of Barcelona from October 2018 to July 2023. A morphofunctional assessment, including anthropometry, bioimpedance analysis (BIA), and handgrip strength, was conducted to apply the GLIM criteria for malnutrition and the EWGSOP2 criteria for sarcopenia. Body composition evaluation was performed through AI-assisted analysis of CT images at the L3 level. ROC analysis was used to determine the predictive capacity of variables derived from the CT analysis regarding the diagnosis of low muscle mass and to describe cutoff points. (3) Results: A total of 586 patients were enrolled, with a mean age of 68.4 ± 10.2 years. Using the GLIM criteria, 245 patients (41.8%) were diagnosed with malnutrition. Applying the EWGSOP2 criteria, 56 patients (9.6%) were diagnosed with sarcopenia. ROC curve analysis for the skeletal muscle index (SMI) showed a strong discriminative capacity of muscle area to detect low fat-free mass index (FFMI) (AUC = 0.82, 95% CI 0.77-0.87, p < 0.001). The identified SMI cutoff for diagnosing low FFMI was 32.75 cm2/m2 (Sn 77%, Sp 64.3%; AUC = 0.79, 95% CI 0.70-0.87, p < 0.001) in women, and 39.9 cm2/m2 (Sn 77%, Sp 72.7%; AUC = 0.85, 95% CI 0.80-0.90, p < 0.001) in men. Additionally, skeletal muscle area (SMA) showed good discriminative capacity for detecting low appendicular skeletal muscle mass (ASMM) (AUC = 0.71, 95% CI 0.65-0.76, p < 0.001). The identified SMA cutoff points for diagnosing low ASMM were 83.2 cm2 (Sn 76.7%, Sp 55.3%; AUC = 0.77, 95% CI 0.69-0.84, p < 0.001) in women and 112.6 cm2 (Sn 82.3%, Sp 58.6%; AUC = 0.79, 95% CI 0.74-0.85, p < 0.001) in men. (4) Conclusions: AI-assisted body composition assessment using CT is a valuable tool in the morphofunctional evaluation of patients with colorectal cancer prior to surgery. CT provides quantitative data on muscle mass for the application of the GLIM criteria for malnutrition and the EWGSOP2 criteria for sarcopenia, with specific cutoff points established for diagnostic use.

Advancing body composition assessment in patients with cancer: First comparisons of traditional versus multicompartment models

Background and aimsMeasurement of body composition using computed tomography (CT) scans may be a viable clinical tool for low muscle mass assessment in oncology. However, longitudinal assessments are often infeasible with CT. Clinically accessible body composition technologies can be used to track changes in fat-free mass (FFM) or muscle, though their accuracy may be impacted by cancer-related physiological changes. The purpose of this study was to examine the agreement among accessible body composition method with criterion methods for measures of whole-body FFM measurements and, when possible, muscle mass for the classification of low muscle in patients with cancer. MethodsPatients with colorectal cancer were recruited to complete measures of whole-body DXA, air displacement plethysmography (ADP), and bioelectrical impedance analysis (BIA). These measures were used alone, or in combination to construct the criterion multicompartment (4C) mode for estimating FFM. Patients also underwent abdominal CT scans as part of routine clinical assessment. Agreement of each method with 4C model was analyzed using mean constant error (CE = criterion – alternative), linear regression including root mean square error (RMSE), Bland-Altman limits of agreement (LoA) and mean percentage difference (MPD). Additionally, appendicular lean soft tissue index (ALSTI) measured by DXA and predicted by CT were compared for the absolute agreement, while the ALSTI values and skeletal muscle index by CT were assessed for agreement on the classification of low muscle mass. ResultsForty-five patients received all measures for the 4C model and 25 had measures within proximity of clinical CT measures. Compared to 4C, DXA outperformed ADP and BIA by showing the strongest overall agreement (CE = 1.96 kg, RMSE = 2.45 kg, MPD = 98.15 ± 2.38%), supporting its use for body composition assessment in patients with cancer. However, CT cutoffs for skeletal muscle index or CT-estimated ALSTI were lower than DXA ALSTI (average 1.0 ± 1.2 kg/m2) with 24.0% to 32.0% of patients having a different low muscle classification by CT when compared to DXA. ConclusionsDespite discrepancies between clinical body composition assessment and the criterion multicompartment model, DXA demonstrates the strongest agreement with 4C. Disagreement between DXA and CT for low muscle mass classification prompts further evaluation of the measures and cutoffs used with each technique. Multicompartment models may enhance our understanding of body composition variations at the individual patient level and improve the applicability of clinically accessible technologies for classification and monitoring change over time.

Sarcopenia, adiposity and large discordance between cystatin C and creatinine-based estimated glomerular filtration rate in patients with cancer.

