Low Muscle Attenuation Research Articles

Prognostic significance of radiodensity-based skeletal muscle quantification using preoperative CT in resected non-small cell lung cancer.

BackgroundSarcopenia is associated with poor prognosis in lung cancer. Skeletal muscle area can be quantified based on radiodensity of CT scan. The purpose of this study was to evaluate the prognostic significance of radiodensity-based detailed skeletal muscle quantification on outcomes after surgery of non-small cell lung cancer (NSCLC).MethodsSingle cross-sectional area of the skeletal muscle (−29 to 150 HU) at the 3rd lumbar vertebra (L3) level retrospectively measured on preoperative CT for NSCLC patients (n=272), who underwent surgical resection during 2011 to 2016. The diagnosis of sarcopenia was made when a L3 muscle index (L3MI; L3 muscle area/height2) of less than 55 cm2/m2 for men and less than 39 cm2/m2 for women. Skeletal muscle was subsequently classified based on radiodensity level as low attenuation muscle (−29 to <30 HU) and high attenuation muscle (30 to 150 HU). Using a maximal-chi-squared test, low attenuation muscle accounted less than 24.5% of the total muscle, which was considered healthy muscle. Data on clinical characteristics (demographic information, TNM stage, histology) and prognosis (disease-free survival; DFS, and overall survival; OS) were collected.ResultsSarcopenia was found 22.4% in preoperative CT (32.9% for men and 6.5% for women). The prevalence of patients with healthy muscle was 15.4% (21.3% for men and 6.5% for women). There was no significant difference between the 3-year DFS rate (77.0% vs. 67.0%, P=0.142) or 3-year OS rate (84.8% vs. 87.9%, P=0.576) between patients with and without sarcopenia. However, patients with healthy muscle tend to show longer 3-year DFS rate (79.4% vs. 67.2%, P=0.094) and 3-year OS rate (92.6% vs. 86.1%, P=0.176). In the multivariable analysis, healthy muscle was one of the independent prognosticators for a 3-year DFS rate (HR, 0.50, P=0.035), along with R1 resection (HR, 5.90, P<0.001), pathologic T stage (HR, 2.69, P<0.001), and pathologic N stage (HR, 2.43, P<0.001).ConclusionsThe proportion of low attenuation muscle was associated with DFS in resected lung cancer patients. Further investigation is needed to establish whether radiodensity-based detailed skeletal muscle quantification could be early biomarker to predict prognosis in NSCLC.

Baseline CT-derived muscle quality influences post-operative morbidity and five-year survival following pancreatic surgery

Purpose: Concerns regarding rapid disease progression have delayed the translation and evaluation of prehabilitation in patients with pancreatic cancer (PC). This study sought to investigate the association between baseline CT-derived muscle indices and post-operative outcome following pancreatic surgery. Methods: Consecutive patients who underwent surgery for suspected pancreatic malignancy at a tertiary, high-volume centre between 2010 and 2013 were identified, and patient status censored on 31st December 2018 to allow a minimum five-year follow up period for all participants. Major post-operative morbidity was defined as per Clavien-Dindo classification (>3). Individual muscle mass and attenuation were measured at the third lumbar vertebrae (L3) using Slice-O-Matic software, and pre-defined BMI- and gender-specific cut-offs applied. Associations between muscle indices and the occurrence of post-operative complications was assessed using binary logistic regression analysis, with results reported as odds ratios (OR) and corresponding 95% confidence intervals. The log-rank (Mantel- Cox) test was used to assess the influence of muscle indices on overall survival. Results: Sarcopenia and low muscle attenuation (MA) were present in 46% and 52% of patients respectively (n=276). Low MA was associated with increased post-operative morbidity (OR 1.6, 95% CI 1.07 -2.19, p=0.029), while both sarcopenia and low MA were associated with reduced overall survival (41 vs 62 months, p=0.036, 29 vs 61 months, p=0.0001 respectively). When patients with pathologically confirmed PC were evaluated separately (n=107), the influence of muscle indices on survival were sustained (sarcopenia 16 vs 26 months, p=0.017, low MA 12 vs 30 months, p= 0.016). Conclusion: Low MA and sarcopenia were prevalent among patients undergoing surgery for suspected pancreatic malignancy. Both factors were associated with increased mortality risk and shorter overall survival, while low muscle attenuation was associated with increased major post-operative morbidity risk. CT-derived muscle assessment could aid patient selection and risk stratification for pancreatic cancer, both by identifying a vulnerable patient cohort in need of pre-operative optimisation, and providing an objective assessment parameter for the evaluation of targeted interventions.

Effects of Contrast Phases on Automated Measurements of Muscle Quantity and Quality Using CT.

