Non-sarcopenia Groups Research Articles

Computed tomography-defined sarcopenia: prognostic predictor of nonrelapse mortality after allogeneic hematopoietic stem cell transplantation: a multicenter retrospective study.

We analyzed clinical cutoffs for defining computed tomography (CT) methods for sarcopenia and examined the prognostic value of CT for allogeneic hematopoietic stem cell transplantation (allo-HCST) outcomes of patients with myeloid malignancy. One hundred twenty-five adult patients with acute myeloid leukemia and myelodysplastic syndrome who underwent first allo-HSCT between 2000 and 2017 were included. Sarcopenia was assessed using CT-based skeletal muscle index (SMI) and mean muscle attenuation at L3. A statistical difference in SMI was confirmed between sarcopenia (n = 52) and nonsarcopenia (n = 73) patients. There were no significant correlations of muscularity with age, performance status, or other characteristics of HSCT. After 2years, overall survival (OS) was 43.5% and 70.1%, disease-free survival was 52.9% and 68.6%, nonrelapse mortality (NRM) was 20.8% and 8.4%, incidence of acute GVHD (≥ grade 2) was 38.8% and 39.1%, that of chronic GVHD was 53.2% and 37.3%, and median duration of hospitalization was 88days and 74days (P = 0.026), respectively, in the sarcopenia and nonsarcopenia groups. Multivariate analysis showed that presence of sarcopenia is a novel adverse factor for high NRM and poor OS. Pretransplant CT-defined sarcopenia is correlated with decreased OS, increased NRM, and prolonged hospitalization.

Association between sarcopenia and levels of growth hormone and insulin-like growth factor-1 in the elderly

BackgroundAge-related sarcopenia is a serious global health issue in elderly individuals and for the community as it induces disability and significant economic burden. The purpose of the study is to understand the factors associated with sarcopenia and the role of growth hormone (GH) and insulin-like growth factor (IGF-1) in the occurrence of sarcopenia.MethodsElderly patients (n = 3276) were included in this cross-sectional study. Survey and measurement of body composition (bioelectrical impedance), grip strength, and step speed were performed according to the Asian Working Group on Sarcopenia (AWGS) diagnostic criteria. Hematological and hormonal indicators were compared between patients with and without sarcopenia in order to identify the associated factors.ResultsThere were significant differences in the demographic parameters between the sarcopenia and non-sarcopenia groups (all P < 0.05). There were significant differences between the two groups regarding the blood levels of GH, IGF-1, testosterone (T), and mechanical growth factor (MGF) (all P < 0.001). Correlation analyses showed that the appendicular skeletal muscle mass (ASMI) was positively associated with gender and BMI, and with GH, T, IGF-1, MGF, BUN, Cr, and Hb levels, but negatively associated with HDL-C (all P < 0.05). Logistic multivariable regression analysis showed that IGF-1, MGF, BMI, and gender were independently associated with appendicular skeletal muscle mass (ASMI) (all P < 0.05).ConclusionsGH and IGF-1 are associated with sarcopenia in the elderly. IGF-1 and MGF are independently associated with the reduction of skeletal muscle mass, along with BMI and gender.

Clinical Features of Sarcopenia in Patients With Lumbar Spinal Stenosis.

Cross-sectional design. To investigate the prevalence of sarcopenia and identify factors associated with sarcopenia in patients with lumbar spinal stenosis (LSS). Patients with LSS have a higher prevalence of sarcopenia compared with healthy older adults. However, the clinical features of sarcopenia in patients with LSS are poorly understood and the factors affecting sarcopenia in patients with LSS remain unclear. Patients diagnosed with LSS based on clinical examination and magnetic resonance imaging findings, and referred to physical therapy, were enrolled. Muscle mass was measured using bioelectrical impedance using InBody S10. We collected a numerical rating scale (NRS) for back pain, the 36-Item Short-Form Survey (SF-36), the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), bone mineral density (BMD), and radiographic measurements of spinal alignment. Sarcopenia was defined according to the Asian Working Group for Sarcopenia guidelines and patients were classified into sarcopenia or nonsarcopenia groups. A total of 178 patients were enrolled: 35 in the sarcopenia group and 143 in the nonsarcopenia group. The prevalence of sarcopenia was 19.7%. The average percent of slip (% slip) among patients in the sarcopenia group was significantly higher compared with those in the nonsarcopenia group (P < 0.05). Body mass index (BMI), BMD, physical function as assessed by the SF-36, and gait disturbance as assessed by the JOABPEQ were significantly lower in the sarcopenia group compared with those in the nonsarcopenia group (P < 0.05). A trend was observed toward between-group differences in back pain on the NRS (P < 0.1). In the logistic regression analysis, significant associations were seen between sarcopenia and % slip (odds ratio 1.15, 95% CI 1.01-1.30). Patients with LSS and sarcopenia have a higher degree of slippage and lower BMI, BMD, and physical function, and reported more severe low back pain, compared with those without sarcopenia. 4.

