Level Of Third Lumbar Vertebra Research Articles

Influence of nutritional status and body composition on postoperative events and outcome in patients treated for primary localized retroperitoneal sarcoma.

Retroperitoneal sarcomas (RPS) are rare tumours of mesenchymal origin, commonly presented as a large tumour mass at time of diagnosis. We investigated the impact of body composition on outcome in patients operated on for primary localized RPS. We retrospectively analysed data for all patients operated on for primary RPS at our institution between 1999 and 2020. Preoperative skeletal muscle area (SMA), visceral and subcutaneous adipose tissue area (VAT and SAT) and muscle radiation attenuation (MRA) were calculated using computed tomography scans at the level of third lumbar vertebra. European Working Group on Sarcopenia in Older People (EWGSOP2) criteria were applied to define myopenia. Using maximum log-rank statistic method we determined the optimal cut-off values of body composition parameters. Myosteatosis was defined based on determined MRA cut-offs. In total 58 patient were eligible for the study. With a median follow-up of 116 months, the estimated 5-year overall survival (OS) and local-recurrence free survival (LRFS) were 66.8% and 77.6%, respectively. Patients with myopenia had significantly lower 5-year OS compared to non-myopenic (p = 0.009). Skeletal muscle index and subcutaneous adipose tissue index predicted LRFS on univariate analysis (p = 0.052 and p = 0.039, respectively). In multivariate analysis high visceral-to-subcutaneous adipose tissue area ratio (VSR) independently predicted higher postoperative complication rate (89.2% vs. 10.8%, p = 0.008). Myosteatosis was associated with higher postoperative morbidity. Myopenia affected survival, but not postoperative outcome in RPS. Visceral obesity, VSR (> 0.26) and myosteatosis were associated with higher postoperative morbidity. VSR was better prognostic factor than VAT in RPS.

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 > 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 >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.

Detection of Sarcopenia in Patients with Liver Cirrhosis Using the Bioelectrical Impedance Analysis.

Bioelectrical impedance analysis (BIA) is a body composition assessment method. We aimed to determine its accuracy in the detection of sarcopenia in patients with liver cirrhosis (LC), using skeletal muscle index (SMI) at the level of third lumbar vertebra (L3-SMI) obtained using multislice computed tomography as the reference method. Patients with LC were enrolled in the period October 2019-March 2022 and follow-ups were conducted until January 2023. Their BIA parameters were compared against L3-SMI, and BIA cut-off values were proposed using AUROC analysis. Patients underwent outcome analysis based on obtained clinical characteristics. A total of 106 patients were included. We found a fair correlation between BIA parameters with the L3-SMI. We determined cut-off values of ≤11.1 kg/m2 for BIA-SMI (Se 73%, Sp 66%, AUROC 0.737, p < 0.001) and ≤5.05° for phase angle (PA) (Se 79%, Sp 60%, AUROC 0.762, p < 0.001) in the detection of sarcopenia. The relative risk of death was 2.2 times higher in patients with skeletal muscle mass (SMM) ≤ 36.5 kg. SMM was significantly associated with outcome in Kaplan-Meier analysis. This non-invasive and simple method that showed fair performances and a very good outcome prediction could provide for the unmet need for fast and affordable detection of sarcopenia in patients with LC and should be further evaluated.

Sarcopenia increases the risk of early biliary infection after percutaneous transhepatic biliary stent placement.

To assess the association between sarcopenia and the risk of early biliary infection (EBI) after percutaneous transhepatic biliary stent (PTBS) placement in patients with inoperable biliary tract cancer (BTC). In this single center, retrospective observational study, patients diagnosed with inoperable BTC undergoing PTBS placement between January 2013 and July 2021 were enrolled. Preoperative sarcopenia was defined based on skeletal muscle mass measured by computed tomography images on the level of third lumbar vertebra within one month before PTBS placement. Patients were divided into two groups in accordance with the status of sarcopenia. Univariate and further multivariate logistic analyses were performed to determine predictors for EBI. Stratified and interactive analyses were conducted to investigate the stability of results. Further receiver operating characteristic curve was performed to determine the predictive value of sarcopenia on EBI after PTBS placement. Totally, 134 patients were included in this retrospective study, with 45 (33.6%) patients characterized as sarcopenia. The incidence rate of EBI was 26.9% (36/134). Multivariate analyses demonstrated that sarcopenia [Odds ratio (OR), 2.75; 95%CI: 1.11-6.77; P=0.028], obstruction length (OR, 1.04; 95%CI: 1.00-1.08; P=0.030) and diabetes (OR, 2.46; 95%CI: 1.01-5.96; P=0.047) were significant predictors of EBI. There were no significant interactions in different subgroups (P for interaction > 0.05). Moreover, the areas under the curves (AUC) revealed that the combined index containing sarcopenia, obstruction length, and diabetes showed the better predictive value (AUC= 0.723) than either one alone. Sarcopenia increased the risk of EBI in patients with inoperable BTC after PTBS placement. Preoperative assessment of sarcopenia may aid in risk stratification. Patients with sarcopenia should be given intensive monitoring.