ObjectiveMuscle quantity and quality can be measured with an automated system on CT. However, the effects of contrast phases on the muscle measurements have not been established, which we aimed to investigate in this study.Materials and MethodsMuscle quantity was measured according to the skeletal muscle area (SMA) measured by a convolutional neural network-based automated system at the L3 level in 89 subjects undergoing multiphasic abdominal CT comprising unenhanced phase, arterial phase, portal venous phase (PVP), or delayed phase imaging. Muscle quality was analyzed using the mean muscle density and the muscle quality map, which comprises normal and low-attenuation muscle areas (NAMA and LAMA, respectively) based on the muscle attenuation threshold. The SMA, mean muscle density, NAMA, and LAMA were compared between PVP and other phases using paired t tests. Bland-Altman analysis was used to evaluate the inter-phase variability between PVP and other phases. Based on the cutoffs for low muscle quantity and quality, the counts of individuals who scored lower than the cutoff values were compared between PVP and other phases.ResultsAll indices showed significant differences between PVP and other phases (p < 0.001 for all). The SMA, mean muscle density, and NAMA increased during the later phases, whereas LAMA decreased during the later phases. Bland-Altman analysis showed that the mean differences between PVP and other phases ranged −2.1 to 0.3 cm2 for SMA, −12.0 to 2.6 cm2 for NAMA, and −2.2 to 9.9 cm2 for LAMA.The number of patients who were categorized as low muscle quantity did not significant differ between PVP and other phases (p ≥ 0.5), whereas the number of patients with low muscle quality significantly differed (p ≤ 0.002).ConclusionSMA was less affected by the contrast phases. However, the muscle quality measurements changed with the contrast phases to greater extents and would require a standardization of the contrast phase for reliable measurement.

Association Between Muscle Quality Measured by Abdominal Computed Tomography and Subclinical Coronary Atherosclerosis

Low muscle mass was known to be associated with cardiovascular diseases. However, only few studies investigated the association between muscle quality and subclinical coronary atherosclerosis. Thus, we evaluated whether muscle quality measured by abdominal computed tomography is associated with the risk of coronary artery calcification. Approach and Results: We conducted a cross-sectional study on 4068 subjects without cardiovascular disease who underwent abdominal and coronary computed tomography between 2012 and 2013 during health examinations. The cross-sectional area of the skeletal muscle was measured at the L3 level (total abdominal muscle area) and segmented into normal attenuation muscle area, low attenuation muscle area, and intramuscular adipose tissue. We calculated the normal attenuation muscle area/total abdominal muscle area index, of which a higher value reflected a higher proportion of good quality muscle (normal attenuation muscle area) and a lower proportion of myosteatosis (low attenuation muscle area and intramuscular adipose tissue). In women, as the normal attenuation muscle area/total abdominal muscle area quartiles increased, the odds ratios (95% CIs) for significant coronary artery calcification (>100) consistently decreased (0.44 [0.24-0.80], 0.39 [0.19-0.81], 0.34 [0.12-0.98]; P=0.003) after adjusting for cardiovascular risk factors including visceral fat area and insulin resistance. In men, the odds ratios in the Q2 group were significantly lower than those in the Q1, but the association was attenuated in Q3-4 after adjustment. A higher proportion of good quality muscle was strongly associated with a lower prevalence of significant coronary artery calcification after adjustment, especially in women. Poor skeletal muscle quality may be an important risk factor for subclinical coronary atherosclerosis.

Impact of musculoskeletal degradation on cancer outcomes and strategies for management in clinical practice.

The prevalence of malnutrition in patients with cancer is one of the highest of all patient groups. Weight loss (WL) is a frequent manifestation of malnutrition in cancer and several large-scale studies have reported that involuntary WL affects 50-80% of patients with cancer, with the degree of WL dependent on tumour site, type and stage of disease. The study of body composition in oncology using computed tomography has unearthed the importance of both low muscle mass (sarcopenia) and low muscle attenuation as important prognostic indications of unfavourable outcomes including poorer tolerance to chemotherapy; significant deterioration in performance status and quality of life (QoL), poorer post-operative outcomes and shortened survival. While often hidden by excess fat and high BMI, muscle abnormalities are highly prevalent in patients with cancer (ranging from 10 to 90%). Early screening to identify individuals with sarcopenia and decreased muscle quality would allow for earlier multimodal interventions to attenuate adverse body compositional changes. Multimodal therapies (combining nutritional counselling, exercise and anti-inflammatory drugs) are currently the focus of randomised trials to examine if this approach can provide a sufficient stimulus to prevent or slow the cascade of tissue wasting and if this then impacts on outcomes in a positive manner. This review will focus on the aetiology of musculoskeletal degradation in cancer; the impact of sarcopenia on chemotherapy tolerance, post-operative complications, QoL and survival; and outline current strategies for attenuation of muscle loss in clinical practice.

Assessment of Myosteatosis on Computed Tomography by Automatic Generation of a Muscle Quality Map Using a Web-Based Toolkit: Feasibility Study.

