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

BACKGROUND 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.AIM To elucidate the associations of body composition measures derived from preoperative CT scans with the prognosis of patients with pancreatic cancer.METHODS 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.RESULTS 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.CONCLUSION Low preoperative SMI was more prevalent in elderly patients and was associated with a poor prognosis among pancreatic cancer patients,especially elderly patients.

Prognostic value of computed tomography derived skeletal muscle mass index in lung cancer:A meta-analysis

BACKGROUND The prognostic role of the skeletal muscle mass index(SMI)derived from computed tomography(CT)imaging been well verified in several types of cancers.However,whether the SMI could serve as a reliable and valuable predictor of long-term survival in lung cancer patients remains unclear.AIM To identify the prognostic value of the CT-derived SMI in lung cancer patients.METHODS The PubMed,Web of Science,and Embase electronic databases were searched up to November 5,2021 for relevant studies.The Reference Citation Analysis databases were used during the literature searching and selection.Hazard ratios(HRs)and 95%confidence intervals(CIs)were calculated to assess the association of the SMI with the overall survival(OS)of lung cancer patients.All statistical analyses were performed with STATA 12.0 software.RESULTS A total of 12 studies involving 3002 patients were included.The pooled results demonstrated that a lower SMI was significantly related to poorer OS(HR=1.23,95%CI:1.11-1.37,P<0.001).In addition,the subgroup analyses stratified by treatment(nonsurgery vs surgery),tumor stage(advanced stage vs early stage),and tumor type(non-small cell lung cancer vs lung cancer)showed similar results.CONCLUSION The CT-derived SMI is a novel and valuable prognostic indicator in lung cancer and might contribute to the clinical management and treatment of lung cancer patients.

Comparison of the Two Algorithms of Skeletal Muscle Mass Index: An Observational Study in a Large Cohort of Chinese Adults

Objective: To compare the two skeletal muscle mass index (SMI) algorithms. One is SMM [SMM(%) = total skeletal muscle mass (kg)/body weight mass (kg) × 100%];and the other is SMH [SMH (kg/m2) = total skeletal muscle mass (kg)/height (m)2]. Methods: Body composition, body mass index (BMI) and body fat percentage (BFP) were estimated using a bioelectrical impedance analyzer. SMI was calculated by the two algorithms described above, and measurement parameters were stratified by age, BMI and levels of physical activity. Results: Levels of BMI, BFP, SMM and SMH differed significantly between the sexes. BMI and BFP were positively associated with age, while SMM was negatively associated with age (β = −0.2294, P < 0.001). Furthermore, SMM was determined to have a negative association with BMI (β = −0.5340, P < 0.001), while a positive association between SMH and BMI (β = 0.7930, P β = −0.9849, P β = −0.0642, P < 0.001) were negatively associated with BFP. In both men and women, SMM maintained the analogous correlation with other indicators. In the general population, SMM showed a gradual downward trend from low body weight to grade III obesity (F = 9528.32, P < 0.001), but SMH (F = 34395.46, P F = 9706.20, P < 0.001) had a reciprocal association. BMI, BFP and SMM differences were observed based on levels of physical activity (P < 0.001). However, there was no significant difference in SMH based on exercise (P > 0.05). Conclusions: SMM may be a more ideal and accurate clinical algorithm for SMI because it is more tightly associated with other body composition indices, as compared with SMH.

Machine learning-based radiomics score improves prognostic prediction accuracy of stage II/III gastric cancer: A multi-cohort study

