Skeletal Muscle Area Research Articles

MP22-04 MAINTENANCE OF SKELETAL MUSCLES WHEN RECEIVING NEOADJUVANT CHEMOTHERAPY IMPROVES THE PROGNOSIS FOR PATIENTS WITH MUSCLE INVASIVE BLADDER CANCER

You have accessJournal of UrologyCME1 Apr 2023MP22-04 MAINTENANCE OF SKELETAL MUSCLES WHEN RECEIVING NEOADJUVANT CHEMOTHERAPY IMPROVES THE PROGNOSIS FOR PATIENTS WITH MUSCLE INVASIVE BLADDER CANCER Maria Aoki, Taku Naiki, Toshiharu Morikawa, Teruki Isobe, Masakazu Gonda, Nami Tomiyama, Nagoya, Japan, Nobuhiko Shimizu, Yusuke Noda, Takashi Nagai, Rika Banno, Satoshi Nozaki, Toshiki Etani, Ryosuke Ando, Noriyasu Kawai, and Takahiro Yasui Maria AokiMaria Aoki More articles by this author , Taku NaikiTaku Naiki More articles by this author , Toshiharu MorikawaToshiharu Morikawa More articles by this author , Teruki IsobeTeruki Isobe More articles by this author , Masakazu GondaMasakazu Gonda More articles by this author , Nami TomiyamaNami Tomiyama More articles by this author , Nagoya Nagoya More articles by this author , Japan Japan More articles by this author , Nobuhiko ShimizuNobuhiko Shimizu More articles by this author , Yusuke NodaYusuke Noda More articles by this author , Takashi NagaiTakashi Nagai More articles by this author , Rika BannoRika Banno More articles by this author , Satoshi NozakiSatoshi Nozaki More articles by this author , Toshiki EtaniToshiki Etani More articles by this author , Ryosuke AndoRyosuke Ando More articles by this author , Noriyasu KawaiNoriyasu Kawai More articles by this author , and Takahiro YasuiTakahiro Yasui More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003247.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The standard treatment for muscle invasive bladder cancer (MIBC) is radical cystectomy. Recently, according to accumulated evidence with neoadjuvant chemotherapy (NAC), a growing number of patients have received mainly platinum-based treatment. Generally, intensive supportive care is essential, particularly in such patients. However, there is no established and reputable standard indicator for supportive care for chemotherapy. To date, we described how nutritional status predicted survival outcome in patients with metastatic bladder cancer treated with immuno-chemotherapy. Therefore, in this study, we retrospectively analyzed biomarkers and the occurrence of adverse events in patients in good general condition receiving NAC. METHODS: We retrospectively reviewed 75 patients with MIBC who received NAC between 2011 and 2022 at our hospitals. Skeletal muscle area at the third lumbar vertebra was measured using computed tomography images obtained from medical records, and a skeletal muscle index (SMI) was calculated. SMI alterations before and after chemotherapy were measured. Patients were divided into high and low SMI alteration groups, and their prognoses were analyzed. RESULTS: Of the 75 patients, 52 and 23 were divided into high and low SMI alteration groups. There were no significant differences in age, body mass index, pathological grade, nutritional markers or the occurrence of adverse events between the two groups. The median progression-free survival (PFS) in the high group was 48.9 months (95% confidence interval [CI]: 18.2–NA); the PFS in the low group did not reach the median. These were statistically significant (p=0.04). CONCLUSIONS: Patients who showed skeletal muscle mass in good condition when receiving NAC resulted in favorable prognostic outcomes compared to patients in worse condition. No association was found between the amount of reduction in SMI and the occurrence of adverse events. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e296 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Maria Aoki More articles by this author Taku Naiki More articles by this author Toshiharu Morikawa More articles by this author Teruki Isobe More articles by this author Masakazu Gonda More articles by this author Nami Tomiyama More articles by this author Nagoya More articles by this author Japan More articles by this author Nobuhiko Shimizu More articles by this author Yusuke Noda More articles by this author Takashi Nagai More articles by this author Rika Banno More articles by this author Satoshi Nozaki More articles by this author Toshiki Etani More articles by this author Ryosuke Ando More articles by this author Noriyasu Kawai More articles by this author Takahiro Yasui More articles by this author Expand All Advertisement PDF downloadLoading ...

Body composition and lung cancer-associated cachexia in TRACERx.

Cancer-associated cachexia (CAC) is a major contributor to morbidity and mortality in individuals with non-small cell lung cancer. Key features of CAC include alterations in body composition and body weight. Here, we explore the association between body composition and body weight with survival and delineate potential biological processes and mediators that contribute to the development of CAC. Computed tomography-based body composition analysis of 651 individuals in the TRACERx (TRAcking non-small cell lung Cancer Evolution through therapy (Rx)) study suggested that individuals in the bottom 20th percentile of the distribution of skeletal muscle or adipose tissue area at the time of lung cancer diagnosis, had significantly shorter lung cancer-specific survival and overall survival. This finding was validated in 420 individuals in the independent Boston Lung Cancer Study. Individuals classified as having developed CAC according to one or more features at relapse encompassing loss of adipose or muscle tissue, or body mass index-adjusted weight loss were found to have distinct tumor genomic and transcriptomic profiles compared with individuals who did not develop such features. Primary non-small cell lung cancers from individuals who developed CAC were characterized by enrichment of inflammatory signaling and epithelial-mesenchymal transitional pathways, and differentially expressed genes upregulated in these tumors included cancer-testis antigen MAGEA6 and matrix metalloproteinases, such as ADAMTS3. In an exploratory proteomic analysis of circulating putative mediators of cachexia performed in a subset of 110 individuals from TRACERx, a significant association between circulating GDF15 and loss of body weight, skeletal muscle and adipose tissue was identified at relapse, supporting the potential therapeutic relevance of targeting GDF15 in the management of CAC.