BackgroundMuscle quality is associated with fatty degeneration or infiltration of the muscle, which may be associated with decreased muscle function and increased disability.ObjectiveThe aim of this study is to evaluate the feasibility of automated quantitative measurements of the skeletal muscle on computed tomography (CT) images to assess normal-attenuation muscle and myosteatosis.MethodsWe developed a web-based toolkit to generate a muscle quality map by categorizing muscle components. First, automatic segmentation of the total abdominal muscle area (TAMA), visceral fat area, and subcutaneous fat area was performed using a predeveloped deep learning model on a single axial CT image at the L3 vertebral level. Second, the Hounsfield unit of each pixel in the TAMA was measured and categorized into 3 components: normal-attenuation muscle area (NAMA), low-attenuation muscle area (LAMA), and inter/intramuscular adipose tissue (IMAT) area. The myosteatosis area was derived by adding the LAMA and IMAT area. We tested the feasibility of the toolkit using randomly selected healthy participants, comprising 6 different age groups (20 to 79 years). With stratification by sex, these indices were compared between age groups using 1-way analysis of variance (ANOVA). Correlations between the myosteatosis area or muscle densities and fat areas were analyzed using Pearson correlation coefficient r.ResultsA total of 240 healthy participants (135 men and 105 women) with 40 participants per age group were included in the study. In the 1-way ANOVA, the NAMA, LAMA, and IMAT were significantly different between the age groups in both male and female participants (P≤.004), whereas the TAMA showed a significant difference only in male participants (male, P<.001; female, P=.88). The myosteatosis area had a strong negative correlation with muscle densities (r=–0.833 to –0.894), a moderate positive correlation with visceral fat areas (r=0.607 to 0.669), and a weak positive correlation with the subcutaneous fat areas (r=0.305 to 0.441).ConclusionsThe automated web-based toolkit is feasible and enables quantitative CT assessment of myosteatosis, which can be a potential quantitative biomarker for evaluating structural and functional changes brought on by aging in the skeletal muscle.

Prediction of clinically relevant pancreatic fistula after pancreatic surgery using preoperative CT scan: A systematic review and meta-analysis

BackgroundBody composition analysis has emerged as a practical tool for predicting outcomes following pancreatic surgery. However, the impact of body composition disorders on clinically relevant postoperative pancreatic fistula (CR-POPF) remains inconclusive. The aim of this study was to review and analyse whether radiographically assessed body composition is predictive of CR-POPF. MethodsPubMed, MEDLINE, Web of Science, and the Cochrane Library databases were searched up to January 2020 to identify relevant studies. CR-POPF was defined according to the definition and grading system proposed by the International Study Group on Pancreatic Surgery (ISGPS). Pooled odds ratios (OR) for CR-POPF were calculated to evaluate the predictive values of radiographically assessed body composition. ResultsFifteen studies published between 2008 and 2019 with a total of 3136 patients were included. There was a significant increase in the incidence of CR-POPF in patients with visceral obesity (OR 2.97, 95% CI 2.05–4.29, P < 0.00001) and sarcopenic obesity (OR 2.88, 95% CI 1.31–6.34, P = 0.009). Conversely, the impact of sarcopenia (OR 0.91, 95% CI 0.65–1.28, P = 0.59) and low muscle attenuation (MA) on CR-POPF did not reach statistical significance. ConclusionPreoperative visceral obesity and sarcopenic obesity are more effective at predicting CR-POPF than decreased muscle quantity and quality. This finding may lead to appropriate management and early intervention of patients at risk of CR-POPF.

Determinants of quality of life in patients with incurable cancer.

Optimizing quality of life (QoL) remains the central tenet of care in patients with incurable cancer; however, determinants of QoL are not clear. The objective of the current study was to examine which factors influence QoL in patients with incurable cancer. A multicenter study of adult patients with advanced cancer was conducted in Ireland and the United Kingdom between 2011 and 2016. Data were collected from patients at study entry and included patient demographics, Eastern Cooperative Oncology Group performance status (ECOG-PS), nutritional parameters (the percentage weight loss [%WL]), muscle parameters assessed using computed tomography images (skeletal muscle index and skeletal muscle attenuation), inflammatory markers (modified Glasgow Prognostic score [mGPS]), and QoL data (the European Organization for Research and Treatment Quality-of-Life Questionnaire C-30). The relation between clinical, nutritional, and inflammatory parameters with QoL was assessed using the Spearman rank correlation coefficient and multivariate binary logistic regression. Components of the European Organization for Research and Treatment Quality-of-Life Questionnaire C-30 (physical function, fatigue, and appetite loss) and summary QoL scores were mean-dichotomized for the logistic regression analyses. Data were available for 1027 patients (51% men; median age, 66years). Gastrointestinal cancer was most prevalent (40%), followed by lung cancer (26%) and breast cancer (9%). Distant metastatic disease was present in 87% of patients. The %WL, ECOG-PS, and mGPS were significantly correlated with deteriorating QoL functional and symptom scales (all P<.001). On multivariate regression analysis, >10% WL (odds ratio [OR], 2.69; 95% CI, 1.63-4.42), an ECOG-PS of 3 or 4 (OR, 14.33; 95% CI, 6.76-30.37), and an mGPS of 2 (OR, 1.58; 95% CI, 1.09-2.29) were independently associated with poorer summary QoL scores. These parameters were also independently associated with poorer physical function, fatigue, and appetite loss (all P<.05). Low skeletal muscle attenuation was independently associated with poorer physical functioning (OR, 1.67; 95% CI, 1.09-2.56), but muscle parameters were not independently associated with fatigue, appetite loss, or QoL summary scores. The current findings indicate that QoL is determined (at least in part) by WL, ECOG-PS, and the systemic inflammatory response in patients with advanced cancer. Identifying early predictors of poor QoL may allow the identification of patients who may benefit from early referral to palliative and supportive care, which has been shown to improve QoL.

