Impact Of Sarcopenia In Patients Research Articles

P311 Prevalence and impact of sarcopenia in patients with inflammatory bowel diseases: a prospective cohort study

Abstract Background Sarcopenia is associated with increased morbidity and mortality in IBD. The main objective of this study was to prospectively evaluate sarcopenia by combining morphological and functional criteria in an outpatient IBD population. Methods In a prospective cohort study, we included all IBD patients admitted to the Day Hospital (DH) of our department between March 1st and 31st, 2023. Patients with short bowel syndrome were not included. Muscle mass was assessed using a Bodystat®1500MDD dual-frequency impedance meter, and muscle function was assessed by measuring handgrip strength, Carym® digital dynamometer. Pre-sarcopenia was defined by a handgrip measurement < 16 to 26, and myopenia was defined by an appendicular muscle mass index (AMMI) < 5.5 to 7 kg/m2 or a fat-free mass index (FFMI) < 15 to 17 in women or men. Sarcopenia was defined by the association of pre-sarcopenia and myopenia. Patients were followed-up at 6 months to measure a composite criterion of disease activity combining one of the factors: FC > 250µg/g, endoscopic activity, therapeutic change, hospitalization, or IBD-related surgery. Results In total, 60 patients were included, median age 37 years (IQR 28-54), 55% women, with CD (52%) or UC (48%) diagnosed 9 years (4-17) ago, mostly in remission (67%, n=40). Patients with CD had ileocolic (48%), ileal (35%), or colonic (16%) involvement. Patients with UC had E1 (7%), E2 (41%), or E3 (52%) involvement. A history of digestive surgery linked to IBD was noted in 30% of cases. The biologics administered were infliximab (61%), vedolizumab (25%), or ustekinumab (14%). The BMI was 24 (21-27) and serum albumin was 41g/l (39-44). The prevalence of sarcopenia, pre-sarcopenia and myopenia was 10%, 11% and 20%, respectively. Sarcopenic patients were significantly older (59 vs. 36 years, p=0.01), with older disease (20 vs. 8 years, p=0.003), and associated joint damage (40% vs. 2%, p=0.002) and tended to involve CD more frequently (80 vs. 49%, p=0.36). There was no significant difference between biologics, BMI or albuminemia in sarcopenic patients, but vitamin D levels tended to be lower (15 vs. 43, p=0.27). Myopenia was significantly associated with a history of surgery (67 vs. 21%, p=0.004), a lower BMI (21 vs. 24, p=0.001) and a more active disease at M6 according to the composite criterion (50 vs. 21%, p=0.04 after adjustment for age, sex, and disease activity at baseline). Myopenia indices were strongly correlated with handgrip values (r=0.7, p<0.001). Conclusion In a prospective study of Day Hospital IBD patients, sarcopenia was identified by impedancemetry in 11% and myopenia in 20% of cases, and associated with an increase in morbidity.

Sarcopenia and osteoarthritis of the hip joint

Sarcopenia is a pathology characterized by a decrease in the mass and strength of muscle tissue in most cases in older people. Osteoarthritis is also a common disease in elderly patients and is characterized by irreversible destructive and dystrophic damage to the joints. Decompensated stages of osteoarthritis of the hip joint often require surgical treatment. It has been noted that the majority of patients requiring total hip replacement for osteoarthritis also suffer from sarcopenia. Considering the clinical and biomechanical role of the muscular system together with the musculoskeletal system, sarcopenia can affect the recovery process of patients after surgery and the success of the operation itself. However, scientific research on the influence of sarcopenia on the results of total hip arthroplasty is insufficient. This article presents the results of a study of the negative impact of sarcopenia in patients who underwent total hip replacement. The study identified sarcopenia as an important risk factor that orthopedic traumatologists should consider when surgically treating patients with stages 3–4 osteoar thritis.

The Association of Sarcopenia and ASA Score to Spinal Cord Ischemia in Patients Treated With the t-Branch Device.

