Preoperative Skeletal Muscle Index Research Articles

Preoperative low skeletal muscle mass index assessed using L3-CT as a prognostic marker of clinical outcomes in pancreatic cancer patients undergoing surgery: A systematic review and meta-analysis.

Reduction in muscle mass can be routinely quantified using computed tomography (CT) of the third lumbar vertebra (L3) during a curative pancreatic cancer (PC) course. This systematic review and meta-analysis aimed to assess the association between preoperative low skeletal muscle index (SMI) measured by L3 CT and postoperative clinical outcomes in PC resectable patients. Three electronic databases (PubMed, Web of Science, and Scopus) were searched for articles published through May 2023. Duplicate titles and abstracts, full-text screening, and data extraction were performed. A meta-analysis was performed for overall survival (OS), recurrence-free survival (RFS), postoperative pancreatic fistula (POPF), morbidity, and postoperative length of stay (P-LOS). The risk of bias was assessed. A total of 2942 patients with PC from 11 studies were identified. Preoperative low SMI was found in 50.9% of PC resectable patients. Preoperative low SMI was significantly associated with adjusted OS (adjusted HR, 1.52; 95% CI 1.25-1.86, P< 0.0001). No significant associations were found between preoperative low SMI and RFS, number of POPF, significant morbidity, and P-LOS (P>0.05). SMI should be evaluated in a timely manner as a predictor of OS in PC resectable patients. Studies assessing nutritional protocols for maintaining/increasing skeletal muscle mass are required to develop a personalized nutritional approach to improve clinical outcomes.

Preoperative low skeletal muscle volume can result in insufficient administration of S-1 adjuvant chemotherapy in older patients with stage II/III gastric cancer.

Older patients are more likely to encounter difficulties receiving chemotherapy, but the factors involved in the continuation of chemotherapy in these patients remain unclear. We investigated the importance of muscle mass as a factor involved in delivering a sufficient dose of postoperative S-1 adjuvant chemotherapy (ACT) to older patients with gastric cancer. The subjects of this study were 79 patients aged ≥ 65years with stage II/III gastric adenocarcinoma, who underwent curative gastrectomy and received S-1 ACT. The overall median relative dose intensity (RDI) was 75.0% (18.8-93.5%). Patients were divided into two groups for receiver operating characteristic analysis according to the cutoff value. Significantly more patients in the high skeletal muscle index (SMI) group achieved > 62% RDI of S-1 ACT (p = 0.03). Conversely, more patients in the low SMI group suffered from S-1-induced nausea (p = 0.03) and discontinued chemotherapy because of adverse events (p = 0.02). Multivariate analysis identified low SMI as an independent factor for insufficient S-1 dose delivery (p = 0.03, hazard ratio = 2.87). Preoperative SMI is an indicator of the low-dose intensity of S-1 ACT in older patients following curative gastrectomy.

Impact of Skeletal Muscle Mass Reduction on Long-term Survival After Radical Resection of Gastric Cancer.

This study aimed to investigate the effect of preoperative skeletal muscle mass and muscle mass loss after surgery on overall survival in patients with gastric cancer who underwent radical resection. We also examined factors involved in postoperative skeletal muscle loss. One hundred fifty gastric cancer patients who underwent radical resection were retrospectively examined. Skeletal muscle index (SMI) was measured using computed tomography before surgery and 1 year after. Degree of muscle reduction (MR) was calculated. Patients were stratified according to preoperative SMI (high/low) and MR (high/low) for analysis. In addition, patients were grouped according to SMI and MR stratification as follows: group A, low SMI/high MR; group B, low SMI/low MR; group C, high SMI/high MR; and group D, high SMI/low MR. In multivariate analysis, preoperative SMI and MR were independent predictors of overall survival. Overall survival significantly differed among groups A, B, C, and D (p<0.0001). The list of groups in order of worsening overall survival was as follows: group D, group C, group B, and group A. In multivariate analysis, patient group according to SMI and MR stratification was an independent predictor of overall survival. MR was affected by operation time (>430 min) and surgical procedure (total gastrectomy). Preoperative SMI and reduction in skeletal muscle mass after gastric cancer surgery were significantly associated with overall survival. Long-term management of these patients should focus on maintenance of postoperative skeletal muscle mass.