MP37-06 MUSCLE CHARACTERISTICS OBTAINED FROM COMPUTED TOMOGRAPHY MAY BE PROGNOSTICATORS IN CASTRATION-RESISTANT PROSTATE CANCER PATIENTS: A SINGLE-CENTER ANALYSIS OF 453 PATIENTS

You have accessJournal of UrologyProstate Cancer: Advanced (including Drug Therapy) III (MP37)1 Apr 2020MP37-06 MUSCLE CHARACTERISTICS OBTAINED FROM COMPUTED TOMOGRAPHY MAY BE PROGNOSTICATORS IN CASTRATION-RESISTANT PROSTATE CANCER PATIENTS: A SINGLE-CENTER ANALYSIS OF 453 PATIENTS Jongsoo Lee*, Ji Eun Heo, Won Sik Jang, Won Sik Ham, Koon Ho Rha, and Young Deuk Choi Jongsoo Lee*Jongsoo Lee* More articles by this author , Ji Eun HeoJi Eun Heo More articles by this author , Won Sik JangWon Sik Jang More articles by this author , Won Sik HamWon Sik Ham More articles by this author , Koon Ho RhaKoon Ho Rha More articles by this author , and Young Deuk ChoiYoung Deuk Choi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000886.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To analyze the effect of muscle mass and quality on the prognosis of patients with castration-resistant prostate cancer. METHODS: Skeletal muscle area and attenuation were measured in the L3 vertebra using computed tomography at the time of CRPC diagnosis to obtain skeletal muscle index (SMI, cm2/m2) and skeletal muscle attenuation (SMA, Hounsfield unit [HU]), which were evaluated as prognosticators of CRPC. In addition, to understand the value of SMI and SMA in the elderly, subgroup analysis was conducted in patients aged <70 and >70 years. RESULTS: In total, 411 patients were included. The median values of skeletal muscle index and skeletal muscle attenuation were 45.2 cm2/m2 and 32.4 Hounsfield unit, respectively. The median survival rate for patients with low and high skeletal muscle index and skeletal muscle attenuation was 19 and 24 and 15 and 26 months, respectively (p=0.015 and p<0.001, respectively). In multivariate analysis, prostate-specific antigen, hemoglobin, alkaline phosphatase, bone metastasis, lymph node metastasis, visceral metastasis, and skeletal muscle attenuation were statistically significant. In subgroup analysis of patients aged <70 and >70 years, skeletal muscle attenuation was a significant prognosticator in both groups, whereas skeletal muscle index was a significant prognosticator only in patients aged >70 years. CONCLUSIONS: Skeletal muscle index and skeletal muscle attenuation can be predictors of survival in castration-resistant prostate cancer. In the era of development of imaging technique, they may substitute body mass index or body surface area as health indexes or dose determinants of medications. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e562-e562 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jongsoo Lee* More articles by this author Ji Eun Heo More articles by this author Won Sik Jang More articles by this author Won Sik Ham More articles by this author Koon Ho Rha More articles by this author Young Deuk Choi More articles by this author Expand All Advertisement PDF downloadLoading ...

The Impact of Sarcopenia and Low Muscle Attenuation on Overall Survival in Epithelial Ovarian Cancer: A Systematic Review and Meta-analysis.

Sarcopenia is defined as a progressive loss of skeletal muscle mass, strength and physical performance. Myosteatosis is an increase of intra- and intermuscular fat and can be measured radiologically by muscle attenuation. The study aim was to perform a systematic review and meta-analysis on the prognostic potential of sarcopenia and low muscle attenuation in relation to 3-year survival rates (3YSR) and 5YSR in epithelial ovarian cancer (EOC). A systematic literature search was conducted using the databases Ovid Medline, EMBASE, and Scopus, using PRISMA guidelines, from inception to 10th of May 2019. Studies evaluated the prognostic potential of sarcopenia and low muscle attenuation on 3YSR and 5YSR in EOC. Quality assessment of included studies was performed using the Methodological Index for Non-Randomised Studies criteria. A comprehensive search of databases resulted in the identification of 2194 studies, resulting in 1695 citations meeting the inclusion criteria. Six studies were included for systematic review. Sarcopenia was not significantly associated with improved 3YSR (OR 1.7, 95% CI 0.8-3.5, p = 0.15) or 5YSR (OR 1.8, 95% CI 1.0-3.2, p = 0.07) in meta-analysis. Normal muscle attenuation was associated with a favourable 3YSR (OR 3.0, 95% CI 2.0-4.5, p < 0.001) and 5YSR (OR 2.3, 95% CI 1.6-3.4, p < 0.001) compared to low muscle attenuation. Our meta-analysis indicated normal muscle attenuation was significantly associated with improved 3YSR and 5YSR in patients with EOC. Sarcopenia was not significantly associated with 3YSR or 5YSR in patients with EOC.