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.

L3 Skeletal Muscle Index Dynamics in Patients with HCV-Related Compensated Cirrhosis Following Sustained Virological Response after Direct Acting Antiviral Treatment.

Background and Objectives: Sarcopenia is commonly associated with liver cirrhosis and predicts clinical outcome. Our aim was to identify the changes in skeletal muscle index (SMI) on computed tomography (CT) examination, as a quantitative marker of sarcopenia, in patients with HCV-related cirrhosis after direct acting antivirals (DAAs) treatment and to assess predictive factors for the evolution of SMI. Materials and Methods: This is a single center retrospective study in patients with HCV-related compensated cirrhosis who obtained sustained virological response (SVR) after DAAs. CT examinations were performed in 52 patients before and within 5–24 months after treatment. The total muscle area (TMA) of abdominal muscle at the level of third lumbar vertebra (L3) was measured at baseline and after SVR. The L3-SMI was calculated from TMA divided by body height squared (cm2/m2). We assessed changes in L3-SMI after SVR according to baseline body mass index (BMI) and laboratory data. Predictive factors were assessed by linear regression model. Results: Patients with L3-SMI above the gender-specific cut-off value at baseline had higher values of serum creatinine (median 0.73) compared to patients with low L3-SMI (median 0.68, p = 0.031). After SVR, 14 patients showed increase of L3-SMI, and 38 patients had a decrease of L3-SMI. BMI in the decreased L3-SMI group was significantly lower (median 26.17) than those without decreased L3-SMI (median 28.84, p = 0.021). ALT values in the decreased L3-SMI group (median 66.5) were significantly lower than those without a decrease in L3-SMI (median 88, p = 0.045). Conclusions: Low creatinine serum level correlates with sarcopenia. SMI was partially influenced by the viral clearance. Lower BMI and ALT serum levels at baseline were predictive for no benefit in terms of muscle mass dynamics. Understanding all the mechanisms involved in sarcopenia and identifying the most vulnerable patients could ensure optimal adapted care strategies.

Psoas Muscle Density Predicts Occurrences of Hepatic Encephalopathy in Patients Receiving Transjugular Intrahepatic Portosystemic Shunts within 1year.

We aimed to assess the efficacy of psoas density (PD) for predicting hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) procedures. Data were collected from patients who underwent TIPS procedures at a single institution between 2013 and 2019. PD was manually measured using software on unenhanced CT scans at the level of third lumbar vertebra. Laboratory and physical examination data were collected within 24h after admission in order to compare the differences between patients with and without post-TIPS HE. A total of 251 patients were included in this study. Among these patients, 77 (30.7%) developed post-TIPS HE within one year after TIPS creation. The threshold of PD for predicting HE was 51.24 Hounsfield unit (HU). PD values less than this threshold were correlated with an increased risk of HE (hazard ratio 0.92; 95% CI 0.89-0.95, P < 0.001). The area under the receiver operating characteristic curve (AUROC) of PD was 0.743 (95% CI 0.685-0.796), which was superior to Model for End-stage Liver Disease (MELD) (0.569, P = 0.007), albumin-bilirubin score (ALBI) (0.641, P = 0.018), and Child-Pugh score (0.583, P = 0.003). PD measurement showed good HE predictive value in cirrhotic patients who underwent TIPS. This measure also performed better than MELD, ALBI and Child-Pugh.

Cancer cachexia syndrome and clinical outcome in patients with metastatic non-small cell lung cancer treated with PD-1/PD-L1 inhibitors: results from a prospective, observational study.