Cachexia index as a prognostic predictor after resection of pancreatic ductal adenocarcinoma

AbstractAimThis study was performed to investigate the relationship between the preoperative cachexia index (CXI) and long‐term outcomes in patients who have undergone radical resection of pancreatic ductal adenocarcinoma (PDAC).MethodsIn total, 144 patients who underwent pancreatic resection for treatment of PDAC were retrospectively analyzed. The relationship between the CXI and the patients' long‐term outcomes after PDAC resection was investigated. The CXI was calculated based on the preoperative skeletal muscle index, serum albumin level, and neutrophil‐to‐lymphocyte ratio. After propensity‐score matching, we compared clinicopathological features and outcomes.ResultsThe multivariate analysis showed that lymph node metastasis (hazard ratio [HR], 1.93; 95% confidence interval [CI], 1.16–3.23; P = 0.0118), R1 resection (HR, 57.20; 95% CI, 9.39–348.30; P &lt; 0.0001), and a low CXI (HR, 2.10; 95% CI, 1.27–3.46; P = 0.0038) were independent and significant predictors of disease‐free survival (DFS) after PDAC resection. Moreover, a low CXI (HR, 3.14; 95% CI, 1.71–5.75; P = 0.0002) was an independent and significant predictor of overall survival (OS) after PDAC resection. After propensity‐score matching, the low CXI group had a significantly worse prognosis than the high CXI group for both DFS and OS.ConclusionThe CXI can be a useful prognostic factor for DFS and OS after pancreatic resection for treatment of PDAC.

MP65-16 AI DRIVEN ASSESSMENT OF BODY COMPOSITION PARAMETERS IN RADICAL CYSTECTOMY PATIENTS: PREDICTORS OF 90-DAY COMPLICATIONS

You have accessJournal of UrologyCME1 Apr 2023MP65-16 AI DRIVEN ASSESSMENT OF BODY COMPOSITION PARAMETERS IN RADICAL CYSTECTOMY PATIENTS: PREDICTORS OF 90-DAY COMPLICATIONS Anthony Fadel, Vidit Sharma, Matthew K. Tollefson, Daniel J. Blezek, Robert F. Tarrell, Prabin Thapa, Lyndsay D. Viers, Aaron M. Potretzke, Stephen A. Boorjian, Igor Frank, Robert P. Hartman, and Boyd R. Viers Anthony FadelAnthony Fadel More articles by this author , Vidit SharmaVidit Sharma More articles by this author , Matthew K. TollefsonMatthew K. Tollefson More articles by this author , Daniel J. BlezekDaniel J. Blezek More articles by this author , Robert F. TarrellRobert F. Tarrell More articles by this author , Prabin ThapaPrabin Thapa More articles by this author , Lyndsay D. ViersLyndsay D. Viers More articles by this author , Aaron M. PotretzkeAaron M. Potretzke More articles by this author , Stephen A. BoorjianStephen A. Boorjian More articles by this author , Igor FrankIgor Frank More articles by this author , Robert P. HartmanRobert P. Hartman More articles by this author , and Boyd R. ViersBoyd R. Viers More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003323.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Sarcopenia is associated with increased mortality after radical cystectomy (RCx). Traditional imaging techniques used to assess sarcopenia are time consuming and labor intensive. Herein we demonstrate the utility of an AI algorithm with deep learning to analyze CT scans and produce body composition parameters in a time-efficient manner. This allows for outcome prediction and correlation of body measures to post-RCx complications. METHODS: Perioperative CT images for 843 RCx patients from 2009-2017 were collected from our institution. An AI algorithm was developed to extract muscle and adipose tissue parameters from 2D axial images at the L3 level. The following areas were segmented: skeletal muscle (SM), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT). Skeletal muscle index (SMI) and fat mass index (FMI) were then calculated. All measures were correlated with post-RCx complications using multivariable logistic regression analysis. RESULTS: There was significant variation in pre-operative body composition (Figure 1). An FMI>208 was associated with significantly more wound complications (40% vs 19%, p<.001) while an FMI>260 was associated with more infectious complications (38% vs 21%, p=.003). After adjusting for patient characteristics, these associations of FMI were maintained on multivariable analysis for more infectious (Odds ratio (OR) 1.004, p=.002) and wound (OR 1.006, p<.001) complications. When examining the components of FMI, SAT was independently associated with more wound complications (OR 1.003, p=.006) whereas VAT was independently associated with increased odds of 90-day infectious complications (OR 1.002, p=.011). Similarly, an SMI<42 was associated with major complications (28% vs 17%, p=.002), and on multivariable analysis higher pre-operative SMI was associated with lower odds of major complications (OR 0.972, p=.008). CONCLUSIONS: An AI algorithm was successfully able to segment body composition areas of adipose and skeletal muscle tissues. Sarcopenia assessment using this AI technology is now clinically feasible. Changes in body parameters corresponded with changes in body indices and were predictive of wound, infectious, and major complications. Source of Funding: None. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e897 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anthony Fadel More articles by this author Vidit Sharma More articles by this author Matthew K. Tollefson More articles by this author Daniel J. Blezek More articles by this author Robert F. Tarrell More articles by this author Prabin Thapa More articles by this author Lyndsay D. Viers More articles by this author Aaron M. Potretzke More articles by this author Stephen A. Boorjian More articles by this author Igor Frank More articles by this author Robert P. Hartman More articles by this author Boyd R. Viers More articles by this author Expand All Advertisement PDF downloadLoading ...