Evaluation of dysphagia in patients with sarcopenia in a rehabilitation setting: insights from the vicious cycle.

Nutritional deficits are known to cause sarcopenia. There is also evidence that sarcopenia itself may cause dysphagia, and swallowing problems are among the reasons for patients to have nutritional deficits. This study aims to evaluate the prevalence of nutritional deficits and dysphagia in patients with or without sarcopenia. 128 patients residing in a rehabilitation clinic are evaluated with EAT-10, MD Anderson Dysphagia Inventory, Functional Oral Intake Status scale, Mini Nutritional Assessment (MNA) and Beck Depression Index. All patients were then classified according to the latest sarcopenia classification proposed by the European Working Group on Sarcopenia in Older People in 2018. Muscle strength and mass were assessed using a hand dynamometer and measuring calf circumference, respectively. Walking velocity was assessed using the 4-m gait speed test. Patients belonging to sarcopenia, probable sarcopenia, and non-sarcopenia groups were then compared using relevant statistical methods to show whether there are differences in outcomes mentioned as well as demographical and clinical status. The presence of oropharyngeal dysphagia risk was only found between sarcopenic [85 (48-100)] and non-sarcopenic [91 (62-100)] individuals (p = 0.026) while other comparisons were insignificant. EAT-10 scores were found to be worse for probably sarcopenic [0 (0-13)] and sarcopenic [0 (0-35)] individuals compared to non-sarcopenics [0 (0-6)], and it was also shown sarcopenics were worse than probable sarcopenics (p = 0.001). While gait velocity only differed between individuals with sarcopenia and not sarcopenic ones, grip strength was deteriorated for both sarcopenic and probably sarcopenic individuals when compared to non-sarcopenics. MNA scores were still significantly worse for probable sarcopenics [10 (3-14)] and sarcopenics [9 (0-13)], when compared to non-sarcopenics [13 (3-14)] latter being even worse than the other two, respectively) (p = 0.0001). Dysphagia and nutritional impairments may be seen in the course of sarcopenia, and this also applies to the condition of probable sarcopenia.

Influence of Sarcopenia on the Effect of Exercise Therapy for Elderly Patients with Chronic Low Back Pain.

Introduction Sarcopenia, a condition characterized by decreased skeletal muscle mass, has increasingly been attracting attention in Japan, which has an aged society. The association between chronic low back pain (CLBP) and muscle mass is important. This study aimed to investigate the effect of exercise therapy for CLBP with or without sarcopenia. Methods This study was a prospective cohort study. Patients who were aged >65 years during 2017-2018 and had CLBP, with pain lasting >12 weeks and pain intensity being ≥3, were included in the study. The patients were divided into two groups: sarcopenia (S) and nonsarcopenia (NS) groups. The numerical rating scale (NRS) for pain intensity, Roland-Morris Disability Questionnaire (RMDQ), Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), Hospital Anxiety and Depression Scale (HADS), trunk muscle strength, a European Quality of Life instrument, and an NRS of treatment satisfaction were assessed. All patients underwent a high-intensity exercise therapy during 2 weeks of hospitalization and were followed up for 1 and 3 months. Results Twenty-eight patients with CLBP were included. The prevalence rate of sarcopenia was 42.9%. The NRS and RMDQ scores and gait function were clinically improved at the end points in all patients with or without sarcopenia. Moreover, high treatment satisfaction was achieved. The quality of life, treatment satisfaction, psychological disorder subscale score of the JOABPEQ, and HADS score tended to be lower in the S group than in the NS group. Conclusions Our short-term exercise therapy was effective for low back pain, disability, and gait disturbance in elderly patients with CLBP with or without sarcopenia. However, the prevalence of sarcopenia was high in elderly patients with CLBP. Although low back pain and disability in patients in the S group were improved by exercise therapy, their quality of life and treatment satisfaction might be lower than those of patients without sarcopenia.