Low-attenuation muscle is a predictor of diabetes mellitus: A population-based cohort study.

Diabetes mellitus is a major global public health issue. Cross-sectional studies have demonstrated that skeletal muscle quality and quantity by computed tomography (CT) is related to glucose metabolism. However, to our knowledge, no longitudinal study has yet to elucidate the association between muscle quality determined by CT and glucose metabolism. Thus, the aim of this study was to evaluate the association between muscle quality and glucose metabolism. In this retrospective study, we evaluated data from 621 middle-aged Japanese individuals without diabetes mellitus from a cohort of employees undergoing annual physical examinations. The cross-sectional skeletal muscle area was determined based on CT data at the level of the third lumbar vertebrae, and the skeletal muscle index (SMI) and density (SMD) were calculated. Low-attenuation muscle (LAM) and normal-attenuation muscle (NAM) were identified and quantified using thresholds of -29 to +29 HU and +30 to +150 HU, respectively. We followed the individuals for a mean period of 3 y, and 27 of them developed diabetes mellitus during this period. Multiple Cox regression analyses revealed that, even after adjustment for visceral fat area index, the LAM index (hazard ratio [HR], 3.07; 95% confidence interval [CI], 1.00-7.52) showed an increased adjusted HR for incident diabetes mellitus. When total SMI and SMD were used in the same models, only total SMD (HR, 0.90; 95% CI, 0.81-0.99) showed a decreased adjusted HR for incident diabetes mellitus. Both LAM index and total SMD were associated with a higher risk for incident diabetes mellitus, whereas NAM index and total SMI were not.

Loss of adipose tissue mass during chemotherapy predicts reduced survival in patients with colorectal cancer treated with palliative intent

AbstractObesity is an established risk factor for colorectal cancer (CRC), however little is known about changes in body composition during chemotherapy and its impact on survival. The aim of this study was to examine in patients with CRC: (1) The prevalence of abnormal body composition phenotypes, (2) The impact of baseline body composition on overall survival, (3) Changes in body composition throughout treatment and its impact on overall survival.A prospective study of adult CRC patients undergoing chemotherapy between 2012–2016 was conducted. Longitudinal changes in body composition were examined using computed tomography (CT) images at two timepoints (interval 7 months, IQR: 5–9 months) using paired t-tests. Sarcopenia and low muscle attenuation (MA) were defined using published cut-offs. Cox proportional-hazards models were used to estimate mortality hazard ratios, adjusted for known prognostic covariates – stage, age, sex, performance status &amp; systemic inflammation.In total, 268 patients were recruited (66% male, mean age 63 years) and 51% were undergoing chemotherapy with a palliative intent. At baseline, 4% were underweight (BMI &lt; 20 kg/m2), 38% had a normal BMI, and 58% were overweight/obese. Despite this, 38% had cancer cachexia, 34% were sarcopenic and 43% had low MA. Neither sarcopenia, sarcopenic obesity nor cachexia at baseline predicted survival. Over 100 days, 68% were muscle stable (± 1 kg), while 25% lost &gt; 1 kg and 7% gained &gt; 1 kg. Fat mass remained stable ± 1 kg in 49%, while 28% lost &gt; 1 kg and 23% gained &gt; 1 kg. When adjusted for known prognostic covariates, baseline BMI (20–25 kg/m2) in those having palliative chemotherapy was independently associated with reduced survival compared to those with BMI indicating overweight (BMI 25–30 kg/m2) [HR: 1.80 (95% CI: 1.04–3.14), p = 0.037]. In those undergoing chemotherapy with palliative intent, a loss of &gt; 6.4% subcutaneous fat (Q1 SAT) over 100 days was predictive of poor survival versus those with small losses, remaining stable or gaining SAT (Q2-4), independent of changes in muscle mass [HR: 2.22 (95% CI: 1.07–4.62), p = 0.033].Patients with CRC, particularly those treated with a palliative intent, experience significant losses in muscle and fat mass during chemotherapy. Loss of SAT mass during palliative chemotherapy is prognostic of poor survival, independent of changes in muscle mass. Baseline BMI in the overweight range confers a survival advantage. Nutritional strategies to prevent or attenuate weight loss during chemotherapy are advisable especially in the context of advanced CRC.