MP72-13 AI CHARACTERIZATION OF LONGITUDINAL CHANGES IN BODY COMPOSITION: PREDICTORS OF CHANGE AFTER RADICAL CYSTECTOMY

You have accessJournal of UrologyCME1 Apr 2023MP72-13 AI CHARACTERIZATION OF LONGITUDINAL CHANGES IN BODY COMPOSITION: PREDICTORS OF CHANGE AFTER RADICAL CYSTECTOMY 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.0000000000003340.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Long term body composition changes after radical cystectomy (RCx) are unknown. Herein, we characterize changes in body composition over one year after RCx and determine predictors of unfavorable change in radiographic nutritional indices. METHODS: CT images for 843 RCx patients from 2009-2017 were collected at baseline, 3 months, and 1 year. Artificial intelligence algorithms extracted two-dimensional axial skeletal muscle and adipose areas at the L3 level. Skeletal muscle index (SMI) and fat mass index (FMI) were calculated, and multivariable logistic regression models were performed to determine factors associated with unfavorable body composition change: absolute top tertile change in FMI and SMI. RESULTS: Muscle and fat body parameters decreased from baseline to 3 months but increased from 3 months to 1 year (Figure 1). However, the distributions of changes in SMI and FMI across these timepoints (Figure 2) show that some patients were able to maintain muscle and fat mass after surgery. In the first 3 months, increasing age and higher BMI were associated with greater loss in FMI (odds ratio (OR) < 1, p<.05); while neoadjuvant chemotherapy was associated with increased gains (OR 1.5, p=.03). After 3 months, robotic surgery was associated with greater gains in FMI (OR 1.8, p=.03). In the first 3 months, on multivariable analysis, men (OR 2.06), increasing BMI (OR 1.08), neoadjuvant chemotherapy (OR 3.98), and any 30-day complications (OR 1.79) were associated with greater loss in SMI from baseline to 3 months (p<.05 for all). After 3 months, older patients had smaller gains in SMI (p<.05), as did patients with bladder cancer recurrences (p<.05). On the contrary, patients with continent diversion were associated with greater gains in SMI (p<.05). CONCLUSIONS: Long-term changes in body composition after RCx are common, and clinically relevant predictors of unfavorable body composition change were identified indicating a catabolic state. Individualized rehabilitation interventions based on these predictors warrants further study. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1029 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 ...

The effect of biological agent on body composition in patients with Crohn’s disease

BackgroundCrohn’s disease (CD) is associated with altered body composition, affecting clinical outcomes. We evaluated the impact of biologics on body composition in CD patients.MethodsThis multicenter longitudinal study across four Korean university hospitals conducted from January 2009 to August 2021 retrospectively reviewed data of CD patients with abdominal computed tomography (CT) before and after the biologic treatment. Skeletal muscle area (SMA), visceral fat area (VFA), and subcutaneous fat area (SFA) of the third lumbar vertebra (L3) on CT were measured. Myopenia was defined as L3 skeletal muscle index (SMI) of < 49 and < 31 cm2/m2 for men and women, respectively.ResultsAmong 112 participants, 79 (70.5%) had myopenia. In the myopenia group, all body composition parameters were significantly increased after the biologic treatment: SMI (37.68 vs. 39.40 cm2/m2; P < 0.001), VFA (26.12 vs. 54.61 cm2; P < 0.001), SFA (44.29 vs. 82.42 cm2; P < 0.001), while no significant differences were observed in the non-myopenia group. In multivariate analysis, penetrating CD (hazard ratio, 5.40; P = 0.020) was the independent prognostic factor for surgery. Operation-free survival rate tended to decrease in the myopenia group (Log-rank test, P = 0.090).ConclusionsBiological agents can increase all body composition parameters in CD patients with myopenia. These patients are more likely to experience surgery.