Effects of sarcopenia, hypoalbuminemia, and laparoscopic surgery on postoperative complications in elderly patients with colorectal cancer: A prospective study.

With the increasing number of elderly patients, the risk of diseases such as colorectal cancer (CRC) has increased. The objective of this prospective study was to explore the effects of sarcopenia, hypoalbuminemia, and laparoscopic surgery on postoperative complications among elderly patients who recently underwent colorectal surgery. Patients aged over 65 years who underwent surgery for CRC at the First Affiliated Hospital of Wenzhou Medical University were considered for this study. The demographical and clinical characteristics of these patients, as well as postoperative complications, were prospectively analyzed. The patients were divided into two groups depending on the diagnosis of sarcopenia, and the clinical variables corresponding to the two groups were compared. Further, the risk factors associated with postoperative complications were evaluated using univariate analysis and multivariate logistic regression analysis. A total of 360 patients fulfilled the inclusion criteria. Incidences of postoperative complications in the sarcopenia and non-sarcopenia groups were at 38.3% and 27.3%, respectively. In addition, sarcopenia (p=0.029) and hypoalbuminemia (p=0.010) were identified as independent risk factors, while laparoscopic surgery (p=0.023) was identified as a protective factor for postoperative complications. However, laparoscopic surgery was a protective factor for postoperative complications in the colon group only (p=0.001). Sarcopenia and hypoalbuminemia are independent risk factors that influence the probability of developing complications following CRC surgery. Laparoscopic surgery is a protective factor for postoperative complications of CRC patients, particularly colon cancer patients.

Sarcopenia is a prognostic factor for TKIs in metastatic thyroid carcinomas.

Among patients with various cancers receiving anticancer drugs, sarcopenia is associated with poor survival and treatment outcomes. We conducted an observational study using skeletal muscle index (SMI) evaluation to investigate the association between sarcopenia and treatment outcomes of tyrosine kinase inhibitors (TKIs) in metastatic thyroid cancer patients. We included 54 patients (19 men, 35 women; age, 66.5 ± 10.9 years) with differentiated thyroid carcinoma (DTC) or medullary thyroid carcinoma (MTC). The records of patients with metastatic DTC and MTC treated with TKIs were retrospectively reviewed. Patients were divided into sarcopenia and non-sarcopenia groups based on SMI. The SMI cutoff values for sarcopenia were 42 and 38 (cm2/m2) for males and females, respectively. Thirty-three patients had sarcopenia before TKI treatment. The sarcopenia group had more females and a lower body mass index. The median progression-free survival (PFS) durations were 13.6 (95% confidence interval (CI): 6.1-29.9) and 41.9 (95% CI: 25.2-not estimable) months in the sarcopenia and non-sarcopenia groups (p= 0.017), respectively. Univariate analysis showed that sarcopenia was significantly associated with PFS (p= 0.037). Sex, age, and performance status did not affect PFS. Multivariate analysis showed that sarcopenia was the only independent prognostic factor for PFS (hazard ratio: 2.488, 95% CI: 1.058-5.846, p= 0.037). Sarcopenia could be a predictive factor of TKI treatment outcomes in patients with metastatic thyroid cancer as well as intervention target to improve prognosis. Further prospective investigations are needed to confirm these preliminary data.

Effects of preoperative sarcopenia on postoperative complications of minimally invasive oesophagectomy for oesophageal squamous cell carcinoma.

Sarcopenia is closely associated with surgical complications in patients with certain cancers. In this study we assessed the relationship between sarcopenia and postoperative complications in patients with oesophageal squamous cell carcinoma. We retrospectively analysed of patients who underwent thoracoscopic combined with laparoscopic radical resection of oesophageal cancer. Preoperative computed tomography to evaluate skeletal muscle mass to diagnose sarcopenia and to evaluate associations with age, body mass index (BMI), lung function and postoperative complications. Among 141 patients, 73 presented with sarcopenia (sarcopenia group) and 68 did not (non-sarcopenia group). The mean skeletal muscle index in all patients was 49.5±9.0 cm2/m2; median, 49.3 cm2/m2. The sarcopenia group included a higher proportion of men (P=0.039) and had a lower BMI than the non-sarcopenia group (P=0.001). There were no significant differences in any other clinical and pathological features. The incidences of postoperative complications in the sarcopenia and non-sarcopenia groups were 63.0% and 36.8%, respectively (P=0.002). The incidences of pulmonary infections and postoperative pleural effusions were 28.8% vs. 11.8% (P=0.011) and 38.4% vs. 20.6% (P=0.020) in the sarcopenia and non-sarcopenia groups, respectively. The incidences of other complications were not significantly different between the two groups. Univariate and multivariate analyses of pulmonary infection-related clinical factors revealed that sarcopenia and forced expiratory volume in the first second as a percent of forced vital capacity (FEV1.0%) were independent risk factors for pulmonary infection after minimally invasive surgery. Preoperative sarcopenia is an independent risk factor for pulmonary infection after minimally invasive oesophagectomy (MIE). Evaluation of preoperative sarcopenia will thus help to prevent postoperative complications.