Mean muscle attenuation correlates with severe acute pancreatitis unlike visceral adipose tissue and subcutaneous adipose tissue.

Acute pancreatitis (AP) is a frequent disorder with considerable morbidity and mortality. Obesity has previously been reported to influence disease severity. The aim of this study was to investigate the association of adipose and muscle parameters with the severity grade of AP. In total 454 patients were recruited. The first contrast-enhanced computed tomography of each patient was reviewed for adipose and muscle tissue parameters at L3 level. Associations with disease severity were analysed through logistic regression analysis. The predictive capacity of the parameters was investigated using receiver operating characteristic (ROC) curves. No distinct variation was found between the AP severity groups in either adipose tissue parameters (visceral adipose tissue and subcutaneous adipose tissue) or visceral muscle ratio. However, muscle mass and mean muscle attenuation differed significantly with p-values of 0.037 and 0.003 respectively. In multivariate analysis, low muscle attenuation was associated with severe AP with an odds ratio of 4.09 (95% confidence intervals: 1.61-10.36, p-value 0.003). No body parameter presented sufficient predictive capability in ROC-curve analysis. Our results demonstrate that a low muscle attenuation level is associated with an increased risk of severe AP. Future prospective studies will help identify the underlying mechanisms and characterise the influence of body composition parameters on AP.

1790P - Predictors of survival in patients with incurable cancer

BackgroundThe aim of the present study was to investigate predictors of survival in a cohort of patients with incurable cancer. This may highlight areas of care which can be addressed to optimise outcomes. MethodsPatient demographics, performance status (ECOG), inflammatory markers (modified Glasgow Performance Score (mGPS)), and nutritional parameters [BMI, % weight loss (WL)] were recorded. Baseline body composition were examined using computed tomography (CT) images. Sarcopenia and low muscle attenuation (MA) were defined using published cut-offs. Cancer cachexia (CC) was defined using the consensus definition (2011). Cox models were used to estimate mortality hazard ratios, adjusted for known prognostic covariates – age, sex & site. ResultsIn total, 1027 patients were recruited (51% male, median age 66 years). Gastrointestinal cancer was most common (40%) and metastatic disease was present in 87% of patients. In total, 86% were on active chemotherapy treatment. On multivariate analysis, primary site, ECOG-PS, WL and mGPS predicted survival. Lung and GI cancer patients had higher risk of death compared to other tumour groups [HR:1.769 (95% CI:1.305–2.398), p<0.001 and HR:1.576 (95% CI:1.211–2.053), p=0.001, respectively]. mGPS score of 1 or 2 were associated with increased risk of death versus mGPS of 0 [HR:1.399 (95% CI:1.024–1.910), p=0.035 & HR:1.831 (95% CI:1.442–2.324), p<0.001, respectively]. WL>10% in the preceding 3 months was associated with reduced survival [HR:2.501 (95% CI:1.425–4.389), p=0.001]. Sarcopenia, CC and low MA were significant predictors of survival on univariate analysis, but not on multivariate analysis. ConclusionsIndependent predictors of survival in this cohort of advanced cancer patients were cancer site, ECOG, WL>10% and mGPS, the latter two being important components of the cancer cachexia syndrome. Attenuation of weight loss and inflammation may improve outcomes for patients undergoing palliative treatment for cancer. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

650P - Loss of subcutaneous adipose tissue during chemotherapy predicts reduced survival in patients with incurable colorectal cancer undergoing palliative therapy

BackgroundObesity is an established risk factor for colorectal cancer (CRC), however little is known about the impact on survival of changes in body composition during chemotherapy. MethodsA prospective study of adult CRC patients undergoing chemotherapy between 2012-2016 was conducted. Baseline body composition and longitudinal changes were examined using computed tomography (CT) images at two timepoints (interval 7 months, IQR:5-9 months) using paired t-tests. Sarcopenia and low muscle attenuation (MA) were defined using published cut-offs. Cox models were used to estimate mortality hazard ratios, adjusted for known prognostic covariates –age, sex, performance status & systemic inflammation. ResultsIn total, 268 patients were recruited (66% male, mean age 63 years) and 51% were undergoing chemotherapy with a palliative intent. At baseline, 4% had BMI <20kg/m2 & 58% had BMI ≥25kg/m2. However, 38%, 34% & 43% had cachexia, sarcopenia & low MA, respectively. Over 100 days, 68% were muscle stable (±1kg), while 25% lost >1kg and 7% gained >1kg. Fat mass remained stable ±1kg in 49%, while 28% lost >1kg and 23% gained >1kg. On multivariate analysis, baseline BMI and subcutaneous fat (SAT) loss predicted survival in patients treated with palliative intent. Normal BMI (20-25kg/m2) predicted reduced survival compared to overweight (25-30kg/m2) [HR:1.80 (95% CI:1.04–3.14), p=0.037]. Loss of>6.4% SAT over 100 days was predictive of poor survival versus gain/<6.4% loss, independent of changes in muscle mass [HR:2.2 (95% CI:1.07–4.62), p=0.033]. ConclusionsPatients with CRC experience significant losses in muscle and fat mass during chemotherapy. Loss of SAT mass during palliative chemotherapy is prognostic of poor survival, independent of changes in muscle mass. Baseline BMI in the overweight range confers a survival advantage. Nutritional strategies to prevent or attenuate weight loss during chemotherapy are advisable especially in the context of advanced CRC. Legal entity responsible for the studyThe authors. FundingBreakthrough Cancer Research. DisclosureAll authors have declared no conflicts of interest.