Creatinine-based estimated glomerular filtration rate (eGFRCRE) may overestimate kidney function in patients with sarcopenia. While cystatin C-based eGFR (eGFRCYS) is less affected by muscle mass, it may underestimate kidney function in patients with obesity. We sought to evaluate the relationship between body composition defined by computed tomography (CT) scans and discordance between creatinine, eGFRCRE and eGFRCYS in adult patients with cancer. This study is a cross-sectional study of consecutive adults with cancer with an abdominal CT scan performed within 90days of simultaneous eGFRCRE and eGFRCYS measurements between May 2010 and January 2022. Muscle and adipose tissue cross-sectional areas were measured at the level of the third lumbar vertebral body using a validated deep-learning pipeline. CT-defined sarcopenia was defined using independent sex-specific cut-offs for skeletal muscle index (<39cm2/m2 for women and <55cm2/m2 for men). High adiposity was defined as the highest sex-specific quartile of the total (visceral plus subcutaneous) adiposity index in the cohort. The primary outcome was eGFR discordance, defined by eGFRCYS>30% lower than eGFRCRE; the secondary outcome was eGFRCYS>50% lower than eGFRCRE. The odds of eGFR discordance were estimated using multivariable logistic regression modelling. Unadjusted spline regression was used to evaluate the relationship between skeletal muscle index and the difference between eGFRCYS and eGFRCRE. Of the 545 included patients (mean age 63±14years, 300 [55%] females, 440 [80.7%] non-Hispanic white), 320 (58.7%) met the criteria for CT-defined sarcopenia, and 136 (25%) had high adiposity. A total of 259 patients (48%) had >30% eGFR discordance, and 122 (22.4%) had >50% eGFR discordance. After adjustment for potential confounders, CT-defined sarcopenia and high adiposity were both associated with >30% eGFR discordance (adjusted odds ratio [aOR] 1.90, 95% confidence interval [CI] 1.12-3.24; aOR 2.01, 95% CI 1.15-3.52, respectively) and >50% eGFR discordance (aOR 2.34, 95% CI 1.21-4.51; aOR 2.23, 95% CI 1.19-4.17, respectively). A spline model demonstrated that as skeletal muscle index decreases, the predicted difference between eGFRCRE and eGFRCYS widens considerably. CT-defined sarcopenia and high adiposity are both independently associated with large eGFR discordance. Incorporating valuable information from body composition analysis derived from CT scans performed as a part of routine cancer care can impact the interpretation of GFR estimates.

Sarcopenia impacts perioperative and survival outcomes after esophagectomy for cancer: a multicenter study

BackgroundThe impact of sarcopenia on outcomes after esophagectomy is controversial. Most data are currently derived from Asian populations. This study aimed to correlate sarcopenia to short-term perioperative complication rates and long-term survival and recurrence outcomes. MethodsA retrospective analysis was performed of patients undergoing esophagectomy for cancer from 3 tertiary referral centers in Australia. Sarcopenia was defined using cutoffs for skeletal muscle index (SMI), assessed on preoperative computed tomography images. Outcomes measured included complications, overall survival (OS), and disease-free survival (DFS). ResultsOf 462 patients (78.4% male; median age, 67 years), sarcopenia was evident in 276 (59.7%). Patients with sarcopenia had a higher rate of major (Clavien-Dindo ≥ 3b) complications (27.9% vs 14.5%; P < .001), including higher rates of postoperative cardiac arrythmia (16.3% vs 9.7%; P = .042), pneumonia requiring antibiotics (14.5% vs 9.1%; P = .008), and 30-day mortality (5.1% vs 0%; P = .002). In the sarcopenic group, the median OS was lower (37 months [95% CI, 27.1–46.9] vs 114 months [95% CI, 75.8–152.2]; P < .001), as was the median DFS (27 months [95% CI, 18.9–35.1] vs 77 months [95% CI, 36.4–117.6]; P < .001). Sarcopenia was an independent risk factor for lower survival on multivariate analysis (hazard ratio, 1.688; 95% CI, 1.223–2.329; P = .001). ConclusionPatients with preoperative sarcopenia based on analysis of SMI are at a higher risk of major complications and have inferior survival and oncologic outcomes after esophagectomy for esophageal cancer.

Prognostic Impact of Skeletal Muscle Index and Vitamin D in Diffuse Large B-Cell Lymphoma