Bioimpedance phase angle is independently associated with myosteatosis: The Shizuoka study

Phase angle (PhA) calculated from the resistance and reactance measured using a bioimpedance device was suggested to represent the degree of fat deposition in muscle (myosteatosis), though no direct evidence is available. We aimed to clarify the possible association between PhA and skeletal muscle myosteatosis in community-dwelling middle-aged to older adults. Participants consisted of 424 Japanese (aged ≥50 years). Leg PhA and skeletal muscle mass index (SMI) were obtained by bioelectrical impedance analysis. The mean attenuation values and cross-sectional area of the mid-thigh skeletal muscle were calculated from computed tomography images and considered as indexes of myosteatosis and skeletal muscle mass, respectively. Leg PhA was positively associated with SMI, and cross-sectional area and mean attenuation value at mid-thigh. Multiple regression analysis adjusted for possible covariates identified leg PhA (β=0.214) and SMI (β=0.260) as independent factors of mid-thigh muscle cross-sectional area (P<0.001), while leg PhA (β=0.349, P<0.001) but not SMI (P=0.645) was associated with mean attenuation value. Similar results were observed in the analysis in the older (≥65 years) subpopulation. The combination of low SMI and low leg PhA showed stepwise association with cross-sectional area, while only individuals with low leg PhA had lower mean attenuated value. Leg PhA was independently associated with mean attenuated value of the mid-thigh skeletal muscle, suggesting that the assessment of PhA in combination with SMI could provide additional information for the evaluation of muscle properties.

Diagnosis of Sarcopenia Using the L3 Skeletal Muscle Index Estimated From the L1 Skeletal Muscle Index on MR Images in Patients With Cirrhosis.

Cirrhotic patients with sarcopenia have poor prognoses and higher mortality. The third lumbar vertebra (L3) skeletal muscle index (SMI) is widely used to assess sarcopenia. However, L3 is generally outside the scanning volume on standard liver MRI. To investigate SMIs change between slices in cirrhotic patients and the relationships between SMI at the 12th thoracic vertebra (T12), the first lumbar vertebra (L1) and the second lumbar vertebra (L2) levels and L3-SMI and assess the accuracy of the estimated L3-SMIs in diagnosing sarcopenia. Prospective. A total of 155 cirrhotic patients (109 with sarcopenia, 67 male; 46 without sarcopenia, 18 male). A 3.0 T, 3D dual-echo T1-weighted gradient echo sequence (T1WI). Two observers analyzed T12 to L3 skeletal muscle area (SMA) in each patient based on T1W water images and calculated the SMI (SMA/height2 ). Reference standard was L3-SMI. Intraclass correlation coefficient (ICC), Pearson correlation coefficients (r), and Bland-Altman plots. Models relating L3-SMI to the SMI at T12, L1, and L2 levels were constructed using 10-fold cross-validation. Accuracy, sensitivity, and specificity were calculated for the estimated L3-SMIs for diagnosing sarcopenia. P < 0.05 was considered statistically significant. Intraobserver and interobserver ICCs were 0.998-0.999. The L3-SMA/L3-SMI were correlated with the T12 to L2 SMA/SMI (r=0.852-0.977). T12-L2 models had mean-adjusted R2 values of 0.75-0.95. The estimated L3-SMI from T12 to L2 levels to diagnose sarcopenia had good accuracy (81.4%-95.3%), sensitivity (88.1%-97.0%), and specificity (71.4%-92.9%). The recommended L1-SMI threshold of 43.24 cm2 /m2 in males and 33.73 cm2 /m2 in females. The estimated L3-SMI from T12, L1 and L2 levels had good diagnostic accuracy in assessing sarcopenia in cirrhotic patients. Although L2 was best associated with L3-SMI, L2 is generally not included in standard liver MRI. L3-SMI estimate from L1 may therefore be most clinically applicable. 1. Stage 2.

Prognostic value of sarcopenia in patients with lung cancer treated with epidermal growth factor receptor tyrosine kinase inhibitors or immune checkpoint inhibitors.

It remains controversial whether sarcopenia has any significant impact on the efficacy of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) or immune checkpoint inhibitors (ICIs) in patients with advanced non-small cell lung cancer (NSCLC). Therefore, in this study, we aimed to assess the association between sarcopenia and clinical outcomes in patients with advanced NSCLC receiving EGFR-TKIs or ICIs as a first-line therapy. We retrospectively enrolled 131 patients with advanced NSCLC treated with first-line EGFR-TKIs or ICIs between 1 March 2019 and 31 March 2021. To estimate sarcopenia, we calculated skeletal muscle index (SMI) as the ratio of skeletal muscle area (cm2) to height squared (m2). Associations between sarcopenia and overall survival (OS) and progression-free survival (PFS) were evaluated using the Kaplan-Meier method and log-rank tests, respectively. A Cox proportional hazards regression model was used to assess the factors associated with OS and PFS. The Student's t-test or Mann-Whitney U test was used to compare the SMI between patients with or without objective response and disease control. The chi-squared test was used to compare adverse events (AEs) between patients with and without sarcopenia. Among the 131 patients, 35 (26.7%) were diagnosed with sarcopenia. Sarcopenia was an independent predictor of poor OS and PFS (p < 0.05) overall and in the EGFR-TKI- and ICI-treated cohorts. Among all patients, those with sarcopenia showed significantly shorter OS and PFS than those without sarcopenia (median OS and PFS: 13.0 vs. 26.0 months and 6.4 vs. 15.1 months; both p < 0.001). These associations were consistent across the subtypes of most clinical characteristics. Statistically significant differences between the objective response (OR) and non-OR groups were also observed in the mean SMI (OR group, 43.89 ± 7.55 vs. non-OR group, 38.84 ± 7.11 cm2/m2; p < 0.001). In addition, we observed similar results with disease control (DC) and non-DC groups (DC group, 42.46 ± 7.64 vs. non-DCR group, 33.74 ± 4.31 cm2/m2; p < 0.001). The AEs did not differ significantly between the sarcopenia and non-sarcopenia groups. Sarcopenia before treatment might be a significant predictor of poor clinical outcomes (shorter OS and PFS, fewer ORs, less DC) in patients with advanced NSCLC treated with EGFR-TKIs or ICIs as the first-line therapy.