Sarcopenia has been identified as an independent predictor of mortality in patients with infrarenal abdominal aortic aneurysm and may also affect outcomes in patients with complex aortic pathologies. The aim of this study was to assess sarcopenia, combined with the American Society of Anesthesiologists (ASA) score, as predictors for spinal cord ischemia (SCI) in patients treated with the t-Branch off-the-shelf device. A single-center retrospective observational study was conducted including elective and urgent patients managed with the t-Branch device (Cook Medical, Bjaeverskov, Denmark) between January 1, 2018, and September 30, 2020. Data were collected according to the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statement. The psoas muscle area (cm2) and attenuation (Hounsfield units, HU) were measured in the arterial phase of the pre-operative computed tomography angiography for each patient. The lean psoas muscle area (LPMA) was used to stratify patients into 3 groups, and further stratification was performed with a combination of the ASA score and LPMA. Eighty patients were included (mean age at 71±9 years; 62.5% males). Thoracoabdominal aneurysms were managed in 72.5% of cases (42.5% for type I-III). Thirty-seven (46%) were treated urgently. Eleven patients died within 30 days (14%). Twelve patients (15%) presented SCI of any severity. Among the LPMA groups, the only statistically significant difference was recorded in age; group 3 was older compared with groups 1 and 2 (67.1 years vs 72.1 years vs 73.5 years, p=0.004). After ASA combined LPMA categorization, 28 patients were considered as low risk, 16 as moderate risk, and 36 as high risk. A statistically significant difference was recorded in terms of SCI (3.5% [1/28] in low risk vs 12.5% [2/16] in moderate risk vs 25% [9/36] in high risk, p=0.049). Multivariate analysis showed that moderate-risk patients were at risk to evolve to SCI (p=0.04). Low-risk patients, with ASA score I-II or LPMA>350cm2HU, are at lower risk for developing SCI after BEVAR using the t-Branch device. Patients' stratification according to the combination of ASA score and psoas muscle area and attenuation may identify a group at higher risk of SCI after branched endovascular aneurysm repair. Sarcopenia has been identified as a factor of increased mortality in patients managed for aortic aneurysm repair. However, significant heterogeneity has been recorded in the tools assessing its presence. In this analysis, an already used method, combining the ASA score and psoas muscle area and attenuation, has been used to assess the impact of sarcopenia in patients managed with the t-branch device. This analysis showed that patients at low risk, with an ASA score I-II or LPMA>350cm2HU were at lower risk to evolve spinal cord ischemia. Along this line, sarcopenia may be a valuable marker for the prediction of perioperative adverse events , other than mortality, in patients managed using complex endovascular repair.

Abstract 5537: Prognostic impact of sarcopenia in patients with metastatic castration sensitive prostate cancer

Abstract Background/Aim: Recently, sarcopenia has been reported to be a useful prognostic factor in cancer patients, including prostate cancer patients. Gleason score, the presence or absence of visceral metastases, and the number of bone metastases, which were used in the LATITUDE and CHAARTED trials, are known prognostic factors for metastatic castration-sensitive prostate cancer (mCSPC). Although a large proportion of patients with mCSPC are elderly, the significance of sarcopenia in metastatic castration-sensitive prostate cancer is unknown. Patients and Methods: Of 193 patients with mCSPC treated at Kanazawa University Hospital between 2000 and 2019, 150 patients with confirmed CT at diagnosis were included. Sarcopenia was determined based on the definition of Martin et al. Overall survival and prognostic factors were retrospectively evaluated. Results: The median age was 72 years, median PSA 241 ng/mL, Gleason score (GS) ≥ 9 in 91 patients, visceral metastases in 23 patients, and sarcopenia in 106 patients. 109 patients (72.7%) were diagnosed as high risk by Latitude risk classification and 105 patients (70%) were diagnosed as high volume by Charted risk classification. All cause death was 64 patients, and the median follow-up period was 38.2 months. The median overall survival was 69.6 months. On multivariate analysis, GS ≥9 (P <0.0001, hazard risk =3.78), LDH ≥ 300 U/L (P <0.0001, hazard risk =2.88), and sarcopenia (P=0.04, hazard risk=2.07) were significant independent poor prognostic factors predicting shorter OS. The prognosis could be significantly stratified into a high risk group if two or more of these three factors were met and a low risk group if one or less was met (44 months vs. 106.4 months, P=0.0001, hazard risk=2.91). This classification more clearly stratified prognosis than the LATITUD classification (55.1 months vs. 135 months, P =0.027, hazard risk =1.8) or the CHAARTED trial classification (52.9 months vs. 135 months, P =0.009, hazard risk =1.98). Conclusion: Sarcopenia that can assess general status was considered useful in the prognostic evaluation of patients with mCSPC. Citation Format: Hiroaki Iwamoto, Kouji Izumi, Atsushi Mizokami. Prognostic impact of sarcopenia in patients with metastatic castration sensitive prostate cancer. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5537.