Albumin–Globulin Score Combined with Skeletal Muscle Index as a Novel Prognostic Marker for Hepatocellular Carcinoma Patients Undergoing Liver Transplantation

Sarcopenia was recently identified as a poor prognostic factor in patients with malignant tumors. The present study investigated the effect of the preoperative albumin-globulin score (AGS), skeletal muscle index (SMI), and combination of AGS and SMI (CAS) on short- and long-term survival outcomes following deceased donor liver transplantation (DDLT) for hepatocellular carcinoma (HCC) and aimed to identify prognostic factors. A total of 221 consecutive patients who underwent DDLT for HCC were enrolled in this retrospective study between January 2015 and December 2019. The skeletal muscle cross-sectional area was measured by CT (computed tomography). Clinical cutoffs of albumin (ALB), globulin (GLB), and sarcopenia were defined by receiver operating curve (ROC). The effects of the AGS, SMI, and CAS grade on the preoperative characteristics and long-term outcomes of the included patients were analyzed. Patients who had low AGS and high SMI were associated with better overall survival (OS) and recurrence-free survival (RFS), shorter intensive care unit (ICU) stay, and fewer postoperative complications (grade ≥ 3, Clavien-Dindo classification). Stratified by CAS grade, 46 (20.8%) patients in grade 1 were associated with the best postoperative prognosis, whereas 79 (35.7%) patients in grade 3 were linked to the worst OS and RFS. The CAS grade showed promising accuracy in predicting the OS and RFS of HCC patients [areas under the curve (AUCs) were 0.710 and 0.700, respectively]. Male recipient, Child-Pugh C, model for end-stage liver disease (MELD) score > 20, and elevated CAS grade were identified as independent risk factors for OS and RFS of HCC patients after DDLT. CAS grade, a novel prognostic index combining preoperative AGS and SMI, was closely related to postoperative short-term and long-term outcomes for HCC patients who underwent DDLT. Graft allocation and clinical decision making may be referred to CAS grade evaluation.

Usefulness of the skeletal muscle index in postoperative ileus of colorectal cancer patients: a retrospective cohort study

BackgroundPostoperative complications of colorectal cancer mainly include infections (surgical site infection, remote infection, etc.), post-operative ileus (POI), and anastomosis leakage. POI reportedly prolongs the hospital stay and increases medical costs. Therefore, predicting POI is very important. There have been some reports on the relationships between sarcopenia and postoperative complications in colorectal cancer patients, but none have been limited to POI. We therefore conducted a retrospective clinical study with a logistic regression analysis to confirm the risk factors for ileus after colorectal cancer surgery.MethodsWe retrospectively analyzed 213 patients who underwent elective oncological colorectal surgery for colorectal cancer from November 2017 to July 2021. The skeletal muscle mass (SMM, kg) was estimated using a whole-body bioelectrical impedance analysis (BIA), and the skeletal muscle index (SMI) was calculated as the SMM/height2. We divided all patients into 2 groups based on a low SMI (male < 8.958 kg/m2, female < 8.443 kg/m2) or normal SMI. Preoperative and intraoperative factors as well as, postoperative outcomes were then compared between the two groups.ResultsThe median (range) age of the 213 included patients was 72.0 (33–91) years old. Complications were noted in 96 patients (45.1%), including 21 (9.9%) with POI. There were 68 (31.9%) low SMI patients. POI occurred significantly more frequently in low SMI patients (19.1%) than in normal SMI patients (5.5%) (p = 0.005). In the multivariate analysis, bleeding (p = 0.039) and a low SMI (p = 0.031) were significantly associated with POI. In addition, a propensity score matching analysis was performed to further reduce the selection bias. As a result, a low SMI was the only independent POI predictor among the 78 matched cases.ConclusionA preoperative low SMI in colorectal cancer patients was considered a risk factor for POI.