The psoas muscle index as a predictor of long-term survival after cardiac surgery for hemodialysis-dependent patients.

Sarcopenia represented by skeletal muscle depletion is closely related to frailty and predicts prognoses in the general population. However, its predictive value for hemodialysis (HD)-dependent patients undergoing cardiac surgery has not been fully investigated. We aimed to clarify the impact of sarcopenia on the outcomes of HD-dependent patients after cardiac surgery. We retrospectively reviewed 138 HD-dependent patients who underwent cardiac surgery between January 2006 and December 2017. Sarcopenia was assessed using the psoas muscle index (PMI), which was calculated using values measured on preoperative computed tomography images and the following formula: cross-sectional area of bilateral psoas muscle/height2. Patients were divided into two groups according to the PMI: the sarcopenia group (≤ 443mm2/m2 for men and ≤ 326mm2/m2 for women; n = 35) and the non-sarcopenia group (> 443mm2/m2 for men and > 326mm2/m2 for women; n = 103). Preoperative characteristics and surgical outcomes were compared. Overall in-hospital mortality did not differ between the sarcopenia and non-sarcopenia groups. However, the patients with sarcopenia had significantly decreased long-term survival. Multivariate analysis revealed that low PMI was a significant independent predictor of long-term mortality (hazard ratio, 1.92; 95% confidential interval, 1.19-3.17; p < 0.01). Long-term survival rates in HD-dependent patients undergoing cardiac surgery are severely affected by the presence of preoperative sarcopenia defined by PMI. Preoperative risk analysis using the PMI might contribute to risk stratification of and decision-making for HD-dependent patients undergoing cardiac surgery.

Cancer-related fatigue and biochemical parameters among cancer patients with different stages of sarcopenia.

Cancer-related fatigue (CRF) is a pervasive symptom experienced by cancer patients. Sarcopenia has been suggested as a treatment target of CRF. This study aims to assess the differences of CRF and biochemical markers among different stages of sarcopenia which remain poorly delineated. A total of 187 patients were included in this cross-sectional study. Based on muscle mass (skeletal muscle index, SMI), muscle strength (handgrip strength), and physical performance (SARC-F score), patients were divided into four groups (non-sarcopenia, pre-sarcopenia, sarcopenia, and severe sarcopenia). Cancer-related fatigue was measured by the Brief Fatigue Inventory (BFI). Biochemical markers were measured by routine blood tests. The BFI score was significantly associated with sarcopenia stage (r=0.500; P<0.001). Cancer patients in severe sarcopenia group suffered from worse CRF than those in non-sarcopenia, pre-sarcopenia, and sarcopenia groups (P<0.001). In the multivariate linear regression model (R2=0.542), CRF was significantly correlated with SARC-F score (standardized B=0.519; P<0.001) and high-sensitivity C-reactive protein (standardized B=0.389; P=0.004). Serum albumin and cholinesterase were statistically correlated with both sarcopenia stage and CRF. The significantly increased occurrence and severity of CRF in cancer patients with sarcopenia suggest that sarcopenia may be a crucial target to improve the management of CRF. Circulating albumin and cholinesterase have the potential to predicting sarcopenia as biomarkers.

Sarcopenia as a Possible Negative Predictor of Limb Salvage in Patients with Chronic Limb-Threatening Ischemia.