Establishment and validation of reference values for abdominal skeletal muscle compartments in children

Sarcopenia, resulting from skeletal muscle loss, is a serious concern in children, for whom nutrition and physical activity are essential for growth. In sarcopenia research, the skeletal muscle mass is often obtained from computed tomography (CT) cross-sectional images in both adults and children; however, the method of evaluating skeletal muscle using CT, especially the area range to be measured, has not yet been validated in children. The aim of this study is to establish reference values for three compartments of the abdominal skeletal muscle area (aSMA) obtained from cross-sectional CT images, and to validate the differences among them by assessing correlations with physical development. We conducted a single-centre, retrospective, cross-sectional study and included patients aged 1-17 years who underwent abdominal CT at Chiba University Hospital from 2007 to 2020. Patients with chronic diseases such as malignant tumours and inflammatory bowel disease were excluded from the analysis. aSMA was obtained from CT cross-sections at the lumbar L3-L4 intervertebral disc level by dividing it into three compartments: the psoas muscle area (PMA), paraspinal muscle area (PSMA), and total skeletal muscle area (TSMA). Quartile regression curves by sex and muscle compartment were generated using non-crossover and nonparametric regression quantile estimation. The correlation between each compartment of aSMA with height and weight was assessed using Spearman's rank correlation coefficient. We analysed the abdominal CT images of 593 children (male: n=335, female: n=258) and generated curves predictive for the 5th, 25th, 50th, 75th, and 95th percentiles for each compartment of aSMA by sex. In patients aged 13 years and older, boys had significantly larger aSMA areas than girls in all three compartments. Among the three compartments, PSMA had the strongest correlation coefficient with height and weight for both boys and girls. We generated quantile regression curves for three aSMA compartments obtained from cross-sectional CT images and established reference values in children. PSMA values were most strongly correlated with height and weight among the three aSMA compartments.

Abstract P2-03-01: Sarcopenia on baseline imaging is associated with toxicity-related discontinuation of endocrine therapy in women with early-stage hormone-positive breast cancer

Abstract Background Adjuvant endocrine therapy (ET) is standard of care in women with hormone receptor-positive (HR+) breast cancer (BC) with the goal to reduce recurrence. However, early discontinuation of ET occurs in 30-40% of women, largely attributable to toxicity, and leads to increased recurrence risk. There is considerable overlap in risk factors that predict toxicity from ET and chemotherapy, including age, co-morbidities, and geriatric conditions. Baseline low skeletal muscle area (SMA) on chest computed tomography (CT) is a surrogate marker for sarcopenia and predicts for significant toxicity and intolerance to chemotherapy in women with BC. No study has assessed the association of sarcopenia with toxicity-related discontinuation of ET in women with early-stage HR+ BC. Methods This single center retrospective cohort study included consecutive women with Stage 0-II HR+ BC who received ET and adjuvant radiotherapy (RT) from 01/2011-12/2017. Inclusion required a minimum of 5-year clinical follow-up after diagnosis. We used a validated deep learning pipeline to quantify SMA (cm2) at the tenth thoracic (T10) vertebral body on existing RT planning CT. The skeletal muscle index (SMI [cm2/m2] = SMA/(patient height (m))2) was calculated to adjust for patient height. Sarcopenia was defined as SMI&amp;lt; 32.3 cm2/m2, based on a previously validated independent cohort of young healthy women. The primary endpoint was toxicity-related discontinuation of ET less than 60 months after initiation of ET. Secondary endpoints included any NCI CTCAE v5.0 Grade 3-5 toxicity from ET and ipsilateral breast tumor recurrence. We assessed associations between ET discontinuation and SMI (continuous), as well as thoracic sarcopenia (dichotomous), using logistic regression adjusting for baseline characteristics. We used cox proportional hazards regression to assess disease-free survival (DFS), defined as ipsilateral breast tumor recurrence, locoregional recurrence, or distant metastasis adjusting for baseline and treatment characteristics. Results A total of 265 women (median age 67 years) met inclusion criteria. The majority of women had a comorbidity index of 0-1 (89%) and were Caucasian (89%). The median follow-up was 82 months, 5-year overall survival was 96% and 5-year DFS was 94%. Diagnoses included DCIS (12%), IDC (76%), or ILC (12%); most were T1 (69%) or T2 (18%) and N0 (85%), ER-positive (100%), PR-positive (85%), or HER2-negative (9%). Most common ET type was anastrozole (63%), letrozole (16%), and tamoxifen (17%). SMI (continuous) was not associated with older age, Charlson Comorbidity Index (CCI), race, or tumor stage. A total of 64 (24%) women experienced toxicity-related early discontinuation of ET. On multivariate analysis (MVA), lower SMI was associated with increased toxicity-related early discontinuation of ET (Odds Ratio [OR] 0.89 per 1 cm2/m2 SMI, p=0.001) independent of age, CCI, ET type, or receipt of adjuvant chemotherapy. Lower SMI was associated with higher risk of grade 3-5 toxicity from ET (OR 0.89 per 1 unit SMI, p=0.001) independent of age, CCI, ET type, or receipt of adjuvant chemotherapy. On MVA, sarcopenia was associated with higher risk of toxicity-related early discontinuation of ET (OR 2.43, p=0.019). DFS was associated with toxicity-related early discontinuation of ET (HR 8.06, p=0.005), grade 3 histology (HR 1.42, p=0.042), and multifocal disease (HR 2.55, p=0.040), but not age, histology, stage, or lymphovascular invasion (p&amp;gt;.05 for all). Conclusion Low baseline thoracic skeletal muscle is associated with toxicity-related early ET discontinuation in women with early-stage HR+ BC. Further studies should attempt to generalize this association to all HR+ BC who are candidates for ET. High-risk patients may be candidates for aggressive symptom management or alternative adjuvant therapies. Citation Format: Anurag Saraf, Ismail Tahir, Bonnie Hu, Anna-Sophia Dietrich, Paul Erik Tonnesen, Greg Sharp, Gayle Tillman, Florian Fintelmann, Rachel Jimenez. Sarcopenia on baseline imaging is associated with toxicity-related discontinuation of endocrine therapy in women with early-stage hormone-positive breast cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-03-01.