Prognostic impact of sarcopenia in patients with pancreatic head tumors: single-center retrospective analysis

Prognostic impact of sarcopenia in patients with pancreatic head tumors: single-center retrospective analysis

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.

Prognostic Impact of Sarcopenia in Patients with Advanced Prostate Carcinoma: A Systematic Review.

Prostate cancer (PCa) is the second most common cancer in men and the fifth leading cause of death from cancer. The possibility of sarcopenia being a prognostic factor in advanced PCa patients has recently become a subject of interest. The aim of the present study was to evaluate the prognostic value of sarcopenia in advanced prostate carcinoma. A systematic review was conducted in Medline, EMBASE, and Web of Science (March, 2021). The quality of studies was assessed using the Quality in Prognosis Studies tool. Meta-analyses for overall, cancer-specific, and progression-free survival were performed. Nine studies (n = 1659) were included. Sarcopenia was borderline associated with a shorter overall survival (HR = 1.20, 95% CI: 1.01, 1.44, P = 0.04, I2 = 43%) but was significantly associated with progression-free survival (HR = 1.61, 95% CI: 1.26, 2.06, P < 0.01; k = 3; n = 588). Available evidence supports sarcopenia as an important prognostic factor of progression-free survival in patients with advanced PCa. However, sarcopenia has a weak association with a shorter overall survival. The evidence on the role of sarcopenia in prostate-cancer-specific survival is insufficient and supports the need for further research. Patient summary: The literature was reviewed to determine whether the loss of muscle mass (sarcopenia) affects the survival in patients with advanced PCa. Patients with advanced PCa and sarcopenia were found to have a shorter progression-free survival (the length of time during and after treatment of a cancer that the patient lives with the disease but it does not get worse), but sarcopenia did not have much influence on the overall survival and cancer-specific survival (the length of time from either the date of diagnosis or the start of treatment to the date of death due to the cancer).

Comorbidity and Prognostic Impact of Sarcopenia in Patients with Advanced Non-small-cell Lung Cancer

Comorbidity and Prognostic Impact of Sarcopenia in Patients with Advanced Non-small-cell Lung Cancer

Effect of Sarcopenia on Survival and Health-Related Quality of Life in Patients with Hepatocellular Carcinoma after Hepatectomy.

Although sarcopenia has been reported as a negative prognostic factor in patients with hepatocellular carcinoma (HCC), the lack of studies with a prospective design utilizing comprehensive sarcopenia assessment with composite endpoints is an important gap in understanding the impact of sarcopenia in patients with HCC. The aim of this study was to investigate the relationship between sarcopenia and postoperative 1-year mortality and health-related quality of life (HRQOL) based on sarcopenia assessment. The study cohort, who received resection surgery for HCC between May 2020 and August 2021, was assessed for sarcopenia based on grip strength, the chair stand test, skeletal muscle mass, and gait speed. The primary outcome measures were 1-year mortality and HRQOL determined using the QLQ-C30 questionnaire. In addition, we collected hospital costs, postoperative hospital stays, complications, 30-day and 90-day mortality, and 90- and 180-day readmission rates. Univariate and multivariate linear regression analyses were conducted to examine factors associated with global health status. A total of 153 eligible patients were included in the cohort. One-year mortality was higher in patients with sarcopenia than in those without sarcopenia (p = 0.043). There was a correlation between sarcopenia and the surgical approach to global health status (p = 0.025) and diarrhea (p = 0.003). Preoperative sarcopenia reduces postoperative survival and health-related quality of life in patients with HCC.

Prognostic impact of sarcopenia in patients with hepatocellular carcinoma treated with PD-1 inhibitor.