Low preoperative skeletal muscle index increases the risk of mortality among resectable pancreatic cancer patients: A retrospective study.

The only potential curative treatment for patients with pancreatic cancer is surgery; however, the prognosis remains poor. Measures of body composition based on computed tomography (CT) have been established as a reliable predictor of the prognosis of cancer patients after surgery. To elucidate the associations of body composition measures derived from preoperative CT scans with the prognosis of patients with pancreatic cancer. One hundred fifteen patients undergoing pancreatic resection with curative intent for pancreatic cancer were retrospectively enrolled. A preoperative CT scan at the third lumbar vertebral level was performed to measure the skeletal muscle index (SMI), mean skeletal muscle radiodensity, subcutaneous adipose tissue index, and visceral to subcutaneous adipose tissue area ratio. The clinical and pathological data were collected. The effects of these factors on long-term survival were evaluated. Among the five body composition measures, only low SMI independently predicted overall survival (OS) [hazard ratio (HR): 2.307; 95% confidence interval (CI): 1.210-4.402] and recurrence-free survival (HR: 1.907; 95%CI: 1.147-3.171). Furthermore, patients with low SMI (vs high SMI) were older (68.8 ± 9.3 years vs 63.3 ± 8.4 years); low SMI was present in 27 of 56 patients (48.2%) aged 65 years and older and in 11 of 59 younger patients (18.6%). In addition, subgroup analyses revealed that the correlation between low SMI and OS was observed only in patients aged 65 years and older. Low preoperative SMI was more prevalent in elderly patients and was associated with a poor prognosis among pancreatic cancer patients, especially elderly patients.

Significance of preoperative evaluation of skeletal muscle index and immune-nutritional status for patients with early-stage non-small cell lung cancer.

Sarcopenia involves several mechanisms, including age-related changes, nutritional deficiencies, and inflammation, and is associated with unfavorable clinical outcomes. However, the significance of skeletal muscle index (SMI) and immune-nutritional status for patients with early-stage non-small cell lung cancer (NSCLC) remains unclear. This retrospective study was performed to investigate associations between preoperative SMI based on computed tomography (CT) at the L1 level and immune-nutritional status, and whether these factors correlated with surgical outcomes. We retrospectively investigated 386 patients with stage I-II NSCLC who underwent curative anatomical pulmonary resection. SMI was assessed on CT at the L1 level and patients were divided into low-SMI (n = 97) and high-SMI (n = 289) groups. We examined the significance of SMI for postoperative outcomes and evaluated correlations between SMI and clinical characteristics, including immune-nutritional status. Low SMI was significantly associated with body mass index and geriatric nutritional risk index. Five-year overall survival rate was significantly lower in the low-SMI group (66.0%) than in the high-SMI group (82.2%, P = 0.004). Multivariate analysis revealed SMI (hazard ratio [HR] 1.850; 95% confidence interval [CI] 1.091-3.135; P = 0.022) and prognostic nutritional index (PNI) (HR 2.031; 95% CI 1.231-3.352; P = 0.006) as independent predictors of overall survival. Low SMI correlated significantly with postoperative complications (P = 0.024). Low preoperative SMI based on CT at the L1 level appears associated with poor prognosis and postoperative complications among patients with early-stage NSCLC. PNI is also an independent prognostic factor for surgical outcomes.

Preoperative skeletal muscle index is associated with early remnant liver regeneration in living donors after right hemihepatectomy for liver transplantation

Preoperative skeletal muscle index is associated with early remnant liver regeneration in living donors after right hemihepatectomy for liver transplantation

Impact of the preoperative skeletal muscle index on early remnant liver regeneration in living donors after liver transplantation.