Background: Sarcopenia is characterized by the loss of muscle mass and strength, commonly observed in older adults. Sarcopenia has become a significant prognostic factor in various cancer types, including diffuse large B-cell lymphoma (DLBCL). Vitamin D, an essential nutrient for bone health and immune function, has been studied as a potential factor in preventing and treating sarcopenia. Vitamin D deficiency has also been reported to be a poor prognostic factor for DLBCL. Therefore, we investigated the relationship between skeletal muscle index (SMI) and vitamin D and its prognostic impact on DLBCL. Methods: We retrospectively analyzed 213 newly diagnosed DLBCL patients from 2012 to 2022 at Gifu University Hospital. The standard regimens in this study included R-CHOP or R-THP-COP. The muscle mass of the third lumbar vertebra was measured and converted to the SMI by dividing the muscle mass by the square of the height (cm 2/m 2). The sex-specific cutoffs for SMI (42 cm 2/m 2 in males and 38 cm 2/m 2 in females) were used to stratify into low and high SMI groups according to The Japan Society of Hepatology guideline. Serum 25-hydroxyvitamin D [25(OH)D] was measured by the electrochemiluminescence method using serum cryopreserved during diagnosis. For analysis, 25(OH)D values were categorized according to three conditions: deficient (&amp;lt; 20 ng/mL), insufficient (20-29 ng/mL), and normal (≥ 30 ng/mL). Results: After excluding ineligible patients, 186 patients were included. The median age was 71 (20-93) years, with 80% of the patients over 60. The median SMI was 39.8 cm 2/m 2 in males (7.4-76.0 cm 2/m 2) and 33.7 cm 2/m 2 (6.9-63.0 cm 2/m 2) in females, with 38 (36%) males and 45 (56%) females determined to have low SMI. The median 25(OH)D was 13.0 ng/mL (4.0-27.1 ng/mL); 35 (19%) patients were vitamin D deficient, 151 (81%) were vitamin D insufficient, and no patient had normal vitamin D. There was no significant difference in 25(OH)D between the low SMI and high SMI groups (P = 0.189). However, when analyzed separately by gender, 25(OH)D was significantly lower in males with the low SMI groups (P = 0.017) but not in females (P = 0.359). Using the ROC curve, the optimal 25(OH)D cutoff for progression-free survival (PFS) and overall survival (OS) was 9.6 ng/mL. Multivariable analysis using the COX proportional hazards model with gender, cell of origin of DLBCL, International Prognostic Index, low SMI, and low 25(OH)D as covariates showed that the hazard ratio (HR) of low SMI for PFS was 1.42 [95% confidential interval (CI) 0.86-2.37, P = 0.17] and OS was 1.38 (95% CI 0.77-2.47, P = 0.28), and the HR of low 25(OH)D for PFS was 2.45 (95% CI 1.47-4.07, P &amp;lt; 0.001) and OS was 3.19 (95% CI 1.76-5.77). P &amp;lt; 0.001). When SMI and 25(OH)D were combined, both PFS and OS could be stratified into four groups, with patients with low SMI and low 25(OH)D having the poorest prognosis (5-year PFS: 40.8%, 5-year OS: 44.3%). Those with high SMI and high 25(OH)D had the best prognosis (5-year PFS: 71.5%, 5-year OS: 82.5%). Conclusion: This study is the first study investigating the relationship between SMI, vitamin D, and survival outcomes in patients with DLBCL. Our study suggests that vitamin D deficiency and low SMI may synergistically affect the prognosis of DLBCL patients. These findings highlight the importance of assessing nutritional status and muscle health in DLBCL patients. Future prospective studies are needed to confirm our findings and to investigate the potential benefits of vitamin D supplementation and interventions to prevent or treat sarcopenia in DLBCL patients.

Automated Sarcopenia Assessment and Outcomes in Head and Neck Cancer with Deep Learning Analysis of Cervical Neck Skeletal Muscle

Sarcopenia is an established prognostic factor in patients diagnosed with head and neck cancers (HNC), typically measured by the skeletal muscle index (SMI) from abdominal muscle mass at L3. While sarcopenia assessment could inform HNC management, it remains impractical, time- and labor-intensive, and operator-dependent. To overcome these challenges, we developed an automated deep learning (DL) platform to calculate SMI at L3 by quantifying cross-sectional cervical skeletal muscle area (SMA) at C3 through auto-segmentation, externally validated it, and evaluated associations with clinical outcomes. Eight hundred twenty-one patients diagnosed with HNC from multiple institutes from 1999-2013, treated with definitive chemoradiation with baseline pre-treatment CT scans, were included for model development (335 training, 96 tuning) and for independent testing (48 internal, and 342 external). Ground truth single-slice segmentations of SM at the mid-C3 vertebral level were manually annotated by radiation oncologists using an established protocol. A multi-stage DL pipeline was developed, with a 2D DenseNet to select the middle slice of C3 section and a 2D UNet to segment the SM, from which SMA was calculated. The model was evaluated using the Dice Similarity Coefficient (DC) for the internal test set, and human acceptability testing on the external test set was performed by two radiation oncologists not involved in annotations. SMI was calculated from C3 SMA based on prior literature, and sarcopenia was defined by an established, sex-specific SMI cutoff. Sarcopenia associations with overall survival (OS) and toxicities were assessed on the external dataset with Cox and logistic multivariable regressions, as indicated. Model DC on the internal test set as 0.90 [95% CI: 0.90-0.91], with an intra-class coefficient of 0.96 for SMA. Human acceptability testing showed a pass rate of 94.4%. Of the 342 patients in the clinical analysis, 261 (76.3%) patients had sarcopenia. Five-year survival was 84.4% in patients without sarcopenia vs 73.1% in patients with sarcopenia (HR 2.21, p = 0.028) (median f/u: 44 mo (IQR: 25 - 66 mo)). On multivariable regression, sarcopenia (HR 2.06, p = 0.037), ACE-27 score 2+ (HR 2.25, p = 0.001), non-oropharynx diagnosis (HR 3.96, p<0.001), and T3-4 stage (HR 2.37, p<0.001) were associated with worse OS. Sarcopenia was associated with longer PEG tube duration on multivariable analysis (HR 1.59, p = 0.003), along with ACE-27 score (HR 1.20, p = 0.012) and non-oropharynx primary site (HR 1.46, p = 0.034). Sarcopenia was associated with higher risk of having PEG tube at last follow up (OR 2.25, p = 0.046). An observed increase in risk of hospitalization <3 months after RT was non-significant (OR 2.18, p = 0.117). We developed and externally validated a fully-automated platform for sarcopenia assessment that can be used on routine HNC imaging. This algorithm is positioned for prospective testing to determine if use will inform HNC management.