1780P - Clinical & nutritional determinants of quality of life in patients with incurable cancer

BackgroundOptimising quality of life (QoL) remains the central tenet of care in patients with incurable cancer, however determinants of this are not clear. MethodsMulti-centre study conducted across 18 sites in Ireland and United Kingdom over a period of 5 years (2011-2016). Data collected included: patient demographics, Performance Status (ECOG-PS), weight loss (%WL) and skeletal muscle index (SMI) and skeletal muscle attenuation (MA) assessed by CT images, inflammatory markers [modified Glasgow Prognostic score (mGPS)] and QoL data (EORTC QLQ-30). The relationship between clinical and nutritional parameters with QoL was assessed using the Spearman rank correlation coefficient & multivariate binary logistic regression. ResultsData were available on 1027 patients, of which 51% were male and the median age was 66 (IQR 57-74) years. Gastrointestinal cancer was most prevalent (40%) and 87% of patients had metastatic disease. %WL, ECOG-PS and mGPS were significantly correlated with deteriorating QoL functional & symptom scales (all p<0.001). On multivariate regression analysis, >10% WL (OR 2.69 [95% CI: 1.63-4.42]), ECOG-PS 3-4 (OR 14.33 [95% CI: 6.76- 30.37]) and mGPS score 2 (OR 1.58 [95% CI: 1.09- 2.29]) were independently associated with poorer summary QoL score. WL & mGPS were also independently associated with poor physical function, fatigue and appetite loss (all p<0.05). Low MA was independently associated with poor physical function (OR 1.67 [95% CI: 1.09-2.56]), but not with fatigue, appetite or QoL summary score. ConclusionsThe findings indicate that QoL is determined in part by WL, ECOG-PS and systemic inflammation in patients with advanced cancer. Although muscle parameters were associated with some QoL domains, no significant independent association with fatigue, appetite loss or QoL summary score was observed. Identifying early predictors of poor QoL may allow the identification of patients who may benefit from early referral to palliative care, which has been shown to improve QoL. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Characterising the impact of body composition change during neoadjuvant chemotherapy for pancreatic cancer

BackgroundPancreatic Cancer remains a lethal disease for the majority of patients. New chemotherapy agents such as Folfirinox offer therapeutic potential for patients who present with Borderline Resectable disease (BRPC). However, results to date are inconsistent, with factors such as malnutrition limiting successful drug delivery. We sought to determine the prevalence of sarcopenia in BRPC patients at diagnosis, and to quantify body composition change during chemotherapy. MethodsThe diagnostic/restaging CT scans of BRPC patients were analysed. Body composition was measured at L3 using Tomovision Slice-O-Matic™. Total muscle and adipose tissue mass were estimated using validated regression equations. Sarcopenia was defined as per gender- and body mass index (BMI)-specific lumbar skeletal muscle index (LSMI) and muscle attenuation reference values. ResultsSeventy-eight patients received neo-adjuvant chemotherapy, and 67 patients underwent restaging CT, at which point a third were deemed resectable. Half were sarcopenic at diagnosis, and sarcopenia was equally prevalent across all BMI categories.. Skeletal muscle and adipose tissue (intra-muscular, visceral and sub-cutaneous) area decreased during chemotherapy (p < 0.0001). Low muscle attenuation was observed in half of patients at diagnosis, and was associated with increased mortality risk. Loss of lean tissue parameters during chemotherapy was associated with an increased mortality risk; specifically fat-free mass, HR 1.1 (95% CI 1.03–1.17, p = 0.003) and skeletal muscle mass, HR 1.21 (95%CI 1.08–1.35, p = 0.001). ConclusionsSarcopenia was prevalent in half of patients at the time of diagnosis with BRPC. Low muscle attenuation at diagnosis, coupled with lean tissue loss during chemotherapy, independently increased mortality risk.