We investigated the correlation between the preoperative skeletal muscle index (SMI) and remnant liver regeneration after right hemihepatectomy for living-donor liver transplantation and aimed to identify preoperative predictors of greater early remnant liver regeneration in living donors. This retrospective study included 525 right hemiliver donors (mean age, 28.9±8.3 years; 345 male patients) between 2017 and 2018, who underwent computed tomography before surgery and on postoperative day (POD) 7. Preoperative anthropometry, laboratory parameters, skeletal muscle area at the third lumbar vertebral level, and liver volume before and after surgery were evaluated. Correlations were analyzed using Pearson correlation coefficients, and stepwise multiple regression analysis was performed to identify independent predictors of greater remnant liver regeneration. Remnant liver regeneration volume on POD 7 was positively correlated with body mass index (BMI; r=0.280, P<0.001) and SMI (r=0.322, P<0.001), and negatively correlated with age (r=-0.154, P<0.001) and the ratio of future remnant liver volume (FRLV) to total liver volume (TLV; r=-0.261, P<0.001). Stepwise multiple regression analysis showed that high BMI (β=0.146; P=0.001) and SMI (β=0.228, P<0.001), young age (β=-0.091, P=0.025), and a low FRLV/TLV ratio (β=-0.225, P<0.001) were predictors of greater remnant liver regeneration. High SMI and BMI, young age, and a low FRLV/TLV ratio may predict greater early remnant liver regeneration in living donors after LDLT.

Significant impact of cachexia index on the outcomes after hepatic resection for colorectal liver metastases.

The purpose of this study was to investigate the relation between preoperative cachexia index (CXI) and long-term outcomes in patients with colorectal liver metastases (CRLM) after hepatic resection. In all,118 patients who underwent hepatic resection for CRLM were analyzed retrospectively. The relationship between CXI and the long-term outcomes in patients after hepatic resection was investigated. CXI was calculated based on preoperative skeletal muscle index, serum albumin level, and neutrophil-lymphocyte ratio. The multivariate analysis showed that extrahepatic lesion (hazard ratio [HR] 2.86, 95% confidence interval [CI] 1.48-5.53, P < .01) and high CXI (HR 0.44, 95% CI 0.20-0.98, P=.04) were independent and significant predictors of disease-free survival. Moreover, extrahepatic lesion (HR 2.32, 95% CI 1.03-5.22, P=.04), high CXI (HR 0.17, 95% CI 0.05-0.57, P < .01), and curability R 1 or 2 (HR 3.29, 95% CI 1.23-8.78, P=.02) were independent and significant predictors of overall survival. CXI is a useful prognostic factor for disease-free survival and overall survival after hepatic resection in CRLM patients.

Impact of preoperative skeletal muscle mass and physical performance on short-term and long-term postoperative outcomes in patients with esophageal cancer after esophagectomy.

BackgroundIn patients with esophageal cancer who undergo esophagectomy, preoperative skeletal muscle mass loss has been reported to be associated with postoperative complications and poor prognosis. However, physical performance has not been fully investigated.MethodsThis study included 363 patients who underwent esophagectomy for thoracic esophageal cancer in 2013‐2018. Preoperative skeletal muscle index (SMI) was measured with multifrequency bioelectrical impedance. Preoperative 6‐minute walk distance (6MWD) was measured as an indicator of physical performance. We investigated the association between these factors and postoperative complications or long‐term prognosis.ResultsPreoperative SMI was not associated with the occurrence of postoperative complications (33% vs 35%, P = .820), but low preoperative 6MWD was significantly associated with the occurrence of postoperative complications rather than high 6MWD (60% vs 30%, P < .001), especially pulmonary complications (23% vs 8%, P = .001). In the analysis of long‐term prognosis, low preoperative SMI was associated with poor survival (Hazard ratio [HR] 1.77, P = .004). Low preoperative 6MWD was also associated with poor survival (HR 2.55, P < .001). Multivariate prognostic analysis showed that pT stage (HR 1.97, P = .001), pN stage (HR 3.27, P < .001), and 6MWD (HR 1.93, P = .008) were independent prognostic factors. In the low 6MWD group, the rate of death from other diseases was significantly higher than the other groups.ConclusionsIt is useful to evaluate 6MWD as a physical performance in addition to SMI when evaluating sarcopenia from the perspective of predicting postoperative complications and long‐term prognosis in patients with esophageal cancer undergoing esophagectomy.