BACKGROUND Although accurately evaluating the overall survival(OS)of gastric cancer patients remains difficult,radiomics is considered an important option for studying pro-gnosis.AIM To develop a robust and unbiased biomarker for predicting OS using machine learning and computed tomography(CT)image radiomics.METHODS This study included 181 stage II/III gastric cancer patients,141 from Lichuan People's Hospital,and 40 from the Cancer Imaging Archive(TCIA).Primary tumors in the preoperative unenhanced CT images were outlined as regions of interest(ROI),and approximately 1700 radiomics features were extracted from each ROI.The skeletal muscle index(SMI)and skeletal muscle density(SMD)were measured using CT images from the lower margin of the third lumbar vertebra.Using the least absolute shrinkage and selection operator regression with 5-fold cross-validation,36 radiomics features were identified as important predictors,and the OS-associated CT image radiomics score(OACRS)was cal-culated for each patient using these important predictors.RESULTS Patients with a high OACRS had a poorer prognosis than those with a low OACRS score(P<0.05)and those in the TCIA cohort.Univariate and multivariate analyses revealed that OACRS was a risk factor[RR=3.023(1.896-4.365),P<0.001]independent of SMI,SMD,and pathological features.Moreover,OACRS outperformed SMI and SMD and could improve OS prediction(P<0.05).CONCLUSION A novel biomarker based on machine learning and radiomics was developed that exhibited exceptional OS discrimination potential.

Predicting disease progression in cirrhotic patients after transjugular intrahepatic portosystemic shunt implantation:A sexstratified analysis

BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)has been extensively used to treat portal hypertension-associated complications,including cirrhosis.The prediction of post-TIPS prognosis is important for cirrhotic patients,as more aggressive liver transplantation is needed when the post-TIPS prognosis is poor.AIM To construct a nutrition-based model that could predict the disease progression of cirrhotic patients after TIPS implantation in a sex-dependent manner.METHODS This study retrospectively recruited cirrhotic patients undergoing TIPS implantation for analysis.Muscle quality was assessed by measuring the skeletal muscle index(SMI)by computed tomography.Multivariate Cox proportional hazard models were utilized to determine the association between SMI and disease progression in cirrhotic patients after TIPS implantation.RESULTS This study eventually included 186 cirrhotic patients receiving TIPS who were followed up for 30.5±18.8 mo.For male patients,the 30-mo survival rate was significantly lower and the probability of progressive events was higher(3.257-fold)in the low-level SMI group than in the high-level SMI group.According to the multivariate Cox analysis of male patients,SMI<32.8 was an independent risk factor for long-term adverse outcomes after TIPS implantation.A model was constructed,which involved creatinine,plasma ammonia,SMI,and acute-on-chronic liver failure and hepatic encephalopathy occurring within half a year after surgery.This model had an area under the receiver operating characteristic curve of 0.852,sensitivity of 0.926,and specificity of 0.652.According to the results of the DeLong test,this model outperformed other models(Child-Turcotte-Pugh,Model for End-Stage Liver Disease,and Freiburg index of post-TIPS survival)(P<0.05).CONCLUSION SMI is strongly associated with poor long-term outcomes in male patients with cirrhosis who underwent TIPS implantation.

Impact of sarcopenia on tumor response and survival outcomes in patients with hepatocellular carcinoma treated by trans-arterial (chemo)-embolization

BACKGROUND At the diagnosis of hepatocellular carcinoma(HCC),more than 90%of HCC patients present cirrhosis,a clinical condition often associated to malnutrition.Sarcopenia is an indirect marker of malnutrition assessable on computed tomography(CT).AIM To evaluate the prognostic value of sarcopenia in patients with HCC treated by trans-arterial(chemo)-embolization.METHODS Patients with HCC treated by a first session of trans-arterial(chemo)embolization and an available CT scan before treatment were included.Sarcopenia was assessed using skeletal muscle index at baseline and at the first radiological assessment.Radiological response was recorded after the first session of treatment using mRECIST.RESULTS Of 225 patients treated by trans-arterial bland embolization(n=71)or trans-arterial chemoembolization(n=154)for HCC between 2007 and 2013,Barcelona Clinic of Liver Cancer stage was A,B,and C in 27.5%,55%,and 16.8%of cases,respectively.Sarcopenia was present in 57.7%of the patients.Patients with sarcopenia presented a higher rate of progressive disease(19%vs 8%,P=0.0236),a shorter progression-free survival(8.3 vs 13.2 mo,P=0.0035),and a shorter median overall survival(19.4 mo vs 35.5 mo,P=0.0149)compared with non-sarcopenic patients.Finally,patients whose sarcopenia appeared after first transarterial treatment had the worst prognosis(P=0.0004).CONCLUSION Sarcopenia is associated with tumor progression and poor survival outcomes after trans-arterial(chemo)-embolization for HCC.