237. PRE-NEOADJUVANT CHEMOTHERAPY SARCOPENIA IS PREDICTIVE OF MORTALITY IN ESOPHAGOGASTRIC ADENOCARCINOMA PATIENTS

Abstract Background Sarcopenia is defined as a loss of skeletal muscle mass and function. Preoperative sarcopenia amongst patients with esophageal cancer has been linked to mortality, various postoperative complications and the severity of these complications. The majority of this evidence comes from populations with squamous cell carcinoma or where neoadjuvant chemoradiotherapy was used. Whether sarcopenia is associated with neoadjuvant chemotherapy (NAC) for esophagogastric adenocarcinoma (EGA) and any link to mortality is not fully understood. Methods Patients diagnosed with EGA between January 2017 and December 2021 and undergoing NAC followed by esophagectomy from a single high-volume center had their pre-NAC CT scans assessed for radiological sarcopenia. Skeletal muscle index (SMI) was calculated from muscle area measured on CT scans at the level of third lumbar vertebra. Previously published SMI cut off values for radiologically defined sarcopenia were used (52.4 cm2 for men and 38.5 cm2 for women). A cox-regression model was used to investigate mortality between those with sarcopenia and those without. Results There were 191 patients included in the analysis. Pre-NAC sarcopenia was associated with increased mortality (Hazard ratio 1.59, 1.00–2.54 p = 0.046). 5-year survival for sarcopenic and non-sarcopenic patients was 27.8% (17.1%, 45.2%) and 35.6% (21.3%, 59.5%), respectively. Median survival was 2.72 and 4.09 years, respectively. Conclusion EGA patients with sarcopenia pre-NAC have a significantly higher chance of mortality in the 5-years following their surgery. Strategies to treat sarcopenia and prevent its further development should be investigated with the aim to increase survival in this cohort.

331. IMPACT OF SARCOPENIA ON RECURRENCE OF ESOPHAGOGASTRIC ADENOCARCINOMA IN PATIENTS THAT HAVE UNDERGONE NEOADJUVANT CHEMOTHERAPY

Abstract Background Sarcopenia is defined as a loss of skeletal muscle mass and function. Preoperative sarcopenia amongst patients with esophageal cancer is known to be associated with post-operative complications and increased mortality. Whether preoperative sarcopenia has an affect on disease recurrence has not been investigated for patients with esophageal adenocarcinoma undergoing neoadjuvant chemotherapy. Methods Patients diagnosed with EGA between January 2017 and December 2021 and undergoing NAC followed by esophagectomy from a single high-volume center had their post-NAC CT scans assessed for radiological sarcopenia. Skeletal muscle index (SMI) was calculated from muscle area measured on CT scans at the level of third lumbar vertebra. Previously published SMI cut off values of 52.4 cm2 for men and 38.5 cm2 for women were used. Patients that had complete resection (R0) of were included in the analysis. A cox-regression model was used to investigate recurrence between those with sarcopenia and those without. Results 133 patients were included in the analysis. Patients with sarcopenia before or after NAC were not more likely to develop disease recurrence than those patients without sarcopenia (Hazard ratio 1.08, 95% CI 0.97–1.17; p &amp;gt; 0.05). Conclusion In this cohort of patients from a single high volume centre, sarcopenia status in EGA patients undergoing NAC and esophagectomy does not significantly impact the rate of disease recurrence.

288. POST-OPERATIVE COMPLICATIONS IN OBESE SARCOPENIC PATIENTS WITH ESOPHAGOGASTRIC ADENOCARCINOMA UNDERGOING NEOADJUVANT CHEMOTHERAPY

Abstract Background Sarcopenia is defined as a loss of skeletal muscle mass and function. Preoperative sarcopenia amongst patients with esophageal cancer has been linked to mortality, various postoperative complications and the severity of these complications. Obesity has been linked with many health problems. Evidence has not been previously published regarding complication rates in obese, sarcopenic patients with esophagogastric adenocarcinoma undergoing neoadjuvant chemotherapy. Methods Patients diagnosed with EGA between January 2017 and December 2021 and undergoing NAC followed by esophagectomy from a single high-volume center had their post-NAC CT scans assessed for radiological sarcopenia. Skeletal muscle index (SMI) was calculated from muscle area measured on CT scans at the level of third lumbar vertebra. Previously published SMI cut off values of 52.4 cm2 for men and 38.5 cm2 for women were used. Obesity was defined as a BMI &amp;gt;30 kg/m2. Post-operative complications were prospectively collected and classified using the Clavien-Dindo (CD) classification system. Patients were grouped as CD 0-I (no-mild complications) or CD II-V (moderate–severe complications). Results There were 191 patients included in the analysis. 25 patients post-NAC were both sarcopenic and obese. There was no significant difference between complication rates in the obese sarcopenic group vs the sarcopenic group. Conclusion EGA patients with obesity and sarcopenia post-NAC do not have a higher chance of developing complications than those patients with just sarcopenia.