Prognostic significance of surgery-induced sarcopenia in the survival of gastric cancer patients: a sex-specific analysis.

BackgroundPreoperative sarcopenia is associated with a poor long‐term prognosis in patients with gastric cancer (GC). Most GC patients rapidly lose muscle mass after gastrectomy. This retrospective cohort study analysed the effect of postoperative muscle loss and surgery‐induced sarcopenia on the long‐term outcomes of patients with GC.MethodsPreoperative and postoperative 1 year abdominal computed tomography scans were available for 1801 GC patients who underwent curative gastrectomy between January 2009 and December 2013 at Seoul National University Bundang Hospital. The patients were categorized into normal, presarcopenia, and sarcopenia groups according to the skeletal muscle index (SMI) measured on computed tomography scans. Patients who were not sarcopenic prior to gastrectomy but became sarcopenic after surgery were defined as the surgery‐induced sarcopenia group.ResultsThere were 1227 men and 574 women included in the study. The mean age of the patients was 59.5 ± 12.3 years. Multivariable Cox‐regression analyses showed that preoperative SMI was not associated with overall survival (OS). However, postoperative sarcopenia was associated with significantly worse OS only in men [hazard ratio (HR), 1.75; 95% confidence interval (CI), 1.08–2.85]. SMI loss was an independent risk factor for OS in the entire cohort and in men (HR, 1.01; 95% CI, 1.00–1.02, for the entire cohort; HR, 1.02; 95% CI, 1.01–1.04, for men). The surgery‐induced sarcopenia group was associated with significantly higher mortality (HR, 1.84; 95% CI, 1.16–2.90, for the cohort; HR, 2.73; 95% CI, 1.54–4.82, for men), although SMI loss and surgery‐induced sarcopenia were not risk factors in women. Similar results were obtained for relapse‐free survival.ConclusionsPostoperative muscle mass loss and surgery‐induced sarcopenia are prognostic factors for survival in patients with GC. Impact of postoperative muscle mass loss and surgery‐induced sarcopenia on survival outcomes is dependent on the sex.

Combination of albumin-globulin score and skeletal muscle index predicts long-term outcomes of intrahepatic cholangiocarcinoma patients after curative resection

Sarcopenia is characterized by loss of skeletal muscle mass and associated with poor postoperative outcomes. This study aimed to investigate the prognostic value of preoperative albumin-globulin score (AGS), skeletal muscle index (SMI) as well as their combination in patients with intrahepatic cholangiocarcinoma (ICC) treated with surgical resection. A total of 613 newly diagnosed ICC patients from two centers were retrospectively analyzed (460 in discovery cohort and 153 in validation cohort). The plain computed tomography images were used to measure SMI. The effect of AGS, SMI and CAS grade on clinicopathological characteristics and long-term outcomes of patients with ICC were analyzed. The SMI was significantly greater in males than in females. Patients with decreased AGS, increased SMI were associated with improved overall survival (OS) and recurrence-free survival (RFS). Stratefied by CAS grade, 68 (14.8%) patients in grade 1 were associated with increased body mass index (BMI) and best postoperative prognosis, whereas 194 (42.1%) patients in grade 3 were linked to worst OS and RFS. The CAS grade showed a promising accuracy in predicting OS and RFS of ICC patients (area under curves [AUCs] were 0.732 and 0.768). Multiple tumors, MVI and elevated CAS grades were identified as independent risk factors for OS and RFS of ICC patients. These results were confirmed by validation cohort. The present study provided compelling evidence that a novel index based on combination of preoperative AGS and SMI was closely related to postoperative long-term outcomes for surgically treated ICC patients. Preoperative evaluation of CAS grade may be useful for risk classification and clinical therapeutic decision-making for ICC patients.

Sarcopenia and modified Glasgow Prognostic Score predict postsurgical outcomes in localized renal cell carcinoma.