Objective: Open revascularization of the lower extremity in patients with chronic limb-threatening ischemia (CLTI) does not guarantee limb salvage. Due to the high prevalence of frailty among these patients, we hypothesized that sarcopenia negatively affects limb prognosis.Methods: Seventy-five CLTI patients who underwent open revascularization between 2011 and 2015 were retrospectively reviewed. The lumbar psoas index, which is the ratio of the cross-sectional area of the psoas major muscles to the patients’ height squared, was used as a surrogate marker for sarcopenia. Male and female patients were stratified separately according to lumbar psoas index values. The lower two-thirds of the population for each sex were defined as the sarcopenia group, with the higher third defined as the non-sarcopenia group.Results: Comorbidities and ambulatory status did not differ between the sarcopenia (n=50) and non-sarcopenia (n=25) groups. The sarcopenia group had significantly lower overall survival rates than the non-sarcopenia group (60% vs 87% at 3 years, P<0.05). Moreover, the limb salvage rates were significantly lower in the sarcopenia group than in the non-sarcopenia group (73% vs 100% at 2 years, P<0.05).Conclusion: Sarcopenia, as measured by the lumbar psoas index, may predict poor limb prognosis in CLTI patients undergoing open revascularization.

Gait speed as a mediator of the effect of sarcopenia on dependency in activities of daily living.

BackgroundSarcopenia in older adults is strongly associated with an increase in dependency in activities of daily living (ADL) and with a decline in gait speed. Interestingly, gait speed has been shown to independently predict mortality. In this context, our study aimed to explore the mediator role of gait speed on the relationship between sarcopenia and dependency in ADL.MethodsA cross‐sectional study was conducted in Colombia, 19 705 older adults with a mean age of 70 years, 55.6% women, 16.1% with sarcopenia, and 14.7% mild, moderate, or severe dependency in ADL, according to ‘SABE Survey 2015’. Sarcopenia was assessed by calf circumference and ADL dependence through the Barthel Index. Gait speed was measured over a distance of 3 m. The association between sarcopenia condition and gait speed and dependency level was analysed by linear regression adjusted by covariates. To examine whether gait speed mediated the association between sarcopenia and dependence components of physical function, simple mediation models were generated using ordinary least squares with the macro PROCESS version 3.2, adjusted for age, sex, and body mass index (BMI).ResultsSignificant differences (P < 0.05) were found in gait speed and dependency in ADL between the sarcopenia and non‐sarcopenia groups after adjusting for age, sex, and BMI. BMI was significantly higher in the non‐sarcopenia group whereas dependency was significantly higher in the sarcopenia group (19.6% vs. 13.8%). Results from mediation model regression analysis indicated a significant and direct detrimental effect of sarcopenia on dependency in ADL (β = −0.05; P < 0.001), and a significant indirect effect of gait speed on the direct effect (−0.009 to −0.004).ConclusionsThe negative effect of sarcopenia on functional dependence was mediated by the gait speed. Therefore, gait speed may positively influence the detrimental effect of sarcopenia for dependency, after adjusting for age, gender, and BMI. Consequently, physical exercise should be promoted and focused to circumvent the gait speed decline associated with age in older people with sarcopenia.

Effects of sarcopenia on functional improvement over the first year after cardiac surgery: a cohort study.

Sarcopenia is linked with poor postoperative outcomes. To evaluate the effects of sarcopenia on first-year functional changes after cardiac surgery. In this prospective cohort study, functional changes (physical activity levels in metabolic equivalent hours/week, 6-minute walking distance in metres, and grip strength in kg) from preoperative baseline to 1, 3, 6 and 12 months postoperatively were compared in adult patients with and without sarcopenia undergoing cardiac surgery at a tertiary medical centre. Presurgical sarcopenia was defined as low muscle mass plus either low strength or poor physical performance (i.e. reduced gait speed). Secondary outcomes (length of hospital stay and 1-year mortality) were compared between sarcopenia and non-sarcopenia groups. Sarcopenia presented in 27.7% ( n=67) of 242 participants. Participants with sarcopenia were significantly older, predominantly women, and had lower body mass index and higher cardiac surgery risk (measured by the EuroSCORE II) than those without sarcopenia. For both groups, physical activity levels, walking distance and grip strength steadily improved over the year following cardiac surgery. Independent of EuroSCORE II, changes in physical activity levels, walking distance and grip strength did not differ significantly between the sarcopenia and non-sarcopenia groups 1, 3, 6 and 12 months after surgery. Nevertheless, the sarcopenia group had a significantly longer length of hospital stay than the non-sarcopenia group (19.4 vs. 15.3 days; β=2.9, P=0.02) but 1-year mortality (3.4 vs. 3.9% for non-sarcopenia group) was comparable. Despite a longer length of hospital stay for the sarcopenia group, sarcopenia was not a restriction for cardiac surgery given their comparable functional improvement and mortality 1 year following surgery.