238. ESOPHAGOGASTRIC ADENOCARCINOMA PATIENTS WITH SARCOPENIA BEFORE OR AFTER NEOADJUVANT CHEMOTHERAPY ARE MORE LIKELY TO HAVE LONGER POST-OPERATIVE INPATIENT STAYS

Abstract Background Sarcopenia is defined as a loss of skeletal muscle mass and function. It is prevalent amongst patients with esophagogastric adenocarcinoma (EGA) and associated with adverse treatment outcomes. The majority of this evidence comes from populations with squamous cell carcinoma or where neoadjuvant chemoradiotherapy was used. Protracted inpatient stays are directly associated with adverse events such as healthcare-associated infections and patient deconditioning and increase the economic burden on healthcare institutions. Methods Patients diagnosed with EGA between January 2017 and December 2021 and undergoing neoadjuvant chemotherapy (NAC) followed by esophagectomy from a single tertiary center in the UK had their pre- and post-NAC CT scans assessed for radiological sarcopenia. Skeletal muscle index (SMI) was calculated from muscle area measured on CT scans at the level of third lumbar vertebra. Previously published SMI cut off values for radiologically defined sarcopenia were used (52.4 cm2 for men and 38.5 cm2 for women). Wilcoxon signed-rank test for non-parametric data was used to determine significance. Results 191 patients were included in the analysis. The number of patients with sarcopenia increased from 96 to 123 following NAC. Sarcopenia before (p = 0.047) or after (p = 0.007) NAC was significantly associated with longer inpatient stays post-operatively. The median stay for patients with sarcopenia before or after NAC was 12 days compared to 9 for those without sarcopenia before or after NAC. Conclusion Radiological sarcopenia is highly prevalent in this cohort of patients and increases following NAC. This study demonstrates that sarcopenia before or after NAC in patients with EGA undergoing esophagectomy are likely to have longer inpatient stays following surgery. Peri-operative treatment to treat and reduce the incidence of sarcopenia should be trialed with the aim of improving post-operative outcomes in this cohort.

OC-011 SARCOPENIA IN COMPLEX ABDOMINAL WALL SURGERY: IMPACT ON THE POSTOPERATIVE COMPLICATIONS

Abstract Aim Sarcopenia is defined as the skeletal muscle mass loss and is considered as a prognostic factor in oncological surgical patients, liver transplant and trauma surgery. It can be reversed with exercise and diet. Nonetheless there is a lack of evidence of its impact on complex abdominal wall surgery. The aim is to evaluate the impact of sarcopenia in postoperative complications after complex incisional hernia repair. Material and Methods Retrospective study of patients undergoing surgery for complex incisional hernias &amp;gt;10cm (W3 of European Hernia Society classification) between 2014–2021. Sarcopenia was stablished as the skeletal muscle index (SMI), measured at L3 transversal section of a preoperative CT-scan. Previously defined literature-based SMI cutoff values were used: men &amp;lt;52,4cm2/m2, women &amp;lt;38,5cm2/m2. Results We included 105 patients, of which 29 (27,6%) were sarcopenic. The mean follow-up was 24,11 (19,28) months. The mean age and body mass index was 65,34 (10,98) and 31,85 (5,55), respectively. Sarcopenia was significantly associated with a higher risk of death [OR 11,21 (IC95% 2,76–45,52); p=0,001]. We observed a difference in need of intensive care unit (ICU) stay [OR 2,24 (IC95% 0,88–5,69); p=0,089] and cardiac complications [OR 2,96 (IC95% 0,79–11,11); p=0,108], not reaching statistical significance. Differences in surgical site occurrence or infection were not observed. After analysing by possible cofounding factors (age, comorbidities, ICU stay), sarcopenia remains associated with a higher risk of death [OR 9,08 (IC95% 2,08–39,59); p=0,003]. Conclusions Given the results of our study sarcopenia might increase the risk of death, independent of age, comorbidities and ICU stay.

Prognostic impact of sarcopenia in patients with locally advanced adenocarcinoma of the esophagogastric junction treated with neoadjuvant chemoradiotherapy.

Few studies have evaluated the significance of sarcopenia in predicting the outcomes of patients with adenocarcinoma of the esophagogastric junction (AEG), especially those who received neoadjuvant chemoradiotherapy (NCRT). We aimed to identify the sarcopenic status and its impact on the outcomes of patients with locally advanced AEG who received NCRT followed by radical surgery or systemic therapy. Patients with T3-4N+M0 AEG with accessible abdominal computed tomography (CT) before and after NCRT were retrospectively analyzed. Body composition parameters, particularly the skeletal muscle index (SMI), were assessed using a CT-based method, and sarcopenia was defined using a predetermined SMI cutoff value. Survival analysis was conducted using the Kaplan-Meier method. A Cox proportional hazards regression model was used to identify independent prognostic factors. Receiver operating characteristic curve analysis was carried out, and the area under the curve (AUC) was calculated to test the prognostic accuracy of different factors. A total of 63 patients were enrolled, 65.1 and 79.4% of whom developed pre- and post-NCRT sarcopenia, respectively. Patients with pre-NCRT sarcopenia had lower radical surgery rates (70.7 vs. 95.5%, p = 0.047) than those without sarcopenia; however, sarcopenic status did not affect other short-term outcomes, including treatment-related toxicity and efficacy. Pre-NCRT sarcopenia was identified as an independent predictive factor for poor overall survival (OS) [adjusted hazard ratio (HR), 6.053; p = 0.002] and progression-free survival (PFS) (adjusted HR, 2.873; p = 0.031). Compared with nutritional indices such as the Nutritional Risk Screening 2002, weight loss during NCRT, and post-NCRT sarcopenia, pre-NCRT sarcopenia was regarded as the best predictive index for the 5-year OS (AUC = 0.735) and PFS rates (AUC = 0.770). Pre-NCRT sarcopenia may be an independent predictive factor for OS and PFS rates in patients with locally advanced AEG receiving multimodal treatment.

Normative cutoffs of muscle mass, muscle strength, and frailty for healthy Indian population.