Body composition and inflammation are gaining importance for prognostication in cancer. This study investigated the individual and combined utility of the preoperative skeletal muscle index (SMI) and the modified Glasgow Prognostic Score (mGPS) for estimating postoperative outcomes in patients with localized renal cell carcinoma (RCC) undergoing nephrectomy. The authors performed a retrospective review of 352 patients with localized RCC. SMI was measured via computed tomography or magnetic resonance imaging. Patients met the criteria for sarcopenia by body mass index- and sex-stratified thresholds. Multivariable and Kaplan-Meier analyses of associations of sarcopenia and mGPS with overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS) were performed. Variables were analyzed independently and combined into risk groups: low risk (nonsarcopenic, low mGPS), medium risk (sarcopenia only), medium risk (inflammation only), and high risk (sarcopenic, high mGPS). Receiver operating characteristic (ROC) curves were used to analyze risk groups in comparison with the Stage, Size, Grade, and Necrosis (SSIGN) score and the modified International Metastatic RCC Database Consortium (IMDC) score. The majority of the patients were at stage pT3 (63%), 39.5% of the patients were sarcopenic, and 19.3% had an elevated mGPS at the baseline. The median follow-up time was 30.4 months. Sarcopenia and mGPS were independently associated with worse OS (hazard ratio for sarcopenia, 1.64; P = .006; hazard ratio for mGPS, 1.72; P = .012), CSS, and RFS. Risk groups had an increasing association with worse RFS (P = .015) and CSS (P = .004) but not OS (P = .087). ROC analyses demonstrated a higher area under the curve for risk groups in comparison with the SSIGN and IMDC scores at 5 years. Sarcopenia and an elevated mGPS were associated with worse clinical outcomes in this study of patients with localized RCC. This has implications for preoperative prognostication and treatment decision-making. Kidney cancer is a disease with a wide variety of outcomes. Among patients undergoing surgical removal of the kidney for cancer that has not spread beyond the kidney, many are cured, but some experience recurrence. Physicians are seeking ways to better predict who is at risk for recurrence or death from kidney cancer. This study has evaluated body composition and markers of inflammation before surgery to predict the risk of recurrence or death after surgery. Specifically, low muscle mass and an elevated inflammation score (the modified Glasgow Prognostic Score) have been associated with an increased likelihood of recurrence of kidney cancer and death.

Preoperative skeletal muscle index and visceral-to-subcutaneous fat area ratio are associated with long-term outcomes of elderly gastric cancer patients after gastrectomy.

Sarcopenia is a risk factor of severe surgical complications, short-term outcomes, and long-term outcomes for patients with gastric cancer. Several computed tomography (CT) measurements have been performed to diagnose sarcopenia. However, the optimal CT measurements for determining long-term outcomes have not been revealed. A retrospective review of gastric cancer patients with clinical stage I, II, or III who underwent gastrectomy at age 75 years or more at Shizuoka General Hospital from 2007 to 2015 was performed. Using preoperative CT, skeletal muscle index (SMI), total psoas area, intramuscular adipose tissue content in multifidus muscle, morphologic change of psoas muscle, and visceral-to-subcutaneous adipose tissue area ratio (VSR) were measured in the third lumbar section. A Cox regression analysis was used to explore prognostic factors for overall survival. A total of 257 patients were reviewed. There were 171, 53, and 33 patients with clinical stages I, II, and III, respectively. A multivariate analysis indicated that, in addition to age, performance status, clinical stage, and types of resection, which are known prognostic factors, SMI and VSR are prognostic factors (p = 0.016, 0.046, respectively). The prognostic score, which was the frequency of positive SMI and VSR values within the cutoff, also indicates overall survival. The five-year OS rates of patients with prognostic scores of 0, 1, and 2 were 90.9%, 62.3%, and 52%, respectively (p < 0.001). Preoperative SMI and VSR were prognostic factors for the overall survival of elderly patients with gastric cancer after gastrectomy.

Skeletal muscle depletion and nutrition support affected postoperative complications in patients who underwent pancreatoduodenectomy.