BackgroundCancer cachexia syndrome (CCS) is an adverse prognostic factor in cancer patients undergoing chemotherapy or surgical procedures. We performed a prospective study to investigate the effect of CCS on treatment outcomes in patients with non-oncogene driven metastatic non-small cell lung cancer (NSCLC) undergoing therapy with programmed cell death protein 1 (PD-1)/programmed death ligand 1 (PD-L1) inhibitors.MethodsPatients were categorized as having cancer cachexia if they had weight loss >5% in the last 6 months prior to immunotherapy (I-O) initiation or any degree of weight loss >2% and body mass index (BMI) <20 kg/m2 or skeletal muscle index at the level of third lumbar vertebra (LSMI) <55 cm2/m2 for males and <39 cm2/m2 for females. LSMI was calculated using computed tomography (CT) scans of the abdomen at the beginning of I-O and every 3 months thereafter.ResultsEighty-three patients were included in the analysis and the prevalence of cancer cachexia at the beginning of I-O was 51.8%. The presence of CCS was associated with inferior response rates to ICIs (P≤0.001) and consisted an independent predictor of increased probability for developing disease progression as best response to treatment, OR =8.11 (95% CI: 2.95–22.40, P≤0.001). In the multivariate analysis, the presence of baseline cancer cachexia consisted an independent predictor for inferior survival, HR =2.52 (95% CI: 1.40–2.55, P=0.002). Reduction of LSMI >5% during treatment did not affect overall survival (OS; P=0.40).ConclusionsCCS is associated with reduced PD-1/PD-L1 inhibitor efficacy in NSCLC patients and should constitute an additional stratification factor in future I-O clinical trials. Further research at a translational and molecular level is required to decipher the mechanisms of interrelation of metabolic deregulation and suppression of antitumor immunity.

P635 Assessment of sarcopenia and nutritional status in a cohort of patients with Crohn’s disease

Abstract Background Altered body composition may negatively impact on the clinical outcome and quality of life of patients with IBD. Sarcopenia, defined as a progressive loss of skeletal muscle mass and function, is commonly observed in patients with IBD and can be reliably assessed by computed tomography (CT) which allows accurate and reproducibile quantification of both abdominal adipose tissues (subcutaneous and visceral), as well as skeletal muscles. We aimed to assess the prevalence of sarcopenia in Crohn’s disease (CD) patients undergoing contrast-enhanced CT(CECT). We further investigated the associations of sarcopenia with visceral fat parameters, disease severity and surgery Methods 40 CD patients (22F, aged 44±16 yrs; BMI 20.8±3.7) who underwent CECT for clinical assessment were retrospectively enrolled. CECT was performed using a 64-rows multi-detector equipment after i.v. injection of non ionic iodinated contrast media with a tailored scan delay. Demographic and clinical data were collected at the date of abdominal CT. Clinical outcome included the rate of surgery within one year. The skeletal muscle index (SMI) at the level of third lumbar vertebra was used to assess sarcopenia defined as a SMI&amp;lt;38.5cm2/m2 in women and &amp;lt;42cm2/m2 in men (Fig1).Clinical malnutrition was defined by a BMI&amp;lt;18.5 kg/m2, while visceral obesity as a visceral fat area ≥130cm2 Results Mean duration of disease was 117 months ± 84. Most patients 60% had a moderate-severe clinical activity based on Harvey Bradshaw index (HBI) &amp;gt;8, whereas 35% had a mild activity (HBI 5–7) and 5% were in remission (HBI&amp;lt;5). Overall, 17(42.5%) patients were sarcopenic. In detail, 14 out of 22 (63.6%) females and only 3 out of 18 (16.6%) males (p=0.04). The majority (65%) had moderate activity of inflammation with a mean of HBI 9.2 ± 1.6. Malnutrition occurred in 41,2% sarcopenic patients with a mean BMI of 16.5±3.75. A significant correlation was observed between BMI and sarcopenia (r=0.4,p&amp;lt;0.001). A total of 25 (62.5%) patients underwent surgery within one year. Among them, 40% patients were sarcopenic, while 60% non sarcopenic (p=0.7). In the total population the mean of visceral fat was 48,03±58.04 and only 4 patients had a visceral fat area ≥104 cm2. The ratio between visceral fat and subcutaneous fat area (VFA/SFA) was 0,57±0.5. The correlation between SMI and visceral fat was significant (r=0.4,p=0.02),while it was not significant with VFA/SFA (p=0.7). For all IBD patients, univariate analysis revealed that female sex (p=0.002) and low BMI (p=0.003) were significantly associated with sarcopenia Conclusion Approximately 42.5%CD patients were sarcopenic. Female sex and low BMI were significantly associated with sarcopenia but this latter did not correlate with the clinical outcome

The association of parameters of body composition and laboratory markers with the severity of hypertriglyceridemia-induced pancreatitis