Population-derived cutoffs for low skeletal muscle mass, skeletal muscle strength, and frailty among Indians are lacking. Studies describing sarcopenia and frailty among patients with chronic liver diseases have used cutoffs derived from Caucasian populations giving erroneous results. We aimed to derive gender-specific cutoffs for low skeletal muscle mass and skeletal muscle strength from healthy Indians. Healthy Indian population consisted of two groups. Group 1 (GpI) included 242 healthy liver donors and group 2 (GpII) 272 healthy health care workers. Skeletal muscle index (SMI) was calculated from computed tomography (CT) abdomen performed prior to donor hepatectomy only in GpI. Liver frailty index (LFI) was computed using the online calculator, after recording hand grip strength (HGS), chair stand-up test (CSUT), and balance test in both groups. HGS was measured using the Smedley handgrip dynamometer. CSUT was noted as time to complete 5 chair stand-ups with subjects' arms folded across the chest. Gender-specific cutoffs of SMI and HGS were derived as <5th percentile of the distribution values and as >95th percentile for CSUT and LFI values. The SMI was measured from GpI subjects (n=242; 120 males [mean age 31.13] and 122 females [mean age 36.60]). The HGS, CSUT, and LFI were measured in GpI and GpII subjects (n=514; 272 males [mean age 34.30] and 242 females [mean age 37.52]). The cutoffs for SMI, HGS, CSUT, and LFI were <27.72 cm2/m2, <25.63 kg, >10 s, and >3.49, respectively for healthy males. The corresponding cutoffs for healthy females were <24.4 cm2/m2, <16.7 kg, > 10 s, and >3.68, respectively. We derived gender-specific cutoffs for SMI, HGS, CSUT, and LFI from healthy adult Indian population, which can be used to detect sarcopenia and frailty among patients with liver diseases, as well as other conditions.

378. FLOT VS ECX: A COMPARISON OF TWO NEOADJUVANT CHEMOTHERAPY REGIMEN’S EFFECTS ON SARCOPENIA IN ESOPHAGOGASTRIC ADENOCARCINOMA PATIENTS

Abstract Sarcopenia is defined as a loss of skeletal muscle mass and function. It is prevalent amongst patients with esophagogastric adenocarcinoma (EGA) and associated with adverse treatment outcomes. Neoadjuvant chemotherapy (NAC) may contribute to sarcopenia development. FLOT, although superior to ECX in terms of survival, has been reported to have higher toxicities. The aim of this study was to compare the effect of ECX and FLOT on sarcopenia and lean body mass (LBM) in EGA patients. Patients diagnosed with EGA between January 2017 and December 2020 and undergoing ECX/FLOT NAC followed by esophagectomy from a single tertiary center in the UK had their pre- and post-NAC CT scans assessed for radiological sarcopenia. Skeletal muscle index (SMI) was calculated from muscle area measured on CT scans at the level of third lumbar vertebra. Previously published SMI cut off values for radiologically defined sarcopenia were used (52.4cm2/m2 for men and 38.5cm2/m2 for women). LBM (kg) was calculated using a previously published formula. 153 patients were included in the analysis. Sarcopenia increased from 77/153 (50.3%) pre-NAC to 98/153 (64.1%) post-NAC (p &amp;lt; 0.005). There were 48/82 (58.5%) ECX and 29/65 (44.6%) FLOT patients sarcopenic pre-NAC. 60/82 (73.2%) ECX and 38/65 (58.5%) FLOT patients were sarcopenic post-NAC and pre-operatively. There was no statistically significant difference observed for development of sarcopenia after NAC between the two NAC regimens (p = 0.793). Similarly, LBM significantly decreased during NAC (p = 0.007), but this effect did not vary between NAC regimen (p = 0.917). Radiological sarcopenia is highly prevalent in EGA patients and significantly increases during NAC. However, this study suggests that there is no difference in the degree of sarcopenia between ECX and FLOT NAC regimens. Impact of pre- and post-FLOT related sarcopenia on treatment outcomes needs to be established alongside strategies to treat this syndrome and prevent its further development.

460. SARCOPENIA AFTER NEOADJUVANT CHEMOTHERAPY IS ASSOCIATED WITH DEVELOPMENT OF MODERATE TO SEVERE POST-OPERATIVE COMPLICATIONS IN ESOPHAGOGASTRIC ADENOCARCINOMA PATIENTS

Abstract Sarcopenia is defined as a loss of skeletal muscle mass and function. Preoperative sarcopenia amongst patients with esophageal cancer has been linked to various postoperative complications and to the degree of severity of these complications. The majority of this evidence comes from populations with squamous cell carcinoma or where neoadjuvant chemoradiotherapy was used. Whether sarcopenia pre- or post-neoadjuvant chemotherapy (NAC) for esophagogastric adenocarcinoma (EGA) is associated with postoperative complications is not fully understood. Patients diagnosed with EGA between January 2017 and December 2020 and undergoing NAC followed by esophagectomy from a single high-volume center had their pre- and post-NAC CT scans assessed for radiological sarcopenia. Skeletal muscle index (SMI) was calculated from muscle area measured on CT scans at the level of third lumbar vertebra. Previously published SMI cut off values for radiologically defined sarcopenia were used (52.4cm2 for men and 38.5cm2 for women). Post-operative complications were prospectively evaluated and classified using the Clavien-Dindo (CD) classification system. Patients were grouped as either CD 0-I (no-mild complications) or CD II-V (moderate–severe complications). There were 144 patients included in the analysis. 62 patients had FLOT NAC and 82 patients had ECX NAC. Pre-NAC sarcopenia was not associated with the development of moderate–severe postoperative complications (p = 0.075). However, sarcopenia assessed on restaging scan post-NAC was found to be associated with moderate–severe postoperative complications (p = 0.044). EGA patients with sarcopenia post-NAC are more likely to develop moderate–severe post-operative complications than those without sarcopenia. Strategies to treat sarcopenia and prevent its further development are desperately needed in order to reduce post-operative complications.