Sarcopenia is an independent risk factor for delayed gastric emptying after pancreaticoduodenectomy

Sarcopenia is defined as the degenerative loss of skeletal muscle and can be measured using the cross-sectional diameter of the psoas muscle on computed tomography. Sarcopenia has been associated with a variety of post-operative complications. We propose that sarcopenia acts as an independent factor predictive of delayed gastric emptying (DGE) after elective pancreaticoduodenectomy (PD).A retrospective analysis of a prospectively maintained database of all patients undergoing PD at our tertiary hepatobiliary center was performed for the period December 2014 - March 2017. For each patient, the preoperative cross-sectional diameter of the psoas muscle at the upper border of L4 was calculated. Measurements in the lowest third of gender specific groups were considered to be sarcopenic. The presence of DGE, post-operative pancreatic fistulas (POPF) and major postoperative complications graded as Clavien Dindo III or more were included in the analysis.A total of 40 patients were included, 15 (37.5%) of whom were classified as sarcopenic. Comparison between the sarcopenic and non-sarcopenia groups revealed homogeneity in terms of gender, age, BMI and pre-operative albumin levels. DGE occurred in 11 patients (27.5%) of whom 7 were sarcopenic. Significantly more sarcopenic patients suffered from DGE (7/15 vs 4/25, p = 0.042). Major postoperative complications and POPF occurred in 15 patients each (37.5%). Nevertheless, sarcopenia was not significantly associated with POPF or other complications. The presence of sarcopenia was found to have a significant relationship with the incidence of DGE (OR 4.594, 95% CI 1.052-20.057).Sarcopenia acted as an independent risk factor predicting DGE after PD but not for POPF or other major postoperative complications.

Skeletal Muscle Loss During Definitive Chemoradiotherapy is Negatively Associated with Outcomes in Locally Advanced Cervical Cancer

Concurrent chemoradiation (CCRT) is the mainstay of treatment for patients with locally advanced cervical cancer (LACC). Emerging reports suggest that sarcopenia might be associated with poor prognosis in many cancers; however, the effect of sarcopenia and skeletal muscle loss during CCRT for LACC remains unknown. We hypothesized that skeletal muscle loss during CCRT could impact outcomes. The aim of this study was to assess the effects of sarcopenia and skeletal muscle changes on the outcomes of patients with LACC. We analyzed the pre- and post-CCRT computed tomography (CT) images of 245 patients with LACC who were treated between 2004 and 2015. The post-CCRT CT images were acquired within 3 months of CCRT. The third lumbar vertebrae (L3) was chosen as a standard landmark, and two consecutive CT images were used to measure the cross-sectional area of the skeletal muscle. Skeletal muscle was identified and quantified by the use of Hounsfield unit thresholds (–29 to +150). The skeletal muscle index (SMI) was calculated as the area of total L3 skeletal muscle (cm2) divided by the square of the height (m2). Sarcopenia was defined as SMI <38.5 cm2/m2. The SMI change was calculated as follows: [(post-CCRT SMI - pre-CCRT SMI)/pre-CCRT SMI] × 100. Patients with an SMI loss or gain of more than 10% were classified as having experienced ‘SMI loss’ or ‘SMI gain,’ respectively. The Cox’s proportional hazards model was used to test for the combined effects of prognostic factors. Survival probabilities were expressed as hazard ratios (HRs) and 95% confidence intervals (CIs). The median follow-up was 62.7 (range, 7.3-152.3) months. Among the 245 patients, 108 (44%) had pre-CCRT sarcopenia. The median interval between pre- and post-CCRT CT scans was 4.8 (range, 3.5-5.9) months. The number of patients who were diagnosed with SMI loss, stable SMI, and SMI gain were 51 (21.8%), 144 (58.5%), and 50 (20.4%), respectively. The survival outcomes were similar in the pre-CCRT sarcopenia and non-sarcopenia groups (5-year overall survival [OS]: 82.5% vs. 83.0%, p = 0.78; 5-year progression-free survival [PFS]: 72.2% vs. 78.8%, p = 0.25). The 5-year OS for the SMI loss, stable SMI, and SMI gain groups was 44.8%, 91.7%, and 95.8%, respectively (p < 0.001), and the 5-year PFS was 38.4%, 84.7 %, and 89.3%, respectively (p < 0.001). On multivariable analysis adjusted for FIGO stage, lymph node status, histology, and treatment, the SMI change, as a continuous variable (HR, 0.77; 95% CI, 0.71–0.83; p < 0.001), and SMI loss (HR, 6.22; 95% CI, 3.12–12.43; p < 0.001) were significant prognostic factors for OS. Pre-CCRT sarcopenia was not an independent prognostic factor for OS (p = 0.78). Skeletal muscle loss during CCRT was a poor prognostic factor for survival in patients with LACC. Our results demonstrate that the importance of body composition in patients with cancer, highlighting the need for specific interventions to improve unfavorable body compositions for potentially improving outcomes.

