Comparison of different surrogate markers of muscle mass for the diagnosis of sarcopenia in patients with colorectal cancer

Background:This study compared the validity of the creatinine-to-cystatin C ratio(CCR),sarcopenia index(SI),and relative skeletalmuscle index(RSMI)as predictors of sarcopenia in patients with colorectal cancer(CRC)and explored their impact on the patient prognosis.Methods:We retrospectively studied patients with CRC who underwent surgical intervention at the Department of Colorectal and Anal Surgery,situatedwithin the First Affiliated Hospital of GuangxiMedical University.The investigation spanned from January 2015 to December 2017,encompassing a cohort of patients subject to surgical management forCRC during this period.Pearson’s correlation analysis was employed to evaluate the relationships between the CCR,SI,RSMI,and skeletal muscle index(SMI)and the patient prognosis.Receiver operating characteristic(ROC)curves were generated to evaluate the predictive precision of these biomarkers and ascertain the optimal cutoff values.Multivariate logistic regression analysis was conducted to pinpoint the independent factors linked with sarcopenia.Survival analyses,contingent on different surrogate markers of muscle mass and sarcopenia,were performed utilizing the Kaplan-Meier method alongside the log-rank test.Results:Weenrolled 815 patientswithCRC(522 male and 293 female patients)whowere eligible for the analysis.In accordancewith the guidelines set forth by the International Consensus on Sarcopenia,sarcopenia was diagnosed in a collective total of 503 patients.A Pearson’s correlation coefficient(r)analysis demonstrated that the CCR,SI,and RSMI were positively correlated with the SMI.In both male and female patients,the RSMI(male:r=0.400,P<0.001;female:r=0.640,P<0.001)was more strongly correlated with the SMI than with the CCR(male:r=0.203,P<0.001;female:r=0.192,P<0.001)or SI(male:r=0.335,P<0.001;female:r=0.285,P<0.001).In male patients,the areas under the ROC curves(AUC)for the CCR,SI,and RSMI were 0.596[(95%confidence interval(CI)=0.545-0.647)],0.648(95%CI=0.599-0.698),and 0.681(95%CI=0.629-0.733),respectively.In female patients,the AUC for the CCR,SI,and RSMI were 0.615(95%CI=0.551-0.680),0.660(95%CI=0.598-0.722),and 0.772(95%CI=0.719-0.825),respectively.A multivariable logistic regression analysis demonstrated that the CCR remained an influential factor for sarcopenia after correcting for confounding[odds ratio(OR)=0.993,95%CI=0.986-1.000,P=0.038].The SI and RSMI also remained influential factors for sarcopenia after correcting for confounding factors(OR=0.983,95%CI=0.972-0.994,P=0.002;and OR=0.401,95%CI=0.320-0.502,P<0.001,respectively).The groups characterized by low CCR and SI demonstrated notably reduced overall survival compared with their counterparts with high CCR and SI(P=0.007 and P=0.001,respectively),whereas the RSMI and sarcopenia did not exhibit a significant correlation with survival(P=0.608 and P=0.062,respectively).Conclusions:The CCR,SI,and RSMI all have predictive value for sarcopenia in patients with CRC.TheRSMI was a better predictor of sarcopenia than either the CCR or SI in both male and female patientswith CRC.However,the RSMI did not have any significant value for predicting the prognosis of patients with CRC.Subsequent prospective investigations are warranted to elucidate a superiormarker or amalgamation thereof,capable of accurately prognosticating sarcopenia and the overall prognosis in individuals diagnosed with CRC.Such studies should aim to meticulously evaluate a comprehensive array of potential markers,considering their individual and collective predictive value in delineating the clinical trajectory of CRC patients.By conducting rigorous prospective analyses,researchers can strive to uncover novel insights into the complex interplay between sarcopenia and CRC outcomes,thereby facilitating the development of more precise prognostic models and tailored therapeutic approaches.

Long-term Efficacy and Safety of Pamidronate Disodium in Treatment of Bone Metastases in Breast Cancer

Objective： To evaluate the long-term efficacy and safety of pamidronate disodium in patients with bone lesions secondary to advanced breast carcinoma. Methods： A retrospective chart review was conducted of 62 patients receiving intravenous pamidronate disodium for metastatic breast cancer. The proportion of patients experiencing at least one skeletal related event （SRE） after 12 months of therapy was determined. Results： The proportion of patients who had an SRE was 29.00% （18 individuals） and the median time to first event was greater than 350 days. Radiotherapy（ll individuals）and pathologic fracture（6 individuals）were the most frequent type of SRE, while cord compression（1 individuals） and hypercalcaemia（0 individuals） were rare. A total of 37 individuals had transient hypocalcaemia without any clinical symptom. No significant creatinine abnormalities were encountered. There were no clinically relevant changes of calcium ,phosphate and creatinine before and after therapy. Conclusion： Long-term treatment with pamidronate disodium significantly reduces and delays skeletal morbidity from osteolytic metastases . Prolonged therapy was well tolerated. This study suggests that the rate of clinically relevant SREs is substantially lower than the event rate observed in phase llI clinical trials.

The investigation of symptoms burden and treatment status in patients with bone metastasis

Objective:This survey was a non-intervention study,which aimed to investigate symptom burden and treatment status in cancer patient with bone metastasis,and to make out whether patients received the normative treatment.Methods:We designed a questionnaire,the main items of which include patient's symptom burden,previous and ongoing treatment.We used it to investigate 120 patients from six different medical agencies.We examined the association between symptoms using Spearman's rank correlation.SPSS software was used to analyze data.Results:The data of one hundred one questionnaires were completed and fitted for analysis.The five most prevalent symptoms were fatigue(84.2%),unhappiness(83.2%),pain(77.2%),dry mouth(77.2%) and lack of appetite(73.3%).Three symptom clusters were identified.Cluster 1 included anxiety and unhappiness and accounted for 61.4% in all patients.Cluster 2 included pain,fatigue and constipation and accounted for 39.6% in all patients.Cluster 3 included nausea,vomiting,lack of appetite and accounted for 27.7% in all patients.Cronbach's alpha coefficient demonstrated high internal reliability in the clusters,with a coefficient ranging from 0.65 to 0.84.The proportion of patients receiving analgesic therapy,bisphosphates therapy,palliative chemotherapy and radiotherapy were 70.3%,63.4%,58.4% and 36.6% respectively.Pain in various degree was obviously alleviated(P < 0.01) after analgesic therapy.Among the surveyed patients,64 patients received bisphosphates therapy,while the administration of zoledronic acid accounted for the most large proportion.The average duration of bisphosphates administration was 5.79 months(SD = 7.43).Patients who received radiotherapy adopted multiple fractions treating mode.Conclusion:Symptom burden was common and severe in patients with bone metastasis,which often appeared as symptom cluster,and significantly affected their quality of life(QOL).The normative treatment should be strengthened to manage and control patients' symptoms and improve their QOL.The analgesic therapy was normative in patients with bone metastasis.Reasons impeding patients to receive bisphosphates were in varieties.More propaganda should be done to generalized bisphosphates therapy for patients with bone metastasis.