Sarcopenia in ovarian cancer: Identifying changes in muscle quantity and quality during treatment of advanced disease (214)

<b>Objectives:</b> Sarcopenia, a loss of muscle mass and function, is a risk factor for decreased survival in advanced epithelial ovarian cancer (EOC). Little is known about the effect of treatment for EOC on sarcopenia and how this relates to outcomes. We aimed to determine the change in sarcopenia measures over the course of primary EOC treatment and how this impacts overall survival. <b>Methods:</b> We utilized an institutional EOC surgical database to identify stage IIIC or IV EOC patients who received primary debulking surgery (PDS) and adjuvant platinum-based chemotherapy between 2006-2016. Patients were included if they underwent at least five cycles of adjuvant chemotherapy and had CT scans available both before PDS (pre) and near completion of six cycles of adjuvant chemotherapy (post). Patient CT scans were analyzed for body composition measures, including skeletal muscle area (SMA), skeletal muscle attenuation (SMD), and skeletal muscle index (SMI), defined as SMA normalized for patient height. Change in muscle quality (SMD) over muscle quantity (SMI) was evaluated by the ratio of SMD/SMI. The percent change ([post – pre] x100/pre) in body composition measures over time were analyzed for association with death. <b>Results:</b> Among 109 patients included in the analysis (mean age, 62.6 years), the majority of patients received 5-6 cycles of adjuvant chemotherapy (83%). The median time between pre- and post-CT scans was 188 days (IQR: 175 to 211 days). Based on SMI cutoff of <39 cm²/m², almost half of the patients (50/109; 45.9%) were sarcopenic at some point during their treatment, including 27 (24.8%) who were sarcopenic on both scans and 23 (21.1%) who became sarcopenic at post-treatment scan. We observed a statistically significant decrease in muscle quantity (mean±SD percent change in SMI, -4.4±9.2; p<0.001) and a non-significant increase in muscle quality (mean±SD percent change in SMD, 6.3±25.1; p=0.28) following treatment. Given these findings, the density of muscle per unit area (SMD/SMI) was analyzed. On average, SMD/SMI increased from pre- to post-treatment CT scans, from 0.83±0.26 to 0.89±0.25 HU*m²/cm², translating to a percent increase of 12.2±30.0 (p<0.001). An increase in the percent change of SMD/SMI over the course of treatment was significantly associated with an increased risk of death (Figure A). In particular, the median OS was 3.6 years in women with percent change in SMD/SMI >10%, 4.8 years in those with percent change between ±10%, and 6.2 years for those with > -10% change (Figure B, p=0.017). There was no significant association observed when evaluating SMI and SMD.Fig. 1 <b>Conclusions:</b> Patients who underwent curative-intent PDS and adjuvant chemotherapy had changes in sarcopenia measures following treatment. Those with an increase in muscle density per unit area following treatment had worse survival; this hypothesis-generating finding illustrates the need for continued research evaluating how patient factors and tumor biology influence sarcopenia and subsequent outcomes in this high-risk group.

Sarcopenia identified by computed tomography (CT) imaging using a machine learning–based convolutional neural network (CNN) algorithm impacts survival in patients with newly diagnosed multiple myeloma (NDMM).

110 Background: Sarcopenia or a loss of muscle mass increases with aging and is associated with increased overall mortality in patients with cancer. Recent advances in machine learning–based CNN algorithms have allowed for the rapid processing of digital images to produce image classifications of body composition. Since incidence of MM is highly associated with aging, we sought to determine if the presence of sarcopenia, as determined by utilizing this machine learning–based CNN algorithm on CT images, had prognostic value in patients with NDMM. Methods: We identified all patients with NDMM from January 2003 to July 2019 who had a standard-dose CT scan that included the L3 vertebral level performed within 6 months of diagnosis. Using a machine learning–based CNN-algorithm, abdominal CT images were analyzed to measure muscle area. These measurements were normalized by dividing the area values by the height of the patient squared (m2) to obtain skeletal muscle index (SMI) values. Patients were categorized as sarcopenic according to international gender-specific consensus cutoffs for SMI (male: &lt; 55 cm2/m2 and female: &lt; 39 cm2/m2). Patients with the following FISH cytogenetics were considered high risk (HR): t(4;14), t(14;16), t(14;20), and deletion 17p/monosomy 17 whereas the remainder were standard risk (SR). Survival analysis was performed using the Kaplan-Meier method and compared via the log-rank method. Results: The study cohort consisted of 344 patients. 68 (20%) were categorized as HR based on FISH cytogenetics.187 (54%) patients were sarcopenic based on their peri-diagnosis standard-dose CT scan. Sarcopenic patients were more likely to have ISS-3 disease (45% vs. 30%; p =.023), be male (73% vs. 48%; p &lt;.001), and be ≥ age 75 (27% vs. 14%; p =.002) compared to non-sarcopenic patients. The median OS for patients with HR FISH and ISS 2 / 3 disease was 40 months and 57 months respectively compared to 90 months and 119 months for those with SR FISH and ISS-1 disease respectively (FISH: p &lt;.004; ISS: p &lt;.001). The median OS for sarcopenic patients was 44 months compared to 90 months for those not sarcopenic (p &lt;.001). The time to next therapy (TTNT) for sarcopenic patients was 39 months compared to 45 months for those not sarcopenic (p =.05). In a multivariable model, the presence of sarcopenia (HR 1.64, 95% CI, 1.05–2.56; p =.03) retained significance in the presence of HR FISH, ISS 2 / 3 disease, and age ≥ 75. Conclusions: Gender-specific sarcopenia identified by a machine learning–based CNN algorithm significantly affects OS in patients with NDMM and is independent of age, ISS stage, and cytogenetic status. Future studies utilizing this machine learning–based methodology of assessing sarcopenia in larger prospective clinical trials are required to validate these findings.