Abstract P3-05-52: Sarcopenia and Post-Mastectomy Breast Reconstruction Outcomes after Radiation Therapy

Abstract Background: Sarcopenia, characterized by the loss of muscle mass, has emerged as a negative prognostic factor in cancer patients. It has been associated with poorer outcomes and increased treatment-related morbidity. Post-mastectomy breast radiation therapy (RT) increases the likelihood of reconstructive complication, with up to 20% of reconstructed women requiring implant removal. The factors that lead to these complications are poorly understood and likely multifaceted. We investigated the relationship between pre-radiation therapy sarcopenia and post-mastectomy reconstruction outcomes. Methods: Chart review was performed to determine demographic, medical, and treatment variables, including reconstruction complication events and failures in breasts treated with mastectomy, immediate reconstruction, and RT. Reconstruction failure was defined as tissue expander or implant removal, resulting in no final reconstruction or autologous reconstruction only. Reconstruction complications included surgical site infection, late infection (1 year post-RT), seroma development, flap necrosis, nipple necrosis, wound dehiscence, capsular contracture, hematoma, extrusion, leak, venous congestion, and unplanned reoperation. An axial slice at the L2 or L3 vertebral body from the radiation therapy planning CT scan was analyzed for skeletal muscle area using a previously validated algorithm, with manual review and adjustment as indicated. Sarcopenia was defined by skeletal muscle index (SMI, skeletal muscle area in cm2 divided by patient’s height squared) below 34.4 cm2/m2. Chi-square, Kaplan Meier, and univariate Cox regression tests were used for analysis. Results: Ninety-nine women with breast cancer who underwent mastectomy, reconstruction, and RT were included in this study. All women had immediate reconstruction: 93 women had tissue expander placement while six women had permanent implant placement. Mean age was 47.5 years (SD 10.6) at diagnosis and median BMI was 24.8. Seventy-six percent were non-smokers, 24% were former smokers, and only 16 (16.2%) and 3 (3.0%) had hypertension or diabetes, respectively. Median follow-up was 2.7 years. Median SMI was 38 cm2/m2 and 18 (18%) met criteria for sarcopenia (SMI &amp;lt; 34.4 cm2/m2). Mastectomy was bilateral in 79 women, skin-sparing in 61, and nipple sparing in 31. Bilateral mastectomy was less frequent amongst women with sarcopenia (61%) compared to 84% of those without sarcopenia (p=0.03). After RT, twenty-three women required unplanned reoperation. Within these 23 women, there were 45 total complications. Complications included surgical site infection (n=18), capsular contracture (n=12), seroma (n=4), wound dehiscence (n=3), and others (n=8). However, only 8 women had reconstructive failure and none were sarcopenic at the time of the RT planning scan. Any complication or failure after RT occurred in similar proportions of patients with and without sarcopenia: 38% and 30%, respectively. Kaplan-Meier curves and univariate Cox regression models showed no significant difference in time to failure (p = 0.380) or time to any event (complication or failure) (p=0.53), between sarcopenic and non-sarcopenic patients. Conclusion: Sarcopenia, using SMI &amp;lt; 34.4 cm2/m2 on pre-radiotherapy planning scans, was not associated with an increased risk of post-radiotherapy reconstructive complication or failure in this selected cohort of non-smokers. Few women had sarcopenia at the time of operation, and results should be validated in a larger series. Citation Format: Yasamin Sharifzadeh, Robert Gao, William S. Harmsen, Jason Klug, Panagiotis Korfiatis, Kimberly Gergelis, Dean A. Shumway, Robert Mutter, Kimberly Corbin. Sarcopenia and Post-Mastectomy Breast Reconstruction Outcomes after Radiation Therapy [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-05-52.

