The prevalence of CT-defined low skeletal muscle mass in patients with metastatic cancer: a cross-sectional multicenter French study (the SCAN study)
Tóm tắt
Cachexia, characterized by involuntary muscle mass loss, negatively impacts survival outcomes, treatment tolerability, and functionality in cancer patients. However, there is a limited appreciation of the true prevalence of low muscle mass due to inconsistent diagnostic methods and limited oncologist awareness. Twenty-nine French healthcare establishments participated in this cross-sectional study, recruiting patients with those metastatic cancers most frequently encountered in routine practice (colon, breast, kidney, lung, prostate). The primary outcome was low skeletal muscle mass prevalence, as diagnosed by estimating the skeletal mass index (SMI) in the middle of the third-lumbar vertebrae (L3) level via computed tomography (CT). Other objectives included an evaluation of nutritional management, physical activity, and toxicities related to ongoing treatment. Seven hundred sixty-six patients (49.9% males) were enrolled with a mean age of 65.0 years. Low muscle mass prevalence was 69.1%. Only one-third of patients with low skeletal muscle mass were receiving nutritional counselling and only 28.4% were under nutritional management (oral supplements, enteral or parenteral nutrition). Physicians highly underdiagnosed those patients identified with low skeletal muscle mass, as defined by the primary objective, by 74.3% and 44.9% in obese and non-obese patients, respectively. Multivariate analyses revealed a lower risk of low skeletal muscle mass for females (OR: 0.22, P < 0.01) and those without brain metastasis (OR: 0.34, P < 0.01). Low skeletal muscle mass patients were more likely to have delayed treatment administration due to toxicity (11.9% versus 6.8%, P = 0.04). There is a critical need to raise awareness of low skeletal muscle mass diagnosis among oncologists, and for improvements in nutritional management and physical therapies of cancer patients to curb potential cachexia. This calls for cross-disciplinary collaborations among oncologists, nutritionists, physiotherapists, and radiologists.
Tài liệu tham khảo
Aoyagi T et al (2015) Cancer cachexia, mechanism and treatment. World J Gastrointest Oncol 7(4):17–29
Fearon K, Arends J, Baracos V (2013) Understanding the mechanisms and treatment options in cancer cachexia. Nat Rev Clin Oncol 10(2):90–99
Fearon K et al (2011) Definition and classification of cancer cachexia: an international consensus. Lancet Oncol 12(5):489–495
Chemama S, Raynard B, Antoun S (2016) Impact of cancer muscle mass loss on anticancer treatment toxicities. Bull Cancer 103(9):786–793
Khan S et al (2016) Detection and evaluation of malnutrition in oncology: what tools, what type of cancer and for what purposes? Bull Cancer 103(9):776–785
Melchior JC et al (2012) Clinical and economic impact of malnutrition per se on the postoperative course of colorectal cancer patients. Clin Nutr 31(6):896–902
Senesse P et al (2012) Nutrition chez le patient adulte atteint de cancer: Recommandations professionnelles de la Société Francophone Nutrition Clinique et Métabolisme (SFNEP)
Coin A et al (2013) Prevalence of sarcopenia based on different diagnostic criteria using DEXA and appendicular skeletal muscle mass reference values in an Italian population aged 20 to 80. J Am Med Dir Assoc 14(7):507–512
Cruz-Jentoft AJ et al (2010) Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing 39(4):412–423
Cruz-Jentoft AJ et al (2019) Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 48(1):16–31
Lieffers JR et al (2012) Sarcopenia is associated with postoperative infection and delayed recovery from colorectal cancer resection surgery. Br J Cancer 107(6):931–936
Prado CM et al (2007) Body composition as an independent determinant of 5-fluorouracil-based chemotherapy toxicity. Clin Cancer Res 13(11):3264–3268
Su H et al (2019) CT-assessed sarcopenia is a predictive factor for both long-term and short-term outcomes in gastrointestinal oncology patients: a systematic review and meta-analysis. Cancer Imaging 19(1):82
Martin L et al (2020) Cancer-associated malnutrition and CT-defined sarcopenia and myosteatosis are endemic in overweight and obese patients. JPEN J Parenter Enteral Nutr 44(2):227–238
Biolo G, Cederholm T, Muscaritoli M (2014) Muscle contractile and metabolic dysfunction is a common feature of sarcopenia of aging and chronic diseases: from sarcopenic obesity to cachexia. Clin Nutr 33(5):737–748