BackgroundHypertriglyceridemia has arisen as the third leading cause of acute pancreatitis. This study aimed at exploring the association between the severity of hypertriglyceridemia-induced pancreatitis (HTGP) and computed tomography (CT)-based body composition parameters and laboratory markers.MethodsLaboratory and clinical parameters were collected from 242 patients with HTGP between 2017 and 2020. Severity of HTGP was evaluated by original or modified CT severity index. Body composition parameters such as area and radiodensity of muscle, subcutaneous adipose tissue and visceral adipose tissue were calculated by CT at the level of third lumbar vertebra. Parameters were compared between mild and moderately severe to severe HTGP. Uni-variate and multi-variate Logistic regression analyses were employed to assess the risk factors of the severity of HTGP.ResultsSeventy patients (28.9%) presented with mild HTGP. Body mass index, waist circumference and all CT-based body composition parameters differed between male and female patients. None was associated with the severity of HTGP, neither in males nor in females. Receiver operating characteristic curves showed that areas under the curves of apolipoprotein A-I and albumin to predict the severity of HTGP were 0.786 and 0.759, respectively (all P < 0.001). Uni-variate and further multi-variate Logistic regression analysis confirmed that low serum albumin (< 35 g/L, P = 0.004, OR = 3.362, 95%CI = 1.492–8.823) and apolipoprotein A-I (< 1.1 g/L, P < 0.001, OR = 5.126, 95%CI = 2.348–11.195), as well as high C-reactive protein (> 90 mg/L, P = 0.005, OR = 3.061, 95%CI = 1.407–6.659) and lipase (P = 0.033, OR = 2.283, 95%CI = 1.070–4.873) were risk factors of moderately severe to severe HTGP. Levels of albumin, apolipoprotein A-I, C-reactive protein and lipase were also associated with the length of hospital stay (all P < 0.05). Besides, low serum albumin, low-density lipoprotein cholesterol and high radiodensity of subcutaneous adipose tissue were significant risk factors of pancreatic necrosis in patients with HTGP (all P < 0.05).ConclusionsLow serum albumin and apolipoprotein A-I, and high C-reactive protein and lipase upon admission were associated with a more severe type of HTGP and longer hospital stay for these patients. Albumin and apolipoprotein A-I may serve as novel biomarkers for the severity of HTGP. However, none of the body composition parameters was associated with the severity of HTGP.

Impact of body composition on clinical outcomes in people with gastric cancer undergoing radical gastrectomy after neoadjuvant treatment

ObjectivesThe influence of body composition on clinical outcomes in individuals with gastric cancer (GC) undergoing radical gastrectomy after neoadjuvant treatment (NT) remains unclear. The purpose of this retrospective study was to investigate the association between body composition before NT or after NT and clinical outcomes in individuals with GC receiving multimodal treatments. MethodsThis retrospective study included individuals with GC who received NT followed by radical gastrectomy between January 2016 and December 2018. Skeletal muscle, visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) were measured by cross-sectional areas at the level of third lumbar vertebra based on single-slice computed tomography scan prior to NT and prior to the surgical operation. Sarcopenia, high VAT, and high SAT were defined using cutoff points of skeletal muscle index, visceral fat area, and subcutaneous fat area. Univariate and multivariate analyses were performed to evaluate risk factors of NT-related adverse events, postoperative complications and predictors of long-term survival. ResultsA total of 110 individuals with GC were enrolled in this study. Sarcopenia was present in 62.7% of them before NT and in 56.4% after NT. Sarcopenia before NT was associated with more NT-related adverse events (odds ratio, 2.901; 95% confidence interval [CI], 1.205–6.983; P = 0.018). High VAT after NT (≥106 cm2) was associated with an increasing incidence of postoperative complications (odds ratio, 4.261; 95% CI, 1.332–13.632; P = 0.015). No body-composition parameter was relevant to tumor pathologic response to NT. As for long-term survival, poor overall survival was associated with both low VAT before NT (<120 cm2; hazard ratio [HR], 2.542; 95% CI, 1.111–5.817; P = 0.027) and low SAT after NT (<99.5 cm2; HR, 2.743; 95% CI, 1.248–6.027; P = 0.012). Similarly, shorter disease-free survival was associated with low VAT before NT (<120 cm2; HR, 2.502; 95% CI, 1.222–5.124; P = 0.012) and low VAT after NT (<106 cm2; HR, 2.505; 95% CI, 1.172–5.358; P = 0.018). ConclusionsBody composition measured by computed tomography could predict NT-related adverse events, postoperative complications, and long-term survival in multimodal treatments for GC. More meaningfully, adipose-tissue status has significant prognostic value for individuals with advanced GC.