Predictive parameters on CT scan for dysthyroid optic neuropathy

AIM:To evaluate the value of parameters on CT scan in predicting dysthyroid optic neuropathy(DON)and to provide guidance for early diagnosis of DON accordingly.METHODS:A total of 67 eyes of 35 patients with thyroid-associated ophthalmopathy(TAO)were included in this study.Patients were divided into 2 groups(DON group and non-DON group).Parameters were measured on high resolution CT,including muscle index(MI),superior ophthalmic vein(SOV)dilatation,extraocular muscle volume/orbit volume(MV/OV),and intracranial fat prolapsed,and be compared between these 2 groups.The relation between those parameters and visual function[visual acuity(VA)and visual field defect(VF defect)]were also evaluated.RESULTS:MI and MV/OV were significantly higher in DON group(P=0.00035 and P=0.00026).No significant difference was detected regarding intracranial fat prolapse existence and SOV dilatation(P=0.37 and P=0.15).MV/OV was found to have significant negative correlation with both VF defect(R=-0.332,P=0.0273)and VA(R=-0.635,P=0.00)while MI was found to have negative linear correlation with VA only(R=-0.456,P=0.00017).The area under receiver operating characteristic curves was 0.82 for MV/OV and 0.75 for MI.The best performance in detecting DON was achieved when MV/OV is set at 0.20 with 72%sensitivity and 87%specificity and MI is set at 0.52 with 64%sensitivity and 80%specificity.CONCLUSION:MI and MV/OV are predictive parameters for DON.Together with clinical manifestations,MV/OV≥0.2 can be used as a good indicator for DON in TAO patients.

Impact of sarcopenia on mortality in patients undergoing liver retransplantation

BACKGROUND Sarcopenia,which is a loss of skeletal muscle mass,has been reported to increase post-transplant mortality and morbidity in patients undergoing the first liver transplant.Cross-sectional imaging modalities typically determine sarcopenia in patients with cirrhosis by measuring core abdominal musculatures.However,there is limited evidence for sarcopenia related outcomes in patients undergoing liver re-transplantation(re-OLT).AIM To evaluate the risk of mortality in patients with pre-existing sarcopenia following liver re-OLT.METHODS This is a retrospective study of all adult patients who had undergone a liver re-OLT at the University of Nebraska Medical Center from January 1,2007 to January 1,2017.We divided patients into sarcopenia and no sarcopenia groups.“TeraRecon AquariusNet 4.4.12.194”software was used to evaluate computed tomography or magnetic resonance imaging of the patients done within one year prior to their re-OLT,to calculate the Psoas muscle area at L3-L4 intervertebral disc.We defined cutoffs for sarcopenia as<1561 mm2 for males and<1464 mm2 for females.The primary outcome was to compare 90 d,one,and 5-year survival rates.We also compared complications after re-OLT,length of stay,and readmission within 30 d.Survival analysis was performed with Kaplan-Meier survival analysis.Continuous variables were evaluated with Wilcoxon rank-sum tests.Categorical variables were evaluated with Fisher’s exact tests.RESULTS Fifty-seven patients were included,32 males:25 females,median age 50 years.Two patients were excluded due to incomplete information.Overall,47%(26)of patients who underwent re-OLT had sarcopenia.Females were found to have significantly more sarcopenia than males(73%vs 17%,P<0.001).Median model for end stage liver disease at re-OLT was 28 in both sarcopenia and no sarcopenia groups.Patients in the no sarcopenia group had a trend of longer median time between the first and second transplant(36.5 mo vs 16.7 mo).Biological markers,outcome parameters,and survival at 90 d,1 and 5 years,were similar between the two groups.Sarcopenia in re-OLT at our center was noted to be twice as common(47%)as historically reported in patients undergoing primary liver transplantation.CONCLUSION Overall survival and outcome parameters were no different in those with and without the evidence of sarcopenia after re-OLT.