Sarcopenia is a progressive generalized loss of skeletal muscle mass commonly observed in advanced stages of cancer. To assess the relationship between sarcopenia and the prognosis of patients with hepatocellular carcinoma (HCC) treated with a programmed cell death 1 (PD-1) inhibitor. This is a retrospective study. This study included patients with HCC treated with camrelizumab between 1 March 2020 and 1 December 2021. The skeletal muscle area at the L3 vertebra middle level was used to calculate the skeletal muscle index. Propensity score matching (PSM) analysis was used to balance the variables between the two groups. In all, 97 patients with HCC were included in the study, with 46 and 51 patients in the sarcopenia group and the non-sarcopenia group, respectively. The baseline characteristics of albumin, Child-Pugh class, albumin-bilirubin score, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio were significantly different between the two groups. In total, 26 patients from each group (n = 52) were selected after the PSM analysis. The progression-free survival (PFS) in the non-sarcopenia group was significantly longer than that in the sarcopenia group before and after PSM analysis (6.5 versus 4.8 months, p = 0.038). In addition, the disease control rate was similar before and after PSM analysis (57.7% versus 69.2%, p = 0.388). The objective response rate in the non-sarcopenia group tended to be higher than that in the sarcopenia group (11.5% versus 30.8%, p = 0.090, after PSM), but no statistically significant difference was found. The median overall survival (OS) in the non-sarcopenia group tended to longer than it in the sarcopenia group before PSM without significant differences (16.3 versus 11.3 months, p = 0.090) and the median OS was similar between the two groups after PSM (16.3 versus 16.8 months, p = 0.735). HCC patients with sarcopenia tended to have higher levels of inflammation and lower levels of albumin than patients without sarcopenia. Sarcopenia is associated with a shorter PFS in HCC patients treated with PD-1 inhibitor.

Sarcopenia and long-term survival outcomes after local therapy for colorectal liver metastasis: a meta-analysis.

Sarcopenia is defined as either low pre-operative muscle mass or low muscle density on abdominal CT imaging. It has been associated with worse short-term outcomes after surgery for colorectal liver metastases. This study aimed to evaluate whether sarcopenia also impacts long-term survival outcomes in these patients. A random-effects meta-analysis was conducted following the PRISMA guidelines. Overall survival (OS) and disease-free survival (DFS) outcomes were evaluated. Eleven studies were included, ten reporting on the impact of low muscle mass and four on low muscle density. Sample sizes ranged between 47 and 539 (2124 patients in total). Altogether, 897 (42%) patients were considered sarcopenic, although definitions varied between studies. Median follow-up was 21-74 months. Low muscle mass (hazard ration (HR) 1.35, 95%CI 1.08-1.68) and low muscle density (HR 1.97, 95%CI 1.07-3.62) were associated with impaired OS. Low muscle mass (pooled HR 1.17, 95%CI 0.94-1.46) and low muscle density (pooled HR 1.13, 95%CI 0.85-1.50) were not associated with impaired RFS. Sarcopenia is associated with poorer OS, but not RFS, in patients with CRLM. Additional studies with standardized sarcopenia definitions are needed to better assess the impact of sarcopenia in patients with CRLM.

Prognostic Impact of Sarcopenia in Patients with Metastatic Hormone-Sensitive Prostate Cancer.