A deep learning model based on the attention mechanism for automatic segmentation of abdominal muscle and fat for body composition assessment.

Quantitative muscle and fat data obtained through body composition analysis are expected to be a new stable biomarker for the early and accurate prediction of treatment-related toxicity, treatment response, and prognosis in patients with lung cancer. The use of these biomarkers can enable the adjustment of individualized treatment regimens in a timely manner, which is critical to further improving patient prognosis and quality of life. We aimed to develop a deep learning model based on attention for fully automated segmentation of the abdomen from computed tomography (CT) to quantify body composition. A fully automatic segmentation deep learning model was designed based on the attention mechanism and using U-Net as the framework. Subcutaneous fat, skeletal muscle, and visceral fat were manually segmented by two experts to serve as ground truth labels. The performance of the model was evaluated using Dice similarity coefficients (DSCs) and Hausdorff distance at 95th percentile (HD95). The mean DSC for subcutaneous fat and skeletal muscle were high for both the enhanced CT test set (0.93±0.06 and 0.96±0.02, respectively) and the plain CT test set (0.90±0.09 and 0.95±0.01, respectively). Nevertheless, the model did not perform well in the segmentation performance of visceral fat, especially for the enhanced CT test set. The mean DSC for the enhanced CT test set was 0.87±0.11, while the mean DSC for the plain CT test set was 0.92±0.03. We discuss the reasons for this result. This work demonstrates a method for the automatic outlining of subcutaneous fat, skeletal muscle, and visceral fat areas at L3.

Metabolomic Methods to Predict Cancer-Associated Skeletal Muscle Wasting from Profiles of Urinary Metabolites

It is known that cachexia is a cancer-associated muscle wasting and reduction in the function status due to treatment especially chemotherapy and in life expectancy, to assess cachexia muscle loss there are many methods as Computed Tomography (CT) scan which has many disadvantages as high cost, invasive, time consuming and cannot detect early stages of muscle wasting [1]. This novel approach uses single-time point urinary metabolite profiles for determining whether the patient is subjected to muscle wasting by analysis of 93 random urine samples from patients with cancer using 2 successive CT images by assessing of lumbar skeletal muscle area by cubic centimeter to estimate the rate of muscle change per time for every patient. The average muscle change over time was -4.71% in 100 days in the muscle-losing group and 3.91% in 100 days in the control group. Bivariate statistics identified metabolites to muscle wasting including constituents and metabolites of muscle as creatine and creatinine, amino acids as serine, threonine, glutamic acid, isoleucine and valine. These results suggest that urine analysis of a single random urine sample is cheap, fast, and non-invasive tool to screen muscle loss and it is useful to clarify prediction of related metabolic conditions possible with methodology presented. The metabolomics methods used in this article are Univariate analysis T-test, correlation analysis, principal component analysis and heatmap clustering.

Visceral Fat as a Risk Factor for Periprosthetic Joint Infection After Total Hip and Knee Arthroplasty

BackgroundVisceral obesity, a strong indicator of chronic inflammation and impaired metabolic health, has been shown to be associated with poor postoperative outcomes and complications. This study aimed to evaluate the relationship between visceral fat area (VFA) and periprosthetic joint infection (PJI) in total joint arthroplasty (TJA) patients. MethodsA retrospective study of 484 patients who had undergone a total hip or knee arthroplasty was performed. All patients had a computed tomography scan of the abdomen/pelvis within two years of their TJA. Body composition data (ie, VFA, subcutaneous fat area, and skeletal muscle area) were calculated at the Lumbar-3 vertebral level via two fully automated and externally validated machine learning algorithms. A multivariable logistic model was created to determine the relationship between VFA and PJI, while accounting for other PJI risk factors. Of the 484 patients, 31 (6.4%) had a PJI complication. ResultsThe rate of PJI among patients with VFA in the top quartile (> 264.1 cm2) versus bottom quartile (< 82.6 cm2) was 5.6% versus 10.6% and 18.8% versus 2.7% in the total hip arthroplasty and total knee arthroplasty cohorts, respectively. In the multivariate model, total knee arthroplasty patients with a VFA in the top quartile had a 30.5 times greater risk of PJI than those in the bottom quartile of VFA (P = .0154). ConclusionVFA may have a strong association with PJI in TJA patients. Using a standardized imaging modality like computed tomography scans to calculate VFA can be a valuable tool for surgeons when assessing risk of PJI.

The correlation of muscle quantity and quality between all vertebra levels and level L3, measured with CT: An exploratory study.