Clinical implication of psoas muscle mass measurement for predicting death within 3 months in patients with incurable uterine cervical or corpus malignancy

The aim of this study was to find a clinical marker for identifying refractory cancer cachexia. We analyzed computed tomography imaging data, which included the third lumbar vertebra, from 94 patients who died of uterine cervix or corpus malignancy. The time between the date of examination and date of death was the most important attribute for this study, and the computed tomography images were classified into >3months before death and ≤3months before death. Psoas muscle mass index was defined as the left-right sum of the psoas muscle areas (cm2) at the level of third lumbar vertebra, divided by height squared (m2). A data set of 94 computed tomography images was obtained at baseline hospital visit, and a data set of 603 images was obtained at other times. One hundred (16.6%) of the 603 non-baseline images were scanned ≤3months before death. Mean psoas muscle mass index change rates at >3months before death and ≤3months before death were -1.3 and -20.1%, respectively (P<0.001). Receiver operating characteristic curve analysis yielded a cutoff value of -13.0%. The area under the curve reached a moderate accuracy level (0.777, 95% confidence interval 0.715-0.838). When we used the cutoff value to predict death within 3months, sensitivity and specificity were 74.0 and 82.1%, respectively. Measuring change in psoas muscle mass index might be useful for predicting cancer mortality within 3months. It could become a potential tool for identifying refractory cancer cachexia.

Sarcopenia correlates with mortality in cirrhotic patients who undergo transjugular intrahepatic portosystemic shunt creation for refractory ascites

Introduction: Sarcopenia correlates with clinical outcome in cirrhotic patients but it's not very clear its role in patients with refractory ascites. Muscle area quantification at the level of third lumbar vertebra using abdominal computed tomography (CT) images is a novel technique for the evaluation of sarcopenia. Aim: With the present study we aimed to evaluate the possible association of sarcopenia and correlates it with mortality after TIPS placement in a subgroup of patients with refractory ascites.

Impact of intramuscular fat accumulation on survival in stage II/III gastric cancer.

19 Background: Intramuscular fat accumulation of skeletal muscle has been reported to be a prognostic factor in various cancers. To evaluate the intramuscular steatosis, intramuscular adipose tissue content (IMAC) measured by CT scan is thought to be an ideal method. However, this kind of study is very limited in curatively resected gastric cancer. So, this study was aimed to clarify the impact of IMAC on survival in stage II/III gastric cancer (GC). Methods: A total of 383 patients with pathological stage II/III GC after curative gastrectomy between January 2009 and December 2013 were included. IMAC was calculated by dividing the CT value of the multifidus muscles with that of the subcutaneous fat at the level of third lumbar vertebra. The IMAC cut-off values associated with cancer-specific survival (CSS) were separated by sex based on the maximum values of Youden index (sensitivity + specificity -1). Patients were classified into normal or high IMAC group according to this cut-off value. Clinicopathological factors and survival outcomes were compared between the two groups. Results: The median values of IMAC were -0.327 (IQR: -0.404- -0.250) in male and -0.239 (IQR: -0.335- -0.114) in female. The cut-off values of IMAC were -0.345 in male and -0.126 in female. Patients were classified into normal IMAC group (n = 204) and high IMAC group (n = 179). Patients in the high IMAC group were elderly, male, obese, having many comorbidities and with poor ECOG-PS compared to those in the normal IMAC group. Interestingly, despite the fact that no significant differences were observed in the pathological findings between the groups, the overall survival and CSS were significantly worse in the high IMAC group than in the normal IMAC group (p &lt; 0.001 and p = 0.035). Moreover, the high IMAC was identified as an independent prognostic factor not only for overall survival but also for CSS (HR: 1.440, p = 0.021, HR: 1.646, p = 0.008, respectively). Conclusions: The high IMAC was significantly associated with worse survival, suggesting that IMAC represents certain oncological implications in patients with GC. Therefore, IMAC could be used as a new prognostic factor in curatively resected GC.

The Challenges of Nutritional Assessment in Cirrhosis.

Nutritional status in patients with cirrhosis is very frequently associated with macro- and micronutrient deficiencies. Cirrhosis itself is the cause of malnutrition and nutritional deficiencies but these conditions have to be identified and addressed properly as they can worsen the prognosis of cirrhosis. The goals of this review are to 1) identify and describe the challenges associated with nutritional assessment in cirrhosis and 2) describe recent advancements when using clinical, laboratory, and instrumental tools in the evaluation of malnourished patients with liver diseases. The most promising tools for nutritional assessment in cirrhosis include the evaluation of body composition with phase angle obtained by bioelectrical impedance analysis, computed tomography transverse images at the level of third lumbar vertebra. The Royal-Free Hospital global assessment algorithm appears to be helpful but needs further validation. Nutritional assessment in cirrhosis is challenging as several factors, including edema, can interfere with it and because of lack of a validated gold standard. Regardless, nutritional assessment methods have been developed in recent years and should gain relevance in the clinical practice.