Simple SummaryAs sarcopenia is recognized as a poor prognostic factor in various type of cancers, we hypothesized that sarcopenia may also have adverse impact in patients with metastatic hormone-sensitive prostate cancer (mHSPC). In this study, we found that sarcopenia is an independent prognostic factor for poor failure-free survival and time to prostate-specific antigen progression in patients with mHSPC who receive early docetaxel or abiraterone acetate treatment. In addition, we performed RNA sequencing of primary tumors to further understand the biological perspective of the presence of sarcopenia in mHSPC. Transcriptomic differences were found between primary tumors with and without sarcopenia, which may have a potential to link between sarcopenia and poor clinical outcomes in these patients.The clinical value of sarcopenia has not been determined yet in metastatic hormone-sensitive prostate cancer (mHSPC). We retrospectively evaluated data of 70 consecutive patients with mHSPC receiving treatment with either early docetaxel (n = 42) or abiraterone acetate (n = 28) between July 2018 and April 2021. Skeletal muscle index was calculated from cross-sectional areas of skeletal muscle on baseline computed tomography (CT), defining sarcopenia as a skeletal muscle index of ≤52.4 cm2/m2. Failure-free survival (FFS), radiographic progression-free survival, and time to prostate-specific antigen (PSA) progression were estimated using the Kaplan–Meier method, and differences in survival probability were compared using the log-rank test. Cox proportional hazards regression analysis was conducted to identify the predictors of clinical outcomes. Patients with sarcopenia (n = 47) had shorter FFS than those without sarcopenia (n = 23) (median, 20.1 months vs. not reached; log-rank p < 0.001). Sarcopenia was independently associated with shorter FFS (hazard ratio (HR), 6.69; 95% confidence interval (CI), 1.57–28.49; p = 0.010) and time to PSA progression (HR, 12.91; 95% CI, 1.08–153.85; p = 0.043). In conclusion, sarcopenia is an independent prognostic factor for poor FFS and time to PSA progression in patients with mHSPC who receive early docetaxel or abiraterone acetate treatment.

Prognostic impact of sarcopenia in patients with head and neck cancer treated with surgery or radiation: A meta-analysis.

BackgroundThe objective of this study was to compare the prognostic impact of sarcopenia in patients with head and neck cancer (HNC) treated with surgery or radiation.MethodsWe systematically searched electronic databases to identify articles reporting the impact of sarcopenia on the prognosis of patients with HNC. Hazard ratios (HRs) and 95% confidence intervals (CIs) for overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS) were extracted and pooled. HR according to treatment modality were estimated using random-effects models. Statistical analyses were carried out using the Comprehensive Meta-Analysis software.ResultsIn total, 18 studies enrolling 3,233 patients were included. Sarcopenia was associated with poor OS in both surgery and radiotherapy groups (hazard ratio [HR] 2.50, 95% confidence interval [CI] 1.95–3.21; HR 1.63, 95% CI 1.40–1.90, respectively). The HR was significantly higher in the surgery group than in the radiotherapy group (p = 0.004), with similar results obtained for DFS (HR 2.59, 95% CI 1.56–4.31; HR 1.56, 95% CI 1.24–1.97 for the surgery and radiotherapy groups, respectively) and DSS (HR 2.96, 95% CI 0.73–11.95; HR 2.67, 95% CI 1.51–4.73 for the surgery and RT groups, respectively).ConclusionsSarcopenia was a poor prognostic factor for HNC, regardless of the treatment modality. However, the adverse effects of sarcopenia on survival were more prominent in the surgery group than in the radiotherapy group. Sarcopenia assessment is required for appropriate treatment decision-making.

The Impact of Sarcopenia in Patients with Peritoneal Surface Disease

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy is increasingly performed in patients with advanced cancer in the abdomen. This treatment prolongs survival for some patients but is known to have a substantial rate of complications. Choosing patients for this procedure can be difficult, and no clear guidelines exist. Muscle mass is a general measure of a patient’s wellness, meaning that patients with low muscle mass for their body weight tend to have more complications from treatment and overall do worse. We evaluated muscle mass prior to surgery in our Cytoreductive surgery/hyperthermic intraperitoneal chemotherapy population to assess how many patients have low muscle mass and the impact on outcomes, such as length of hospital stay, complications and survival. We find that about 25% of our patient population has low muscle mass, and low muscle mass is associated with a higher burden of cancer and shorter survival. We were able to evaluate muscle mass in a small number of patients after surgery, expecting to find decreased muscle mass in all the patients after a complex operation and long recovery. In fact, none of the patients had low muscle mass, including those who were low prior to surgery.