FA08.03: PREOPERATIVE SARCOPENIA INFLUENCES THE RISK OF POSTOPERATIVE PNEUMONIA IN PATIENTS WITH ESOPHAGEAL CANCER

Abstract Background Exact measurement of muscle mass is enabled by body composition analyzer, and it is reported that a body composition affects the perioperative outcomes. In this study, we investigated the relationship between depletion of preoperative muscle mass (sarcopenia) and postoperative outcomes in patients with esophageal cancer treated esophagectomy. Methods A total 58 esophageal cancer patients who underwent esophagectomy between January 2014 and January 2018 were enrolled. Preoperative muscle mass was evaluated by InBody-3.0 and S-10 which is body composition analyzer and expressed as muscle mass index; MMI (kg/m2) by dividing the muscle mass by the height in meters squared. The cut off values of MMI were the gender-specific lowest 20%, and we defined low MMI as sarcopenia. Postoperative complications were graded according to the Clavien-Dindo classification, univariate and multivariate analysis were performed for postoperative pneumonia. About the pneumonia, we defined that invasive shadow was observed by X-ray or CT and bacteria detected by sputum culture. Results By the definition of sarcopenia in this study, sarcopenia was determined in 11 patients (19%). Sarcopenia was significantly correlated with lower body weight (P &lt; 0.001), lower body mass index (P &lt; 0.001), the VC% (P = 0.0178). In other factors, there is no significant difference between sarcopenia and non-sarcopenia groups. Compared with non-sarcopenic patients, sarcopenic patients had a higher risk of postoperative pneumonia and chylothorax (P = 0.0144 and P = 0.0105). For other complications, the differences were not significant. In univariate analysis, sarcopenia (P = 0.0144), hypoalbuminemia (P = 0.0236), operative blood loss (P = 0.0436) were associated with postoperative pneumonia. Multivariate analysis revealed that sarcopenia (P &lt; 0.001) and longer operation time (P = 0.0354) were independent predictors of postoperative pneumonia. Conclusion Preoperative sarcopenia was identified as independent risk factor for postoperative pneumonia after esophagectomy. Preoperative nutrition and rehabilitation therapy may contribute to the prevention of pneumonia after surgery. Disclosure All authors have declared no conflicts of interest.

Comparative outcomes of inpatient fragility fracture intensive rehabilitation management (FIRM) after hip fracture in sarcopenic and non-sarcopenic patients: a prospective observational study.

To evaluate the effects of fragility fracture integrated rehabilitation management (FIRM) on the functional outcomes of sarcopenic and non-sarcopenic inpatients following hip fracture surgery. This prospective observational study was carried out with patients over 65years of age who underwent hip surgery for fragility hip fracture and received multidisciplinary rehabilitation. Sarcopenia was defined according to the Asian Working Group for Sarcopenia criteria. Demographic and functional characteristics were analyzed before and after rehabilitation during inpatient care to evaluate short-term outcomes. Sixty-eight patients were eligible for the study, and 32 (47.1%) satisfied the criteria for sarcopenia. The pre-fracture ambulatory status was lower in the sarcopenia group (KOVAL: 1.74 ± 1.42 vs. 1.22 ± 0.42, p = 0.022). The overall functional levels were significantly lower in the sarcopenia group before and after rehabilitation. Overall function was significantly improved in both groups after FIRM, and with the exception of Korean Instrumental Activities of Daily Living scores, there were no differences between the groups in the changes after FIRM. Pre-fracture independent ambulatory function was significantly correlated with short-term ambulatory functional recovery in both sarcopenia and non-sarcopenia groups [n = 22 (91.7%), p = 0.023 vs. n = 27 (84.4%), p = 0.028]. Our results suggest that FIRM was effective for short-term functional recovery in older patients with or without sarcopenia who have suffered fragility hip fracture. Considering sarcopenia, which has a detrimental effect on functional outcomes after rehabilitation, the impact of sarcopenia on FIRM should be investigated further over a longer period of time.