Value of Computed Tomography-Defined Sarcopenia: A Prognostic Predictor of Non-Relapse Mortality Following Allogeneic Hematopoietic Stem Cell Transplantation in Patients with Acute Myeloid Leukemia and Myelodysplastic Syndrome

Background: Malnutrition is an important factor in patients for allogeneic hematopoietic stem cell transplantation (allo-HCT). Valid and convenient methods are required for determining muscularity to evaluate severity of malnutrition, and a secondary analysis of computed tomography (CT) images is an accessible method for this evaluation. Compared with several CT-based methods for sarcopenia (degenerative muscle loss), the impact of the prognostic value of sarcopenia in patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) following allo-HCT remains controversial.Patients and Methods: We retrospectively reviewed the data of 125 adult patients with AML and MDS who had undergone allo-HCT for the first time between 2000 and 2016. Sarcopenia was assessed using the following CT-based evaluation methods at the time of transplant: skeletal muscle index (SMI) and mean muscle attenuation (MA) at third lumbar vertebrae (L3) level. SMI (cm2/m2) was calculated using the cross-sectional imaging area of the following skeletal muscles (cm2): rectus abdominus, abdominal (lateral and oblique), psoas, and paraspinal (quadratus lumborum and erector spinae) muscles and was normalized by height. The CT Hounsfield unit (HU) thresholds were −29.0-150 for skeletal muscles. Mean MA HU was calculated for the fatty tissue infiltration of the muscles at L3 level using previously reported HU thresholds. Sex-specific cutoffs for both SMI and MA were determined using ROC analysis. Threshold values of SMI and MA, demarcating significantly lower survival at 100 days from allo-HCT, were defined as sarcopenia. Fifty-two (41.6%) patients were defined as having sarcopenia on the basis of muscle mass and the fatty infiltration of muscle. In the patients with sarcopenia (n = 52) and those without sarcopenia (n = 73), SMI values (mean ± SD) were 45.6 ± 4.2 and 52.4 ± 5.1 cm2/m2, respectively (P < 0.001), and MA values (mean ± SD) were 33.6 ± 1.7 and 35.4 ± 1.6, respectively (P=0.021). We evaluated correlation between the sarcopenia and prognosis in patients with AML and MDS following allo-HCT.Results: This study enrolled 125 patients, including 73 males and 52 females, with a median age of 47 years (16-65 years) at transplant. Body weight, serum total protein, body mass index (BMI), SMA, and skeletal MA were significantly higher in the males than in the females. There were no significant differences in the sex, age, Eastern Cooperative Oncology Group performance status, and other characteristics of the patients at allo-HCT. A median follow-up was 1198 days (8-5230 days).In the patients with sarcopenia and those without sarcopenia, at 2 years of overall survival was 43.5% and 70.1% (95% CI, 0.293-0.569 and 0.579-0.794, respectively; P= 0.004, Figure 1), respectively; disease-free survival was 52.9% and 68.6% (95% CI, 0.324-0.619 and 0.558-0.784, respectively; P= 0.031), respectively; cumulative incidence of relapse was 37.5% and 21.5% (95% CI, 0.239-0.511 and 0.127-318, respectively; P= 0.239), respectively; and non-relapse mortality (NRM) was 20.8% and 8.4% (95% CI, 0.106-0.334 and 0.034-0.164,respectively; P= 0.027, Figure 1). Causes of NRM were as follows: infection in 10 patients, TMA in 2 patients, acute GVHD in 6 patients, chronic GVHD in 3 patients, cerebral bleeding in 2 patients, and unknown causes in 2 patients. Infection was the major cause of NRM in patients with sarcopenia (7/11 deaths as NRM from infections). The patients with sarcopenia showed a longer duration of hospitalization than those without sarcopenia, in terms of the median number of days from transplantation to discharge (88 and 74 days, respectively; P= 0.026). Univariate and multivariate analyses revealed that sarcopenia is a prognostic predictor of NRM (HR, 2.24; 95% CI, 1.41-4.81; P= 0.031).Conclusion: The results of this study suggest that among 125 patients with AML and MDS who had undergone allo-HCT for the first time, the presence of sarcopenia was associated with a lower survival rate and higher NRM, resulting in longer duration of hospitalization. [Display omitted] DisclosuresFujisawa:Bristol-Myers squibb: Honoraria; Chugai Pharmaceutical: Honoraria; Celgene: Honoraria.