Impact of sarcopenia on clinical outcomes of patients undergoing simultaneous liver and kidney transplantation: a cohort study

BackgroundThe impact of sarcopenia in patients undergoing simultaneous liver and kidney transplantation (SLKT) has not been fully delineated. The aim of this single-centre-cohort-study was to evaluate the impact of sarcopenia on the clinical outcomes. MethodsBetween 2003 and 2018, 79 patients underwent SLKT. Sarcopenia was assessed via the total psoas muscle area (TPA) at the level of the 3rd. lumbar vertebra. Sarcopenia threshold was TPA < 1460 mm2 (women) and <1560 mm2 (men). We identified post-operative biliary, vascular and digestive complications. Survival analysis was performed by the Kaplan Meier method (log-rank test). ResultsWe included 43/79 SLKT recipients (56%male, median age of 58 [53−63] years). The prevalence of cirrhosis was 74% (n = 32) with median MELD-score of 21 (20−22) and that of polycystic-liver-disease was 26% (n = 11). End-stage-renal-disease of unknown origin was 36.2% (n = 12). Dialysis before transplantation was performed in 54,8% (n = 23) of patients. The median TPA was 1138 (926−1510) mm2, and sarcopenia was detected in 72% of patients (n = 31). No difference in patient or death-censored graft-survival between sarcopenic and non-sarcopenic groups at 1 year was reported. Also, no differences at 6-months’ post-transplant-complication-free and infection-free-survival rates were found. ConclusionIn this cohort of patients, no differences were observed in patients, grafts, complications or infection-free survival between sarcopenic or no sarcopenic SLKT patients. Future multi-centre studies are needed to validate and extend the generalisability of these findings.

Sarcopenia in patients after an episode of acute decompensated heart failure: An underdiagnosed problem with serious impact

Sarcopenia is a multifactorial syndrome resulting in a decrease in both muscle mass and function. Little is known about the prevalence and prognostic impact of sarcopenia in patients with acutely decompensated chronic heart failure (ADHF). We aimed to evaluate the prevalence (main endpoint) and impact of sarcopenia on ADHF patients. 140 ADHF patients were enrolled between November 2014 and September 2018 in a multicenter prospective longitudinal study. A similar, independent multi-departmental cross-sectional study in 165 ADHF patients was used for external validation of prevalence data. All subjects were assessed on the European Working Group on Sarcopenia criteria. Ninety-one patients (65%) had sarcopenia (vs. 53.6% in the external replication regional cohort). Patients with sarcopenia were older and more likely to have eGFR <60ml/min/1.73 m2 (p<0.001 and p=0.002). Sarcopenia was associated with impaired functional status [lower 6min walking test (220±108 vs. 279±170, p=0.03) and 4m gait speed (0.56±0.24 vs. 0.80±0.37, p<0.001)] and autonomy [Instrumental activities of daily living: 6.7±1.4 vs. 7.3±1.2, p=0.005]. Over up to 4 years' follow-up, 30 cardiovascular (CV) deaths and 42 non-CV deaths occurred. In a multivariable analysis, sarcopenia was associated with time to first non-CV hospitalization (hazard ratio 1.93; 95% confidence interval 1.14-3.24; p=0.014) but not with any other hospitalization, any mortality endpoint, or a composite endpoint of CV death and HF hospitalization. The prevalence of sarcopenia in ADHF patients is high and associated with greater risk of non-CV hospitalizations, highlighting the importance of identifying and managing the condition in a multidisciplinary approach. NCT03153774.

Clinical impact of sarcopenia in patients with uterine cervical cancer treated with radiotherapy

Objective: Though sarcopenia is known to be associated with worse prognosis in various tumors, studies regarding the significance of sarcopenia in uterine cervical cancer are uncommon. We investigated the clinical impact of sarcopenia in patients with uterine cervical cancer treated with radiotherapy (RT). Methods: Among 104 patients who received RT for uterine cervical cancer between 2011 and 2018, 58 patients treated with a definitive or adjuvant aim were included in this study. Sarcopenia was determined by measuring the skeletal muscle area using computed tomography that was performed for RT planning. Results: Among the 58 patients, 30 patients (51.7%) had sarcopenia and 20 patients (66.7%) with sarcopenia had a normal body mass index (BMI). The median age of patients was 55.5 years. There was no linear relationship between age and prevalence of sarcopenia. During the median follow-up period of 35 months, 3 patients died and 11 patients had disease recurrence or progression. Sarcopenia was associated with a worse progression-free survival (PFS; HR 12.301, 95% CI 2.243–67.450, p = 0.004). The 2-year PFS rates of patients with and without sarcopenia were 66.3% and 92.3%, respectively (p = 0.008). Conclusions: Sarcopenia was observed in approximately half of the patients who received RT for cervical cancer, including patients with a normal BMI. Sarcopenia was associated with a worse PFS, and treatment interruption or discontinuation was more frequent among patients with sarcopenia. Evaluation of skeletal muscle mass and support to reduce skeletal muscle loss could be useful to optimize treatment and achieve better PFS.