In patients with cancer, low muscle mass has been associated with a higher risk of fatigue, poorer treatment outcomes, and mortality. To determine body composition with computed tomography (CT), measuring the muscle quantity at the level of lumbar 3 (L3) is suggested. However, in patients with cancer, CT imaging of the L3 level is not always available. Thus far, little is known about the extent to which other vertebra levels could be useful for measuring muscle status. In this study, we aimed to assess the correlation of the muscle quantity and quality between any vertebra level and L3 level in patients with various tumor localizations. Two hundred-twenty Positron Emission Tomography (PET)-CT images of patients with four different tumor localizations were included: 1. head and neck (n = 34), 2. esophagus (n = 45), 3. lung (n = 54), and 4. melanoma (n = 87). From the whole body scan, 24 slices were used, i.e., one for each vertebra level. Two examiners contoured the muscles independently. After contouring, muscle quantity was estimated by calculating skeletal muscle area (SMA) and skeletal muscle index (SMI). Muscle quality was assessed by calculating muscle radiation attenuation (MRA). Pearson correlation coefficient was used to determine whether the other vertebra levels correlate with L3 level. For SMA, strong correlations were found between C1-C3 and L3, and C7-L5 and L3 (r = 0.72-0.95). For SMI, strong correlations were found between the levels C1-C2, C7-T5, T7-L5, and L3 (r = 0.70-0.93), respectively. For MRA, strong correlations were found between T1-L5 and L3 (r = 0.71-0.95). For muscle quantity, the correlations between the cervical, thoracic, and lumbar levels are good, except for the cervical levels in patients with esophageal cancer. For muscle quality, the correlations between the other levels and L3 are good, except for the cervical levels in patients with melanoma. If visualization of L3 on the CT scan is absent, the other thoracic and lumbar vertebra levels could serve as a proxy to measure muscle quantity and quality in patients with head and neck, esophageal, lung cancer, and melanoma, whereas the cervical levels may be less reliable as a proxy in some patient groups.

Effect of skeletal muscle area and prognostic nutritional index in periampullary tumors.

The skeletal muscle area (SMA) and prognostic nutritional index (PNI) are both considered as predictive parameters for mortality and morbidity for various type of cancer. In this study, we aimed to identify the effects of pre-operative SMA and PNI values on post-operative mortality and morbidity in patients with periampullary region tumors (PRT). Patients between 2010 and 2020 were retrospectively analyzed and divided into two groups according to SMA and PNI cutoff values. Univariate and multivariate analysis was performed to find potential risk factors. The mean age was 65.94 ± 11.242 and 54 (60.6%) of the patients were male. Hypertension was found a reducing factor for morbidity in both univariate and multivariate analysis (p = 0.039; p = 0.045). Chronic obstructive pulmonary disease and low PNI were found as factors affecting mortality in univariate analysis (p = 0.046; p = 0.014). However, only low PNI was found as an enhancing factor for mortality in multivariate analysis. Although SMA is not a risk factor for post-operative morbidity and mortality, PNI can be considered as a risk factor for mortality in patients with PRT.

The use of the second thoracic vertebral landmark for skeletal muscle assessment and computed tomography-defined sarcopenia evaluation in patients with head and neck cancer.

The cross-sectional area (CSA) of skeletal muscle (SM) at the third lumbar vertebra (L3) is used to determine computed tomography (CT)-defined sarcopenia. We investigated the feasibility of SM assessment at the second thoracic vertebra (T2) in patients with head and neck cancer (HNC). Diagnostic PET-CT scans were used to develop a prediction model for L3-CSA using T2-CSA. Effectiveness of the model and cancer-specific survival (CSS) were investigated. Scans of 111 patients (85% male) were evaluated. The predictive formula: L3-CSA (cm2 )=174.15 + [0.212 × T2-CSA (cm2 )] - [40.032 × sex] - [0.928 × age (years)] + [0.285 × weight (kg)] had good correlation r= 0.796, ICC=0.882 (p< 0.001). SM index (SMI) mean difference (bias) was -3.6% (SD 10.2, 95% CI -8.7% to 1.3%). Sensitivity (82.8%), specificity (78.2%), with moderate agreement (ƙ= 0.540, p< 0.001). Worse 5-year CSS with lower quartile T2-SMI (51%, p= 0.003). SM at T2 can be effectively used for CT-defined sarcopenia evaluation in HNC.

Prediction of whole body composition utilizing cross-sectional abdominal imaging in pediatrics.

Although body composition is an important determinant of pediatric health outcomes, we lack tools to routinely assess it in clinical practice. We define models to predict whole-body skeletal muscle and fat composition, as measured by dual X-ray absorptiometry (DXA) or whole-body magnetic resonance imaging (MRI), in pediatric oncology and healthy pediatric cohorts, respectively. Pediatric oncology patients (≥5 to ≤18 years) undergoing an abdominal CT were prospectively recruited for a concurrent study DXA scan. Cross-sectional areas of skeletal muscle and total adipose tissue at each lumbar vertebral level (L1-L5) were quantified and optimal linear regression models were defined. Whole body and cross-sectional MRI data from a previously recruited cohort of healthy children (≥5 to ≤18 years) was analyzed separately. Eighty pediatric oncology patients (57% male; age range 5.1-18.4 y) were included. Cross-sectional areas of skeletal muscle and total adipose tissue at lumbar vertebral levels (L1-L5) were correlated with whole-body lean soft tissue mass (LSTM) (R2 = 0.896-0.940) and fat mass (FM) (R2 = 0.874-0.936) (p < 0.001). Linear regression models were improved by the addition of height for prediction of LSTM (adjusted R2 = 0.946-0.971; p < 0.001) and by the addition of height and sex (adjusted R2 = 0.930-0.953) (p < 0.001)) for prediction of whole body FM. High correlation between lumbar cross-sectional tissue areas and whole-body volumes of skeletal muscle and fat, as measured by whole-body MRI, was confirmed in an independent cohort of 73 healthy children. Regression models can predict whole-body skeletal muscle and fat in pediatric patients utilizing cross-sectional abdominal images.