Mourtzakis M et al (2008) A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care. Appl Physiol Nutr Metab 33(5):997–1006
Perthen JE et al (2018) Intra- and interobserver variability in skeletal muscle measurements using computed tomography images. Eur J Radiol 109:142–146
van Vugt JL et al (2017) A comparative study of software programmes for cross-sectional skeletal muscle and adipose tissue measurements on abdominal computed tomography scans of rectal cancer patients. J Cachexia Sarcopenia Muscle 8(2):285–297
Prado CM et al (2008) Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol 9(7):629–635
Thibault R et al (2009) Use of 10-point analogue scales to estimate dietary intake: a prospective study in patients nutritionally at-risk. Clin Nutr 28(2):134–140
Oken MM et al (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5(6):649–655
HAS (2019) Diagnosis of malnutrition in children and adults: methodological recommendations for clinical practice
Forrest LM et al (2004) Comparison of an inflammation-based prognostic score (GPS) with performance status (ECOG) in patients receiving platinum-based chemotherapy for inoperable non-small-cell lung cancer. Br J Cancer 90(9):1704–1706
Pamoukdjian F et al (2018) Prevalence and predictive value of pre-therapeutic sarcopenia in cancer patients: a systematic review. Clin Nutr 37(4):1101–1113
Shachar SS, Williams G, Muss HB, Nishijima TF (2016) Prognostic value of sarcopenia in adults with solid tumours: a meta-analysis and systematic review. Eur J Cancer 57:58–67
Caan BJ, Meyerhardt J, Kroenke CH, Alexeeff S, Xiao J, Weltzien E, Feliciano EC, Castillo AL, Quesenberry CP, Kwan ML, Prado CM (2017) Explaining the obesity paradox: the association between body composition and colorectal cancer survival (C-SCANS Study). Cancer Epidemiol Biomark Prev. 26(7):1008–1015
Antoun S, Baracos V, Birdsell L, Escudier B, Sawyer MB (2010) Low body mass index and sarcopenia associated with dose-limiting toxicity of sorafenib in patients with renal cell carcinoma. Ann Oncol 21(8):1594–1598
Prado CM, Lieffers J, McCargar LJ, Reiman T, Sawyer MB, Martin L, Baracos VE (2008) Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol 9(7):629–35
Martin L et al (2013) Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol 31(12):1539–1547
Rier HN, Jager A, Sleijfer S, Maier AB, Levin M‐D (2016) The prevalence and prognostic value of low muscle mass in cancer patients: a review of the literature. Oncology 21(11):1396–1409. https://doi.org/10.1634/theoncologist.2016-0066
von Haehling S, Anker MS, Anker SD (2016) Prevalence and clinical impact of cachexia in chronic illness in Europe, USA, and Japan: facts and numbers update 2016. J Cachexia Sarcopenia Muscle 7(5):507–509
Aapro M et al (2014) Early recognition of malnutrition and cachexia in the cancer patient: a position paper of a European School of Oncology Task Force. Ann Oncol 25(8):1492–1499
Gyan E et al (2017) Malnutrition in patients with cancer. JPEN J Parenter Enteral Nutr 148607116688881
Lacau St Guily J et al (2018) NutriCancer: a French observational multicentre cross-sectional study of malnutrition in elderly patients with cancer. J Geriatr Oncol 9(1):74–80
Raynard B, Hébuterne X, Goldwasser F, AitHssain A, DubrayLongeras P, Barthélémy P, Rosso E, Phoutthasang V, Bories C, Digue L, Laharie D, Desport JC, Falkowski S, Lacau Saint Guily J, Gyan E (2017) Crossed perceptions about malnutrition in patients and their doctors in oncology. Bull Cancer. 104(11):921–928
Barret M et al (2014) Sarcopenia is linked to treatment toxicity in patients with metastatic colorectal cancer. Nutr Cancer 66(4):583–589
Ross PJ et al (2004) Do patients with weight loss have a worse outcome when undergoing chemotherapy for lung cancers? Br J Cancer 90(10):1905–1911
Van Cutsem E, Arends J (2005) The causes and consequences of cancer-associated malnutrition. Eur J Oncol Nurs 9(Suppl 2):S51-63
Fujiwara N et al (2015) Sarcopenia, intramuscular fat deposition, and visceral adiposity independently predict the outcomes of hepatocellular carcinoma. J Hepatol 63(1):131–140
Paris MT et al (2018) Influence of contrast administration on computed tomography-based analysis of visceral adipose and skeletal muscle tissue in clear cell renal cell carcinoma. JPEN J Parenter Enteral Nutr 42(7):1148–1155
van Vugt JLA et al (2018) Contrast-enhancement influences skeletal muscle density, but not skeletal muscle mass, measurements on computed tomography. Clin Nutr 37(5):1707–1714
Morsbach F et al (2019) Body composition evaluation with computed tomography: Contrast media and slice thickness cause methodological errors. Nutrition 59:50–55