Decreased serum fatty acid binding protein 4 concentrations are associated with sarcopenia in chronic hemodialysis patients

BackgroundFatty acid binding protein 4 (FABP4) is found to play a role in skeletal muscle homeostasis. Since the dysregulation of FABP4 and sarcopenia are both highly prevalent in patients on chronic hemodialysis (HD), the correlation between them remains unknown. We aimed to examine this relationship in a cross-sectional study. MethodsA total of 120 chronic HD patients were recruited, and whose skeletal muscle mass, handgrip strength, and gait speed were assessed and blood samples were obtained. We grouped these participants into sarcopenia (n = 20) and non-sarcopenia groups according to European Working Group on Sarcopenia in Older People criteria. ResultsThe sarcopenia group exhibited lower weight (P < 0.001), height (P = 0.019), waist circumference (P < 0.001), body mass index (P < 0.001), body fat mass (P = 0.004), and lower serum triglycerides (P = 0.009), creatinine (P < 0.001), phosphorus (P = 0.013), intact parathyroid hormone (P = 0.012), and FABP4 concentrations (P = 0.005), and higher malnutrition–inflammation scores (MIS) (P = 0.031), urea reduction rates (P < 0.001), and fractional clearance index for urea (Kt/V) values (P < 0.001). Serum FABP4 concentrations (odds ratio (OR): 0.98, 95% confidence interval (CI): 0.96–0.99, P = 0.043), body fat mass (OR: 0.86, 95% CI: 0.77–0.97, P = 0.013), MIS (OR: 6.90, 95% CI: 1.31–36.36, P = 0.023), and Kt/V (each increase of 0.1, OR: 2.15, 95% CI: 1.29–3.57, P = 0.003) were independent predictors of sarcopenia in chronic HD patients. ConclusionsWe delineated the association between serum FABP4 concentrations and sarcopenia in chronic HD patients.

Sarcopenia is associated with a greater incidence of delayed gastric emptying following pancreaticoduodenectomy

Sarcopenia is the degenerative loss of skeletal muscle and has been associated with a variety of post-operative complications. We propose sarcopenia is associated with delayed gastric emptying (DGE) following elective pancreaticoduodenectomy (PD). A retrospective analysis of a computerised database maintained in real time of all patients undergoing PD within our hepatobiliary unit was performed. The cross-sectional area of the psoas muscle at the upper border of L3 was calculated and corrected for patient height. The lowest quartile of gender specific groups was considered to be sarcopenic. 61 patients were included, 32 male and 29 female of whom 8 from each group were sarcopenic (26.2%). Although the sarcopenic and non-sarcopenia groups were found to be comparable, significantly more sarcopenic patients were older (75 vs 64 years, p=0.003), had a lower body mass index (21.9 vs 25.0kg/m2, p=0.003) and suffered from DGE (7/16 vs 8/45, p=0.045). On multivariate analysis, these variables maintained their significance with DGE having an OR of 6.042 (p=0.036). Sarcopenia is significantly associated with DGE, older age and lower BMI in this specific cohort of patients. Further research into the reversibility of this phenomenon is warranted.

No Deterioration in Clinical Outcomes of Carbon Ion Radiotherapy for Sarcopenia Patients with Hepatocellular Carcinoma.

The relationship between sarcopenia and prognosis in carbon ion radiotherapy (C-ion RT) for hepatocellular carcinoma (HCC) has not yet been reported, therefore we analyzed the presence or absence of sarcopenia before C-ion RT as a prognostic factor for patients with HCC. Data were retrospectively collected for patients who had undergone C-ion RT for HCC between September 2010 and December 2016. For defining the presence or absence of sarcopenia, skeletal muscles in the third lumbar vertebrae level were measured. Clinical outcomes were compared in the sarcopenia and non-sarcopenia groups. Of the 68 patients who were analyzed, 22 were classified into the sarcopenia and 46 into the non-sarcopenia groups. Median follow-up of patients was 33.5 months. The three-year overall survival (OS) rates in the sarcopenia and non-sarcopenia groups were 66% and 77%, respectively (p=0.51). Sarcopenia was not a prognostic factor for patients with HCC treated with C-ion RT, which was effective in HCC patients with sarcopenia without worsening the OS.