Effects of weight loss and sarcopenia on response to chemotherapy, quality of life, and survival

It has frequently been shown that patients with cancer are one of the largest hospital patient groups with a prevalence for malnutrition. Weight loss is a frequent manifestation of malnutrition in patients with cancer. Several large-scale studies over the past 35 y have reported that involuntary weight loss affects 50% to 80% of these patients with the degree of weight loss dependent on tumor site and type and stage of disease. The aim of this review was to determine the consequences of malnutrition, weight loss, and muscle wasting in relation to chemotherapy tolerance, postoperative complications, quality of life, and survival in patients with cancer. The prognostic impact of weight loss on overall survival has long been recognised with recent data suggesting losses as little as 2.4% predicts survival independent of disease, site, stage or performance score. Recently the use of gold-standard methods of body composition assessment, including computed tomography, have led to an increased understanding of the importance of muscle abnormalities, such as low muscle mass (sarcopenia), and more recently low muscle attenuation, as important prognostic indicators of unfavourable outcomes in patients with cancer. Muscle abnormalities are highly prevalent (ranging from 10-90%, depending on cancer site and the diagnostic criteria used). Both low muscle mass and low muscle attenuation have been associated with poorer tolerance to chemotherapy; increased risk of postoperative complications; significant deterioration in a patients' performance status, and poorer psychological well-being, overall quality of life, and survival.

Cigarette Smoking Is Associated With Lower Quadriceps Cross-sectional Area and Attenuation in Older Adults.

In addition to well-established links with cardiovascular and respiratory diseases, cigarette smoking may affect skeletal muscle; however, associations with quadriceps atrophy, density, and function are unknown. This study explored the associations of current and former smoking with quadriceps muscle area and attenuation as well as muscle force (assessed as knee extension peak torque) and rate of torque development-a measure of muscle power in older adults. Data from 4469 older adults, aged 66-95 years at baseline in the Age, Gene/Environment Susceptibility-Reykjavik Study with measurements of thigh computed tomography, isometric knee extension testing, self-reported smoking history, and potential covariates were analyzed. Sex differences were observed in these data; therefore, our final analyses are stratified by sex. In men, both former smokers and current smokers had lower muscle area (with β= -0.10, 95% confidence interval [CI] = -0.17 to -0.03 and β = -0.19, 95% CI = -0.33 to -0.05, respectively) and lower muscle attenuation (ie, higher fat infiltration, β = -0.08, 95% CI = -0.16 to -0.01 and β = -0.17, 95% CI = -0.34 to -0.01, respectively) when compared with never smokers. Smoking status was not associated with male peak torque or rate of torque development. In women, current smoking was associated with lower muscle attenuation (β = -0.24, 95% CI = -0.34 to -0.13) compared to never smoking. Among female smokers (current and former), muscle attenuation and peak torque were lower with increasing pack-years. Results suggest that cigarette smoking is related to multiple muscle properties at older age and that these relationships may be different among men and women. This article presents novel data, as it examined for the first time the relationship between smoking and computed tomography-derived quadriceps muscle size (cross-sectional area) and attenuation. This study suggests that current cigarette smoking is related to higher muscle fat infiltration, which may have significant health implications for the older population, because of its known association with poor physical function, falls, and hip fractures.

One-Year Lifestyle Intervention, Muscle Lipids, and Cardiometabolic Risk

Low-attenuation muscle (LAM) area at mid-thigh, a computed tomography (CT)-derived index of intramuscular lipids, is associated with insulin resistance, obesity, and type 2 diabetes. The present study aimed at testing the hypothesis that changes in LAM area in trunk muscles from a single abdominal scan could provide relevant information to evaluate the effects of a lifestyle intervention without the use of a mid-thigh CT scan. Cardiometabolic risk variables, including waist circumference, lipoprotein-lipid profile, glucose tolerance, and cardiorespiratory fitness, were assessed in a sample of 102 dyslipidemic viscerally obese men at baseline and after a 1-yr lifestyle intervention. Abdominal (L4-L5) and mid-thigh CT scans were performed and abdominal muscles classified as psoas and core muscles. Scans were segmented to calculate muscle areas, LAM areas, and mean attenuation values. All muscle groups showed a decrease in LAM areas (P < 0.0001) in response to the lifestyle intervention. Changes in LAM areas were significantly associated with changes in triglycerides, high-density lipoprotein (HDL) cholesterol, cholesterol/HDL cholesterol ratio and log triglycerides/HDL cholesterol ratio (mid-thigh, 0.20 ≤ |r| ≤ 0.29; psoas, 0.28 ≤ |r| ≤ 0.38; core, 0.29 ≤ |r| ≤ 0.34, P < 0.05). Changes in core LAM area were significantly associated with changes in 2-h glucose levels, glucose area measured during the oral glucose tolerance test and homeostasis model assessment of insulin resistance (0.21 ≤ r ≤ 0.34, P < 0.05). Stepwise regression analyses showed that changes in LAM psoas area were associated with changes in HDL cholesterol and the cholesterol/HDL cholesterol ratio independently from changes in visceral adiposity. Changes in trunk LAM areas are useful indices of changes in mid-thigh LAM area observed with a 1-yr lifestyle intervention. Thus, an additional mid-thigh scan is not necessary to evaluate muscle lipid content by CT when an abdominal CT scan is available.