Usefulness of skeletal muscle measurement by computed tomography in patients with esophageal cancer: changes in skeletal muscle mass due to neoadjuvant therapy and the effect on the prognosis.

This analysis was performed to clarify the usefulness of skeletal muscle measurements using computed tomography (CT) in patients with esophageal cancer and the effect of treatment-induced changes in the skeletal muscle mass on the prognosis. Ninety-seven male patients who underwent thoracoscopic esophagectomy for esophageal squamous cell carcinoma were included in the study. The preoperative CT images were analyzed retrospectively. In a survival analysis performed according to the preoperative data of skeletal muscle, the low-skeletal muscle index (l-SMI) group had a poorer outcome than the normal skeletal muscle index (n-SMI) group in terms of both the overall survival (OS) and the relapse-free survival (RFS) (OS: P < 0.01, RFS: P = 0.01). In the multivariate analysis for the OS, preoperative l-SMI was an independent predictor (hazard ratio: 3.68, 95% confidence interval 1.32-10.2, P = 0.01). In patients who underwent neoadjuvant therapy (NAT), the SMI was significantly reduced after NAT (P < 0.01). The preoperative skeletal muscle area on CT was strongly correlated with the results of a bioelectrical impedance analysis (BIA) (ρ = 0.77, P < 0.01). A decreased preoperative skeletal muscle mass was associated with a poor outcome. In patients who underwent NAT, the SMI was significantly reduced after NAT. An analysis of the skeletal muscle mass using CT images was found to be useful for providing data that corresponded with BIA data.

A multicenter study to investigate the role of sarcopenia as a prognostic factor in patients with hepatocellular carcinoma treated by trans-arterial radioembolization.

532 Background: Trans-arterial radioembolization (TARE) is a form of radiation therapy performed by selective intra-arterial injection of microspheres loaded with Yttrium-90 in hepatocellular carcinoma (HCC). The aim of this study is to identify prognostic factors for overall survival (OS) and progression free survival (PFS) in patients with HCC undergoing TARE. Methods: This is a multi-center retrospective study on consecutive HCC patients undergoing TARE from Jul 2009 to May 2019. Using pre-treatment plain computed tomography imaging, the total cross-sectional area (cm2) of abdominal skeletal muscle at the third lumbar vertebra was measured. The skeletal muscle index (SMI) was calculated by normalizing muscle area to patient height. Results: A total of 347 patients were included in the study (mean age 66 years, 284 male patients). 107 patients (30.8%) had portal vein tumor thrombus (PVTT). 126 patients (36.3%) were classified as sarcopenia. Median 5-year OS was 31.3 months (95% CI 24.7–37.9) and median 12-month PFS was 9.7 months (95% CI 8.0–11.4). Sarcopenia (HR, 1.44; 95% CI, 1.01-2.04, p=0.04), PVTT (HR, 1.70; 95% CI, 1.13-2.56, p=0.01), hypoalbuminemia (≤3.5 g/dL) (HR 1.64; 95% CI 1.17-2.30, p&lt;0.01), and prior treatment experience (HR 1.61; 95% CI 1.00-2.57, p=005) were independently associated with poor 5-year OS by multivariate Cox regression analysis. Sarcopenia, PVTT, multifocal tumor, and prior treatment experience were independent predictors of PFS in multivariate analysis. Conclusions: TARE is an effective therapy for patients with advanced HCC. In patients undergoing TARE, Sarcopenia and PVTT are independent predictors of both OS and PFS.

Low skeletal muscle mass is associated with mortality in kidney transplant recipients.

Muscle wasting in chronic kidney disease is associated with increased cardiovascular events, morbidity, and mortality. However, whether pretransplantation skeletal muscle mass affects kidney transplantation (KT) outcomes has not been established. We analyzed 623 patients who underwent KT between 2004 and 2019. We measured the cross-sectional area of total skeletal muscle at the third lumbar vertebra level on pretransplantation computed tomography scan. The patients were grouped into low and normal skeletal muscle mass groups based on the sex-specific skeletal muscle mass index lowest quartile. During the entire follow-up period, 45 patients (7.2%) died and 56 patients (9.0%) experienced death-censored graft loss. Pretransplantation low skeletal muscle mass was independently associated with all-cause mortality (adjusted hazard ratio, 2.269; 95% confidence interval, 1.232-4.182). Low muscle mass was also associated with an increased risk of hospital readmission within 1 year after transplantation. Death-censored graft survival rates were comparable between the 2 groups. The low muscle group showed higher creatinine-based estimated glomerular filtration rates (eGFRs) than the normal muscle group. Although cystatin C-based eGFRs were measured in only one-third of patients, cystatin C-based eGFRs were comparable between the 2 groups. Pretransplantation low skeletal muscle mass index is associated with an increased risk of mortality and hospital readmission after KT.