Body composition has been shown closely related to the outcome in surgical patients. The aim of the present study was to investigate whether preoperative skeletal muscle condition and postoperative nutrition would affect major complications in patients underwent pancreaticoduodenectomy (PD). This retrospective study included 265 patients underwent PD. Body composition data was extracted from the L3 level of the preoperative CT scan. Univariable and multivariable regression analyses were performed to investigate correlations between body composition data and postoperative complications. Furthermore, a subgroup analysis was conducted to explore the relationship between postoperative nutrition strategy and the outcome. Of all the 265 patients, major complications occurred in 81 patients (30.6%). Cutoff values for skeletal muscle depletion were defined by ROC curve analysis from postoperative complications in skeletal muscle index (SMI) (male 47.32 cm2/m2 and female 40.65 cm2/m2). Univariable analysis and multivariable regression revealed age (OR 1.49, 95% CI 1.22-1.83, p = 0.026), SMI (OR 0.77, 95% CI 0.51-0.94, p = 0.015) and skeletal muscle density (SMD) (OR 0.85, 95% CI 0.64-1.03, p = 0.029) were independent predictors for major complications. Subgroup analysis showed the initial parenteral nutrition time (IPNT) (OR 1.89, 95% CI 1.43-2.49, p = 0.032) and average protein delivery (APD) (OR 0.76, 95% CI 0.53-0.89, p = 0.021) were significantly associated with major complications in patients with lower SMI. Preoperative skeletal muscle index and density were independently associated with major complications in patients underwent PD. In patients with lower SMI, early parenteral nutrition and higher protein delivery were related to better outcome.

Body composition among patients undergoing surgery for colorectal cancer.

IntroductionNutritional status assessment is an important part of preoperative patient evaluation, but the standard anthropometric parameters do not appear to be adequate.AimTo determine the changes in the values of bioelectrical impedance analysis (BIA) parameters in patients 3 months after undergoing surgery for colorectal cancer (CRC).Material and methodsBIA and nutritional status assessment parameters were determined in 80 patients prior to undergoing surgery for CRC. The results 3 months after surgery for 64 of those patients were then compared with their initial assessments.ResultsAccording to standard WHO ranges, 54% of the patients were diagnosed as being overweight and 29% as obese. The percentage of patients categorized as obese amounted to 56% when this was defined as high fat mass. Moderate sarcopaenia, defined as a low skeletal muscle index (SMI) or low percentage of skeletal muscle mass, was diagnosed in 21% and 29% of patients, respectively. Patients with postoperative weakness that made it impossible for them to attend the control visit had a lower preoperative skeletal muscle mass (p = 0.01) and SMI value (p = 0.001). Parameters of BIA did not discriminate patients with postoperative complications, which occurred in 23% of individuals enrolled.ConclusionsA significant proportion of the patients undergoing surgery for CRC were overweight or obese, which could mask the sarcopaenia that presented in 21–29% of them. Sarcopaenia was the only parameter predictive of a postoperative decrease in performance status.

Influence on the Kinetic Growth Rate after PVE and ALPPS

Purpose: "Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy" (ALPPS) and "Portal Vein Embolization" (PVE) have an important role in the treatment of malignant liver tumors. Both procedures induce rapid and effective hypertrophy of the future liver remnant (FLR) to prevent postoperative liver failure. The aim of this study is to determine impact factors on the kinetic growth rate (KGR) and subsequently FLR, in terms of complications, posthepatectomy liver failure (PHLF) and survival. Method: Patients undergoing ALPPS and PVE from 2010 until 2020 were included. KGR was defined as the quotient of hypertrophy and the time interval in weeks between intervention (PVE/ALPPS step 1) and resection. Results: Overall, 90 patients underwent ALPPS and 82 patients received PVE. The association between KGR and PHLF indicates a significant nonlinear effect in PVE (p=0.009) and ALPPS (p=0.05). For ALPPS, the incidence of PHLF significantly decreased from 30% to 8% (p=0,032) at cutoff value of KGR of >7 %/week. Patients with a KGR of >7%/week had a higher preoperative skeletal muscle index (p=0,029), but the same body mass index (p=0,301). Tumor anemia showed an association with a reduction of KGR (p=0,159). However, the KGR had no effect on postoperative morbidity, mortality, and long-term survival. For patients undergoing PVE, no valuable cutoff value for KGR could be calculated for a reduction of PHLF. Furthermore, the KGR was not influenced by preoperative metabolic or laboratory values. Conclusion: A KGR >7%/week showed a reduction of PHLF after ALPPS, but did not influence the morbidity and mortality. Skeletal muscle index and tumor anemia could be adjustable preoperative parameters to improve the KGR for patients undergoing ALPPS. For PVE, the KGR seems to be stable and no influencing factors could be found.