Prognostic Impact of Sarcopenia in Patients With Biliary Tract Cancer Undergoing Chemotherapy.

Sarcopenia affects the treatment of various cancer types but its impact on chemotherapy efficacy and prognosis in biliary tract cancer remains unclear. Thus, we evaluated whether sarcopenia independently affects the outcome of chemotherapy for biliary tract cancer. Data of 50 patients who underwent chemotherapy for biliary tract cancer at two affiliated centres were retrospectively analysed. The association of clinical factors, including sarcopenia, with overall survival and time to treatment failure was analysed. Sarcopenia was an independent factor negatively influencing overall survival and time to treatment failure in univariate and multivariate analyses (median overall survival, sarcopenic vs. non-sarcopenic patients: 10.6 vs. 16.6 months; hazard ratio=2.19, p=0.018; time to treatment failure: 5.3 vs. 13.1 months, hazard ratio=2.50, p=0.019). Sarcopenia may affect the efficacy of chemotherapy and prognosis in biliary tract cancer. Thus, improving sarcopenia may improve the prognosis of patients with biliary tract cancer undergoing chemotherapy.

Impact of sarcopenia in patients with advanced or recurrent colorectal cancer treated with regorafenib.

Regorafenib is a key agent for patients with advanced or recurrent colorectal cancer. Sarcopenia represented by skeletal muscle depletion is closely related to frailty and predicts oncological prognoses. We hypothesized that sarcopenia negatively affects the time to treatment failure (TTF) or overall survival (OS) of patients treated with regorafenib. We retrospectively reviewed the medical records of all patients treated with regorafenib between May 2013 and April 2019 at our institution. The cross-sectional area of the psoas muscle at the level of the third lumbar vertebra on baseline computed tomography (CT) was assessed to calculate the psoas muscle index (PMI). Sarcopenia was defined based on PMI cut-off values for Asian adults (6.36cm2/m2 for males and 3.92cm2/m2 for females). Thirty-four patients were analyzed. The prevalence of sarcopenia was 44.1%. Sarcopenia was significantly associated with poorer OS (median 3.2 vs. 5.3months, p = 0.031). Less 75% 1-Month Relative Dose Intensity patients experienced significantly shorter TTF and OS than the rest, as did patients receiving total regorafenib dose of < 3360mg (median 3.1 and 9.4months, p < 0.001). Multivariate analysis showed that sarcopenia was a significant predictor of prognosis. Sarcopenia was a predictive marker of negative outcome for patients with advanced or recurrent colorectal cancer treated with regorafenib. Screening for sarcopenia can be used to identify patients more likely to benefit from regorafenib in routine clinical practice.

Sarcopenia Does Not Worsen Survival in Patients With Cirrhosis Undergoing Transjugular Intrahepatic Portosystemic Shunt for Refractory Ascites.

The impact of sarcopenia in patients undergoing transjugular intrahepatic portosystemic shunt (TIPSS) insertion for refractory ascites is unknown. All adult patients who underwent TIPSS insertion for refractory ascites between 2010 and 2018 were included. Skeletal muscle index at L3 was used to determine sarcopenia status. One hundred seven patients were followed for 14.2 months. Sarcopenia was present in 57% of patients. No patient had history of pre-TIPSS hepatic encephalopathy (HE). De novo HE occurred in 30% of patients. On multivariate analysis, only platelet count and L3-SMI predicted de novo HE. On multivariate analysis, age and model for end-stage liver disease with sodium predicted mortality, whereas L3-SMI and sarcopenia did not. In patients with repeat imaging, L3-SMI improved significantly post-TIPSS compared with baseline. Sarcopenia should not be considered as a contraindication to TIPSS insertion in refractory ascites because it is not associated with de novo HE or increased mortality.